Abstract
OBJECTIVE: We sought to compare the combined diagnostic reliability of sonohysterography and
endometrial biopsy with fractional curettage with hysteroscopy in the initial evaluation
of postmenopausal women with abnormal uterine bleeding. STUDY DESIGN: This year-long, prospective, controlled, clinical investigation was initiated Sept.
1, 1995. All postmenopausal women with abnormal uterine bleeding were offered inclusion,
with 104 enrolled. An endometrial biopsy was performed at the time of initial evaluation.
Routine transvaginal ultrasonography was then used to measure the uterus, ovaries,
and endometrial stripe thickness, followed immediately by sonohysterography to evaluate
the symmetry of endometrial wall thickness and delineate any intraluminal masses.
Definitive histopathologic sampling was obtained by fractional curettage with hysteroscopy
and statistically compared with the diagnoses arrived at by endometrial biopsy and
sonohysterography. RESULTS: The combination of endometrial biopsy and transvaginal sonohysterography positively
correlated with the surgical findings >95% of the time, with a sensitivity and specificity
of 94% and 96%, respectively (confidence interval 91% to 99%). No patients with endometrial
hyperplasia or cancer were misdiagnosed. CONCLUSIONS: Sonohysterography combined with endometrial biopsy is a reliable office tool for
evaluating postmenopausal women with abnormal uterine bleeding. Medical management
of those patients identified as having no endometrial abnormalities can be considered
with confidence, while saving the cost and surgical risk of fractional curettage.
Patients with intraluminal masses should be referred for surgical management in a
timely fashion. (Am J Obstet Gynecol 1998;178:956-61.)
Keywords
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Article Info
Publication History
Accepted:
October 21,
1997
Received in revised form:
July 24,
1997
Received:
May 27,
1997
Footnotes
☆From the Department of Obstetrics and Gynecology, Keesler Medical Center, Keesler Air Force Base.
☆☆Supported entirely by the United States Air Force and the Department of Defense.
★Reprint requests: Captain Lawrence P. O'Connell, MD, Department of Obstetrics and Gynecology, 10 MDG/SGOBO, 4102 Pinion Dr., Suite 100, USAFA, CO 80840-4000.
★★6/1/87002
Identification
Copyright
© 1998 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
