The diagnostic value of transvaginal sonography in the diagnosis of endometrial malignancy in women with peri- and postmenopausal bleeding.

The purpose of this study was to evaluate transvaginal sonography and curettage in the diagnosis of endometrial malignancy in women with peri-, and postmenopausal bleeding. Diagnostic curettage has been the method of choice to diagnose endometrial cancer. The purpose of this study was also to evaluate the value of transvaginal sonography in decreasing the number of curettages, because the costs of curettage are huge today and only 10% of the women in this group will be diagnosed with endometrial cancer. Transvaginal sonography was performed on 353 women with peri- or postmenopausal bleeding before curettage. Endometrial malignancy was found in 42 patients, in 12/242 (5%) of women aged less than 60 years and 30/111 (27%) of women aged 60 years or more. All the patients with endometrial cancer had an endometrial thickness of 6 mm or more measured by transvaginal sonography. The sensitivity of ultrasound to detect malignancy was 100%, the specificity was 43.4%, the positive and negative predictive values were 19.2% and 100%. If the limit of 6 mm of endometrial thickness had been used in this study, 38.2% of the curettages could have been avoided.

Cytologic evidence of the association of condylomatous lesions with dysplastic and neoplastic changes in the uterine cervix.

Cytologic smears were obtained from 272 women shown, during a mass screening program, to have histologically proven severe dysplasia, carcinoma in situ or invasive squamous cell carcinoma of the uterine cervix. These smears were scrutinized with special attention to the detection of the cytologic pattern recently established as diagnostic of condyloma virus infection in the genital tract. The results disclosed positive cytologic findings in a considerable percentage of the smears studied, in contrast to an absolute failure to demonstrate any cytologic evidence of the presence of genital herpesvirus infection. The frequency figures of the positive findings were in accordance with the previously established frequency figures of histologically verified condylomatous lesions, thus confirming the applicability of the cytologic criteria used. The significance of the findings is discussed in the light of cervical carcinogenesis, and the conclusion is drawn that one should seriously consider the possibility that the virus behind the condylomatous lesions is the agent responsible for, or contributing to, the development of uterine cervical carcinoma.