Try Biopsy, Imaging Before More Invasive Tests.

CHICAGO -- Office-based sonohysterography and endometrial biopsy may help some patients avoid more invasive surgical procedures such as D & C and hysteroscopy in the evaluation of abnormal uterine bleeding.

In a recent study 113 patients with abnormal uterine bleeding underwent endometrial biopsy and saline sonohysterography before undergoing hysteroscopy, hysteroscopy with D & C, or hysterectomy for a more definitive diagnosis. On the basis of sonohysterography and biopsy findings alone, an additional 20 patients opted to be followed for 6 months instead of undergoing the more invasive tests, Dr. Lillian Mihm said at the annual meeting of the American College of Obstetricians and Gynecologists.

The combination of sonohysterography and endometrial biopsy had a 96% sensitivity for determining the underlying cause of abnormal uterine bleeding. In addition the combination had a positive and negative predictive values of 76% and 93%, respectively, said Dr. Mihm of the University of Virginia, Charlottesville.

However, the combination's specificity was only 65%, which means that its ability to help providers determine an exact anatomic defect is limited, Dr. Mihm said.

Still, given the high sensitivity of the sonohysterography/biopsy combination, if these tests are normal "many patients may opt to continue with conservative [medical] management" rather than pursue more invasive tests, she said ...