title: Reproducibility of Endometrial Pathologic Findings Obtained on Hysteroscopy, Transvaginal Sonography, and Gel Infusion Sonography in Women With Postmenopausal Bleeding.
abstract: OBJECTIVE
  To evaluate and compare interobserver variation in endometrial pattern recognition with hysteroscopy (HY) and transvaginal sonography (TVS) and gel infusion sonography (GIS) with regard to the diagnosis of endometrial pathology.
  
  
  METHODS
  Prospective study (Canadian Task Force II-1).
  
  
  METHODS
  University clinic.
  
  
  METHODS
  One hundred twenty-two consecutive women with postmenopausal bleeding and an endometrium thickness ≥ 5 mm.
  
  
  METHODS
  Two observers using HY and 2 others using TVS and GIS evaluated the endometrial pattern in recorded video clips. Interobserver agreement regarding findings obtained with TVS, GIS, and HY for a diagnosis of cancer, hyperplasia, polyps, and no endometrial pathology was expressed by κ coefficients and compared.
  
  
  RESULTS
  Interobserver agreement (κ) was as follows: identification of normal endometrium: HY (.74), TVS (.68), and GIS (.48); diagnosis of cancer: HY (.56), TVS (.59), and GIS (.34); classification in all categories of endometrial pathology: HY (.70), TVS (.47), and GIS (.41) (p < .05 HY vs GIS). The presence of additional endometrial polyps decreased agreement on HY in patients with hyperplasia or cancer. Observer agreement was poor regarding the diagnosis of hyperplasia by all techniques.
  
  
  CONCLUSIONS
  Observer agreement regarding both HY and TVS was reliable for the diagnosis of a normal endometrium but poor with HY, TVS, and especially GIS for a diagnosis of cancer. In patients with hyperplasia or cancer, agreement between observers was especially low in the presence of additional polyps when HY was used. These findings call attention to the need for systematic methods to improve reliability in endometrial pattern recognition.
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: dueholm@dadlnet.dk.
authors.forename: Margit
authors.initials: M
authors.lastname: Dueholm
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Ina Marie D
authors.initials: IM
authors.lastname: Hjorth
authors.affiliation: Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Secher
authors.affiliation: Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Annemette
authors.initials: A
authors.lastname: Jørgensen
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Gitte
authors.initials: G
authors.lastname: Ørtoft
mesh_terms: D004715:Endometriosis / Q000000981:diagnostic imaging / Q000473:pathology*; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005782:Gels; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D011247:Pregnancy; D011446:Prospective Studies; D015203:Reproducibility of Results; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D014621:Vagina
chemical_list: D005782:Gels
keywords: Endometrial neoplasms; Hysteroscopy; Observer variation; Postmenopause; Ultrasonography; Uterine hemorrhage