TY - JOUR
T1 - Diagnostic evaluation of the endometrium in postmenopausal bleeding
T2 - An evidence-based approach
AU - Van Hanegem, N.
AU - Breijer, M. C.
AU - Khan, K. S.
AU - Clark, T. J.
AU - Burger, M. P.M.
AU - Mol, B. W.J.
AU - Timmermans, A.
PY - 2011/1/1
Y1 - 2011/1/1
N2 - Postmenopausal bleeding (PMB) is a common complaint in general gynecological practice. Women with PMB have around a 10% chance of having endometrial carcinoma and therefore PMB always needs further evaluation. This article summarizes the reviews on the subject and provides an overview of the use of diagnostic tools in patients with PMB. Four types of diagnostic test are described: sonographic measurement of endometrial thickness, endometrial sampling, hysteroscopy and saline infusion sonography. All four have been independently shown to be accurate in excluding endometrial cancer. However, neither in systematic reviews nor in international guidelines is consensus found regarding the sequence in which these methods should be employed in women with PMB. For measurement of endometrial thickness in symptomatic women, a cut-off value of 3 mm is recommended, but the cost-effectiveness of this strategy has yet to be shown. Research should now focus on the incorporation of individual patient characteristics and pre-test probabilities for cancer in algorithms for the investigation of PMB, and the most cost-effective sequenced combination of the four types of test.
AB - Postmenopausal bleeding (PMB) is a common complaint in general gynecological practice. Women with PMB have around a 10% chance of having endometrial carcinoma and therefore PMB always needs further evaluation. This article summarizes the reviews on the subject and provides an overview of the use of diagnostic tools in patients with PMB. Four types of diagnostic test are described: sonographic measurement of endometrial thickness, endometrial sampling, hysteroscopy and saline infusion sonography. All four have been independently shown to be accurate in excluding endometrial cancer. However, neither in systematic reviews nor in international guidelines is consensus found regarding the sequence in which these methods should be employed in women with PMB. For measurement of endometrial thickness in symptomatic women, a cut-off value of 3 mm is recommended, but the cost-effectiveness of this strategy has yet to be shown. Research should now focus on the incorporation of individual patient characteristics and pre-test probabilities for cancer in algorithms for the investigation of PMB, and the most cost-effective sequenced combination of the four types of test.
KW - Endometrial biopsy
KW - Endometrial carcinoma
KW - Endometrial thickness
KW - Hysteroscopy
KW - Postmenopausal bleeding
KW - Saline infusion sonography
UR - http://www.scopus.com/inward/record.url?scp=78651397168&partnerID=8YFLogxK
U2 - 10.1016/j.maturitas.2010.11.010
DO - 10.1016/j.maturitas.2010.11.010
M3 - Review Article
AN - SCOPUS:78651397168
SN - 0378-5122
VL - 68
SP - 155
EP - 164
JO - Maturitas
JF - Maturitas
IS - 2
ER -
