US evaluation of the uterus in patients with postmenopausal bleeding: A positive effect on diagnostic decision making

PURPOSE: To assess the accuracy of hysterosonography (HSG) and its role in diagnostic confidence and therapeutic clinical decision making among referr ing physicians caring for patients with postmenopausal bleeding (PMB). MATERIALS AND METHODS: One hundred twenty-three patients with PMB underwent transvaginal ultrasonography (US) and HSG. They were examined for cancer, polyp, leiomyoma, and hyperplasia. Physicians assessed the effect of the st udies on diagnostic confidence and care, including biopsy, dilation and cur ettage, hysteroscopy, hormone manipulation, and/or patient reassurance. Abn ormality was proved with histopathologic evaluation, and normality, with 6- month follow-up. RESULTS: In 10 patients, HSG was unsuccessful, and in 15, follow-up was inc omplete; this left 98 patients. Endometrial polyps were seen in 46 (47%) pa tients; leiomyoma, in 11 (11%); cancer, in four (4%); hyperplasia, in eight (8%); and normal findings, in 29 (30%). Our calculations yielded a sensiti vity of 98% and a specificity of 88%. In 86 (88%) patients, US added certai nty to the diagnosis; in 78 (80%), it resulted in a change in patient treat ment. CONCLUSION: HSG and transvaginal US in patients with PMB improves diagnosti c accuracy, clinical decision making, and the clinician's diagnostic certai nty. In patients with benign causes of PMB, the absence of abnormality at H SG and a normal endometrial biopsy result may eliminate the need for furthe r studies.