Transvaginal ultrasound, uterine biopsy and hysteroscopy for postmenopausal bleeding.
OBJECTIVE
To determine the importance of endometrial biopsy and transvaginal ultrasound in patients with postmenopausal bleeding.


METHODS
Eighty patients with postmenopausal bleeding were submitted to transvaginal ultrasound followed by endometrial biopsy. Hysteroscopy and dilatation and curettage were carried out to confirm normality of the uterine cavity.


RESULTS
The endometrial echo could be visualized in all patients with postmenopausal bleeding. The biopsy failed to detect one case (1.38%) of adenocarcinoma and 14 cases (17.5%) of endometrial polyps. The sensitivity in detecting endometrial malignancy was 94.44% for endometrial biopsy and 100% for transvaginal ultrasound, when the endometrial thickness was more than 8 mm.


CONCLUSIONS
When the thickness of the endometrial echo is less than 3 mm there is no need for anatomopathologic investigation. When this limit was adopted, all cases were associated with endometrial atrophy, and when the limit was 4 mm or more, active endometria were detected, requiring further histopathologic investigation by hysteroscopy and directed biopsies. Above 8 mm, malignancy may be found.
Department of Gynecology, Escolo Paulista de Medicina, Federal University of São Paulo, Brazil.
M G
MG
Giusa-Chiferi
W J
WJ
Gonçalves
E C
EC
Baracat
L C
LC
de Albuquerque Neto
C C
CC
Bortoletto
G R
GR
de Lima
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis*; D017698:Postmenopause; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology