Outpatient Endometrial Sampling Research Articles

Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy.

We examined the relative significance of hysteroscopic and ultrasonographic evidence of endometrial atrophy in relation to insufficient sample on outpatient endometrial biopsy in women with abnormal uterine bleeding. Multivariate logistic regression modelling was used to evaluate the independent effects of age, menopausal status, hysteroscopic findings and sonographic endometrial thickness on outpatient endometrial sampling (sufficient or insufficient) used as the binary dependent variable. Insufficient sample on endometrial biopsy was associated with hysteroscopic finding of endometrial atrophy (OR 4.79, 95% CI 1.05-21.91, P = 0.04) and sonographic endometrial thickness below 5 mm (OR 0- 19. 95% CI 0.07-0.53, P = 0.001). There was no association with patient's age and menopausal status. In conclusion, when reassuring women with insufficient sample on outpatient endometrial biopsy, one can be confident about absence of pathology provided the hysteroscopic and sonographic endometrial assessment is consistent with endometrial atrophy.

The significance of an 'insufficient' Pipelle sample in the investigation of post‐menopausal bleeding

Out-patient endometrial sampling is a commonly performed procedure in the investigation of post-menopausal bleeding. We hypothesized that an 'insufficient' Pipelle sample reliably reflected the absence of serious endometrial pathology. A review of 141 consecutive cases reported as 'insufficient' for diagnostic purposes revealed 29 (20%) cases to have uterine pathology after secondary investigation. These included two cases of endometrial carcinoma and two other cases of uterine malignancy. These results do not support the initial hypothesis and suggest that in women presenting with post-menopausal bleeding, an 'insufficient' sample is an indication for further investigation.

The diagnostic accuracy of ultrasound scan in predicting endometrial hyperplasia and cancer in postmenopausal bleeding

To determine the accuracy of ultrasound scan in the diagnosis of endometrial hyperplasia and cancer in postmenopausal bleeding. A prospective diagnostic accuracy study (1996-97). Minimal access surgical training centers in two large teaching hospitals. Ultrasound scan and outpatient endometrial sampling were performed on 96 patients with postmenopausal bleeding. Patients unable to have these outpatient procedures had a formal inpatient hysteroscopy and curettage. Test performance characteristics were computed for ultrasound scan comparing its estimate of endometrial thickness with histologic diagnosis that served as a 'gold' standard. Accuracy of the ultrasonic endometrial thickness was estimated using sensitivity, specificity and predictive values for binary data. For multilevel data, the diagnostic accuracy was computed using likelihood ratios (LRs). An LR < decreased the probability that endometrial hyperplasia/cancer was present, whereas an LR > 1 increased the probability that such lesion was present. Using endometrial thickness > or =4 mm, the sensitivity of ultrasound to detect the endometrial malignancy was 92.9%, the specificity was 500%, and the positive and negative predictive values were 24.1% and 97.6% respectively. Analysis using likelihood ratio (LR) revealed that LR was 0.14 for endometrial thickness > or =4.0 mm, 0.94 for endometrial thickness 4.1-9.0 mm, and 3.3 for endometrial thickness >9.0 mm. In women with postmenopausal bleeding, malignancy can probably be safely excluded if sonographic endometrial thickness is < or = 4.0 mm. However, the probability of endometrial hyperplasia/cancer is not particularly altered by the knowledge that endometrial thickness on scan is >4.0 mm.

A study to determine the underlying reason for abnormal glandular cytology and the formulation of a management protocol.

A retrospective review is presented of 89 patients with glandular dyskaryosis in order to formulate a management protocol. Fifteen patients had cervical intraepithelial neoplasia (CIN) without glandular abnormality (17%). One patient had adenocarcinoma in situ of the cervix and one patient had vaginal intraepithelial neoplasia (VAIN) grade III. Twenty-two patients had endometrial carcinoma (24.5%) and 11 patients had cervical carcinoma (12.5%). Of the patients presenting with post-menopausal bleeding as well as having glandular dyskaryosis, 69% had a gynaecological malignancy. In conclusion, colposcopy and out-patient endometrial sampling are recommended in all cases. Patients with abnormal endometrial sampling require hysteroscopy. Cone biopsy is necessary to exclude occult glandular disease if cytology remains abnormal despite negative colposcopy and sampling.

P231 Diagnostic assessment of postmenopausal uterine bleeding by outpatient hysteroscopy and endometrial sampling

P231 Diagnostic assessment of postmenopausal uterine bleeding by outpatient hysteroscopy and endometrial sampling

How should we investigate women with postmenopausal bleeding?

