1. Diagnostic workup for postmenopausal bleeding: a randomised controlled trial.
- Author
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van Hanegem N, Breijer MC, Slockers SA, Zafarmand MH, Geomini P, Catshoek R, Pijnenborg J, van der Voet LF, Dijkhuizen F, van Hoecke G, Reesink-Peters N, Veersema S, van Hooff M, van Kesteren P, Huirne JA, Opmeer BC, Bongers MY, Mol B, and Timmermans A
- Subjects
- Biopsy, Female, Humans, Middle Aged, Polyps diagnosis, Precancerous Conditions complications, Precancerous Conditions diagnosis, Uterine Diseases complications, Uterine Hemorrhage diagnosis, Uterine Neoplasms complications, Uterine Neoplasms diagnosis, Uterus pathology, Watchful Waiting, Hysteroscopy statistics & numerical data, Polyps complications, Postmenopause, Uterine Diseases diagnosis, Uterine Hemorrhage etiology
- 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 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., (© 2016 Royal College of Obstetricians and Gynaecologists.)
- Published
- 2017
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