An assessment of the value of ultrasonographic screening for endometrial disease in postmenopausal women without symptoms

• Published in: American journal of obstetrics and gynecology Vol. 184; no. 2; pp. 70 - 74
• Main Authors: Fleischer, Arthur C., Wheeler, James E., Lindsay, Iain, Hendrix, Susan L., Grabill, Scott, Kravitz, Barbara, MacDonald, Brian
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.01.2001; Elsevier
• Subjects: Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Biological and medical sciences; Biopsy, Needle; Double-Blind Method; Endometrial Hyperplasia - diagnostic imaging; Endometrial Hyperplasia - pathology; Endometrial Neoplasms - diagnostic imaging; Endometrial Neoplasms - pathology; endometrium; Endometrium - diagnostic imaging; Endometrium - pathology; Female; Genital system. Mammary gland; hormone replacement therapy; Humans; idoxifene; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Osteoporosis, Postmenopausal - prevention & control; Placebos; Postmenopause; Sensitivity and Specificity; Tamoxifen - analogs & derivatives; Tamoxifen - therapeutic use; Transvaginal ultrasonography; Ultrasonic investigative techniques; Ultrasonography; Uterine Diseases - diagnostic imaging; endometrium; hormone replacement therapy; Transvaginal ultrasonography; idoxifene; Sonography; Adenocarcinoma; Human; Toxicity; Hyperplasia; Antiestrogen; Asymptomatic; Malignant tumor; Antihormone; Genital diseases; Idoxifene; Transvaginal route; Echography; Uterine diseases; Postmenopause; Predictive value; Female; Diagnosis; Endometrium
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1067/mob.2001.111088

Objective: Our purpose was to evaluate the use of transvaginal ultrasonography for the detection of endometrial disease in a population of postmenopausal women who were without symptoms. Study Design: Postmenopausal women were screened for potential inclusion in 2 multicenter, double-blind, placebo-controlled studies of 2 years’ duration to evaluate the safety and efficacy of idoxifene in the prevention of osteoporosis. Baseline endometrial evaluation was performed by transvaginal ultrasonography and aspiration biopsy of the endometrium. Results: A total of 1926 women were screened by transvaginal ultrasonography, and 1833 of them had endometrial thickness ≤6 mm. Five cases of endometrial abnormality (adenocarcinoma [n = 1] and atypical hyperplasia [n = 4]) were detected in the 1750 women from this cohort who underwent biopsy. The negative predictive value was >99%. One case of adenocarcinoma was detected in the 42 women who had endometrial thickness >6 mm and underwent biopsy. However, the sampling rate (45%) of women with endometrial thickness >6 mm was too low for confidence in the positive predictive value of 2%. Conclusions: Despite a high negative predictive value, transvaginal ultrasonography may not be an effective screening procedure for detection of endometrial abnormality in untreated postmenopausal women who are without symptoms. (Am J Obstet Gynecol 2001;184:70-4.)