Page 145 - The diagnostic work-up of women with postmenopausal bleeding

The accuracy of endometrial sampling
further diagnostic work-up for focal intracavitary pathology in women with a failed, insufficient or benign result of endometrial sampling seems warranted.
The results of this systematic review suggest that the sensitivity of endometrial sampling is lower than was thought before for all types of disease, but especially for the diagnosis of atypical hyperplasia and endometrial disease in general.The question is if we can reassure patients without an endometrial polyp and a benign result of endometrial sampling. Is sensitivity of endometrial sampling especially low in women with an endometrial polyp? Unfortunately, we cannot answer these questions based on available literature. Therefore, more research on this subject is needed, using larger samples, given the prevalence of endometrial cancer and atypical hyperplasia (5-10%). Future research should therefore aim to gather information about large (prospective) cohorts of patients with PMB, to study the (cost-)effectiveness and diagnostic accuracy of the endometrial biopsy and hysteroscopy in the diagnostic pathway in women with PMB and a thickened endometrium on TVS.
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