Endometrial thickness screening in premenopausal women with abnormal uterine bleeding

Abstract

We read with interest the analysis by Getpook and Wattanakumtornkul on endometrial thickness screening in premenopausal women. However certain issues need to be clarified: Endometrial biopsy has replaced dilatation and curettage (D&C) as the diagnostic tool in the evaluation of abnormal bleeding with equivocal efficacy (level 3 evidence). This minimally invasive modality is safe convenient and low-risk. In-office sampling of the endometrial lining can be performed with the Novak or Kevorkian curet the Pipelle endometrial-suction curet and the Vabra aspirator. Studies reveal that endometrial biopsy has sensitivities ranging from 83 to 96% for the detection of endometrial cancer in comparison to hysterectomy specimens. Can the authors kindly comment on why they preferred D&C over endometrial biopsy? Studies that examined large populations in Scandinavia Italy and the United States showed the accuracy of using transvaginal sonography (TVS) as a predictor of the presence or absence of endometrial disease. A meta-analysis confirmed the use of TVS as a means of excluding endometrial carcinoma. Could the authors comment on the incidence of abnormal endometrial sonographic texture in their population? Endometrium becomes progressively thicker during the normal menstrual cycle. Menstruating endometrium will always be thinner. The authors did not mention the time/phase of menstrual cycle when D&C was conducted. Exogenous hormone use has an influence on endometrial thickness. The authors did not mention the percentage of women who were already receiving exogenous hormones. We therefore seek the authors clarification on the points listed above and hope further discussion and suggestion will contribute to the advancement and popularity of the authors findings among practicing gynecologists. (full text)