title: US evaluation of the uterus in patients with postmenopausal bleeding: A positive effect on diagnostic decision making.
abstract: OBJECTIVE
  To assess the accuracy of hysterosonography (HSG) and its role in diagnostic confidence and therapeutic clinical decision making among referring physicians caring for patients with postmenopausal bleeding (PMB).
  
  
  METHODS
  One hundred twenty-three patients with PMB underwent transvaginal ultrasonography (US) and HSG. They were examined for cancer, polyp, leiomyoma, and hyperplasia. Physicians assessed the effect of the studies on diagnostic confidence and care, including biopsy, dilation and curettage, hysteroscopy, hormone manipulation, and/or patient reassurance. Abnormality was proved with histopathologic evaluation, and normality, with 6-month follow-up.
  
  
  RESULTS
  In 10 patients, HSG was unsuccessful, and in 15, follow-up was incomplete; this left 98 patients. Endometrial polyps were seen in 46 (47%) patients; leiomyoma, in 11 (11%); cancer, in four (4%); hyperplasia, in eight (8%); and normal findings, in 29 (30%). Our calculations yielded a sensitivity of 98% and a specificity of 88%. In 86 (88%) patients, US added certainty to the diagnosis; in 78 (80%), it resulted in a change in patient treatment.
  
  
  CONCLUSIONS
  HSG and transvaginal US in patients with PMB improves diagnostic accuracy, clinical decision making, and the clinician's diagnostic certainty. In patients with benign causes of PMB, the absence of abnormality at HSG and a normal endometrial biopsy result may eliminate the need for further studies.
authors.affiliation: Department of Radiology, DC069.10, University of Missouri Health Sciences Center, One Hospital Dr, Columbia, MO 65212, USA. breer@health.missouri.edu
authors.forename: R L
authors.initials: RL
authors.lastname: Bree
authors.forename: R A
authors.initials: RA
authors.lastname: Bowerman
authors.forename: M
authors.initials: M
authors.lastname: Bohm-Velez
authors.forename: C B
authors.initials: CB
authors.lastname: Benson
authors.forename: P M
authors.initials: PM
authors.lastname: Doubilet
authors.forename: S
authors.initials: S
authors.lastname: DeDreu
authors.forename: M R
authors.initials: MR
authors.lastname: Punch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011127:Polyps / Q000150:complications / Q000000981:diagnostic imaging; D017698:Postmenopause; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D014599:Uterus / Q000000981:diagnostic imaging*