TRIAGE OF ABNORMAL POSTMENOPAUSAL BLEEDING - A COMPARISON OF ENDOMETRIAL BIOPSY AND TRANSVAGINAL SONOHYSTEROGRAPHY VERSUS FRACTIONAL CURETTAGE WITH HYSTEROSCOPY

OBJECTIVE: We sought to compare the combined diagnostic reliability of sonohysterography and endometrial biopsy with fractional curettage wi th hysteroscopy in the initial evaluation of postmenopausal women with abnormal uterine bleeding. STUDY DESIGN: This year-long, prospective, controlled, clinical investigation was initiated Sept. 1, 1995. All p ostmenopausal women with abnormal uterine bleeding were offered inclus ion with 104 enrolled. An endometrial biopsy was performed at the time of initial evaluation. Routine transvaginal ultrasonography was then used to measure the uterus, ovaries. and endometrial stripe thickness, followed immediately by sonohysterography to evaluate the symmetry of endometrial wall thickness and delineate any intraluminal masses. Def initive histopathologic sampling was obtained by fractional curettage with hysteroscopy and statistically compared with the diagnoses arrive d at by endometrial biopsy and sonohysterography. RESULTS: The combina tion of endometrial biopsy and transvaginal sonohysterography positive ly correlated with the surgical findings>95% of the time, with a sensi tivity and specificity of 94% and 96%, respectively (confidence interv al 91% to 99%). No patients with endometrial hyperplasia or cancer wer e misdiagnosed. CONCLUSIONS: Sonohysterography combined with endometri al biopsy is a reliable office tool for evaluating postmenopausal wome n with abnormal uterine bleeding. Medical management of those patients identified as having no endometrial abnormalities can he considered w ith confidence, while saving the cost and surgical risk of fractional curettage. Patients with intraluminal masses should be referred for su rgical management in a timely fashion.