Transvaginal ultrasonography Sample Clauses

Transvaginal ultrasonography. The development and availability of transvaginal ultrasound offered a non invasive procedure that can accurately image the uterus and endometrium. In contrast to diagnostic hysteroscopy, transvaginal ultrasound has no complications and is well tolerated by patients (Xxxxx et al. 1991). So, in view of the inadequacies of D&C and the fact that up to 83% of women undergoing an invasive procedure such as diagnostic hysteroscopy were not found to have endometrial pathology (Lo et al. 2000) transvaginal ultrasound has been evaluated as a possible first line assessment of women with postmenopausal bleeding (Xxxxxxx et al. 1995). In 1990 Osmers et al. scanned 103 post menopausal women with post menopausal bleeding and established that in women with an endometrial thickness of over 4mm the risk of endometrial cancer increased significantly (Osmers et al. 1990). Similar results were reported by Xxxxx et al. a year later (Xxxxx et al. 1991). Around the same time Xxxxxxxxx et al. reported that in postmenopausal women with bleeding, if the endometrium is <5mm on transvaginal scan minimal tissue is obtained on sampling (Xxxxxxxxx et al. 1990). However, both Osmers and Xxxxx used curettage as their gold standard which may have led them to miss a substantial proportion of cancers given the low diagnostic yield of this procedure (Xxxxxx 1982). In order to remedy this deficiency Xxxxxxx at al. performed a study of the predictive value of transvaginal ultrasound using outpatient hysteroscopy and biopsy for all patients as the gold standard. In this study all 6 women with postmenopausal bleeding who were diagnosed to have cancer on hysteroscopy had an abnormal transvaginal scan (Xxxxxxx et al. 1995). However 16 women with an abnormal transvaginal scan had a normal diagnostic hysteroscopy. Nevertheless using transvaginal ultrasound as first line investigation of women with postmenopausal bleeding would have reduced the rate of an invasive procedure such as hysteroscopy by 50%. In 1995 the first of a series of multicentre trials to evaluate transvaginal scanning as the initial investigation of women with postmenopausal women was reported. In 1138 women with postmenopausal bleeding 114 endometrial cancers were diagnosed by curettage and none of these women had an endometrial thickness less than 5mm (Xxxxxxxx et al. 1995). Using a 4mm cut off the positive predictive value for detecting any endometrial pathology was 61% whilst the negative predictive value was 97%. Similar results...