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To the Editor: Dr Smith-Bindman and colleagues¹ report the results of a meta-analysis evaluating the role of endovaginal ultrasound (EVUS) in excluding endometrial cancer and other endometrial abnormalities. The other endometrial abnormalities include endometrial polyps and submucous leiomyomata, both common causes of postmenopausal bleeding. We agree that using an endometrial thickness threshold of 5 mm results in a high sensitivity and specificity for endometrial cancer. We believe that using EVUS alone is not adequate to exclude benign causes of postmenopausal bleeding and routinely perform hysterosonography in these patients.²

In a recently completed multicenter trial, we evaluated 124 patients who presented with postmenopausal bleeding. Each patient underwent endometrial biopsy, EVUS, and hysterosonography; 106 patients had the definitive diagnosis established with dilation and curettage (D&C), hysteroscopy, or hysterectomy. The remaining patients who had negative findings had 6-month follow-up with absence of disease and cessation of symptoms. Sixty percent of the patients were . . . [Full Text of this Article]