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Korean Journal of Obstetrics & Gynecology 2007;50(9):1240-1246.
Published online September 1, 2007.
The diagnostic role of hysteroscopy in postmenopausal bleeding.
Cheol Hwa Sin, Soo Ah Kim, Weon Suk Ki, Hyo Young Jeoung, Soo Young Song, Hyuk Jung
1Department of Obstetrics and Gynecology, College of Medicine, Chosun University, Gwangju, Korea. bimilo@hanmail.net
2Department of Medicine, Graduate School, Chosun University, Gwangju, Korea.
To compare the diagnostic accuracy of ultrasonographic endometrial thickness with that of hysteroscopy, it is to establish the most appropriate method for the diagnosis of endometrial cancer and other endometrial diseases in postmenopausal women with abnormal uterine bleeding (AUB). METHODS: This retrospective study was conducted in 105 consecutive postmenopausal patients with AUB, who underwent ultrasonographic evaluation of endometrial thickness, hysteroscopy and endometrial biopsy. Evaluation of sensitivity and specificity was performed. RESULTS: Histologic findings for <4 mm level revealed that atrophy was present in 30 (71.4%) and in 1 case (2.4%) endometrial cancer was found; for > or =4 mm values polyps and myomas were present in 31 (49.2%) and there were 3 (4.8%) in endometrial cancer. Sensitivity and specificity for trans-vaginal ultrasound, with a cut-off value > or =4 mm, was 75% and 40.6%. CONCLUSIONS: Generally speaking, obstetrics & gynecologists know that endometrial aspiration biopsy is the routine method in postmenopausal women with AUB. However transvaginal ultrasound remains the first line diagnostic procedure in postmenopausal women without AUB. In case of endometrial thickness less than 4 mm, it is likely to miss the early stage endometrial cancer but trans-vaginal ultrasound remains the first line diagnostic procedure in postmenopausal women, because it is not invasive and has high sensitivity for detecting endometrial cancer and other endometrial disease; According to our experience, hysteroscopy with biopsy is mandatory in all postmenopausal women with AUB.
Key Words: Endometrial cancer, Hysteroscopy, Postmenopausal AUB, Trans-vaginal ultrasonography

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