title: Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding.
abstract: OBJECTIVE
  To determine the prevalence of focally growing lesions in the uterine cavity in women with postmenopausal bleeding and endometrium > or = 5 mm and the extent to which such lesions can be correctly diagnosed by D&C.
  
  
  METHODS
  In a prospective study, 105 women with postmenopausal bleeding and endometrium > or = 5 mm at transvaginal ultrasound examination underwent diagnostic hysteroscopy, D&C and hysteroscopic resection of any focally growing lesion still left in the uterine cavity after D&C. Twenty-four women also underwent hysterectomy. If the histological diagnosis differed between specimens from the same patient, the most relevant diagnosis was considered the final one.
  
  
  RESULTS
  Eighty percent (84/105) of the women had pathology in the uterine cavity, and 98% (82/84) of the pathological lesions manifested a focal growth pattern at hysteroscopy. In 87% of the women with focal lesions in the uterine cavity, the whole or parts of the lesion remained in situ after D&C. D&C missed 58% (25/43) of polyps, 50% (5/10) of hyperplasias, 60% (3/5) of complex atypical hyperplasias, and 11% (2/19) of endometrial cancers. The agreement between the D&C diagnosis and the final diagnosis was excellent (94%) in women without focally growing lesions at hysteroscopy.
  
  
  CONCLUSIONS
  If there are focal lesions in the uterine cavity, hysteroscopy with endometrial resection is superior to D&C for obtaining a representative endometrial sample in women with postmenopausal bleeding and endometrium > or = 5 mm.
authors.affiliation: Department of Obstetrics and Gynecology, University of Lund, University Hospital, Malmö, Sweden. elisabeth.epstein@obst.mas.lu.se
authors.forename: E
authors.initials: E
authors.lastname: Epstein
authors.forename: A
authors.initials: A
authors.lastname: Ramirez
authors.forename: L
authors.initials: L
authors.lastname: Skoog
authors.forename: L
authors.initials: L
authors.lastname: Valentin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis / Q000601:surgery; D015907:Hysteroscopy; D008875:Middle Aged; D011127:Polyps / Q000175:diagnosis / Q000601:surgery; D017698:Postmenopause; D011446:Prospective Studies; D014592:Uterine Hemorrhage / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery