Page 106 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 5
Appendix
Women with endometrial carcinoma during follow-up
In the first year after randomization, one woman who presented with recurrent bleeding, randomized to the hysteroscopy group, was diagnosed with endometrial cancer. This woman presented with recurrent bleeding after seven months and biopsy taken at hysteroscopy showed an endometrial carcinoma grade 1. More than 12 months after randomization, another woman in the hysteroscopy group and one woman in the expectant management group, both presenting with recurrent bleeding, were diagnosed with endometrial cancer.
Table A1. Patient characteristics of women with a missed diagnosis of atypical hyperplasia or endometrial cancer with Pipelle®
Age, years; median (IQR) 63 (56-76) 57 (54-62)
Missed (pre) cancer (n=6)
True benign result of Pipelle® (n= 81)
BMI, kg/m2; median (IQR)
Years since menopause; median (IQR) Endometrial thickness, mm; median (IQR)
35.9 (30.4-41.3)* 10 (4-27)
12 (12-18)*
27.5 (24.3-32.2) 4 (2-12)
8 (6-12)
*indicates a significantly different result compared to women with a true benign result of endometrial biopsy.
The woman in the hysteroscopy group returned with recurrent bleeding two months after initial hysteroscopic removal of a benign polyp and the gynecologist advised to switch hormonal treatment, without any further diagnostic work-up.Almost two years later, this woman returned with a new episode of bleeding; diagnostic work-up byTVS and endometrial sampling showed a thickened endometrium and pathology from a biopsy taken at hysteroscopy showed atypical hyperplasia. She underwent a hysterectomy and final pathology revealed an endometrial carcinoma grade 1.
The woman with endometrial carcinoma found in the expectant management group came back with recurrent bleeding 23 months after randomization.TVS showed irregular intracavitary abnormalities and pathology (endometrial sampling) showed a grade 1 endometrial carcinoma. FIGO stage 1A endometrial carcinoma was diagnosed in all three women after hysterectomy.
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