A 56-year-old postmenopausal female presents with a single episode of painless vaginal spotting. She has been menopause-free for 5 years and takes no hormone replacement therapy. Physical examination is unremarkable. What is the mandatory first-line diagnostic investigation to exclude endometrial adenocarcinoma?
Answer and explanation
Correct answer: A. Transvaginal ultrasound (TVUS) to assess endometrial thickness, followed by endometrial biopsy
- Step 1: Postmenopausal bleeding must be considered endometrial cancer until proven otherwise (accounting for approximately 10% of cases).
- Step 2: Transvaginal ultrasound measuring endometrial thickness (< 4-5 mm has high negative predictive value) followed by pipelle endometrial biopsy is mandatory.
Answer
Transvaginal ultrasound (TVUS) to assess endometrial thickness, followed by endometrial biopsy.
Why not the others: 'Reassurance and observation for recurrence' is dangerously negligent and delays diagnosis of malignancy; 'Cervical Papanicolaou (Pap) smear alone' screens for cervical cancer and has poor sensitivity for endometrial adenocarcinoma; 'Serum CA-125 measurement alone' lacks specificity and is not a screening tool.
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