Investigation of choice in a 55 years old post menopausal woman who has presented with postmenopausal bleeding :

Ans. is b i.e. Fractional curettage In a woman with postomenopausal bleeding chances of Endometrial carcinoma are very high. Therefore such a patient should be evaluated so as to rule out Endometrial carcinoma. Investigations for Endometrial Carcinoma : Endanietrial Aspiratio _illus.:1)T is the accepted first step in evaluating a patient with abnormal uterine bleeding or suspected pa gy. The diagnostic accuracy of an office based endometrial biopsy is 90-98% when compared with subsequent findings at dilatation and curettage (D&C)".... Novak 13/e. p 1350 Endometrial biopsy can be performed in outpatients and has the advantage of being simple, quick. safe, inexpensive, convenient and avoding the need of anaesthesia. Dilatation and Fractional Curettage : It is most definitive procedure for diagnosis of endometrial carcinoma but should be res rued for situations in which Aspiration biopsy cannot be performed like : Cervical Sten is Patient's non mpliance for biopsy Specimen obta ned is inadequate for biopsy If in case bleeding recurs after a negative repo on endometrial aspiration. - Fractional currettage comprises of histological study of endocervical scraping before dilating the cervix followed by cervical dilatation and currettage from the isthimus, body of uterus and fundus separately. 3. Hysteroscopy : It is required for ruling out polyps as cause of bleeding. 4. Transvaginal Ultrasound : May be useful adjunct to Endometrial biopsy for evaluating abnormal uterine bleeding and selecting patients for additional testings. Findings on USG requiring fuher evaluation : Endometrial thickness > 4mmdeg Polypoidal mass. Collection of fluid within the uterus. 5. Pap smear : It is not a reliable test for diagnosis of Endometrial carcinoma. Only 30 - 50% patients with Endometrial carcinoma have positive pap test and they are women with advanced disease. Remember : * First investigations in case of endometrial cancer - Endometrial aspiration biopsy. Best investigation for diagnosing endometrial cancer - Fractional curettage.