Figure 4. Management algorithm for postmenopausal women undergoing tamoxifen therapy. This algorithm was used to analyze the test performance of the sequential combination of transvaginal US (TVUS) and hysterosonography (HSG). At transvaginal US, an endometrial thickness cutoff point of either 5 or 6 mm was used. When transvaginal US depicted at least 2 mL of fluid in the endometrial cavity, hysterosonography was not attempted.