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Ultrasonography |
1 From the Department of Radiology, DC069.10, University of Missouri Health Sciences Center, One Hospital Dr, Columbia, MO 65212 (R.L.B.); the Departments of Radiology (R.A.B., S.D.) and Obstetrics and Gynecology (M.R.P.), University of Michigan, Ann Arbor, Mich; the Department of Radiology, Western Pennsylvania Hospital, Pittsburgh (M.B.V.); and the Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass (C.B.B., P.M.D.). Received June 11, 1999; revision requested August 9; revision received October 12; accepted October 26. Supported in part by a grant from the Society of Radiologists in Ultrasound Research and Education Fund. Address correspondence to R.L.B. (e-mail: breer@health.missouri.edu).
PURPOSE: To assess the accuracy of hysterosonography (HSG) and its role in diagnostic confidence and therapeutic clinical decision making among referring 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 studies on diagnostic confidence and care, including biopsy, dilation and curettage, hysteroscopy, hormone manipulation, and/or patient reassurance. Abnormality 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 incomplete; this left 98 patients. Endometrial polyps were seen in 46 (47%) patients; leiomyoma, in 11 (11%); cancer, in four (4%); hyperplasia, in eight (8%); and normal findings, in 29 (30%). Our calculations yielded a sensitivity of 98% and a specificity of 88%. In 86 (88%) patients, US added certainty to the diagnosis; in 78 (80%), it resulted in a change in patient treatment.
CONCLUSION: HSG and transvaginal US in patients with PMB improves diagnostic accuracy, clinical decision making, and the clinician's diagnostic certainty. In patients with benign causes of PMB, the absence of abnormality at HSG and a normal endometrial biopsy result may eliminate the need for further studies.
Index terms: Uterus, abnormalities, 854.1495, 854.315, 854.318, 854.3199, 854.33 • Uterus, endometrium • Uterus, US, 854.12981, 854.12983
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