Browsing by Author "MAKLAD, N"

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    TRANSVAGINAL HYSTEROSONOGRAPHY - COMPARISON WITH BIOPSY IN THE EVALUATION OF POSTMENOPAUSAL BLEEDING
    (1995) DUBINSKY, TJ; PARVEY, HR; GORMAZ, G; CURTIS, M; MAKLAD, N
    Transvaginal sonography is a highly sensitive method for detecting endometrial thickening. In the postmenopausal woman such thickening is non-specific and can be due to hyperplasia, polyps, submucosal endoluminal fibroids, or carcinoma. In such cases, transvaginal sonography combined with transvaginal hysterosonography may assist in the workup of these endometrial processes. We compared the combination of transvaginal sonography and transvaginal hysterosonography to aspiration endometrial biopsy in the evaluation of women with postmenopausal bleeding. We prospectively performed transvaginal sonography in 148 women within 1 month (range, 10 days to 2 months) after having had an aspiration endometrial biopsy. Transvaginal hysterosonography was then performed in 81 of these women who had endometrial thickness greater than 5 mm. In these 81 patients, transvaginal hysterosonography confirmed 45 lesions: 23 pedunculated endometrial masses and 22 inhomogeneous sessile lesions. Women with positive transvaginal hysterosonography examinations then underwent hysteroscopy or hysterectomy, whereas women with negative examinations were followed conservatively. Forty-one of the 45 cases with endoluminal masses on transvaginal hysterosonography had false-negative aspiration biopsies. Of the five (11%) lesions that were malignant, three resulted in false-negative biopsies, one biopsy revealed hyperplasia, and only one biopsy was true positive. All 36 women with negative transvaginal hysterosonography examinations also had negative biopsy findings. We conclude that the combination of transvaginal sonography and transvaginal hysterosonography is more sensitive in the detection of endometrial pathologic lesions than is endometrial biopsy, and that transvaginal sonography or transvaginal hysterosonography should be included in the evaluation of women with postmenopausal bleeding.
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    TRANSVAGINAL HYSTEROSONOGRAPHY IN THE EVALUATION OF SMALL ENDOLUMINAL MASSES
    (1995) DUBINSKY, TJ; PARVEY, HR; GORMAZ, G; MAKLAD, N
    Transvaginal sonography is highly sensitive for detecting endometrial mass lesions, but it is nonspecific. Biopsies performed on patients with abnormal findings seen on TVS often are negative. We performed transvaginal hysterosonography prospectively on 48 consecutive patients with endometrial thickness demonstrated on TVS to be between 5 and 10 mm to assess whether this technique would be useful in the evaluation of such patients. TVHS is a simple, painless technique that is performed by placing a small catheter into the endometrial canal and infusing a small amount of saline solution under sonographic visualization. Of 48 suspected lesions, TVHS confirmed only 19 endoluminal masses: 11 fibroids and eight polyps. Polyps tended to be homogeneously echogenic and to have a pedunculated attachment to the uterine wall without interruption of the endometrial lining. Fibroids showed more heterogeneous echogenicity and had a more sessile attachment. Four patients in our series had false-negative biopsy results prior to having had endometrial mass lesions depicted on TVHS. TVHS may prevent unnecessary biopsies in those patients who appear to have abnormalities on TVS. By depicting the nature of the attachment of endoluminal masses to the uterine wall more clearly, TVHS also may help direct subsequent biopsy procedures.