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      EFICIENCIA DE LOS MÉTODOS DIAGNÓSTICOS EN EL ESTUDIO DEL SANGRADO UTERINO ANORMAL EN LA PERI Y POSTMENOPAUSIA

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          Abstract

          El sangrado uterino anormal es un importante síntoma que puede indicar la presencia de cáncer o hiperpla-sia endometrial. El objetivo de este estudio es evaluar la eficiencia de los diversos métodos diagnósticos en pacientes peri y postmenopáusicas con sangrado uterino anormal y proponer una vía de manejo en estas pacientes. Diferentes métodos diagnósticos serán evaluados, incluyendo ecografíatransvaginal, sonohiste-rografía, Doppler, resonancia magnética nuclear, biopsia por Pipelle, dilatación y curetage e histeroscopia. Está demostrado que la ecografía transvaginal tiene una alta eficiencia para el reconocimiento de lesiones difusas, mientras que sonohisterografía tiene una alta eficiencia para identificar lesiones focales. Por otro lado, la biopsia por Pipelle ha demostrado descartar patología difusa con una alta eficiencia. Se concluye que la mejor vía para el estudio de pacientes con sangrado uterino anormal es realizar una ecografíatransvaginal y una histerosonografía en el mismo momento, seguido por una biopsia mediante Pipelle. Finalmente, puede ser sugerido que por esta vía es altamente probable que todos los casos de cáncer e hiperplasia endometrial puedan ser identificados

          Translated abstract

          Abnormal uterine bleeding is an important symptom that can mean presence of endometrial cáncer or endometrial hyperplasia. The aim of this study is to assess the effectiveness of selected diagnostic methods in peri and potmenopausal women with abnormal uterine bleeding, and to propose a way to manage in these patients. Different diagnostic methods are assessed, which include transvaginal ultrasonography, sonohysterography, Doppler technique, magnetic resonance images, biopsy by Pipelle, dilatation and curettage, and hysteroscopy. It is founded that ultrasonography has a high efficiency when it comes for identifying diffuse lesions, while sonohysterography has a high efficiency for identify focal lesions. On the other hand biopsy by Pipelle has demonstrated to rule out diffuse pathology with a high efficiency. It is concluded that the best way to manage patients with abnormal uterine bleeding by performing ultrasonography and sonohysterography at the same time followed by a Pipelle biopsy. Finally, it can be suggested that by this way it is highly probable that all cases with endometrial carcinoma and endometrial hyperplasia can be identified

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          The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis.

          H. Brölmann, B W Mol, F. Dijkhuizen … (2000)
          Endometrial assessment by means of biopsy or sampling of endometrial cells is a minimally invasive alternative for dilatation and curettage (D&C) or hysteroscopy. The use of this technique is believed to reduce the cost of the diagnostic work-up for abnormal uterine bleeding without reducing accuracy. Because the authors were not aware of any systematic review of this test, they performed a meta-analysis to assess the accuracy of endometrial sampling devices in the detection of endometrial carcinoma and atypical hyperplasia. The authors searched the literature for studies published between 1966 and 1999 comparing the results of endometrial sampling with findings at D&C, hysteroscopy, and/or hysterectomy. They found 39 studies that included 7914 women. For each study, the fraction of patients was calculated in which endometrial sampling failed. Furthermore, the authors calculated the fraction of cases of endometrial carcinoma and atypical hyperplasia that were identified correctly as well as the fraction of women in whom these diseases were diagnosed false positively. The detection rate for endometrial carcinoma was higher in postmenopausal women compared with premenopausal women. In both postmenopausal and premenopausal women, the Pipelle was the best device, with detection rates of 99. 6% and 91%, respectively. For the detection of atypical hyperplasia, there was only one study that reported explicitly on postmenopausal women, thereby hampering the possibility of subgroup analysis. Again, the Pipelle was the most sensitive technique with a sensitivity of 81%. The specificity of all devices was > 98%. Endometrial biopsy with the Pipelle is superior to other endometrial techniques in the detection of endometrial carcinoma and atypical hyperplasia. The accuracy of the Pipelle is higher in postmenopausal women compared with premenopausal women. Copyright 2000 American Cancer Society.
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            How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding.

