Page 155 - The diagnostic work-up of women with postmenopausal bleeding

at initial hysteroscopy. In these 50 polyps, the pathology results showed six (pre) cancers (6%). From this trial we can conclude that in women with PMB, a thickened endometrium and benign endometrial sampling, operative hysteroscopy does not reduce recurrent bleeding.Yet, hysteroscopy detected focal endometrial (pre) cancer in 6% of women who had benign endometrial sampling.This finding indicates that in these women, further diagnostic work-up is warranted to detect focal (pre) cancers missed by endometrial sampling.
5. Is the diagnostic work-up for and the removal of benign endometrial polyps cost-effective in women with PMB?
Results of the cost-effectiveness analysis performed alongside the above-described
randomised trial are presented in Chapter 6. Outcomes for the cost-effectiveness
analysis (CEA) were cost-differences for the two randomisation-groups and
incremental cost-effectiveness ratios for the prevention of recurrent bleeding and
detection of endometrial (pre) cancers. Statistically, the results show that costs in the
inter vention group were significantly higher compared to the expectant management
group (cost difference 780 euro (95% 550; 1158)), however the effect difference in
the number of women with recurrent bleeding was not significantly different between
the two groups (-3% (95% CI -13; 8%)).The CEA for the detection of endometrial
(pre) cancers showed both a statistically significant effect difference (7% (95% CI 3;
14%)) and a statistically significant cost difference (780 euro (95% 550; 1158)). To
detect one case of (pre) cancer, 10,917 euro should be invested in the hysteroscopy
group as compared with the expectant management group. These costs can be
lowered to 8,913 euro if a strategy that uses SIS to select women for hysteroscopy
is employed. In women with PMB (a thickened endometrium and benign endometrial 8 sampling) operative hysteroscopy does not reduce recurrent bleeding, however hysteroscopy detected focal endometrial (pre) cancer in 6% of these women. A
strategy using hysteroscopy in all women with a thickened endometrium and benign endometrial sampling is about 2000 euro more expensive per patient than a strategy using SIS to select women for therapeutic hysteroscopy to detect endometrial (pre) cancers.
6. Is the diagnostic accuracy of outpatient endometrial sampling as high as we thought based on previous literature?
Summary / samenvatting
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