Evaluation of the woman with postmenopausal bleeding - Society of Radiologists in ultrasound-sponsored consensus conference statement

Objectives. A panel of 14 physicians practicing medicine in the United Stat es with expertise in radiology, obstetrics and gynecology, gynecologic onco logy, hysteroscopy, epidemiology, and pathology was convened by the Society of Radiologists in Ultrasound to discuss the role of sonography in women w ith postmenopausal bleeding. Broad objectives of this conference were (1) t o advance understanding of the utility of different diagnostic techniques f or evaluating the endometrium in women with postmenopausal bleeding; (2) to formulate useful and practical guidelines for evaluation of women with pos tmenopausal bleeding, specifically as it relates to the use of sonography; and (3) to offer suggestions for future research projects. Setting. October 24 and 25, 2000, Washington, DC, preceding the annual Society of Radiologi sts in Ultrasound Advances in Sonography conference. Procedure. Specific qu estions to the panel included the following: (1) What are the relative effe ctiveness and cost-effectiveness of using transvaginal sonography versus of fice (nondirected) endometrial biopsy as the Initial examination for a woma n with postmenopausal bleeding? (2) What are the sonographic standards for evaluating a woman with postmenopausal bleeding? (3) What are the abnormal sonographic findings in a woman with postmenopausal bleeding? (4) When shou ld saline infusion sonohysterography or hysteroscopy be used in the evaluat ion of postmenopausal bleeding? (5) Should the diagnostic approach be modif ied for patients taking hormone replacement medications, tamoxifen, or othe r selective estrogen receptor modulators? Conclusions. Consensus recommenda tions were used to create an algorithm for evaluating women with postmenopa usal bleeding. All panelists agreed that because postmenopausal bleeding is the most common presenting symptom of endometrial cancer, when postmenopau sal bleeding occurs, clinical evaluation is indicated. The panelists also a greed that either transvaginal sonography or endometrial biopsy could be us ed safely and effectively as the first diagnostic step. Whether sonography or endometrial biopsy is used initially depends on the physician's assessme nt of patient risk, the nature of the physician's practice, the availabilit y of high-quality sonography, and patient preference. Similar sensitivities for detecting endometrial carcinoma are reported for transvaginal sonograp hy when an endometrial thickness of greater than 5 mm is considered abnorma l and for endometrial biopsy when "sufficient" tissue is obtained. Currentl y, with respect to mortality, morbidity, and quality-of-life end points, th ere are insufficient data to comment as to which approach is more effective . The conference concluded by identifying several important unanswered ques tions and suggestions that could be addressed by future research projects.