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1 "Guidelines for management of patients with abnormal vaginal blood loss in the post menopause" from NVOG guidelines No. 4; February 1997. With permission from the Dutch Society for Obstetrics and Gynaecology.
Source publication
This thesis aims to evaluate the diagnostic work-up in postmenopausal women presenting with abnormal vaginal bleeding. In the guideline of the Society of Dutch Gynaecologist and Obstetricians a gynecological examination, including cervical cytology, is followed by transvaginal sonography (TVS). When the endometrial thickness (ET) is 4 mm or less, t...
Contexts in source publication
Context 1
... algorithm of the NVOG is represented in Figure 1.1. In short a gynecological ex- amination, including cervical cytology (Figure 1.2), is performed, followed by transvaginal sonography using high frequency (5-7.5 MHz) transducers (Figure 1.3). ...
Context 2
... algorithm of the NVOG is represented in Figure 1.1. In short a gynecological ex- amination, including cervical cytology (Figure 1.2), is performed, followed by transvaginal sonography using high frequency (5-7.5 MHz) transducers (Figure 1.3). Endometrial thickness (ET) is measured as a double layer measurement at the thickest part of the endometrium in the longitudinal plane. ...
Context 3
... algorithm of the NVOG is represented in Figure 1.1. In short a gynecological ex- amination, including cervical cytology (Figure 1.2), is performed, followed by transvaginal sonography using high frequency (5-7.5 MHz) transducers (Figure 1.3). Endometrial thickness (ET) is measured as a double layer measurement at the thickest part of the endometrium in the longitudinal plane. ...
Context 4
... case of abnormal findings in the cervical cytology, or in case the ET is more than 4 mm or not assessable, histology is indicated. In the 1997 version of the guideline office endometrial sampling techniques are advocated, specifically the Vabracurette and the Pipelle endometrium sampler (Figure 1.4). 12 These techniques combine high sensitivity for endometrial cancer in women complaining of 1 "Guidelines for management of patients with abnormal vaginal blood loss in the post menopause" from NVOG guidelines No. 4;February 1997. ...
Context 5
... patients presenting with a first episode of abnormal postmenopausal bleeding the guideline of the Dutch Society of Obstetrics and Gynaecology ("Nederlandse Vereniging voor Obstetrie en Gynaecologie" (NVOG)) gives priority to the detection of malignancy or atypical hyperplasia (Figure 1.1). 12 Patient recruitment for our study started in January 2001 and ended in June 2003. ...
Context 6
... 5) A cost-benefit analysis by Dijkhuizen et al, 99 showed that in women presenting with post- menopausal bleeding with an a-priori risk of 15% it would be cost effective to perform office endometrial sampling rather than TVS to detect serious endometrial pathology. TVS however can also detect adnexal masses, bladder abnormalities (including malignancies) and other significant pathology in the pelvis that might otherwise go unnoticed ( Figure 1.3E). [149][150][151][152][153] Therefore, one can debate whether the TVS can be omitted in women presenting with a gynecologic complaint such as postmenopausal bleeding. ...
Context 7
... of this thesis concerns the diagnostic process in women with postmenopausal bleed- ing. After diagnosing endometrial cancer the question arises whether TVS can be of use in assessing stage and deciding on treatment (Figure 1.3). Several studies have reported on the diagnostic accuracy of TVS for assessment of myometrium infiltration in patients with endometrial cancer. ...
Citations
Saline infusion sonography (SIS) and endometrial aspiration can both be performed with the same catheter in 1 session. The objective of this study was to evaluate the effect of the order of investigations (aspiration-SIS vs SIS-aspiration) on the quality of the endometrial sample.
Single-blind randomized controlled trial (Canadian Task Force classification I).
Academic teaching hospital.
A total of 113 women with abnormal uterine bleeding who visited the outpatient clinic were included in the study.
The included women were randomly allocated either to SIS and subsequent endometrial aspiration, or to the reverse order. Both examinations were performed in 1 session with the same catheter. All aspiration specimens were sent to the same pathologist, who evaluated the quality of the samples.
The quality of the endometrial aspiration specimen was significantly better in the group of women who had aspiration before SIS, compared with women who were allocated to the reverse order (p=.04). Blood and mucus staining and the presence of endometrial epithelium had a significant influence on the sample quality. The difference between both groups was most pronounced in premenopausal women (p=.005).
This study shows that the proportion of adequate specimens is higher when endometrial aspiration is done first with subsequent SIS. Aspiration should be performed before SIS to decrease the chance of obtaining an insufficient endometrial aspiration specimen.
