title: Intra-cavitary uterine pathology in women with abnormal uterine bleeding: a prospective study of 1220 women.
abstract: OBJECTIVE
  Our primary aim was to assess how patients' characteristics, bleeding pattern, sonographic endometrial thickness (ET) and additional features at unenhanced ultrasound examination (UTVS) and at fluid instillation sonography (FIS) contribute to the diagnosis of intracavitary uterine pathology in women presenting with abnormal uterine bleeding (AUB). We further aimed to report the prevalence of pathology in women presenting with AUB.
  
  
  METHODS
  1220 consecutive women presenting with AUB underwent UTVS, colour Doppler imaging (CDI) and FIS. Most women (n = 1042) had histological diagnosis.
  
  
  RESULTS
  Mean age was 50 years and 37% were postmenopausal. Of 1220 women 54% were normal, polyps were diagnosed in 26%, intracavitary fibroids in 11%, hyperplasia without atypia in 4% and cancer in 3%. All cancers were diagnosed in postmenopausal (7%) or perimenopausal (1%) women. ET had a low predictive value in premenopausal women (LR+ and LR- of 1.34 and 0.74, respectively), while FIS had a LR+ and LR- of 6.20 and 0.24, respectively. After menopause, ET outperformed all patient characteristics for the prediction of endometrial pathology (LR+ and LR- of 3.13 and 0.24). The corresponding LR+ and LR- were 10.85 and 0.71 for CDI and 8.23 and 0.26 for FIS.
  
  
  CONCLUSIONS
  About half of the women presenting to a bleeding clinic will have pathology. In premenopausal women, benign lesions are often the cause of AUB. For the prediction of intracavitary pathology ET is of little value in premenopausal women. CDI and FIS substantially improve the diagnostic accuracy.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Van den Bosch
authors.affiliation: KU Leuven Department of Development and Regeneration, Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Ameye
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Van Schoubroeck
authors.affiliation: KU Leuven Department of Development and Regeneration, Leuven, Belgium. ; Department of Obstetrics and Gynecology, Imperial College London, Hammersmith Campus, London, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Bourne
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospitals KULeuven, Leuven, Belgium. ; KU Leuven Department of Development and Regeneration, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
keywords: Ultrasonography; endometrial cancer; leiomyoma; metrorrhagia; polyps