Use of hysterosonography in women with abnormal postmenopausal bleeding.
OBJECTIVE
Hysterosonography (HS) allows evaluation of the endometrial cavity by endouterine administration of sterile physiologic solution. We aimed to identify the role of HS and transvaginal ultrasonography (TU) in postmenopausal women with unexplained bleeding in order to avoid further invasive investigation for patients with atrophic endometrium, and to obtain significant information on intracavitary focal lesions.


METHODS
Eighty postmenopausal women with unexplained metrorrhage underwent both TU and HS. They were subsequently referred for hysteroscopy or dilatation and curettage, and histology was obtained.


RESULTS
The sensibility of TU was comparable with that of HS (90% vs 93%). However, the specificity of TU was only 30%. Combined use of TU and HS raised sensibility and specificity to 95.9% and 96.7%, respectively.


CONCLUSIONS
HS is superior to TU in the diagnosis of focal lesions because the uterine cavity, lesion volume and margins, and associated diffuse endometrial alterations are adequately depicted. HS is particularly valuable with benign focal lesions associated with atrophic endometrium, as in patients under tamoxifen in whom TU fails to detect the uterine cavity.
Department of Gynaecology and Obstetrics, University of Genoa, Italy.
M
M
Valenzano
S
S
Costantini
S
S
Cucuccio
M C
MC
Dugnani
R
R
Paoletti
N
N
Ragni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002455:Cell Division; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008875:Middle Aged; D017698:Postmenopause; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging*; D014599:Uterus / Q000000981:diagnostic imaging*; D014621:Vagina / Q000000981:diagnostic imaging