Skip to main content
SpringerLink
Log in

Transvaginal sonography, sonohysterography, and hysteroscopy for investigation of focal intrauterine lesions in women with recurrent postmenopausal bleeding after dilatation & curettage

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To determine the diagnostic accuracy of different diagnostic methods (blind dilatation & curettage (D&C), transvaginal ultrasonography (TVS), sonohysterography (SH), and hysteroscopy) compared with gold standard (hysteroscopic biopsy’s histopathologic result) in diagnosis of focal intrauterine lesions of recurrent postmenopausal bleeding.

Methods

36 postmenopausal women with recurrent vaginal bleeding after a normal D&C results were enrolled into the study. TVS, SH, hysteroscopy were performed on all patients. Outcomes of blind D&C, TVS, SH, and hysteroscopy were compared with results of gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated.

Results

Blind D&C sensitivity, specificity, PPV, and NPV were 47, 68, 57, 59%, respectively in comparison with gold standard. Blind D&C fails to diagnose 70% of all focal intracavitary lesions. TVS sensitivity, specificity, PPV, NPV were 63, 78, 89, 41%, respectively. SH yielded better results; with 93% sensitivity, 56% specificity, 86% PPV, and 71% NPV. Hysteroscopy sensitivity, specificity, PPV, and NPV were 100, 44, 84, 100%, respectively.

Conclusions

In experienced hands, SH can be an initial evaluation method of uterine cavity for detecting focal lesions in women with recurrent postmenopausal bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Weber G, Merz E, Bahlmann F et al (1998) Evaluation of different transvaginal sonographic diagnostic parameters in women with postmenopausal bleeding. Ultrasound Obstet Gynecol 12:265–270

    Article  CAS  PubMed  Google Scholar 

  2. Dubinsky TJ, Stroehlein K, Abu Ghazzeh Y et al (1999) Prediction of benign and malignant endometrial disease: hysterosonographic pathologic correlation. Radiology 210:393–397

    CAS  PubMed  Google Scholar 

  3. Stock RJ, Kanbur A (1975) Perhysterectomy curettage. Obstet Gynecol 45:537–541

    CAS  PubMed  Google Scholar 

  4. Epstein E, Ramirez A, Skoog L et al (2001) Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 80:1131–1136

    CAS  PubMed  Google Scholar 

  5. Dijkhuizen FP, Brolmann HA, Potters AE et al (1996) The accuracy of transvaginal ultrasonography in the diagnosis of endometrial abnomalities. Obstet Gynecol 87:345–349

    Article  CAS  PubMed  Google Scholar 

  6. Smith P, Bakos O, Heimer G et al (1991) Transvaginal ultrasound for identifying endometrial abnormality. Acta Obstet Gynecol Scand 70:591–594

    Article  CAS  PubMed  Google Scholar 

  7. Goldstein SR (1994) Unusual ultrasonographic appearances of the uterus in patients receiving tamoxifen. Am J Obstet Gynecol 170:447–451

    CAS  PubMed  Google Scholar 

  8. Langer RD, Pierce JJ, O’Hanlan KA et al (1997) Transvaginal ultrasonography compared with endometrial biopsy for detection of endometrial disease. Postmenopausal estrogen/progestin interventions trial. N Engl J Med 337:1792–1798

    Article  CAS  PubMed  Google Scholar 

  9. Di Naro E, Bratta FG, Romano F et al (1996) The diagnosis of benign uterine patology using transvaginal endohysterosonography. Clin Exp Obstet Gynecol 23:103–107

    CAS  PubMed  Google Scholar 

  10. Jorizzo JR, Riccio GJ, Chen MYM et al (1999) Sonohysterography: the next step in the evaluation of the abnormal endometrium. Radiographics 19:117–130

    Google Scholar 

  11. Farquhar C, Ekeroma A, Furness S et al (2003) A sistematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Acta Obstet Gynecol Scand 82:493–504

    PubMed  Google Scholar 

  12. Cepnı I, Ocal P, Erkan S et al (2005) Comparison of transvaginal sonography, saline infusion sonography and hysteroscopy in the evaluation of uterine cavity pathologies. Aust N Z J Obstet Gynaecol 45:30–35

    Article  PubMed  Google Scholar 

  13. Gimpelson RJ, Rappold HO (1988) A comparative study between panoramic hysteroscopy with direct biopsies and dilatation and curettage: a review of 276 cases. Am J Obstet Gynecol 158:489–492

    CAS  PubMed  Google Scholar 

  14. Tahir MM, Bigrigg MA, Browning JJ et al (1999) A randomised controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage. Br J Obstet Gynaecol 106:1259–1264

    CAS  PubMed  Google Scholar 

  15. Pasrija S, Trivedi SS, Narula K (2004) Prospective study of saline infusion sonohysterography in evaluation of perimenopausal and postmenopausal women with abnormal uterine bleeding. J Obstet Gynaecol Res 30:27–33

