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Evidence summaries

Endovaginal Ultrasound to Exclude Endometrial Cancer and other Endometrial Abnormalities

Endovaginal ultrasound has a high sensitivity for detecting endometrial cancer and other endometrial disease and can reliably identify postmenopausal women with vaginal bleeding who are unlikely to have significant endometrial disease so that endometrial sampling may be unnecessary. Level of evidence: "A"

A systematic review 1 including 35 studies with a total of 5892 subjects was abstracted in DARE. Mean (standard deviation) of endometrial thickness according to pathology: normal 4 (1) mm, endometrial polyp 10 (3) mm, hyperplasia 14 (4) mm, and cancer 20 (6) mm. Sensitivity and specificity were reported for endometrial disease using endovaginal thickness measurements to define an abnormal result. Using 5 mm threshold the sensitivity for endometrial disease was 92% and specificity 81%. The sensitivity for cancer was 96% and specificity was 61%. Accuracy of detection of endometrial disease stratified by hormone replacement therapy: no HRT: sensitivity 95%, specificity 92%, positive likelihood 11.9, negative likelihood 0.05. HRT: sensitivity 91%, specificity 77%, positive likelihood 4.0, negative likelihood 0.12.

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    References

    • Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, Brand R, Grady D. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998 Nov 4;280(17):1510-7. [PubMed][DARE]

Primary/Secondary Keywords