Diagnostic workup for postmenopausal bleeding: a randomised controlled trial.

Autor: van Hanegem N; Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands., Breijer MC; Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands., Slockers SA; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands., Zafarmand MH; Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.; Department of Public Health, Academic Medical Centre, Amsterdam, the Netherlands., Geomini P; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands., Catshoek R; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands., Pijnenborg J; Department of Obstetrics and Gynaecology, Twee Steden Hospital, Tilburg, the Netherlands., van der Voet LF; Department of Obstetrics and Gynaecology, Deventer hospital, Deventer, the Netherlands., Dijkhuizen F; Department of Obstetrics and Gynaecology, Rijnstate hospital, Arnhem, the Netherlands., van Hoecke G; Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, Dordrecht, the Netherlands., Reesink-Peters N; Department of Obstetrics and Gynaecology, Medical Spectrum Twente, Enschede, the Netherlands., Veersema S; Department of Obstetrics and Gynaecology, St. Antonius Hospital, Nieuwegein, the Netherlands., van Hooff M; Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam, the Netherlands., van Kesteren P; Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands., Huirne JA; Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, the Netherlands., Opmeer BC; Clinical Research Unit, Academic Medical Centre, Amsterdam, the Netherlands., Bongers MY; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands., Mol B; The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia., Timmermans A; Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: BJOG : an international journal of obstetrics and gynaecology [BJOG] 2017 Jan; Vol. 124 (2), pp. 231-240. Date of Electronic Publication: 2016 May 26.
DOI: 10.1111/1471-0528.14126
Abstrakt: 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.)
Databáze: MEDLINE
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