Hysteroscopy in the diagnosis of postmenopausal bleeding

2007 ◽  
Vol 13 (3) ◽  
pp. 132-134 ◽  
Author(s):  
Bramara Guruwadayarhalli ◽  
Siân E Jones ◽  
Vyjayanthi Srinivasan
Keyword(s):  
Gold Standard ◽  
Hospital Admissions ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Endometrial Biopsy ◽  
Postmenopausal Bleeding ◽  
First Line ◽  
Endometrial Cavity ◽  
Outpatient Hysteroscopy ◽  
Transvaginal Ultrasound Scan

Postmenopausal bleeding (PMB) accounts for 5% of gynaecology referrals. Investigations should exclude malignancy and pre-malignancy, and diagnose the benign conditions that need treatment. The three modalities that are most commonly used are transvaginal ultrasound scan (TVS), endometrial biopsy (EB) and hysteroscopy. Most authors agree that the first-line investigation should be TVS, followed by endometrial assessment (EB or hysteroscopy) if the endometrial thickness is >4 mm. When scanning demonstrates the possibility of pathology, outpatient hysteroscopy and biopsy are the gold standard for investigating the endometrial cavity. Focal pathology can be removed during the hysteroscopy, thereby reducing hospital admissions and costs.

scholarly journals Clear Cell Carcinoma of the Endometrium in a Patient Presenting with Postmenopausal Bleeding but Negative Endometrial Biopsy

2021 ◽  
pp. 1768-1772
Author(s):  
Swechchha Silwal ◽  
Sumeet Kumar Yadav ◽  
Benedict Amalraj ◽  
Mohamed Mandeel ◽  
Geetha Krishnamoorthy
Keyword(s):  
Endometrial Cancer ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Endometrial Biopsy ◽  
Postmenopausal Bleeding ◽  
Gynecological Malignancy ◽  
The Usa

Endometrial carcinoma is the most common gynecological malignancy in the USA with approximately 66,570 cases and 12,940 deaths in 2020. Clear cell carcinoma (CCC) of the endometrium is an estrogen-independent type II endometrial cancer which accounts for <5% of endometrial cancer. When diagnosed roughly, 45% of patients have extrauterine metastases. Current American College of Obstetrics and Gynecology guidelines recommend transvaginal ultrasound for postmenopausal bleeding and a biopsy for those with endometrial thickness >5 mm. However, we present a case of a postmenopausal woman with a history of fibroid where endometrial biopsy has failed to make diagnosis twice. Hence, further testing should be performed in patients with unexplained postmenopausal bleeding including vaginal hysterectomy with lymph node dissection.

A Clinico-pathological Study of Transvaginal Endometrial Thickness Measurement in Asymptomatic Postmenopausal Patients and Patients with Postmenopausal Bleeding

2019 ◽  
pp. 1
Author(s):  
Ayse Filiz Gokmen Karasu ◽  
Seda Ates ◽  
Tugba Gurbuz ◽  
Nurhan Sahin ◽  
Taha Takmaz ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Thickness Measurement ◽  
University Hospital ◽  
Postmenopausal Bleeding ◽  
Pathological Study ◽  
Endometrial Polyps ◽  
Endometrial Sampling ◽  
Proliferative Endometrium

<p><strong>Objective:</strong> We aimed to determine the frequency of endometrial pathologies of patients who presented to our outpatient clinic with postmenopausal bleeding (PMB) and asymptomatic menopausal patients with a finding of thickened endometrium on transvaginal ultrasonography.</p><p><strong>Study Design:</strong> This study was performed at Bezmialem University Hospital. Women who presented to our clinic from January 2015 to January 2017 were analyzed. Patients were divided to two groups. All patients underwent transvaginal ultrasound with a 7.5 MHz probe. Endometrial sampling was performed by either blind D&amp;C (dilatation &amp; curettage) or pipelle sampling. We excluded patient specimens that were obtained by hysteroscopy.</p><p><strong>Results:</strong> Electronic records of a total of 368 patients in menopause were inspected. Out of these patients; 287 (78%) underwent endometrium sampling indicated by bleeding. Eighty-one patients (22%) were asymptomatic; however, a thickened endometrium echo on TVUSG examination (≥ 5 mm) was suspected. The median age was 57 (42-85). In both groups the two leading causes of endometrial pathology was; endometrial polyps followed by proliferative endometrium. The frequency of endometrial cancer was 9.4 % for the PMB group and 1.2 % in the asymptomatic patient group</p><p><strong>Conclusion:</strong> Evaluation of PMB as soon as possible is essential for diagnosing endometrial pathologies. Role of endometrial thickness is decisive in detecting patients at high risk for malignancy especially with comorbid conditions. Histopathological evaluation is mandatory for ruling out malignancy.</p>

Value of endometrial thickness assessed by transvaginal ultrasound for the prediction of endometrial cancer in patients with postmenopausal bleeding

2017 ◽  
Vol 296 (2) ◽  
pp. 319-326 ◽  
Author(s):  
Amelie Schramm ◽  
Florian Ebner ◽  
Emanuel Bauer ◽  
Wolfgang Janni ◽  
Ulrike Friebe-Hoffmann ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Postmenopausal Bleeding

Investigation of Endometrial Abnormalities in Asymptomatic Women Treated With Tamoxifen and an Evaluation of the Role of Endometrial Screening