    Article  PubMed  Google Scholar 

  16. Bettocchi S, Ceci O, Vicino M et al (2001) Diagnostic inadequacy of dilatation and curettage. Fertil Steril 75:803–805

    Article  CAS  PubMed  Google Scholar 

  17. Goldfarb HA (1989) D&C results improved by hysteroscopy. N J Med 86:277–279

    CAS  PubMed  Google Scholar 

  18. Epsteın E (2004) Management of postmenopausal bleeding in Sweden: a need for increased use of hydrosonography and hysteroscopy. Acta Obstet Gynecol Scand 83:89–95

    PubMed  Google Scholar 

  19. Coeman D, Belle Y, Vanderick G et al (1993) Hysteroscopic findings in patients with a cervical polyp. Am J Obstet Gynecol 169:1563–1565

    CAS  PubMed  Google Scholar 

  20. Bouda J Jr, Hradecky L, Rokyta Z (2000) Hysteroscopic polypectomy versus fractionated curettage in the treatment of corporal polyps—recurrence of corporal polyps. Ceska Gynekol 65:147–151

    PubMed  Google Scholar 

  21. Goldstein SR, Zeltser I, Horan CK et al (1997) Ultrasonography based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol 177:102–108

    Article  CAS  PubMed  Google Scholar 

  22. Stadtmauer L, Grunfeld L (1995) The significance of endometrial filling defects detected on routine transvaginal sonography. J Ultrasound Med 14:169–172

    CAS  PubMed  Google Scholar 

  23. Fedele L, Bianchi S, Dorta M et al (1991) Transvaginal ultrasonography versus hysteroscopy in the diagnosis of uterine submucous myomas. Obstet Gynecol 77:745–748

    CAS  PubMed  Google Scholar 

  24. Stovall TG, Solomon SK, Ling FW (1989) Endometrial sampling prior to hysterectomy. Obstet Gynecol 73:405–409

    CAS  PubMed  Google Scholar 

  25. Vries LD, Dijkhuizen FPHLJ, Mol BWJ et al (2000) Comparison of transvaginal sonography, saline infusion sonography, and hysteroscopy in premenopausal women with abnormal uterine bleeding. J Clin Ultrasound 28:217–223

    Article  PubMed  Google Scholar 

  26. Epstein E, Ramirez A, Skoog L et al (2001) Transvaginal sonography, saline contrast sonohysterography, and hysteroscopy for the investigation of women with postmenopausal bleeding and endometrium >5 mm. Ultrasound Obstet Gynecol 18:157–162

    Article  CAS  PubMed  Google Scholar 

  27. Rogerson L, Bates J, Weston M et al (2002) A comparison of outpatient hysteroscopy with saline infusion hysterosonography. Br J Obstet Gynecol 109:800–804

    Google Scholar 

  28. Widrich T, Bradley LD, Mitchinson AR et al (1996) Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium. Am J Obstet Gynecol 174:1327–1334

    Article  CAS  PubMed  Google Scholar 

  29. Kroon CD, Bock GH, Dieben SW et al (2003) Saline contrast hysterosonography in abnormal uterine bleeding. A systematic review and meta-analysis. Int J Obstetrics Gynaecol 110:938–947

    Google Scholar 

  30. Wolman I, Groutz A, Gordon D et al (1999) Timing of sonohysterography in menstruating women. Gynecol Obstet Invest 48:254–258

    Article  CAS  PubMed  Google Scholar 

  31. Mihm LM, Quick VA, Brumfield JA et al (2002) The accuracy of endometrial biopsy and saline sonohysterography in the determination of the cause of abnormal uterine bleeding. Am J Obstet Gynecol 186:858–860

    Article  PubMed  Google Scholar 

  32. Reslova T, Tosner J, Resl M et al (1999) Endometrial polyps. A clinical study of 245 cases. Arch Gynecol Obstet 262:133–139

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Obstetrics and Gynecology Department, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey

    A. Yasemin Karageyim Karsidag, Esra Esim Buyukbayrak, Bulent Kars, Orhan Unal & M. Cem Turan

  2. Kozyatagi 19 Mayis Mah. Okur Sok. Leyli Apt., No: 6/20 34736 Kadikoy, Istanbul, Turkey

    A. Yasemin Karageyim Karsidag

Authors
  1. A. Yasemin Karageyim Karsidag
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Esra Esim Buyukbayrak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bulent Kars
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Orhan Unal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Cem Turan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Yasemin Karageyim Karsidag.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karageyim Karsidag, A.Y., Buyukbayrak, E.E., Kars, B. et al. Transvaginal sonography, sonohysterography, and hysteroscopy for investigation of focal intrauterine lesions in women with recurrent postmenopausal bleeding after dilatation & curettage. Arch Gynecol Obstet 281, 637–643 (2010). https://doi.org/10.1007/s00404-009-1150-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-009-1150-9

Keywords

Search

Navigation