ABSTRACT
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.
Subject(s)
Endometrial Neoplasms/diagnosis , Polyps/diagnosis , Uterine Hemorrhage , Aged , Aged, 80 and over , Biopsy , Endometrium/pathology , Female , Humans , Hysteroscopy , Middle Aged , Postmenopause , Prospective Studies , Sensitivity and Specificity , Ultrasonography , Uterine Hemorrhage/diagnostic imaging , Uterine Hemorrhage/etiology , Uterine Hemorrhage/pathologyABSTRACT
The study was conducted on 748 women who reported genital bleeding occurring at least one year after the last menstruation. Benign causes were most frequent than malignant causes. Among the benign causes, the most frequent were cervicitis (19.95%), prolapsed uterus with decubitus ulcer (19.41%), dysfunctional hemorrhage (13.29%) and endometrial polyps (12.77%). In the group of malignant causes, cancer of the cervix was the neoplasm most often detected (59.26%); endometrial cancer was next, affecting 29.63%. The cancer of the cervix/cancer of the body ratio was 2:1. In summary, many causes, both benign and malignant, can provoke abnormal postmenopausal bleeding. Thus, curettage of the uterus should be reserved for doubtful cases, i.e., in situations in which, after all non invasive methods of investigations have been exhausted, the possibility of the occurrence of malignant lesions still persist.