1999 ◽  
Vol 17 (7) ◽  
pp. 2050-2050 ◽  
Author(s):  
C.D.B. Love ◽  
B. B. Muir ◽  
J. B. Scrimgeour ◽  
R. C.F. Leonard ◽  
P. Dillon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
False Positive ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
False Positive Rate ◽  
Low Frequency ◽  
Endometrial Thickening ◽  
Increased Risk ◽  
Outpatient Hysteroscopy ◽  
Asymptomatic Women

PURPOSE: Tamoxifen is the most commonly prescribed adjuvant therapy for women with breast cancer. It has agonist activity on the endometrium and is associated with an increased risk of endometrial cancer. The aim of this study was to evaluate whether screening with transvaginal ultrasound (TV USS) with or without hysteroscopy is worthwhile. PATIENTS AND METHODS: A total of 487 women with breast cancer, 357 treated with tamoxifen and 130 controls, were screened with TV USS, and endometrial thickness was measured. Women with thickened endometrium underwent outpatient hysteroscopy. RESULTS: Length of time on tamoxifen ranged from 5 to 191 months (mean, 66 months), and endometrial thickness ranged from 1 to 38 mm (mean, 7.3 mm). Women treated with tamoxifen had significantly thicker endometrium than did controls (P < .0001). There was a statistically significant (P < .0001) positive correlation between length of time on tamoxifen and endometrial thickness. One hundred forty-five women had endometrium greater than 5 mm on USS, and 134 underwent successful outpatient hysteroscopy, 61 of whom had atrophic endometrium, resulting in a 46% false-positive scan rate. The remaining women all had benign features to explain the USS findings. CONCLUSION: TV USS detects a high incidence (41%) of apparent endometrial thickening in women treated with tamoxifen, although 46% had atrophic endometrium on further assessment, and none of the remaining asymptomatic women had significant lesions. Length of time on tamoxifen relates to endometrial thickening as measured by TV USS. TV USS is a poor screening tool because of the high false-positive rate. The low frequency of significant findings suggests that endometrial screening in asymptomatic women is not worthwhile.

scholarly journals Evaluation of International Endometrial Tumor Analysis Sonographic Criteria in diagnosis of Endometrial Carcinoma

2020 ◽  
Vol 3 (2) ◽  
pp. 01-09
Author(s):  
Ahmed Hagras
Keyword(s):  
Diagnostic Tool ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Endometrial Biopsy ◽  
University Hospitals ◽  
Non Invasive ◽  
Doppler Study ◽  
Endometrial Tumor ◽  
Low Incidence ◽  
Local Examination

Postmenopausal vaginal bleeding is a sign that should not be Ultrasound imaging has become an effective diagnostic tool of gynecological practice throughout the years. Endometrial diagnosis typically involves invasive investigational approaches. Today, however, with the advent of high-resolution transvaginal ultrasound and Doppler ultrasonography (non-invasive diagnostic tool), is an alternative candidate to replace invasive approaches. The aim of this study is to evaluate the contribution of the terms and definitions described by the IETA group when designing a malignancy model for better diagnosis of malignancy in cases with postmenopausal uterine bleeding. In the present study 120 patients with postmenopausal bleeding were included in the study. The study was conducted from April 2017 to April 2019 at Tanta University hospitals, Obstetrics & Gynecology and Diagnostic Radiology departments. Both patients were subjected to the following: full history taking, general examination, local examination, 2D transvaginal ultrasonography, Doppler study, hysteroscopy examination, endometrial biopsy. Symptomatic postmenopausal women with endometrial thickness > 5 mm have been chosen because women with a lower endometrial thickness have a very low incidence of cancer and a prospective evaluation.

scholarly journals Does Probability Guided Hysteroscopy Reduce Costs in Women Investigated for Postmenopausal Bleeding?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
M. C. Breijer ◽  
N. van Hanegem ◽  
N. C. M. Visser ◽  
R. H. M. Verheijen ◽  
B. W. J. Mol ◽  
...  
Keyword(s):  
Cost Minimization ◽  
Patient Characteristics ◽  
Endometrial Biopsy ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Postmenopausal Bleeding ◽  
Diagnostic Strategies ◽  
Predicted Probability ◽  
Outpatient Hysteroscopy ◽  
Strategy I

Objective. To evaluate whether a model to predict a failed endometrial biopsy in women with postmenopausal bleeding (PMB) and a thickened endometrium can reduce costs without compromising diagnostic accuracy.Design, Setting, and Population. Model based cost-minimization analysis.Methods. A decision analytic model was designed to compare two diagnostic strategies for women with PMB: (I) attempting office endometrial biopsy and performing outpatient hysteroscopy after failed biopsy and (II) predicted probability of a failed endometrial biopsy based on patient characteristics to guide the decision for endometrial biopsy or immediate hysteroscopy. Robustness of assumptions regarding costs was evaluated in sensitivity analyses.Main Outcome Measures. Costs for the different strategies.Results. At different cut-offs for the predicted probability of failure of an endometrial biopsy, strategy I was generally less expensive than strategy II. The costs for strategy I were always € 460; the costs for strategy II varied between € 457 and € 475. At a 65% cut-off, a possible saving of € 3 per woman could be achieved.Conclusions. Individualizing the decision to perform an endometrial biopsy or immediate hysteroscopy in women presenting with postmenopausal bleeding based on patient characteristics does not increase the efficiency of the diagnostic work-up.

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