title: Clinical evaluation of women with PMB. Is it always necessary an endometrial biopsy to be performed? A review of the literature.
abstract: BACKGROUND
  Endometrial carcinoma is the most distressing cause of abnormal vaginal bleeding. The intention of clinical management in the case of postmenopausal bleeding is to achieve an accurate diagnosis without overinvestigation.
  
  
  METHODS
  We studied the available literature on the diagnostic evaluation of postmenopausal women with vaginal bleeding, accentuating the most important aspects on this topic: the accuracy of sonography and endometrial biopsy in predicting endometrial hyperplasia and endometrial carcinoma.
  
  
  RESULTS
  The accuracy of the above tests in predicting endometrial hyperplasia and endometrial carcinoma is a subject of continuing debate. Μοreover, in the last decades, there has been an explosion of publications indicating that ultrasound may be useful in predicting endometrial pathology.
  
  
  CONCLUSIONS
  Since advanced endometrial carcinoma has been known to occur in cases without noticeable endometrial thickness on ultrasound, the clinician should beware of the diagnostic evaluation of postmenopausal women with vaginal bleeding.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Marina
authors.initials: M
authors.lastname: Dimitraki
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsikouras
authors.forename: Sophia
authors.initials: S
authors.lastname: Bouchlariotou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Dafopoulos
authors.forename: Vasileios
authors.initials: V
authors.lastname: Liberis
authors.forename: Georgios
authors.initials: G
authors.lastname: Maroulis
authors.forename: Alexander Tobias
authors.initials: AT
authors.lastname: Teichmann
mesh_terms: D001707:Biopsy, Needle; D004714:Endometrial Hyperplasia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016889:Endometrial Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D017698:Postmenopause; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology*