Transvaginal ultrasound, endometrial cytology sampled by Gynoscann and histology obtained by Uterine Explora Curette compared to the histology of the uterine specimen. A prospective study in pre- and postmenopausal women undergoing elective hysterectomy.
BACKGROUND
The purpose of this study was to evaluate the diagnostic value of transvaginal ultrasound measurement of endometrial thickness, cytology obtained by Gynoscann, and histology of the endometrium sampled by Uterine Explora Curette compared with histology of the uterine specimen as the gold standard.


METHODS
Consecutive patients admitted for hysterectomy had transvaginal ultrasound, sampling by Gynoscann, and Uterine Explora Curette done just before surgery, after informed consent.


RESULTS
A total of 181 women entered the study. Sixteen had endometrial cancer, seven had atypical hyperplasia and nine had complex hyperplasia. A total of 168 patients had a transvaginal ultrasound done. At a cutoff limit of 4mm (endometrial thickness of 4mm or less indicating normal endometrium), the sensitivity was 90.3%, the specificity 24.8%, the positive predictive value 21.4% and the negative predictive value 91.9%. One endometrial cancer, one atypical and one complex hyperplasia were missed. The Gynoscann method showed a sensitivity of 62.5%, a specificity of 94.0%, a positive predictive value of 69.0% and a negative predictive value of 92.1%. Two cancers, three atypical and six complex hyperplasia were missed. The Uterine Explora Curette showed a sensitivity of 90.6%, a specificity of 100.0%, a positive predictive value of 100.0% and a negative predictive value of 98.0%. One endometrial cancer and two complex hyperplasia were missed.


CONCLUSIONS
Transvaginal ultrasound is a reliable method in excluding endometrial pathology. The Uterine Explora Curette was superior to Gynoscann in diagnosing neoplasia of the endometrium. It was found to have the same diagnostic accuracy as conventional dilatation and curettage.
Kufahl
J
J
Department of Gynecology and Obstetrics, Central Hospital Naestved, Denmark.
Pedersen
I
I
Sindberg Eriksen
P
P
Helkjaer
P E
PE
Larsen
L G
LG
Jensen
K L
KL
de Nully
P
P
Philipsen
T
T
Wåhlin
A
A
D000328:Adult; D000368:Aged; D004107:Dilatation and Curettage; D017558:Elective Surgical Procedures; D004714:Endometrial Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007258:Informed Consent; D008875:Middle Aged; D017698:Postmenopause; D017697:Premenopause; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery