Outpatient Endometrial Biopsy Research Articles

Efficacy of transrectal ultrasound in assessing endometrium of postmenopausal women with axial uterus.

To evaluate the acceptance and efficacy of transrectal ultrasound (TRS) in assessing the endometrium in postmenopausal women with an axial uterus. This was a prospective cross-sectional study conducted between October 2015 and October 2018 of consecutive postmenopausal women with an axial uterus on transvaginal ultrasound (TVS). Women with a known diagnosis of gynecological malignancy were excluded. TRS was offered immediately after TVS without prior bowel preparation. A single operator determined subjectively whether the endometrium was visualized satisfactorily on TVS and TRS. In women with postmenopausal bleeding (PMB), endometrial thickness (ET) was measured and endometrial morphology was categorized as atrophic, uniformly thickened, benign endometrial polyp or endometrial cancer, based on subjective pattern recognition. All women with PMB and a non-atrophic endometrium underwent outpatient endometrial biopsy, hysteroscopy or hysterectomy. The success rate of TRS in assessing satisfactorily the endometrium was compared with that of TVS. In patients with PMB, ET measurements and subjective diagnosis of endometrial cancer on TVS vs TRS were compared. Of the 1553 women who underwent TVS examination, 103 (6.6%) had an axial uterus, of whom 76 (73.8%) presented with PMB. TRS was accepted by 66/103 (64.1%) women with an axial uterus. TRS assessed satisfactorily a significantly higher proportion of endometria compared with TVS (90.9% vs 62.1%; χ2 = 14.1, P < 0.001). In 50 women with PMB and an axial uterus who underwent both TVS and TRS, TVS failed to visualize the endometrium satisfactorily in 15 (30.0%) women, whilst TRS provided satisfactory images in all cases. Among the 35 women with PMB and a satisfactory endometrial assessment on TVS and TRS, measurements of ET on TRS were significantly lower compared to those on TVS (median difference, -1.2 (interquartile range, -3.0 to -0.4) mm). The overall agreement of TVS and TRS on the presence or absence of endometrial cancer using subjective pattern recognition was 30/35 (85.7%; 95% CI, 74.1-97.3%). While all seven cases of histologically confirmed endometrial cancer were diagnosed correctly on TRS, four were misdiagnosed on TVS as benign polyps or uniformly thickened endometrium. TRS is an acceptable and effective way to assess the endometrium in postmenopausal women with an axial uterus. Among women presenting additionally with PMB, TRS is associated with a higher proportion of satisfactory endometrial assessments and fewer misdiagnoses of endometrial cancer by subjective pattern recognition compared with TVS. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

P–750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients: 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2–6min), compared to 4min50 in the control group (range 1–12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time: 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings: Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

P-750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2-6min), compared to 4min50 in the control group (range 1-12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

2020 Hong Kong College of Obstetricians and Gynaecologists guideline on investigations of premenopausal women with abnormal uterine bleeding.

Abnormal uterine bleeding in premenopausal women is a common gynaecological symptom and composes of abnormality in the frequency, duration, regularity, and flow volume of menstruation. It could constitute the presentation of various gynaecological malignancies. An appropriate history and physical examination are mandatory to ascertain the diagnosis. Depending on the clinical condition, a complete blood picture, thyroid function test, clotting profile, chlamydia test, cervical smear, and pregnancy test can be performed. Ultrasound should be performed in cases with a pelvic mass, unsatisfactory physical examination, persistent symptoms, or no response to medical treatment. In women aged ≥40 years, an out-patient endometrial biopsy with Pipelle should be performed. In women aged <40 years with risk factors for endometrial cancer, persistent symptoms, or no response to medical treatment, an endometrial biopsy should be performed to rule out endometrial cancer. Hysteroscopy or saline infusion sonohysterography is more sensitive than ultrasound for diagnosing endometrial pathology. Details of the above recommendations are presented.

Current role of Pipelle endometrial sampling in early diagnosis of endometrial cancer.

Endometrial cancer is the most common gynecologic cancer in developed countries. The most prevalent, however not pathognomonic symptom of the disease is abnormal uterine bleeding. The diagnosis of endometrial cancer is based on the histologic results of endometrial sampling. Endometrial biopsy could be obtained using different modalities: hysteroscopy-directed endometrial biopsy, uterine curettage or office endometrial biopsy. Outpatient endometrial biopsy using different devices for the evaluation of abnormal uterine bleeding is gaining popularity. The most popular office-based device for endometrial sampling procedure is the Pipelle device. Currently, Pipelle endometrial sampling is widely used to diagnose endometrial cancer in women with abnormal uterine bleeding and/or postmenopausal bleeding. The method became very useful due to easiness and simplicity of the procedure, availability of a device, as well as high sensitivity in detecting endometrial cancer. Many studies compared the validity and accuracy of Pipelle biopsy with dilation and curettage in the detection of various endometrial pathologies. Published results state that Pipelle biopsy and uterine curettage are almost equally reliable in the evaluation of endometrial pathologies. Moreover, Pipelle biopsy appears more beneficial as it does not require hospital admission and anaesthesia. However, it is proven the Pipelle technique has a limited capacity to identify endometrial polyps, and some authors, based on their study, claim that dilation and curettage is a more reliable method in terms of correlation with the final histological results. In addition, there are many factors affecting the efficiency of the endometrial biopsy. Failure to get samples that are adequate for histological examination is one of the problems associated with Pipelle sampling. The above mentioned contradictory conclusions by different researchers and lack of guidance to avoid inadequate sampling present the demand for further studies on the comparison of Pipelle biopsy and uterine curettage efficiency and accuracy.

Performance Characteristics of Endometrial Sampling in Diagnosis of Endometrial Carcinoma.

Outpatient endometrial biopsy can give false-negative results, with a 0.9% reported posttest probability for endometrial carcinoma (EC) after a negative result. Our objective was to determine if there has been any improvement in the performance characteristics of endometrial biopsy over the last 15 yr. All hysterectomy specimens with a diagnosis of EC or atypical hyperplasia (AH), reported between May 2011 and May 2015, were identified and cross-referenced for any negative endometrial sampling results during the 5 yr before hysterectomy. Negative endometrial samples were defined as either benign findings or insufficient/nondiagnostic, excluding those diagnosed as AH or EC and those for which follow-up sampling was recommended because of atypia. Of 1677 hysterectomy specimens showing AH or EC there were previous negative biopsies in 172: 116 benign and 56 insufficient/nondiagnostic. Over the same period 22,875 negative endometrial biopsy specimens were reported in our region. The posttest probability of having EC or AH in the hysterectomy specimen, given a negative endometrial biopsy result, was 0.74%. In a subset of 90 cases in which a negative biopsy was followed by a diagnosis of AH or EC in a hysterectomy specimen, the slides were independently reviewed. There were no cases where a diagnosis of carcinoma was missed. In 12 samples atypia or possible atypia was identified, and the level of agreement with the original diagnosis was excellent κ=0.83±0.05. In a prospective comparison of examination of 3 levels from each block versus a single slide in 319 cases, the routine preparation of additional slides did not yield clinically significant information. Although there has been evolution in the diagnostic criteria for AH and for recognition of morphologically subtle forms of AH or EC, our results demonstrate a significant lack of sensitivity of outpatient endometrial sampling in the diagnosis of endometrial malignancy/premalignancy. The sensitivity problems are mainly attributable to failure to sample abnormal endometrium. Independent review of slides or examination of additional levels did little to increase the diagnostic yield.

Medications for pain relief in outpatient endometrial sampling or biopsy: a systematic review and network meta-analysis

To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). Systematic review and network meta-analysis of randomized controlled trials. Not applicable. Pre- or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). The intensity of pain during, immediately after, and 10-30minutes after procedure assessed by the 10-cm visual analog scale. Lidocaine spray was the most effective medication for reducing pain during OEB (P-score = 0.83) and immediately after OEB (P-score = 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score = 1.00), followed by misoprostol plus lidocaine (P-score = 0.87). Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA.

Endometrial Biopsy: American College of Nurse-Midwives.

Endometrial biopsy can be used to diagnose endometrial hyperplasia, endometrial cancer, and uterine infections. This cost-effective procedure has minimal side effects, and complications are rare. The purpose of this clinical bulletin is to provide clinicians with guidance about endometrial biopsy including the procedure's advantages and disadvantages, indications and contraindications, and side effects. In addition, step-by-step instructions for performing endometrial biopsy, the equipment required, selection of sampling devices, and care before and after the procedure are discussed.

Accuracy of Preoperative Endometrial Sampling for the Detection of Endometrial Pathology: a Retrospective Study

Objective: To investigate the accuracy of endometrial sampling in&#x0D; the diagnosis of endometrial pathology and the need of intraoperative&#x0D; frozen section.&#x0D; &#x0D; Methods: One hundred forty women who underwent endometrial&#x0D; sampling followed by hysterectomy between 2011 and 2014 were&#x0D; included in this study. Data were retrieved from patient files and&#x0D; pathology archives in Department of Obstetrics and Gynecology,&#x0D; Jose R. Reyes Memorial Medical Center, Manila, Philippines.&#x0D; &#x0D; Results: There were 25 patients with malignancy but endometrial&#x0D; sampling detected only 22 of them. The endometrial sampling&#x0D; sensitivity and specificity for detecting cancer were 88% and 100%,&#x0D; respectively with negative and positive predictive values of 97.5%&#x0D; and 100%, respectively. In 3 patients, the endometrial sampling&#x0D; failed to detect malignancy; 1 patient had a preoperative diagnosis&#x0D; of complex hyperplasia with atypia, 1 patient had complex&#x0D; hyperplasia without atypia and 1 patient had adenofibroma. A total&#x0D; of eighty patients had benign findings. There were fifty-three cases&#x0D; with finding of proliferative endometrium and twenty-seven were&#x0D; secretory. Twenty-three (55.0%) and 11 (39.0%) cases were&#x0D; confirmed by the hysterectomy specimen, respectively. The&#x0D; sensitivity of endometrial sampling in detecting benign samples was&#x0D; 76.0% and the specificity reached up to 83.0%. The histopathology&#x0D; result of the other fourteen cases were reported of having atrophy,&#x0D; twelve cases were reported of having endometrial hyperplasia, four&#x0D; with basal endometrium, four with endometrial polyp and one with&#x0D; adenomyosis.&#x0D; &#x0D; Conclusion: Outpatient endometrial biopsy has a high overall&#x0D; accuracy in diagnosing endometrial cancer when the specimen&#x0D; obtained is sufficient. A positive test result is more accurate for&#x0D; ruling in disease than a negative test result is for ruling it out.&#x0D; However, the diagnosis should be confirmed by frozen section in&#x0D; patients with complex hyperplasia and adenofibroma.&#x0D; &#x0D; [Indones J Obstet Gynecol 2017; 5-1: 23-29]&#x0D; &#x0D; Keywords: abnormal uterine bleeding, endometrial hyperplasia,&#x0D; endometrial sampling, frozen section, pipelle

Nastanak, etiološki faktori, dijagnostika i lečenje karcinoma endometrijuma kod starih

Endometrial cancer affects mainly postmenopausal women, usually between the ages of 6075 years. The main risk factors are obesity, diabetes, hypertension, application of tamoxifen for more than 5 years and a positive family history. More than 90% of women have bleeding of unknown origin, and discharge from the vagina that can occur long before the postmenopausal bleeding. These symptoms allegations suspicion of endometrial cancer. The first step is outpatient endometrial biopsy searches or hospital fractional curettage. When makes the diagnosis, another possibility is transvaginal ultrasound searches. The stages of the disease from I to IV are determined by surgery, laparotomy or laparoscopy, and include cytological examination. Prognosis depends on the stage, the greater extent of the disease and elderly patients. It is treated with hysterectomy, bilateral adenksektomy, usually removal of the pelvic lymph nodes and paraaortal or complete removal of the affected tissue. The early stage of the disease includes surgical treatment but increasing stages included: chemotherapy, radiation and hormonal therapy. In the fourth stage usually indicated only radiotherapy.

A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding.

Objective. To determine whether structured assessment of outpatient endometrial biopsies decreases the number of inconclusive samples. Design. Retrospective cohort study. Setting. Single hospital pathology laboratory. Population. Endometrial biopsy samples of 66 women with postmenopausal bleeding, collected during the usual diagnostic work-up and assessed as insufficient for a reliable histological diagnosis. Methods. Endometrial biopsy samples were requested from the pathology laboratories. The retrieved samples were systematically reassessed by a single pathologist specialized in gynecology. Main Outcome Measure. Disagreement between initial assessment and conclusion after structured reassessment. Results. We retrieved 36 of 66 endometrial biopsy samples from six different pathology laboratories. Structured reassessment of the retrieved samples by a single pathologist specialized in gynecology did not change the conclusion in 35 of the 36 samples. The remaining sample contained a large amount of endometrial tissue and the diagnosis at reassessment was endometrial hyperplasia without atypia. All other samples contained insufficient material for a reliable diagnosis. Conclusion. A structured reassessment of endometrial biopsies samples, which were classified as inconclusive due to insufficient material, did not change the conclusion. Although it might be helpful for pathologists to have diagnostic criteria for adequacy and/or inadequacy of an endometrial biopsy sample, the gain in efficiency is likely to be small.

Hysteroscopic View of Endometrial Atypia: A Review of Two Cases

Abstract Background: Hysteroscopy enables direct visualization of the endometrial cavity via the cervix with an endoscope and a light source. Diagnostic and therapeutic indications include: abnormal uterine bleeding; postmenopausal endometrial thickening; removal of endometrial polyps; resection of submucosal myomata; incision of uterine septa; directly visualizing and removing intrauterine foreign bodies; hysteroscopic sterilization; recurrent miscarriages; endocervical lesions; lysis of uterine synechiae; abnormal hysterosalpingography; and infertility. Cases: Case 1: A 73-year-old postmenopausal female presented with right lower-quadrant abdominal fullness, and she had a thickened endometrium (9.4 mm) on noted on ultrasound. An outpatient endometrial biopsy was attempted but was unsuccessful because the patient had cervical stenosis. She underwent hysteroscopy and dilation and curettage (D&C). Hysteroscopy revealed the presence of lesions in the endometrial cavity, and samples of these lesions showed f...

Endometrial disruption does not improve implantation in patients who have failed the transfer of euploid blastocysts.

PurposeTo assess the impact of single pass outpatient endometrial biopsy in patients at the highest risk for an endometrial cause for failed implantation; those that have failed to conceive despite the transfer of morphologically normal euploid embryos.MethodsThis is a retrospective cohort study consisting of all patients less than 42 years old who failed their first euploid blastocyst transfer and subsequently completed a second transfer cycle of euploid blastocysts. Cycles were analyzed to determine if a single pass endometrial biopsy, termed 'endometrial disruption', was performed in a cycle preceding their second embryo transfer. Transfer outcomes were analyzed and implantation rates calculated. Data analysis was performed to compare outcomes between patients who had endometrial disruption performed versus those that did not.ResultsTwo hundred ninety patients failed their first euploid embryo transfer and subsequently completed a second euploid embryo transfer and were included. Thirty-nine patients underwent endometrial disruption and 251 did not. There were no statistical differences in clinical implantation rate or sustained implantation rate between the group with endometrial disruption and subjects without any intervention (Clinical IR, 43.6 % vs. 55.0 %, p = 0.13; 38.5 % vs. 42.6 %, p = 0.60). When controlling for transfer order there was no statistical difference noted in implantation rates.ConclusionsSingle pass endometrial biopsy has no impact on endometrial receptivity in the highest risk subgroup- patient's that have failed to sustain the transfer of morphologically normal euploid embryos- as evidenced by equivalent implantation rates. It is possible that variations in technique may alter outcomes and randomized trials are needed to answer this question.

Role of Local Anesthetics on Pain Relief in Endometrial Biopsy: Randomized Clinical Trial

Objectives: Endometrial biopsy is necessary for diagnosing the reason of abnormal uterine bleeding in perimenopausal women. Currently outpatient endometrial biopsy is used for evaluation of abnormal uterine bleeding which is associated with moderate to severe pain. Using lidocaine is one of the procedures which is used for pain relief while biopsy. This study is aimed at comparing the effect of different local anesthesia procedures on pain relief during endometrial biopsy. Materials and Methods: In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB (Abnormal Uterine Bleeding), candidates for endometrial biopsy, were randomly assigned into four equal groups, to receive: 1-intrauterine lidocaine; 2-cervical spray lidocaine; 3intrauterine lidocaine plus cervical spray lidocaine; or 4-intrauterine distilled water. Pain relief was measured at 3 different times: during endometrial biopsy, just after and 15 minutes after biopsy. Results: Pain intensity was reduced significantly at different times in intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine receivers in compare with the groups which received cervical spray lidocaine and distilled water. The mean of difference pain relief during biopsy and 15 minutes after that was reduced significantly in the group which received intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine in comparison with the other two groups. Conclusion: Intrauterine lidocaine was effective during endometrial biopsy, and using it with cervical spray lidocaine had no more beneficial effect. 1Associate Professor of Ob & Gyn, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2Professor of Ob & Gyn, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 3Resident of Ob & Gyn, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 4Associate Professor of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran. Article History: Received 9 October 2013 Accepted 7 January 2014 Revised 25 December 2013 Available online 7 January 2014 Corresponding Author: Elaheh Ouladsahebmadarek, Associate Professor of Ob & Gyn, Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

The effect of different local anesthesia methods on pain relief in outpatient endometrial biopsy: randomized clinical trial.

Endometrial biopsy is necessary for diagnosing the reason of abnormal uterine bleeding in perimenopausal women. Currently outpatient endometrial biopsy is used for evaluation of abnormal uterine bleeding which is associated with moderate to severe pain. Using lidocaine is one of the procedures which is used for pain relief while biopsy. This study is aimed at comparing the effect of different local anesthesia procedures on pain relief during endometrial biopsy. In this randomized clinical trial, 160 multiparous 40-55 years old women with AUB, candidates for endometrial biopsy, were randomly assigned into four equal groups, to receive: 1-intrauterine lidocaine; 2-cervical spray lidocaine; 3- intrauterine lidocaine plus cervical spray lidocaine; or 4-intrauterine distilled water. Pain relief was measured at 3 different times: during endometrial biopsy, just after and 15 minutes after biopsy. Pain intensity was reduced significantly at different times in intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine receivers in compare with the groups which received cervical spray lidocaine and distilled water. The mean of difference pain relief during biopsy and 15 minutes after that was reduced significantly in the group which received intrauterine lidocaine and intrauterine lidocaine with cervical spray lidocaine in comparison with the other two groups. Intrauterine lidocaine was effective during endometrial biopsy, and using it with cervical spray lidocaine had no more beneficial effect.

A novel outpatient endometrial biopsy biospy deviceto exclude endometrial cancer

Currently there is no consensus on the best device and technique for obtaining endometrial biopsies to exclude cancer. Outpatient methods available include aspiration devices (Pipelle) and disruption devices (Tao brush). We evaluated a new device which combines Global endometrial Disruption using a brush with a built in suction Process (GDP-Tao).

