Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results

Doorn, Helena C. van; Opmeer, Brent C.; Burger, Curt W.; Duk, M. Jitze; Kooi, G.S.; Mol, Ben Willem J.

doi:10.1016/j.ijgo.2007.05.040

Cited by 44 publications

(51 citation statements)

References 24 publications

(47 reference statements)

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“…Our study results also showed a low concordance rate of 39.3% between EM aspiration and D&C biopsy conducted for follow-up evaluation of hormonal therapy and that 46.4% of the samples obtained by using the EM sampling method were insufficient. Van Doorn et al [29] conducted a prospective cohort study in 913 postmenopausal women with vaginal bleeding. Of these patients, 403 underwent office EM sampling.…”

Section: Discussionmentioning

confidence: 99%

“…Sixty-six samples (16.4%) were insufficient. The authors also reported that three patients were diagnosed with EC and one patient was diagnosed with EM atypical hyperplasia when evaluated by using hysteroscopy and D&C biopsy [29]. Furthermore, Clark et al [30] reported that 20% of samples collected from postmenopausal women through EM aspiration biopsy contained insufficient materials.…”

Section: Discussionmentioning

confidence: 99%

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Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

et al. 2017

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ObjectiveTo determine whether less invasive endometrial (EM) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage (D&C) biopsy in early-stage endometrial cancer (EC) patients treated with high dose oral progestin and levonorgestrel intrauterine system (LNG-IUS).MethodsWe conducted a prospective observational study with patients younger than 40 years who were diagnosed with clinical stage IA, The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility. The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS. Treatment responses were evaluated every 3 months. EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue samples were histologically compared. The diagnostic concordance rate of the two tests was examined with κ statistics.ResultsTwenty-eight pairs of EM samples were obtained from five patients. The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3% (κ value=0.26). Of the seven samples diagnosed as normal with D&C, three (42.8%) were diagnosed as normal by using EM aspiration biopsy. Of the eight samples diagnosed with endometrioid adenocarcinoma by using D&C, three (37.5%) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy. Of the 13 complex EM hyperplasia samples diagnosed with the D&C, five (38.5%) were diagnosed with EM hyperplasia by using EM aspiration biopsy. Of the samples obtained through EM aspiration, 46.4% were insufficient for histological evaluation.ConclusionTo evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS, D&C should be conducted after LNG-IUS removal.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

et al. 2017

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“…These were caused by sampling error due to necrosis, and resulted in a diagnosis of EC upon reexamination. In cases of inadequate sampling and a suspicious EM thickness, further diagnostic workup is necessary or approximately 6% of EM pathology will be overlooked [14,15] . However, a recent systematic review of published studies found that a mean EM thickness of 2.9 mm in 2,952 postmenopausal women required histological examination and identified no valid cutoff value on which to base recommendations for EM histological examination in asymptomatic women [16] .…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of Endometrial Cell Block Cytology in Postmenopausal Women

Nishida

Murakami²,

Kuroda³

et al. 2017

Acta Cytologica

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Objective: To investigate the diagnostic utility of endometrial (EM) cell block (CB) cytology for the detection of intrauterine malignancy in postmenopausal women. Methods: We reviewed the medical records of 104 postmenopausal women between January 2012 and November 2014. We reviewed symptoms upon admission, body mass index, parity, transvaginal ultrasonographic findings, and histopathological results based on CB and conventional cytology. Results: The mean age was 62.6 (range 48-95) years. The mean menopausal age was 50.8 years and the mean duration of menopause was 12.0 years. The sensitivity of CB and conventional cytology was 82.3% (29/35) and 85.7% (30/35) and the specificity was 98.6% (68/69) and 94.2% (65/69), respectively. The sensitivity and specificity of CB cytology combined with conventional cytology were 82.3% (29/35) and 94.2% (65/69), respectively. The predictive values for EM hyperplasia and type-II carcinoma were 100 and 85.7%, respectively. Conclusion: CB cytology provides specimens for examination in a single outpatient session. Additionally, immunohistochemical staining can provide useful information for histological diagnosis. A combination of CB and conventional cytology can improve the diagnostic accuracy of EM lesions and may be a valid method for screening in postmenopausal women.

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“…Two studies confirmed a high failure rate (51% and 64%, of which 30% and 48% were insufficient samples) [17,18]. Malignancy cannot be excluded in women with insufficient ES [19,20], and HY is often added. Insufficient ES is costly and painful for patients, and the wait time can cause anxiety.…”

Section: Discussmentioning

confidence: 92%

Reproducibility of Endometrial Pathologic Findings Obtained on Hysteroscopy, Transvaginal Sonography, and Gel Infusion Sonography in Women With Postmenopausal Bleeding

Dueholm

Hjorth

Secher

et al. 2015

Journal of Minimally Invasive Gynecology

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Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results

Abstract: In women with postmenopausal bleeding and a nonreassuring transvaginal ultrasound evaluation, a nondiagnostic office endometrial sample does not rule out endometrial cancer and further endometrial sampling is advisable.

Cited by 44 publications

References 24 publications

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

Clinical Utility of Endometrial Cell Block Cytology in Postmenopausal Women

Reproducibility of Endometrial Pathologic Findings Obtained on Hysteroscopy, Transvaginal Sonography, and Gel Infusion Sonography in Women With Postmenopausal Bleeding

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