            V Feldstein, Derek Smith, Greta E Weiss (2004)
            Transvaginal sonography (TVS) is routinely performed as part of a pelvic sonogram in postmenopausal women, and images of the endometrium are frequently obtained. In women without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium is not known. The aim of this study was to determine an endometrial thickness threshold that should prompt biopsy in a postmenopausal woman without vaginal bleeding. This was a theoretical cohort of postmenopausal women aged 50 years and older who were not receiving hormone therapy. We determined the risk of cancer for a postmenopausal woman with vaginal bleeding when the endometrial thickness measures > 5 mm, and then determined the endometrial thickness in a woman without vaginal bleeding that would be associated with the same risk of cancer. We used published and unpublished data to determine the sensitivity and specificity of TVS, the incidence of endometrial cancer, the percentage of women symptomatic with vaginal bleeding, and the percentage of cancer that occurs in women without vaginal bleeding. Ranges for each estimate were included in a sensitivity analysis to determine the impact of each estimate on the overall results. In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is thick (> 5 mm) and 11 mm) and 0.002% if the endometrium is thin ( 11 mm a biopsy should be considered as the risk of cancer is 6.7%, whereas if the endometrium measures < or = 11 mm a biopsy is not needed as the risk of cancer is extremely low.
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              Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis.

              R. Gupta, Khalid Khan, Winnie W. Y. Chien … (2002)
              Our aim was to determine the diagnostic accuracy of endometrial thickness measurement by pelvic ultrasonography for predicting endometrial carcinoma and disease (hyperplasia and/or carcinoma) during an investigation of postmenopausal bleeding. We performed a systematic quantitative review of the available published literature, which consisted of online searching the MEDLINE and EMBASE databases (1966-2000) coupled with scanning of bibliography of known primary and review articles. The selection of studies, assessment of study quality, and extraction of data were performed in duplicate under masked conditions. Included in the analyses were 57 studies with 9031 patients. Accuracy data were summarized using likelihood ratios for various cut-off levels of abnormal endometrial thickness. The commonest cut-offs were 4 mm (9 studies) and 5 mm (21 studies), measuring both endometrial layers. None of the nine studies using the < or = 4 mm cut-off level were of good quality. Only four studies (out of the 21) used the < or = 5 mm cut-off level, which employed the best-quality criteria. Using the pooled estimates from these four studies only, a positive test result raised the probability of carcinoma from 14.0% (95% CI 13.3-14.7) to 31.3% (95% CI 26.1-36.3), while a negative test reduced it to 2.5% (95% CI 0.9-6.4). In conclusion, ultrasound measurement of endometrial thickness alone, using the best-quality studies cannot be used to accurately rule. However, a negative result at < or = 5 mm cut-off level measuring both endometrial layers in the presence of endometrial pathology rules out endometrial pathology with good certainty.
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                Author and article information

                Journal
                Journal ID (publisher-id): rchog
                Title: Revista chilena de obstetricia y ginecología
                Abbreviated Title: Rev. chil. obstet. ginecol.
                Publisher: Sociedad Chilena de Obstetricia y Ginecología (Santiago, , Chile )
                ISSN (Print): 0048-766X
                ISSN (Electronic): 0717-7526
                Publication date (Print and electronic): 2008
                Volume: 73
                Issue: 1
                Pages: 58-62
                Affiliations
                [01] orgnameUniversidad Andrés Bello orgdiv1Facultad de Ciencias de la Salud orgdiv2Escuela de Medicina Chile
                Article
                Publisher ID: S0717-75262008000100010 Publisher ID: S0717-7526(08)07300110
                DOI: 10.4067/S0717-75262008000100010
                SO-VID: 06ecd1d0-c571-4f6e-bcce-5b690b99b079
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 5
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                SciELO Chile

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                Subject: Documento

                Keywords: metrorragia,Abnormal uterine bleeding,metrorrhagia,Sangrado uterino anormal,cáncer endometrial,endometrial cáncer
                Data availability:
                Keywords: metrorragia, Abnormal uterine bleeding, metrorrhagia, Sangrado uterino anormal, cáncer endometrial, endometrial cáncer

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