Endometrial sampling devices for early diagnosis of endometrial lesions

Abstract

PurposeEndometrial carcinoma is the most common gynecologic malignancy in both developed and some developing countries. Unlike cervical cancer, for which there is routine screening, only patients symptomatic for endometrial carcinoma typically seek medical help for its diagnosis and treatment. Dilatation and curettage (D&C) has been the standard procedure for evaluating suspicious endometrial lesions. The discomfort and injury caused by the D&C procedure, however, restrict its use as a screening method for early diagnosis of endometrial lesions. High-risk endometrial cancer patients would benefit from an effective and low-cost screening test. In recent years, several endometrial devices have been developed and proposed as screening tools.MethodsWe have reviewed and evaluated the literature relating to the endometrial sampling devices in clinical use or clinical trials, with the goal of comparing devices and identifying the most appropriate ones for screening for endometrial lesions. Eligible literature was identified from systematic PubMed searches, and the relevant data were extracted. Comments, letters, unpublished data, conference proceedings, and case reports were excluded from our search. Seventy-four articles on endometrial sampling devices were obtained for this review.ResultsThe main screening devices for endometrial carcinoma are aspiration devices (such as the Vabra aspirator), Pipelle, Tao Brush, and SAP-1 device. Among these devices, the Tao Brush is the most promising endometrial sampler for screening for endometrial lesions. However, its sampling insufficiency, cost, and unsuccessful insertion rate (20 % in nulliparous and 8 % in parous women) are problematic.ConclusionsA more accurate and low-cost endometrial sampler, with improved specimen sufficiency and higher sensitivity for endometrial lesions, needs tobe developed and clinically verified.

Factors Associated with Insufficient Endometrial Sampling in Postmenopausal Women

“…Traditionally, dilation and curettage (D&C) have been used as a standard method of assessing the endometrium (6). Many alternative techniques with different vacuum equipment such as Pipelle, Vabra or Karman endometrial vacuum aspiration devices have been developed to obtain endometrial biopsies (7,8). The Karman aspirator is an endometrial sampling device that can be used to terminate early pregnancy but it is also an effective and acceptable method for the diagnosis of endometrial pathology (9).…”

New perspectives on screening and early detection of endometrial cancer

“…). Tao brush has, however, certain flaws due to its cost, and unsuccessful insertion rate (20% in nulliparous and 8% in parous women, which is comparable to pipelle sampling: 22 and 8%, respectively) . Pipelle samples a portion of the endometrium by aspiration for histological assessment, while Tao brush obtains material from the endometrium for cytological evaluation.…”

“…2 Tao brush is a promising endometrial sampler that causes less discomfort among women compared to pipelle sampling. 14,54 Contrary to Pap brush, which is aimed to sample the exocervical and endocervical canal, Tao brush is inserted at the level of the fundus in the uterine cavity ( Fig. 3).…”

“…Sensitivity of pipelle to diagnose endometrial cancer ranges from 62% to 99%, while agreement rates on tumor grade and pathology diagnosis are moderate (67 and 73%, respectively) . Limitations include sample insufficiency in 20–30% of the cases, unsuccessful insertions (in occasions due to cervical stenosis or prolapse), and as well an abnormal sonographic appearance of the endometrium …”

“…12 Limitations include sample insufficiency in 20-30% of the cases, 13 unsuccessful insertions (in occasions due to cervical stenosis or prolapse), and as well an abnormal sonographic appearance of the endometrium. 11,14 The different types of endometrial cancers derive from different precursor lesions (screening criterion 4; Table 1 and Fig. 1).…”