Page 40 - The diagnostic work-up of women with postmenopausal bleeding

Chapter 2
Figure 3. Possible diagnostic pathway in postmenopausal bleeding. Figure 3. Possible diagnostic pathway in postmenopausal bleeding
postmenopausal bleeding
The dashed box shows that SIS can be useTdhetdoashdeidstbinogxushisohwsbtehattwSeISecnanfobecausleadntodddistifinfugsueishpbaetwheoelnogy before performing a hysteroscofpocya, laacncdodridffiunsge ptoathtohloeglyobceafol rperpoetrofocrmoli.ng a hysteroscopy, according to the local protocol.
Future research should also aim to maximise accuracy in relation to cost-effectiveness for the different methods. Incorporation of a combination of endometrial thickness and patient characteristics within a single diagnostic pathway increased diagnostic accuracy in some studies.40-42 Future research has to focus on the combination of different diagnostic tests as well as the incorporation of patient characteristics, rather than on the diagnostic accuracy of a single test. Furthermore, by combining and analysing individual patient data from different studies (i.e. meta-analysis of individual patient data), larger databases can be obtained, in which previously described models can be externally validated.40-43
38
TVS
ED ≤ cut-off
ED > cut-off
ED-sampling
(pre)cancer ruled out
insufficient/ inadequate sample
(pre)cancer
expectant management
SIS
treatment
recurrent bleeding
diagnostic/
therapeutic hysteroscopy