Journal of Ultrasound in Medicine, Vol 20, Issue 10 1025-1036, Copyright © 2001 by American Institute of Ultrasound in Medicine
Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement
R. B. Goldstein, R. L. Bree, C. B. Benson, B. R. Benacerraf, J. D. Bloss, R. Carlos, A. C. Fleischer, S. R. Goldstein, R. B. Hunt, R. J. Kurman, A. B. Kurtz, F. C. Laing, A. K. Parsons, R. Smith-Bindman and J. Walker
Department of Radiology, University of California, San Francisco, 94143-0628, USA.
OBJECTIVES: A panel of 14 physicians practicing medicine in the United
States with expertise in radiology, obstetrics and gynecology, gynecologic
oncology, hysteroscopy, epidemiology, and pathology was convened by the
Society of Radiologists in Ultrasound to discuss the role of sonography in
women with postmenopausal bleeding. Broad objectives of this conference
were (1) to advance understanding of the utility of different diagnostic
techniques for evaluating the endometrium in women with postmenopausal
bleeding; (2) to formulate useful and practical guidelines for evaluation
of women with postmenopausal bleeding, specifically as it relates to the
use of sonography; and (3) to offer suggestions for future research
projects. SETTING: October 24 and 25, 2000, Washington, DC, preceding the
annual Society of Radiologists in Ultrasound Advances in Sonography
conference. PROCEDURE: Specific questions to the panel included the
following: (1) What are the relative effectiveness and cost-effectiveness
of using transvaginal sonography versus office (nondirected) endometrial
biopsy as the initial examination for a woman with postmenopausal bleeding?
(2) What are the sonographic standards for evaluating a woman with
postmenopausal bleeding? (3) What are the abnormal sonographic findings in
a woman with postmenopausal bleeding? (4) When should saline infusion
sonohysterography or hysteroscopy be used in the evaluation of
postmenopausal bleeding? (5) Should the diagnostic approach be modified for
patients taking hormone replacement medications, tamoxifen, or other
selective estrogen receptor modulators? CONCLUSIONS: Consensus
recommendations were used to create an algorithm for evaluating women with
postmenopausal bleeding. All panelists agreed that because postmenopausal
bleeding is the most common presenting symptom of endometrial cancer, when
postmenopausal bleeding occurs, clinical evaluation is indicated. The
panelists also agreed that either transvaginal sonography or endometrial
biopsy could be used safely and effectively as the first diagnostic step.
Whether sonography or endometrial biopsy is used initially depends on the
physician's assessment of patient risk, the nature of the physician's
practice, the availability of high-quality sonography, and patient
preference. Similar sensitivities for detecting endometrial carcinoma are
reported for transvaginal sonography when an endometrial thickness of
greater than 5 mm is considered abnormal and for endometrial biopsy when
"sufficient" tissue is obtained. Currently, with respect to mortality,
morbidity, and quality-of-life end points, there are insufficient data to
comment as to which approach is more effective. The conference concluded by
identifying several important unanswered questions and suggestions that
could be addressed by future research projects.
