ENDOVAGINAL ULTRASOUND TO EXCLUDE ENDOMETRIAL CANCER AND OTHER ENDOMETRIAL ABNORMALITIES

Context.-Postmenopausal vaginal bleeding is a common clinical problem. Endovaginal ultrasound (EVUS) is a noninvasive diagnostic test that m ay help determine which women should undergo endometrial biopsy. Objec tive.-To determine the accuracy of EVUS in detecting endometrial disea se in postmenopausal women with vaginal bleeding according to hormone replacement use. Data Sources.-Literature search of English-language a nd non-English-language articles published from 1966 through November 1996 using MEDLINE and by a manual search of bibliographies of publish ed articles, Study Selection.-Studies were included if they prospectiv ely collected EVUS measurements of endometrial thickness prior to obta ining endometrial tissue for histologic evaluation in postmenopausal w omen with vaginal bleeding. Of 85 studies that included data on EVUS a nd endometrial histology, 35 were included in the meta-analysis and in cluded 5892 women. Data Extraction.-Articles were reviewed and indepen dently selected and abstracted by 2 reviewers. Disagreement was resolv ed by consensus. Data Synthesis.-The overall summary mean weighted est imates of sensitivity and specificity were calculated for thresholds o f endometrial thickness from 3 to 10 mm, Using a 5-mm threshold to def ine abnormal endometrial thickening, 96% (95% confidence interval [CI] , 94%-98%) of women with cancer had an abnormal EVUS result, whereas 9 2% (95% CI, 90%-93%) of women with endometrial disease (cancer, polyp, or atypical hyperplasia) had an abnormal result. This did not vary by hormone replacement use. However, the number of women with normal his tology who had an abnormal EVUS result did vary by hormone replacement use. In women who were not using hormone replacement therapy, 593 (8% ) with normal histological findings had an abnormal EVUS result (speci ficity, 92%; 95% CI, 90%-94%), whereas 1544 (23%) using hormone replac ement therapy had an abnormal EVUS result (specificity, 77%; 95% CI, 7 5%-79%), For a postmenopausal woman with vaginal bleeding with a 10% p retest probability of endometrial cancer, her probability of cancer is 1% following a normal EVUS result. Conclusion.-Endovaginal ultrasound has a high sensitivity for detecting endometrial cancer and other end ometrial disease and can reliably identify postmenopausal women with v aginal bleeding who are highly unlikely to have significant endometria l disease so that endometrial sampling may be unnecessary.