title: Targeted and tailored diagnostic strategies in women with perimenopausal bleeding: advantages of the sonohysterographic approach.
abstract: OBJECTIVE
  Diagnosis and treatment of endometrial pathology nowadays ranges from clinical examination to transvaginal ultrasound (TVS), saline infusion sonohysterography (SIS), hysterosalpingography (HSG) and hysteroscopy (HYS). However, many gynaecologists prescribe blind endometrial biopsies, such as Vacuum ABRAsion (VABRA), as single strategy. The purpose of this work is to evaluate whether the procedure of VABRA should still be performed alone in perimenopausal women with abnormal uterine bleeding, compared to biopsies and samples obtained after a previous transvaginal sonohysterography.
  
  
  METHODS
  We retrospectively reviewed the records of 216 patients referred to our Ultrasonography and Day-Surgery Center between November 2005 and December 2006 with persistent premenopausal uterine bleeding, spotting or postmenopausal bleeding. One hundred and five out of 216 pts.(48.6%), defined as Group "A", underwent a sole endometrial sampling by VABRA; 111 out of 216 pts. (51.4%), Group "B", had a SIS first.
  
  
  RESULTS
  Vabra showed a poor sensitivity in the diagnosis of polyps (19%) and submucosal myoma, with a negative predictive value of 73.4%. Likelihood ratio for test negative was 0.81, with an overall diagnostic accuracy of 75%.
  
  
  CONCLUSIONS
  This study confirms that blind endometrial biopsies should no longer be performed as the only diagnostic strategy in perimenopausal women with abnormal uterine bleeding. On the other hand, a sonohysteroscopy-guided approach allows an accurate detection of focal lesions; nevertheless, it should not be forgotten that SIS is an ultrasound based procedure, and may provide further information on endometrial thickness, myomas, ovaries and pelvis.
authors.affiliation: Department of Gynecologic, Obstetric and Neonatal Sciences, Unit of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy. carla.verrottidipianella@unipr.it
authors.forename: Carla
authors.initials: C
authors.lastname: Verrotti
authors.forename: Gianluca
authors.initials: G
authors.lastname: Benassi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Caforio
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Nardelli
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007889:Leiomyoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D047648:Perimenopause / Q000502:physiology*; D011127:Polyps / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014463:Ultrasonography / Q000379:methods*; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery