title: Transvaginal sonography, sonohysterography, and hysteroscopy for investigation of focal intrauterine lesions in women with recurrent postmenopausal bleeding after dilatation & curettage.
abstract: OBJECTIVE
  To determine the diagnostic accuracy of different diagnostic methods (blind dilatation & curettage (D&C), transvaginal ultrasonography (TVS), sonohysterography (SH), and hysteroscopy) compared with gold standard (hysteroscopic biopsy's histopathologic result) in diagnosis of focal intrauterine lesions of recurrent postmenopausal bleeding.
  
  
  METHODS
  36 postmenopausal women with recurrent vaginal bleeding after a normal D&C results were enrolled into the study. TVS, SH, hysteroscopy were performed on all patients. Outcomes of blind D&C, TVS, SH, and hysteroscopy were compared with results of gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated.
  
  
  RESULTS
  Blind D&C sensitivity, specificity, PPV, and NPV were 47, 68, 57, 59%, respectively in comparison with gold standard. Blind D&C fails to diagnose 70% of all focal intracavitary lesions. TVS sensitivity, specificity, PPV, NPV were 63, 78, 89, 41%, respectively. SH yielded better results; with 93% sensitivity, 56% specificity, 86% PPV, and 71% NPV. Hysteroscopy sensitivity, specificity, PPV, and NPV were 100, 44, 84, 100%, respectively.
  
  
  CONCLUSIONS
  In experienced hands, SH can be an initial evaluation method of uterine cavity for detecting focal lesions in women with recurrent postmenopausal bleeding.
authors.affiliation: Obstetrics and Gynecology Department, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. ykarageyim@yahoo.com
authors.forename: A Yasemin
authors.initials: AY
authors.lastname: Karageyim Karsidag
authors.forename: Esra Esim
authors.initials: EE
authors.lastname: Buyukbayrak
authors.forename: Bulent
authors.initials: B
authors.lastname: Kars
authors.forename: Orhan
authors.initials: O
authors.lastname: Unal
authors.forename: M Cem
authors.initials: MC
authors.lastname: Turan
mesh_terms: D000368:Aged; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D012008:Recurrence; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery