Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology?

Svirsky, Ran; Smorgick, Noam; Rozowski, Uri; Sagiv, Ron; Feingold, Mordechai; Halperin, Reuvit; Pansky, Moty

doi:10.1016/j.ajog.2008.02.015

Cited by 73 publications

(56 citation statements)

References 11 publications

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“…Although recent studies suggest that further diagnostic work‐up in case of benign histology is recommended to exclude focal endometrial (pre)malignancy 20, 21, 22, 23, all women in our study that developed endometrial cancer after initial benign histology or hyperplasia without atypia, presented with recurrent postmenopausal bleeding, and were diagnosed with early stage disease. Therefore, based on these data, we cannot yet recommend the need for additional work‐up.…”

Section: Discussionmentioning

confidence: 73%

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

Visser

Sparidaens

Brink

et al. 2016

Acta Obstet Gynecol Scand

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IntroductionWomen with postmenopausal bleeding and endometrial thickness >4 mm undergo endometrial sampling to exclude endometrial cancer. The aim of this study is to investigate the relative risk of developing endometrial cancer in a prospective cohort after initial work‐up for postmenopausal bleeding showing reassuring histology or insufficient sampling.Material and methodsAll women presenting with postmenopausal bleeding were prospectively included from January 2009 to April 2011. Follow‐up data were collected from patient charts and PALGA (Dutch Pathology Registry). Hazard ratios for endometrial cancer were determined by calculating standardized incidence ratios.ResultsA total of 668 women were included and 568 women were available for follow‐up [median follow‐up time 47 (range 7–63) months]. Women who presented with postmenopausal bleeding, endometrial thickness >4 mm and hyperplasia without atypia on biopsy at the first presentation showed a significantly increased risk (standardized incidence ratio 17.15, 95% confidence interval 1.96–61.93) of being diagnosed with endometrial cancer during the first four years of follow up compared with the age‐specific population. All women that developed endometrial cancer after initial reassuring histology presented with recurrent postmenopausal bleeding. None of the women with endometrial thickness >4 mm and no or insufficient sample for histology at the first presentation developed endometrial cancer during the follow up.ConclusionsAlthough in general, women with endometrial hyperplasia without atypia are considered to have a low risk for cancer, we observed a significant long‐term risk of endometrial cancer after postmenopausal bleeding. Whether additional diagnostics or a more stringent follow‐up regimen would be cost‐effective, needs to be studied.

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Section: Discussionmentioning

confidence: 73%

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

Visser

Sparidaens

Brink

et al. 2016

Acta Obstet Gynecol Scand

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“…Although blind curettage may be utilized to attempt to resect polyps, operative hysteroscopy with polypectomy is preferable because blind curettage may not result in a complete removal of polyps and is associated with an increased risk of such complications as uterine perforation and infection [24,37,38]. Hysteroscopic-guided polyp resection yields direct visualization of polyps, allowing for complete removal of the specimen.…”

Section: Treatmentmentioning

confidence: 99%

When Should Endometrial Polyps Be Treated?

Lee

Seibel

Kaunitz

2012

Curr Obstet Gynecol Rep

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Endometrial polyps are localized intrauterine overgrowths of endometrial glands and stroma covered by a surface epithelium. They occur singularly or in multiples, may be sessile or pedunculated, and range from a few millimeters to several centimeters in size. They are common, present in 7.8%-41% of women. Their detection has increased with the advent of high-resolution transvaginal sonography, saline-infusion ultrasonography, and hysteroscopy. Polyps are encountered in both premenopausal and postmenopausal women. Many women are asymptomatic, while others present with abnormal bleeding patterns. Most polyps are benign, but hyperplastic and malignant polyps also may occur. Appropriate management of endometrial polyps includes observation, medication, and surgery. Treatment of these lesions should be tailored to each patient based on their symptoms, menopausal status, risk of malignancy, and fertility desires.

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“…For this purpose, there is a range of complementary tests, such as endometrium biopsy, curettage and diagnostic hysteroscopy. 7 Hysteroscopy allows for endoscopic evaluation of the uterine cavity, with the advantage of video recording, which makes it possible to obtain a second opinion. This test can be conducted in a clinic regime, and can be well tolerated without requiring anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Comparação do ultrassom transvaginal e da histeroscopia ambulatorial no diagnóstico das doenças endometriais em mulheres menopausadas

Yela¹,

Ravacci²,

Monteiro³

et al. 2009

Rev. Assoc. Med. Bras.

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Objective.To compare the effectiveness of transvaginal ultrasound and outpatient diagnostic hysteroscopy in the diagnosis of intrauterine diseases in postmenopausal women. MethOds. The sample consisted of 243 postmenopausal women who submitted to diagnostic hysteroscopy in the year of 2006. All the women were referred from primary healthcare units after submitting to transvaginal ultrasound to assess the endometrial cavity. Results. The mean age of women was 61±9.4 years, and the mean time since entering menopause was 11±8.3 years. We observed endometrial hyperplasia and endometrial cancer in 6.6% of cases. Ultrasound presented 95.6% sensitivity, 7.4% specificity, positive predictive value of 53.3% and negative predictive value of 60%, whereas hysteroscopy presented 95.7%; 83%; 82.2% and 95.9%, respectively. cOnclusiOn. Hysteroscopy showed superior accuracy compared to ultrasound in the diagnosis of endometrial diseases.

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Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology?

Cited by 73 publications

References 11 publications

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

When Should Endometrial Polyps Be Treated?

Comparação do ultrassom transvaginal e da histeroscopia ambulatorial no diagnóstico das doenças endometriais em mulheres menopausadas

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