To evaluate the optimum method(s) of investigating women with postmenopausal bleeding. Prospective study of 76 postmenopausal women. Teaching Hospital. Interventions. All women had pipelle endometrial biopsy in outpatient clinic. Prior to inpatient hysteroscopy and uterine curettage, each woman had pelvic ultrasonography to measure the endometrial thickness and to exclude ovarian pathology. Pipelle biopsy was successful in 70% of cases and has a sensitivity of 70%. Hysteroscopy has superior diagnostic capabilities allowing direct visualisation of the endometrial cavity with directed biopsies. Endometrial thickness of > 5 mm used as an indicator of endometrial pathology compared to uterine curettage has a sensitivity of 83%, a specificity of 77%, and a positive predictive value of 54%. Ultrasound also detected five ovarian tumors, two of which were malignant and three missed by pelvic examination alone. We recommend the routine use of pelvic ultrasonography in all women with postmenopausal bleeding as it is an invaluable diagnostic tool in excluding ovarian pathology. In addition, sampling of the endometrial cavity, preferably with outpatient hysteroscopy, is mandatory for histological diagnosis. Overall, the combination of ultrasound and outpatient endometrial sampling would spare hospital admission for at least 60% of women with postmenopausal bleeding.

A Comparison of Outpatient Endometrial Sampling with Hysteroscopy, Curettage and Cystoscopy in the Evaluation of Postmenopausal Bleeding

SummaryThe standard management of women with postmenopausal bleeding now tends to be by hysteroscopy under general anaesthesia, though the use of outpatient endometrial sampling has been evaluated. The two approaches have been compared in the present study. Outpatient endometrial sampling is an effective screening procedure for endometrial malignancy, though it will miss benign conditions and particularly endometrial polyps. It has advantages for patients, reducing anxiety and risks, with cost savings for the hospital.

Outpatient Endometrial Sampling with the Pipelle Curette

This study compares outpatient endometrial sampling using the Pipelle endometrial sampling curette with conventional dilation and curettage (D&C) in patients with abnormal uterine bleeding. Endometrial sampling with the Pipelle curette was performed in 172 and D&C in 97 women. No complications were encountered with either of these procedures. One hundred and seventy (98.8%) of the Pipelle aspirations attempted were successfully completed. Sufficient material for histological assessment was obtained in 154 (90.6%) of the women who underwent Pipelle endometrial sampling and in only 66 (68%) of those who underwent D&C (p < 0.0001). In postmenopausal women, adequate specimens were obtained in 74 of 88 (84.1%) by Pipelle and in only 22 of 48 (45.8%) by D&C. In 45 cases the histologic diagnosis of the endometrium obtained by Pipelle sampling was compared with the one of endometrium obtained by D&C or hysterectomy performed shortly thereafter. The diagnosis was identical in 43 (95.5%) cases. Endometrial sampling with the Pipelle was well tolerated causing occasionally only slight discomfort.

The diagnostic value and patient acceptability of outpatient endometrial sampling with Gynoscann.

Endometrial sampling with Gynoscann was performed in the outpatient department in 70 women with abnormal vaginal bleeding prior to dilatation and curettage (D&C). Successful endometrial sampling was achieved in 62 (89%) patients; Of the samples obtained 44 (71.0%) were adequate for cytological assessment and 46 (74.2%) for histological assessment, compared to 80% of D&C samples being adequate for histological examination. In those patients in whom outpatient endometrial sampling was adequate, both the cytological and histological diagnosis agreed with the D&C. The outpatient endometrial sampling was well tolerated by the patients since the majority (89%) experienced either no or little pain. Vaginal bleeding following the procedure was minimal in all except 1 patient. Endometrial sampling with Gynoscann may be useful for endometrial assessment prior to commencement of hormonal therapy and hysterectomy. It is a potentially useful screening test for early detection of endometrial cancer in patients at risk.

How quickly does Lamicel dilate the cervix?

SummaryLamicel is a synthetic cervical dilator used before legal abortion and before outpatient endometrial sampling. The rate of cervical dilatation was investigated in a longitudinal observational study with serial ultrasound measurements. The ultimate cervical dilatation is variable but the pregnant cervix dilates more than the nonpregnant cervix (range 6-10 mm and 6-5-8-5 mm respectively). The non-pregnant and pregnant cervix dilates to 80 per cent of its dilatation in 3 hours and 4 hours respectively. Therefore, the overnight use of Lamicel is unnecessary.