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Transvaginal ultrasound, uterine biopsy and hysteroscopy for postmenopausal bleeding
M G Giusa-Chiferi1, W J Gonçalves, E C Baracat
1Department of Gynecology, Escolo Paulista de Medicina, Federal University of São Paulo, Brazil.
Objectives:
To determine the importance of endometrial biopsy and transvaginal ultrasound in patients with postmenopausal bleeding.
Methods:
Eighty patients with postmenopausal bleeding were submitted to transvaginal ultrasound followed by endometrial biopsy. Hysteroscopy and dilatation and curettage were carried out to confirm normality of the uterine cavity.
Results:
The endometrial echo could be visualized in all patients with postmenopausal bleeding. The biopsy failed to detect one case (1.38%) of adenocarcinoma and 14 cases (17.5%) of endometrial polyps. The sensitivity in detecting endometrial malignancy was 94.44% for endometrial biopsy and 100% for transvaginal ultrasound, when the endometrial thickness was more than 8 mm.
Conclusions:
When the thickness of the endometrial echo is less than 3 mm there is no need for anatomopathologic investigation. When this limit was adopted, all cases were associated with endometrial atrophy, and when the limit was 4 mm or more, active endometria were detected, requiring further histopathologic investigation by hysteroscopy and directed biopsies. Above 8 mm, malignancy may be found.