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Diagnostic strategies for postmenopausal bleeding.

Breijer MC, Timmermans A, van Doorn HC, Mol BW, Opmeer BC - Obstet Gynecol Int (2010)

Bottom Line: Postmenopausal bleeding (PMB) is a common clinical problem.Patients with PMB have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy.Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

ABSTRACT
Postmenopausal bleeding (PMB) is a common clinical problem. Patients with PMB have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS) is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy) can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

No MeSH data available.


Related in: MedlinePlus

Possible diagnostic pathways for postmenopausal bleeding. The areas surrounded by a dotted square require futher research.
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Related In: Results  -  Collection


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fig1: Possible diagnostic pathways for postmenopausal bleeding. The areas surrounded by a dotted square require futher research.

Mentions: Figure 1 shows an algorithm with possible diagnostic pathways for PMB. In this figure an evidence-based approach is combined with approaches requiring more research. Two areas require further research: (1) probability modelling to calculate the pretest probability of endometrial cancer based on patient characteristics [37] and the implementation of such a model in the diagnostic strategy and finally implementation into daily practice and (2) diagnostic approach to benign pathology. That is wether or not subsequent endometrial cavity evaluation for benign abnormalities should be performed after malignancy has been ruled out [41].


Diagnostic strategies for postmenopausal bleeding.

Breijer MC, Timmermans A, van Doorn HC, Mol BW, Opmeer BC - Obstet Gynecol Int (2010)

Possible diagnostic pathways for postmenopausal bleeding. The areas surrounded by a dotted square require futher research.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2821624&req=5

fig1: Possible diagnostic pathways for postmenopausal bleeding. The areas surrounded by a dotted square require futher research.
Mentions: Figure 1 shows an algorithm with possible diagnostic pathways for PMB. In this figure an evidence-based approach is combined with approaches requiring more research. Two areas require further research: (1) probability modelling to calculate the pretest probability of endometrial cancer based on patient characteristics [37] and the implementation of such a model in the diagnostic strategy and finally implementation into daily practice and (2) diagnostic approach to benign pathology. That is wether or not subsequent endometrial cavity evaluation for benign abnormalities should be performed after malignancy has been ruled out [41].

Bottom Line: Postmenopausal bleeding (PMB) is a common clinical problem.Patients with PMB have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy.Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

ABSTRACT
Postmenopausal bleeding (PMB) is a common clinical problem. Patients with PMB have 10%-15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS) is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy) can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

No MeSH data available.


Related in: MedlinePlus