Radiologic clinics of North America
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Radiol. Clin. North Am. · Jul 2003
ReviewUltrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding.
Transvaginal ultrasound with SIS is a cost-minimizing screening tool for perimenopausal and postmenopausal women with vaginal bleeding. Its use decreases the need for invasive diagnostic procedures for women without abnormalities, and ultrasound increases the sensitivity of detecting abnormalities in women with pathologic conditions. Vaginal sonography is preferred over uniform biopsy of postmenopausal women with vaginal bleeding because it (1) is a less invasive procedure, (2) is generally painless, (3) has no complications, and (4) may be more sensitive for detecting carcinoma than blind biopsy. ⋯ It remains unproven whether certain patients at higher risk for carcinoma should proceed directly to invasive evaluation. Women on tamoxifen with persistent recurrent bleeding, women with significant risk factors for carcinoma, and women with life-threatening hemorrhage comprise this group. Further studies are still necessary to evaluate high-risk patients and determine whether ultrasound or biopsy is really the most cost-effective initial test.