COMBINING VAGINAL ULTRASONOGRAPHY AND OFFICE ENDOMETRIAL SAMPLING IN THE DIAGNOSIS OF ENDOMETRIAL DISEASE IN POSTMENOPAUSAL WOMEN

Objective: To investigate the value of the combined use of vaginal ult rasonography and endometrial sampling in the office for the diagnosis of endometrial disease in postmenopausal women. Methods: One hundred f orty consecutive postmenopausal women presenting with uterine bleeding or endometrial cells on cervical cytology entered the study. Vaginal ultrasonography was used to measure the endometrial thickness, followe d by use of the Pipelle endometrial sampler. Pipelle biopsy was not fe asible in two patients. The results of hysteroscopy with biopsy or hys terectomy, performed within 6 weeks in all but 12 patients, were consi dered the final diagnosis. The accuracy of ultrasound and Pipelle was measured against the final diagnosis. Results: The sensitivity of vagi nal ultrasonography for endometrial disease was 98.2 and 82.0% if cuto ff points for endometrial thickness of 2 and 4 mm, respectively, were used. All six patients with endometrial carcinoma had endometrial thic knesses exceeding 12 mm. Pipelle endometrial sampling had a sensitivit y of 44.6% and a specificity of 98.5% for endometrial disease. All cas es of endometrial carcinoma were detected by sampling in the office se tting. Conclusion: This study illustrates the value of vaginal scannin g in the diagnosis of endometrial disease in symptomatic, postmenopaus al women. A 4-mm cutoff point for endometrial thickness seemed appropr iate. The sensitivity of Pipelle sampling for endometrial carcinoma wa s excellent, but relatively weak for other endometrial disease because it failed to detect endometrial polyps and submucous myomas. The comb ined use of ultrasound and Pipelle sampling offers sufficient diagnost ic information for most symptomatic postmenopausal women.