Novel approach to outpatient endometrial biopsy to detect endometrial cancer.

e16522 Background: Currently there is no consensus on the best device and technique for obtaining endometrial biopsies to rule out cancer. Outpatient methods available include aspiration devices (Pipelle) and disruption devices (Tao brush). This study evaluated a new device which combines Global endometrial Disruption using a brush with a built in suction Process (GDP-Tao). Methods: After IRB approval, endometrial specimens were collected using the GDP-Tao from fresh uteri after completion of hysterectomies. Endometrial pathology results from the new device were compared to the final hysterectomy diagnosis by blinded review. Results: Patients (n = 33) were 29-86 years old (median 56), 67% obese, 52% menopausal. Uterine sounds were 2.5-11cm (median 6.6 cm), weight 45-3500g (median 238g), 15% of cervical os were stenotic but all allowed the device to pass without other instrumentation with overall diagnostic rate of 91% (30/33) 15/15 pathologically confirmed malignant specimens were correctly identified by the new device including 2 GDP-Tao specimens with atypical hyperplasia (AH) and hysterectomy pathology with AH and focal adenocarcinoma. Classifying any atypia from the GDP-Tao as “positive” then the detection rate for malignancy was 100% (PPV). 11/11 samples were benign in GDP-Tao and final pathology. There were 3 non-diagnostic (ND) samples from GDP-Tao with final pathology of benign endometrium. One specimen was ND due to absence of tissue from prior endometrial ablation. There was one device result of “proliferative endometrium” with final pathology of focal complex atypical hyperplasia and one device result of “rare atypical cells” with final diagnosis of endometrial polyp. Sensitivity and specificity were 94% and 92%, and negative predictive value was 82% for the identification of both atypical hyperplasia and malignancy. When stratified by uterine size, benign or malignant, the results were similar. Conclusions: Our validation study showed encouraging data thatthis new endometrial sampling device, which combines tissue disruption and aspiration into a single process, provides a reliable mean of obtaining adequate sample to accurately detect endometrial cancer with a high negative and positive predictive value.

Efficacy of levonorgestrel intrauterine system (LNG-IUS) for abnormal uterine bleeding and contraception.

To find out clinical response, side effects and patients' acceptability of levonorgestrel-releasing intrauterine system (LNG-IUS). Observational study. Gynaecology Department of Shifa International Hospital, Islamabad, from June 2005 to May 2008. Adult women were enrolled in the study. In group-A, 57 married women were enrolled presented with abnormal uterine bleeding while in group-B, 16 married women attended for contraception. All women in group-A had thyroid stimulating hormone, pelvic ultrasound and outpatient endometrial biopsy. Detailed counselling was done before insertion. Outcome variables were improvement in bleeding pattern, safety profile, spontaneous expulsion rate and continuation at the end of one year. In group-A (abnormal bleeding) menstrual cycle became normal in 40.4% women in the first 3 months. At the end of one year, 50.9% women experienced normal cycle, 8.8% were oligomenorrhic and 12.3% were amenorrhic. In group-B (contraceptive group) all women started with normal cycles. At the end of 3 months 42% complained of vaginal spotting which reduced to 10% at the end of one year. Menstrual pattern at the end of one year showed normal cycles in 52%, oligomenorrhea in 19% and amenorrhea in 10% women. Vaginal spotting was experienced by 42% women at 3 months as main complaint which reduced to 10% at the end of one year, however, 7% women requested for removal of device at one year. LNG-IUS is an effective and acceptable treatment for abnormal uterine bleeding as well as for contraception. Vaginal spotting was the most frequent side effect experienced by both groups.

0474: A Systematic Approach to Abnormal Uterine Bleeding. Saline Infusion Sonohysterography or Outpatient Endometrial Pipelle Biopsy?

0474: A Systematic Approach to Abnormal Uterine Bleeding. Saline Infusion Sonohysterography or Outpatient Endometrial Pipelle Biopsy?

Perimenopausal Depression

Perimenopausal Depression