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- W2156458429 abstract "The report of Mihm et al1Mihm LM Quick VA Brumfield JA Connors Jr, AF Finnerty JJ. The accuracy of endometrial biopsy and saline hysterography in the determination of the cause of abnormal uterine bleeding.Am J Obstet Gynecol. 2002; 186: 858-860Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar is a clearly written and a well-done study. It shows the value of sonohysterography. However, I have to differ with their recommendation that this is the best method of evaluating patients before definitive surgical care. Gimpleson and Rappold2Gimpleson RJ Rappold HO. A comparative study between panoramic hysteroscopy with directed biopsies and dilation and curettage.Am J Obstet Gynecol. 1987; 69: 679Google Scholar did not consider hysteroscopy and curettage the gold standard, but rather they showed that hysteroscopy with directed biopsies was more accurate than a blind curettage. A review of their paper suggested that, if more tissue than a small hysteroscopic biopsy specimen had been sent to the pathologist, the results would have been even more striking. With the premise that more tissue would increase accuracy, I reviewed my own experience. I found that using a suction curettage in addition to hysteroscopically directed biopsy increased the accuracy of a hysteroscopic approach.3Loffer FD. Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: the value of a negative hysteroscopic view.Obstet Gynecol. 1989; 73: 16PubMed Google Scholar Suction curettage has long been advocated as an office procedure.4Grimes DA. Diagnostic dilation and curettage: a reappraisal.Am J Obstet Gynecol. 1982; 142: 1PubMed Scopus (318) Google Scholar Because more than 90% of my diagnostic hysteroscopies are done in the office setting with the patient under local anesthesia, I believe that the increased sensitivity and specificity of a hysteroscopic approach before definitive surgery is preferable to that of sonohysterography. Unfortunately, as the authors point out, only a few gynecologists perform office hysteroscopy. The reason is probably lack of training and economic disincentives. For the patients of those gynecologists who do not yet do office hysteroscopy, sonohysterography is valuable." @default.
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- W2156458429 date "2003-01-01" @default.
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- W2156458429 title "Direct visualization of the uterine cavity provides a better triage than saline hysterography" @default.
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- W2156458429 doi "https://doi.org/10.1016/s0002-9378(03)70139-2" @default.
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