title: An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms.
abstract: OBJECTIVE
  Our purpose was to evaluate the use of transvaginal ultrasonography for the detection of endometrial disease in a population of postmenopausal women who were without symptoms.
  
  
  METHODS
  Postmenopausal women were screened for potential inclusion in 2 multicenter, double-blind, placebo-controlled studies of 2 years' duration to evaluate the safety and efficacy of idoxifene in the prevention of osteoporosis. Baseline endometrial evaluation was performed by transvaginal ultrasonography and aspiration biopsy of the endometrium.
  
  
  RESULTS
  A total of 1926 women were screened by transvaginal ultrasonography, and 1833 of them had endometrial thickness < or =6 mm. Five cases of endometrial abnormality (adenocarcinoma [n = 1] and atypical hyperplasia [n = 4]) were detected in the 1750 women from this cohort who underwent biopsy. The negative predictive value was >99%. One case of adenocarcinoma was detected in the 42 women who had endometrial thickness >6 mm and underwent biopsy. However, the sampling rate (45%) of women with endometrial thickness >6 mm was too low for confidence in the positive predictive value of 2%.
  
  
  CONCLUSIONS
  Despite a high negative predictive value, transvaginal ultrasonography may not be an effective screening procedure for detection of endometrial abnormality in untreated postmenopausal women who are without symptoms.
authors.affiliation: Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Fleischer
authors.forename: J E
authors.initials: JE
authors.lastname: Wheeler
authors.forename: I
authors.initials: I
authors.lastname: Lindsay
authors.forename: S L
authors.initials: SL
authors.lastname: Hendrix
authors.forename: S
authors.initials: S
authors.lastname: Grabill
authors.forename: B
authors.initials: B
authors.lastname: Kravitz
authors.forename: B
authors.initials: B
authors.lastname: MacDonald
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D001707:Biopsy, Needle; D004311:Double-Blind Method; D004714:Endometrial Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control; D010919:Placebos; D017698:Postmenopause; D012680:Sensitivity and Specificity; D013629:Tamoxifen / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014463:Ultrasonography; D014591:Uterine Diseases / Q000000981:diagnostic imaging*
chemical_list: D010919:Placebos; D013629:Tamoxifen; C071362:idoxifene