Post-menopausal bleeding. Comparison between ultrasonography, hysteroscopy and histology’s results
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Abstract
Background: Post-menopausal bleeding are frequently found in gynaecological consultations and requires the search of an organic cause
Aim: To value the profit and the performances of the transvaginal ultrasonography and the hysteroscopy in the determination of the causes of post-menopausal bleeding.
Methods: 80 patients presenting abnormal uterine bleeding in post menopause period have been explored in our department with transvaginal ultrasonography and hysteroscopy. The findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. We have calculated in our study the sensitivity, the specificity, the positive and negative predictive values of transvaginal ultrasonography and hysteroscopy.
Results: The sensitivity, the specificity, the positive and negative values predictive of the transvaginal ultrasonography is respectively 93, 75%, 87, 5%, 83, 3% and 95, 45%. In the other part, hysteroscopy seems more performant in the diagnosis of intrauterine abnormalities with the respective values: 100%, 95, 83%, 94, 11% and 100%.
Conclusion: The initial investigation in front of all mennorhagic patients must be the transvaginal ultrasonography but we also need the hysteroscopy because its highly accurate means in the diagnosis of the causes of excessive uterine bleeding in post menopausal period.
Aim: To value the profit and the performances of the transvaginal ultrasonography and the hysteroscopy in the determination of the causes of post-menopausal bleeding.
Methods: 80 patients presenting abnormal uterine bleeding in post menopause period have been explored in our department with transvaginal ultrasonography and hysteroscopy. The findings have been evaluated on the basis of specimens obtained from either endometrial biopsy, hysterectomy or operative hysteroscopy. We have calculated in our study the sensitivity, the specificity, the positive and negative predictive values of transvaginal ultrasonography and hysteroscopy.
Results: The sensitivity, the specificity, the positive and negative values predictive of the transvaginal ultrasonography is respectively 93, 75%, 87, 5%, 83, 3% and 95, 45%. In the other part, hysteroscopy seems more performant in the diagnosis of intrauterine abnormalities with the respective values: 100%, 95, 83%, 94, 11% and 100%.
Conclusion: The initial investigation in front of all mennorhagic patients must be the transvaginal ultrasonography but we also need the hysteroscopy because its highly accurate means in the diagnosis of the causes of excessive uterine bleeding in post menopausal period.
Keywords:
Transvaginal ultrasonography - Hystéroscopy - Excessive uterine bleeding##plugins.themes.academic_pro.article.details##
References
- Dijkhuizen FP, Brölmann HA, Potters AE et al. The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnormalities. Obstet Gunecol 1996;87:345- 9.
- Goodman A. abnormal genital tract bleeding. Clin Cornerstone 2000; 3: 25 - 35.
- Alc'Azar J.L., Laparte C. comparative study of transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding. Gynecol Obstet Invest 1996; 41: 47 - 9.
- Garuti G, Sambruni I, Cellani F et al. hysteroscopy and transvaginal ultrasonography in post menopausal women with uterine bleeding. Int J Gynecol Obstet 2009; 65: 25 - 33.
- Barbero M, Enria R, Pagliano M. et al. Comparative study of diagnosic hysteroscopy and transvaginal ultrasonography in patients with abnormal uterine hemorrhage during the peri- and post-menopausal period. Minerva Gynecol 1997; 49: 491 - 7.
- Smith-Bindman R., Kerlikowski K., Felstein VA et al. endovaginale ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998; 280: 1510 - 7.
- Rozenbaum H. Hiérarchie des techniques d'imagerie devant des métrorragies post-ménopausiques. Report Hum Horm 1997 ; 10 : 531 - 6.
- Cacciatore B., Ramsay T., Lehtovirta P. Transvaginal sonography and hysteroscopy in bleeding. Acta Obstet Gynecol Scand 2008; 73: 413 - 6.
- Savelli L., De laco P., Santini D et al. Histopathologic features and risk factors for begninity, hyperplasia, and cancer in endometrial polyps. Am J Obstet Gynecol 2009; 188: 927 - 31.
- Lumbiganon P., Rugpo S., Phandhu-Fang S et al. Protective effect of depolmdroxyprogesterone acetate on surgical treated uterine leiomyomas: a multicentre case-control study. Br J Obstet Gynecol 1995; 103: 909 - 14.
- Descargues G., Lemercier E., David C., et al. Quelle exploration réaliser de première intention face aux méno-métrorragies ? JGynecol Obstet Biol Reprod 2001; 30: 59 - 64.
- Yildirim M., Oktem M., Dilek TU. Endometrial thickness and histopathologic findings in women with postmenopausal bleeding. Int J Gynecol Obstet 2003; 80: 307 - 8.
- Granberg S., Ylöstalo P., Wickland M. Endometrial sonographic and histologic findings in women with and without hormone replacement therapy suffering from postmenopausal bleeding. Maturiats 1997; 27: 35 - 40.
- Okaro E., Bourne T., Sporadic abnormal vaginal bleeding (intermenstrual, postcoital and post-menopausal bleeding). Current Obstet Gynecol 2002; 12; 334 - 40.
- Dorum A., Kristensen GB., Skaar O. Evaluation of endometrial thickness measured by endovaginale ultrasound in women with post-menopausal bleeding. Acta Obstet Gynecol Scand 1996: 75; 475 - 9.
- Gupta JK., Wilson S., Desai P. How should we investigate women with post menopausal bleeding? Acta Obstet Gynecol 1996; 75: 475 - 9.
- Roger V., Cravello L., Stolla L et al. Place de l'hystéroscopie dans l'ecploration des métrorragies post-ménopausiques. Presse Ped 1998; 27: 1294 - 5.
- O'Connell L.P., Fries M.H., Zeringue E et al. Triage of abnormal postmenopausal bleeding: a comparison of endometrial biopsy and transvaginal sonohysterography versus fractional curettage with hysteroscopy. Am J Obstet Gynecol 1998; 178: 956 - 61;
- Wolman I., Jaffa A.J. Sensitivity and specificity of sonohysterogaphy for the evaluation of the uterine cavity in menopausal patients. J Ultasound Med 2007; 15: 285-8.
- [Bonilla-Musoles F., Rage F., Osborne N.G et al. Threedimensional hysterosonography for the study of endometrial tumors: comparaison with conventional transvaginal sonography, hysterosalpingography and hysteroscopy. Gynecol Obstet 1997; 65: 245 - 52.