Page 13 - The diagnostic work-up of women with postmenopausal bleeding

(a biopsy of the lining of the uterus, which is performed in an outpatient setting), 1 saline infusion sonography (SIS, an ultrasound in which water or gel used to better
visualise the inside of the uterus), out- or inpatient hysteroscopy (inspection of the
inside of the uterus with a small camera). As a result, it is unclear whether extensive
diagnostic work-up has to be performed in all women presenting with PMB to rule out both endometrial cancer and endometrial polyps. Maybe it is enough to select women with a high risk of endometrial cancer for further diagnostics and reassure the ones with a low risk.Furthermore,it is unclear if we can save patients with benign endometrial sampling from (unnecessary) invasive procedures, and whether such a strategy would be cost-effective.
Research objectives, questions and general approach
In order to address these gaps in the available literature, this thesis studies two aspects of diagnostic work-up of women with PMB.The first is the selection of women with a high or low risk of endometrial cancer.This selection can be done by selecting women based on their patient characteristics, using a prediction model or by selecting women based on the result of endometrial sampling.The second aspect is the diagnosis and treatment of (benign) endometrial polyps. More precisely, the thesis aims to answer six research questions:
1. What is known in the literature about the diagnostic work-up of women with PMB?
2. Which prediction models on the chance of endometrial cancer in women with PMB are available in the literature and which model shows the best performance?
3. Is a prediction model based on patient characteristics useful in daily practice to differentiate between women with a high or a low risk of endometrial cancer?
4. Is the diagnostic work-up for and the removal of benign endometrial polyps effective in women with PMB to prevent recurrent bleeding?
5. Is the diagnostic work-up for and the removal of benign endometrial polyps cost-effective in women with PMB?
6. Is the diagnostic accuracy of outpatient endometrial sampling as high as we thought based on previous literature?
General introduction
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