Diagnostic workup for postmenopausal bleeding: a randomised controlled trial
van Hanegem, N.; Breijer, M. C.; Slockers, S. A.; Zafarmand, M. H.; Geomini, P. M A J; Catshoek, R.; Pijnenborg, J. M A; van der Voet, L. F.; Dijkhuizen, F. P H L J; van Hoecke, G. C R; Reesink-Peters, N.; Veersema, S.; van Hooff, M. H A; van Kesteren, P. J M; Huirne, J. A.; Opmeer, B. C.; Bongers, M. Y.; Mol, B. W J; Timmermans, A.
(2017) BJOG - An International Journal of Obstetrics and Gynaecology, volume 124, issue 2, pp. 231 - 240
(Article)
Abstract
Objective: To evaluate the effectiveness of hysteroscopy for the detection and treatment of endometrial polyps versus expectant management in women with postmenopausal bleeding (PMB), a thickened endometrium and benign endometrial sampling. Design: Multicentre, randomised controlled trial. Setting: Three academic hospitals and nine non-academic teaching hospitals in the Netherlands. Population: Women
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with PMB, an endometrial thickness >4 mm and benign result from endometrial sampling. Methods: Women were randomised to either further diagnostic workup by hysteroscopy (preceded by saline infusion sonography) or expectant management. Main outcomes: The primary outcome measure was recurrence of PMB within a year after randomisation. Secondary outcome measures were time to recurrent bleeding and recurrent bleeding after more than 1 year. In the hysteroscopy group, the presence of polyps and the results of their histology were registered. Results: Between January 2010 and October 2013, 200 women were randomised; 98 to hysteroscopy and 102 to expectant management. Within 1 year a total of 15 women (15.3%) in the hysteroscopy group experienced recurrent bleeding, versus 18 (18.0%) in the expectant management group (relative risk 0.85 (95% CI 0.46–1.59). In the hysteroscopy group, 50/98 (51%) polyps were diagnosed of which 6/98 (6%) showed evidence of endometrial (pre)malignancy; final pathology results after hysterectomy showed three women with hyperplasia with atypia and three women with endometrial cancer. Conclusion: In women with PMB, a thickened endometrium and benign endometrial sampling, operative hysteroscopy does not reduce recurrent bleeding. Hysteroscopy detected focal endometrial (pre)malignancy in 6% of women who had benign endometrial sampling. This finding indicates that in these women, further diagnostic workup is warranted to detect focal (pre)malignancies, missed by blind endometrial sampling. Tweetable abstract: In women with PMB, hysteroscopy does not reduce recurrent bleeding but is warranted to detect focal malignancy.
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Keywords: Endometrial carcinoma, endometrial polyp, endometrial sampling, hysteroscopy, Obstetrics and Gynaecology, Journal Article
ISSN: 1470-0328
Publisher: Wiley-Blackwell
Note: Publisher Copyright: © 2016 Royal College of Obstetricians and Gynaecologists Copyright: Copyright 2018 Elsevier B.V., All rights reserved.
(Peer reviewed)