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https://hdl.handle.net/2440/115631
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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 1471-0528 |
Statement of Responsibility: | 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 hysteroscopy |
Rights: | © 2016 Royal College of Obstetricians and Gynaecologists |
DOI: | 10.1111/1471-0528.14126 |
Published version: | http://dx.doi.org/10.1111/1471-0528.14126 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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