The Diagnosis of AUB: Causes and the Emerging Diagnostic Option


PROGRAM 1:
A New and Better Standard of Care Than Blind Biopsy for the Diagnosis of Abnormal Uterine Bleeding

Host: Andrea J. Singer, MD
Guest: Steven R. Goldstein, MD

Recent advances in technology are significantly changing the way physicians evaluate patients with abnormal uterine bleeding (AUB).

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Overview

Recent advances in technology are significantly changing the way physicians evaluate patients with abnormal uterine bleeding (AUB). Clinicians must understand the gravity of abnormal uterine bleeding in terms of patient health. One-third of patient visits to the gynecologist are for abnormal bleeding – accounting for more than 70% of gynecologic consults in perimenopausal and postmenopausal women. For younger women between ages 19 and 39, abnormal bleeding most frequently occurs as a result of pregnancy, benign structural lesions, anovulatory cycles in polycystic ovarian syndrome, abnormalities of hormonal contraception, and occasionally even endometrial hyperplasia.

Join host Dr. Andrea Singer as she welcomes Dr. Steven R. Goldstein to discuss AUB and Endosee, an in-office diagnostic hysteroscopy. Dr. Goldstein is a Professor of Obstetrics and Gynecology at the New York University School of Medicine, immediate Past President of the American Institute of Ultrasound in Medicine, and a clinical practitioner in the Faculty Practice Suites at New York University.


PROGRAM 2:
Abnormal Uterine Bleeding (AUB): Impact of Direct Visualization for Earlier Diagnosis




Host Renée Simone Yolanda Allen, MD, MHSc., FACOG
Guest Abigail Feathers, MD
Guest Kevin J. Lee, MD, MSPH, FACOG

Guest Stephen M. Volin, MD

Endometrial biopsy (EMB) has limitations in diagnosing abnormalities within the uterine cavity. If cancer occupies less than 50% of the surface area of the endometrial cavity, the cancer can be missed by a blind EMB alone.


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Overview

Endometrial biopsy (EMB) has limitations in diagnosing abnormalities within the uterine cavity. If cancer occupies less than 50% of the surface area of the endometrial cavity, the cancer can be missed by a blind EMB alone. And, EMB alone could potentially miss the diagnosis of focal lesions in up to 18% of patients. In this first discussion of a 2-part series, experts will be discussing the benefits of direct visualization of the uterine cavity at the point-of-care and its benefits to both you and your patients.

Host Dr. Renee Allen welcomes:

  • Abigail Feathers, MD, Fellow of the American College of Obstetricians and Gynecologists (FACOG) and practicing gynecologist at Garrett Regional Medical Center, Oakland, MD.
  • Kevin J. Lee, MD, MSPH, FACOG, practices minimally invasive gynecology and gynecologic endoscopy in Baltimore, MD. Dr. Lee has particular expertise and interest in uterine fibroids, abnormal uterine bleeding, pelvic pain, endometriosis, and health disparities.
  • Stephen M. Volin, MD, founder and managing physician with The Women’s Health Group and the Colorado Pelvic Floor and Incontinence Center, instructor with the University of Colorado School of Medicine and Rocky Vista University

PROGRAM 3:
Endosee: Changing the Work Up of Abnormal Uterine Bleeding




Host Renée Simone Yolanda Allen, MD, MHSc., FACOG
Guest Abigail Feathers, MD
Guest Kevin J. Lee, MD, MSPH, FACOG

Guest Stephen M. Volin, MD

In this second discussion of a 2-part series, host Dr. Renee Allen welcomes back gynecologic experts as they discuss “Endosee: Changing the Work Up of Abnormal Uterine Bleeding.”


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Overview

In this second discussion of a 2-part series, host Dr. Renee Allen welcomes back gynecologic experts as they discuss “Endosee: Changing the Work Up of Abnormal Uterine Bleeding.” They will review their experience on how Endosee benefits their individual practices, the benefits to their patients, and the overall healthcare system. Our medical guest experts are Dr. Abigail Feathers, solo practitioner, Medical and Surgical Gynecologist in Oakland, Maryland; Dr. Kevin J. Lee, minimally invasive GYN surgeon at MedStar Medical Group Women’s Health at MedStar Good Samaritan Hospital in Baltimore, Maryland; and Dr. Stephen M. Volin, founder and managing partner of the Women’s Health Group in Denver, Colorado.

“This handheld, portable system can be set up in minutes and in any examination room, so it is not disruptive to my practice or my patients.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI

“Endosee brought about a mind-set change. By using it, you realize that you’re doing patients a service by getting to a diagnosis as soon as possible.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI

“In addition to offering physicians immediate visualization to gather important diagnostic information, Endosee also allows us to perform an endometrial biopsy and hysteroscopy in the same visit.”

Ethan Goldstein, MD
  • Ethan Goldstein, MD
  • Robotic & Minimally Invasive Surgery Program
  • Huron Valley-Sinai Hospital, Detroit, MI

“Dramatic shifts within the Centers for Medicare & Medicaid Services fee schedule in 2017 – and commensurate changes in the private insurance market – have now ramped up [the value of in-office hysteroscopy]… According to national payment amounts, performing this procedure in the office earned an average of $1,382.07 in 2017, compared with $409.60 in 2016.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“The benefits of integrating hysteroscopy into office practice have been compelling for some time. An in-office approach is patient centered, more efficient, and clinically valuable. It also has had the potential to be economically valuable for practices that are able to perform a mix of diagnostic and therapeutic/operative hysteroscopies.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“In addition to reimbursement levels, it’s important to consider the efficiencies of in-office hysteroscopy. The setup is relatively simple and requires a dedicated exam room, not a surgical suite... Hysteroscopy at the hospital, or even at an ambulatory surgical center, involves time driving, changing, and waiting for anesthesia.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“For our patients… an in-office approach offers less out-of-pocket expense (deductibles), less time away from family/work, avoidance of general anesthesia/intubation, and greater patient comfort from being within a familiar environment. For diagnostic procedures, the patient can be in and out in less than 30 minutes, and for operative procedures, she can be in and out in 1-2 hours, compared with more than 4 hours at the hospital.”

Aarathi Cholkeri-Singh, MD
  • Aarathi Cholkeri-Singh, MD
  • University of Illinois, Chicago, IL
  • Advocate Lutheran General Hospital, Park Ridge, IL

“[Before January, 2017,] higher procedural costs in the office…actually discouraged the physician who wanted to perform cases in the office. [The] increase in the reimbursement for hysteroscopic endometrial biopsy and/or polypectomy…creates a distinct monetary advantage, which along with increased physician efficiency and patient comfort, has led to more physicians bringing these surgeries to an in-office setting.”

Charles E. Miller, MD
  • Charles E. Miller, MD
  • University of Illinois, Chicago, IL
  • Lutheran General Hospital, Park Ridge, IL

No longer is hysteroscopy considered experimental or of dubious value. My hysteroscope is my stethoscope. It allows me to evaluate myriad gynecologic conditions: infertility, endometrial polyps, heavy menstrual bleeding, irregular menstrual cycles, equivocal findings on transvaginal ultrasound and imaging, postmenopausal bleeding, leukorrhea, intracavitary leiomyoma, retained products of conception, post-operative healing after Asherman’s, myomectomy, and foreign bodies.”

Linda Bradley
  • Linda Bradley
  • Professor of Surgery at Cleveland Clinic
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