Procedure (CPT code)*	Advantages	Disadvantages
Transvaginal ultrasonography (76830)	Least invasive method; also examines adnexa ≤ 4-mm cutoff: 95% sensitive and 47% specific for carcinoma in postmenopausal women ≤ 3-mm cutoff: 98% sensitive and 35% specific for carcinoma in postmenopausal women^44,45	10% of patients have inadequate imaging and require a second test; not effective for evaluating intracavitary fibroids and polyps^41,47,51
Endometrial biopsy (58100)	Less invasive than diagnostic hysteroscopy for tissue diagnosis in a global process; can be performed in the office 91% sensitive and 99.7% specific for carcinoma^46,49	Low sensitivity for focal lesions^42,43
Saline infusion sonohysteroscopy (58340)	Triages women to endometrial biopsy if global process or to diagnostic hysteroscopy for focal lesions; as good as diagnostic hysteroscopy for detecting polyps or fibroids 95% sensitive and 88% specific for carcinoma^47,52	7% procedure failures; 3% with pain/vagal symptoms; need separate procedure for tissue diagnosis^46,52
Diagnostic hysteroscopy (58555)	Direct visualization allowing biopsy of focal lesions 95% sensitive and 90% specific for carcinoma^52–54	Risks of instrumentation, complication rate of 2%⁵³
Operative hysteroscopy (58558)	Detection and treatment in one procedure; alternative to hysterectomy for some lesions	Higher surgical risk than diagnostic hysteroscopy because of resection of lesions; usually performed under general anesthesia