Postmenopausal bleeding: a diagnostic approach for both private and public sectors.
OBJECTIVE
To assess the optimal diagnostic approach to women with postmenopausal bleeding by comparing transvaginal ultrasound and endometrial sampling with office hysteroscopy.


METHODS
A prospective collective study was performed on 102 consecutive patients with postmenopausal bleeding who were evaluated by ultrasound measurement of the endometrial thickness (EL), endometrial sampling by Accurette and outpatient hysteroscopy and directed biopsy.


RESULTS
Accurette was inadequate for histological diagnosis in 65 of 136 samples and many repeat investigations were required. In all 16 cases of endometrial polyps, ultrasound measurement of the EL was > or =4 mm and hysteroscopy confirmed the findings. Accurette detected only 5 polyps. All 7 cases of endometrial hyperplasia were detected using an EL of > or =4 mm and hysteroscopy confirmed the findings. Accurette failed to detect 5 out of 7 cases of endometrial hyperplasia. Five cases of endometrial cancer were diagnosed: all had an EL > or =4 mm but were inadequately sampled for diagnostic purposes in 3 cases. A definitive diagnosis was made on hysteroscopy in 4 cases (1 patient did not have a hysteroscopy).


CONCLUSIONS
Accurette is not a good sampling device for the diagnosis of postmenopausal bleeding. An ultrasound measurement of the EL > or =4 mm in patients with postmenopausal bleeding warrants further investigation. Outpatient office hysteroscopy is an accurate and sensitive modality to employ as a first line investigation for definitive diagnosis.
Department of Obstetrics and Gynaecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa.
J M
JM
Spicer
I
I
Siebert
T F
TF
Kruger
D000230:Adenocarcinoma / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004714:Endometrial Hyperplasia / Q000175:diagnosis; D016889:Endometrial Neoplasms / Q000175:diagnosis; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D018200:Mixed Tumor, Mullerian / Q000175:diagnosis; D011127:Polyps / Q000175:diagnosis; D017698:Postmenopause; D017149:Private Sector; D011446:Prospective Studies; D017150:Public Sector; D012680:Sensitivity and Specificity; D013019:South Africa; D018084:Ultrasonography, Interventional; D014591:Uterine Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014592:Uterine Hemorrhage / Q000209:etiology*