Optimal Order of Successive Office Hysteroscopy and Endometrial Biopsy for the Evaluation of Abnormal Uterine Bleeding

Sarkar, Papri; Mikhail, Emad; Schickler, Robyn; Plosker, Shayne; Imudia, Anthony N.

doi:10.1097/aog.0000000000002202

Cited by 9 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A 2018 randomized clinical trial showed that performing a hysteroscopy first ensures a better image, whereas a biopsy yields an adequate tissue sample with fewer attempts [21]. In the current literature, there are no systematic correlation data between the hysteroscopic features of a single hysteroscopic elementary lesion and the diagnosis of endometrial hyperplasia.…”

Section: Discussionmentioning

confidence: 99%

“…There is no doubt that hysteroscopy and targeted biopsy represent a diagnostic evolution of blind techniques, such as pipelle, in the identification of focal endometrial pathologies, including those of a hyperplastic type [3,4,27,33]. At present, blind biopsies commonly do not allow any focal lesions to be assessed, but some authors suggest that biopsies under hysteroscopic guidance could be significantly improved by the use of blind sampling, especially when the hyperplastic process is widespread [21].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

et al. 2019

View full text Add to dashboard Cite

The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Random endometrial biopsies are advocated to improve the sensitivity and specificity of the diagnostic method [ Figure 2 ]. [ 35 36 37 ]…”

Section: E Ndometrial S Ampling With H Ysteroscopy Using 5 F R mentioning

confidence: 99%

A mini-review of office hysteroscopic techniques for endometrial tissue sampling in postmenopausal bleeding

Haimovich

Tanvir

2021

J Mid-life Health

View full text Add to dashboard Cite

Postmenopausal bleeding (PMB) is a common cause for a gynecological visit. Endometrial cancer risk varies from 3% to 25% in women with PMB. There is a significant concern of malignancy of the endometrium and the endocervical canal by a physician in postmenopausal women, and hence, most prefer operating room hysteroscopies with dilation and curettage (D & C) compared to in-office procedures. With increased availablility of miniaturized instruments such as mini- resectoscope and tissue removal systems, there is high likelihood of blind D & C being replaced by hysteroscopic- guided targetted biopsy or visual D & C. The cost-effectiveness of office hysteroscopy is also well demonstrated. In December 2020, an electronic search was performed of PubMed, MEDLINE, and Cochrane Library to look for articles on office hysteroscopic biopsy techniques in postmenopausal women from 2010 to 2020. Relevant studies were included where various office hysteroscopic techniques are used for endometrial sampling in PMB. Studies with 5 Fr scissors, biopsy forceps, crocodile forceps, cup forceps, bipolar electrode, in-office tissue removal system (morcellator), flexible hysteroscope, and mini-resectoscope were included. Standard reference was used as an adequate endometrial sample for histology. The objective of this review is to explore the current evidence on different office hysteroscopic techniques available for endometrial tissue sampling in PMB. Research Question: What are the different available in - office hysteroscopy techniques for obtaining endometrial biopsy? Clinical Importance: Understanding the adequacy of an endometrial tissue sample obtained by different in - office hysteroscopy techniques and their accuracy by histology.

show abstract

Ultrasound‐Guided Polypectomy

Sarkar,

Vest,

Baker

et al. 2024

J of Ultrasound Medicine

View full text Add to dashboard Cite

ObjectiveTo present a novel technique for office resection of pedunculated endometrial polyps under ultrasound guidance.MethodsA prospective trial was conducted at an academic center where women with abnormal uterine bleeding (AUB) who were diagnosed an endometrial polyp following saline infusion sonogram (SIS), were offered polyp removal under ultrasound guidance using a universal grasping forceps (2.5 mm × 25 cm). The primary outcome was to evaluate the feasibility of this technique for complete removal of the polyp. The secondary outcomes were to evaluate the patients' pain score, satisfaction score using visual analogue score (VAS), and efficacy of the technique in alleviating symptoms in patients with AUB due to polyps.ResultsThirty patients participated, with a mean age of 54.8 ± 11 years. Average polyp volume was 1.87 cm3 and mean duration for polypectomy was 11 minutes 31 seconds. The median pain score immediately post‐procedure was 5 (0–9). We were unable to complete the procedure in two patients due to patient discomfort and poor visualization. Complete removal of polyp was ensured by checking for a thin endometrial echo at the end of the procedure and by performing SIS at 3‐months post‐procedure. Of the 22 patients who returned for follow‐up, 19 (86.36%) showed no evidence of polyp on SIS and all reported resolution of AUB symptoms. The median satisfaction score at the follow‐up was 10/10. Adequate pathology samples were obtained from all cases, diagnosing malignancy in one and endometrial hyperplasia in one patient.ConclusionThis technique offers safe and effective removal of pedunculated endometrial polyps in an office setting, avoiding the need for general anesthesia. It can be offered as a therapeutic option at the initial point of contact, providing symptom relief and tissue diagnosis while reducing costs and patient visits.

show abstract

Optimal Order of Successive Office Hysteroscopy and Endometrial Biopsy for the Evaluation of Abnormal Uterine Bleeding

Abstract: ClinicalTrials.gov, NCT02472184.

Cited by 9 publications

References 26 publications

Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

A mini-review of office hysteroscopic techniques for endometrial tissue sampling in postmenopausal bleeding

Ultrasound‐Guided Polypectomy

Contact Info

Product

Resources

About