What are the procedures for treatment of women demonstrating PMB?
Procedures for the analysis and treatment of women demonstrating PMB have expanded since the 1990s with the arrival of transvaginal ultrasound scan (TVUS) and outpatient hysteroscopy. TVS is the first line of imaging choice for the assessment of women presenting with abnormal uterine bleeding. The evolving of TVUS is supported by a study carried out by Salim et al., showing that TVUS in PMB women has reported a sensitivity of 97%, specificity of 74%, for the detection of endometrial abnormalities, in comparison with hysteroscopic biopsy. However, a further study concluded by Stewart, claims that women who are PM a sonohysteroscopy also known as saline infusion sonogram (SIS) and diagnostic hysteroscopy are of benefit. In this systemic review, 5000 women were tested and reported a similar performance for the diagnosis of endometrial pathology.
In all three modalities sensitivity were TVUS-91%, SIS-95%, hysteroscopy- 90% and specificity TVUS-90%, SIS-92% and hysteroscopy-93%. Both the SIS and hysteroscopy give a better diagnosis in terms of the shape of the lesion than TVUS alone. No doubt that TVUS is a safe, less patient discomfort and cost-effective method for diagnosing uterine pathologies, however more importantly in high-risk population the initial investigation with endometrial biopsy is also more cost-effective but comes with patient discomfort. As TVUS has many advantages, it, however, comes with drawbacks such as being operator dependent and limited field of view, and in many cases may overestimate myometrial invasion when determining malignancies.
In PMB women the measurements of the endometrial thickness must be documented in the diagnostic report as per national and departmental guidelines, this would categorize patients into either high or low risk regarding endometrial malignancy. The threshold measurement for PM endometrial thickness can differ in many centers ranging from being.