[Which initial tests should be performed to evaluate meno-metrorrhagias? A comparison of hysterography, transvaginal sonohysterography and hysteroscopy].
OBJECTIVE
Evaluate the feasibility and the value of hysterography, sonohysterography and hysteroscopy for investigation of abnormal uterine bleeding. Method. Longitudinal blind study of thirty-eight patients consulting for abnormal uterine bleeding during pre- and post menopause. All patients underwent an hysterography and transvaginal sonohysterography, in random order, followed by an hysteroscopy with histological sample. The results were compared with the histo-pathological examination that was used for reference diagnosis. Statistical study of sensitivity, specificity and Positive and Negative Predictive Value (PPV-NPV) of each investigation; rate of agreement by the coefficient of Kappa.


RESULTS
The hysterography offers a PPV of 83% and a NPV of 100%. The interpretation errors were associated with the simple mucous hypertrophy interpreted as "hyperplasy". The limits correspond to a contrast agent allergy. The sonohysterography had a VPP of 89% and a VPN of 100%. The false positive is due to the difficulties of distinguishing the clots from the polyps. The limits correspond to the difficulties of cervix catheterization (13%). As regards the hysteroscopy, the VPP was 81.5% and the VPN of 75%. The interpretation mistakes were associated with mucous hypertrophy and the hyperplasy.


CONCLUSIONS
The most useful examination for abnormal uterine bleeding, in the first instance, is transvaginal sonography with saline instillation. A complement by Doppler study would probably make it possible to limit the false positives.
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Clinique Gynécologique et Obstétricale, Hôpital Charles-Nicolle, CHU Rouen.
Lemercier
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David
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Genevois
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Lemoine
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JP
Marpeau
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015982:Bias; D001706:Biopsy; D003663:Decision Trees; D003951:Diagnostic Errors; D019160:Endosonography / Q000379:methods / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods / Q000592:standards*; D015907:Hysteroscopy / Q000379:methods / Q000592:standards*; D008595:Menorrhagia / Q000175:diagnosis*; D008796:Metrorrhagia / Q000175:diagnosis*; D008875:Middle Aged; D018579:Patient Selection; D017698:Postmenopause; D017697:Premenopause; D011446:Prospective Studies; D012680:Sensitivity and Specificity