Endometrial study in patients with postmenopausal metrorrhagia.
BACKGROUND
The aim of the study was to devise a strategy to diagnose malign endometrial pathologies (adenocarcinoma or atypical hyperplasia) that minimizes the number of invasive tests done (hysteroscopy, aspiration biopsy or curettage) with no loss of its detection efficiency.


METHODS
We retrospectively studied the clinical histories of 779 postmenopausal women at the University Hospital Complex of Albacete, for whom an endometrial study had been done (hysteroscopy, aspiration biopsy or curettage) with a 1-year follow-up between 1 March 2006 and 31 March 2008.


RESULTS
There were 77 cases of a malignant pathology (66 adenocarcinomas and 11 hyperplasias with atypia); 96.1% had metrorrhagia, and there were only 3 cases of asymptomatic patients (all 3 presented endometrial thickness of > 5 mm: 10, 12 and 15 mm). The sensitivity and specificity of the transvaginal ultrasound, with a 5 mm cut-off point to diagnose a malignant pathology, were 98.4% and 30.1%, respectively; 89.1% and 99.6%, respectively, for aspiration biopsy; 83.9% and 99.1%, respectively, for hysteroscopy without biopsy; and both were 100% for biopsy. Statistical significance was considered at p < 0.05 and confidence intervals were calculated at 95%.


CONCLUSIONS
In postmenopausal women with metrorrhagia, the first action to take is to do a transvaginal ultrasound, followed by en endometrial study, but only if the endometrium is irregular or endometrial thickness is ≥ 5 mm; in asymptomatic women, the cut-off point should be set at 10 mm. The immediate method of choice is an ambulatory biopsy.
Obstetrics and Gynecology Department, Hospital and University Complex of Albacete (SESCAM), Albacete, Spain.
María C Serna
MC
Torrijos
Obstetrics and Gynecology Department, Hospital and University Complex of Albacete (SESCAM), Albacete, Spain.
Gaspar González
GG
de Merlo
Obstetrics and Gynecology Department, Hospital and University Complex of Albacete (SESCAM), Albacete, Spain.
Esteban González
EG
Mirasol
Obstetrics and Gynecology Department, Hospital and University Complex of Albacete (SESCAM), Albacete, Spain.
María Teresa Gómez
MT
García
Obstetrics and Gynecology Department, Hospital and University Complex of Albacete (SESCAM), Albacete, Spain.
Carmen Ángel
CÁ
Parra
Department of Medical Sciences, School of Medicine, University Autonóma, Madrid, Spain.
Enrique Iglesias
EI
Goy
adenocarcinoma; aspiration biopsy; hysteroscopy; metrorrhagia; ultrasound