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Type: Journal article
Title: Diagnostic workup for postmenopausal bleeding: a randomised controlled trial
Author: van Hanegem, N.
Breijer, M.
Slockers, S.
Zafarmand, M.
Geomini, P.
Catshoek, R.
Pijnenborg, J.
van der Voet, L.
Dijkhuizen, F.
van Hoecke, G.
Reesink-Peters, N.
Veersema, S.
van Hooff, M.
van Kesteren, P.
Huirne, J.
Opmeer, B.
Bongers, M.
Mol, B.
Timmermans, A.
Citation: BJOG: an International Journal of Obstetrics and Gynaecology, 2017; 124(2):231-240
Publisher: WILEY
Issue Date: 2017
ISSN: 1470-0328
Statement of
N. van Hanegem, M.C. Breijer, S.A. Slockers, M.H. Zafarmand, P.M.A.J. Geomini, R. Catshoek, J.M.A. Pijnenborg, L.F. van der Voet, F.P.H.L.J. Dijkhuizen, G.C.R. van Hoecke, N. Reesink-Peters, S. Veersema, M.H.A. van Hooff, P.J.M. van Kesteren, J.A. Huirne, B.C. Opmeer, M.Y. Bongers, B.W.J. Mol, A. Timmermans
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.
Keywords: Endometrial carcinoma
endometrial polyp
endometrial sampling
Rights: © 2016 Royal College of Obstetricians and Gynaecologists
DOI: 10.1111/1471-0528.14126
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