title: Comparison of office hysteroscopy, transvaginal ultrasonography and endometrial biopsy in evaluation of abnormal uterine bleeding.
abstract: OBJECTIVE
  A comparison between office hysteroscopy, transvaginal ultrasonography and endometrial biopsy was performed, in terms of detection of intrauterine lesions. A secondary objective was assessment of evaluatory approach in the management of abnormal uterine bleeding in an outpatient setting.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A total of 54 women were evaluated for abnormal uterine bleeding. Assessment included performance of an endometrial biopsy, a transvaginal ultrasound scan followed by office hysteroscopy. Results of hysteroscopy were taken as the gold standard. Sensitivity and specificity of the investigations were assessed. The bleeding pattern was classified as heavy regular, irregular, postmenopausal and heavy or unscheduled bleeding on hormone replacement therapy.
  
  
  RESULTS
  The incidence of focal intrauterine lesions in patients presenting with abnormal bleeding was 52% for all ages and 31% for the postmenopausal group. Seventy-five percent of the patients with Hb < 11 gm% and 67% with an enlarged uterus harbored a focal pathology. The incidence of lesions in patients with heavy regular bleeding was 74%. The sensitivity and specificity of transvaginal ultrasound when compared with results of hysteroscopy was 0.60 and 0.88 respectively. A normal endometrial biopsy had a negative predictive value of 51%. The sensitivity and specificity of endometrial biopsy were 0.04 and 0.83, respectively.
  
  
  CONCLUSIONS
  Both transvaginal ultrasound and endometrial biopsy exhibited poor sensitivity for detection of focal intrauterine lesions. Considering the significantly high incidence of intrauterine lesions in patients presenting with abnormal bleeding, the most cost-effective approach appears to be proceeding with hysteroscopy early in assessment.
authors.affiliation: Department of Reproductive Endocrinology and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. Pal.Lubna@mgh.harvard.edu
authors.forename: L
authors.initials: L
authors.lastname: Pal
authors.forename: L
authors.initials: L
authors.lastname: Lapensee
authors.forename: T L
authors.initials: TL
authors.lastname: Toth
authors.forename: K B
authors.initials: KB
authors.lastname: Isaacson
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001707:Biopsy, Needle; D004717:Endometrium / Q000473:pathology*; D019160:Endosonography; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012984:Software; D014591:Uterine Diseases / Q000150:complications / Q000175:diagnosis*; D014592:Uterine Hemorrhage / Q000209:etiology*