When screening for endometrial cancer in a perimenopausal woman with dysfunctional uterine bleeding, which is preferred – transvaginal ultrasound or endometrial biopsy? Do you recommend both?—KRISTIN NEILSEN, MSN, FNP, CNM, Oshkosh, Wis.

While both these modalities are options for first-line screening, endometrial biopsy is the more sensitive and specific for the diagnosis of endometrial cancer. Endometrial biopsy can also reveal other non-neoplastic conditions (e.g., hormonal imbalances). The indication for testing may help determine which test is optimal for your patient. While endometrial biopsy is preferable in a woman with dysfunctional uterine bleeding, a woman taking a medication like tamoxifen (Nolvadex) may require recurrent monitoring, making ultrasound a less invasive and more tolerable option. Abnormal transvaginal ultrasound findings (typically any measurement >5 mm) should be followed up with endometrial biopsy for definitive diagnosis. For information comparing these procedures, see N Engl J Med. 1997;337:1792-1798.—Lisa Stern, APRN