Sono-Guided Endometrial Biopsy: Comparison with Hysteroscopy Biopsy

Abstract

Objective: To assess the feasibility, tolerance and diagnostic accuracy of endometrial biopsy (EB) during sonohysterography (SH) compared to EB after hysteroscopy (HSC) in endometrial disorders. Methods: 105 consecutive patients with irregular uterine bleeding were included prospectively in the calendar year 2001. SH and flexible HSC were performed in an office setting, subsequently and in a random order, by two different practitioners blind to the former experiment. SH-EB was performed using a 3.1-mm ultrasound-guided Bernard catheter in the uterine cavity still partly distended and with a gentle 20-ml syringe vacuum aspiration. The biopsy was directed on focal lesions or else randomly when no targets had previously been found. A Cornier Pipelle^® was used to perform EB after HSC. We investigated all patients by biopsy, independent of the endometrial thickness. HSC-EB was the gold standard. Results: For both methods, cervical catheterism was impossible in 20 patients, 75 of them successfully underwent both exams. Duration and tolerance were similar. SH was effective in the distinction between normal and pathologic cavities, as well as in the diagnosis of polyps. Endometrium appeared significantly thinner with HSC (1.8 mm) when compared to SH (2.9 mm, p < 0.05). Histological endometrial assessment failed in 30 cases of SH-EB and in 22 cases in HSC-EB (NS). There was a poor correlation of the histological results of both techniques. Hyperplasia has never been diagnosed by SH-EB, whereas 3 EB issued from HSC-EB brought up this diagnosis. Conclusion: SH-EB with our technique did not improve the diagnostic potential of SH and severe diagnosis was missed. Histological assessment should fail less when we exclude endometrial atrophy. The diameter of the catheter and the aspiration technique must be revised and the learning curve must be considered. Our technique cannot replace EB by HSC.

Hysteroscopic findings in women at risk of HNPCC. Results of a prospective observational study

“…The feasibility of diagnostic hysteroscopy in women at risk of HNPCC was similar to that in the overall population in an earlier study [9]. Furthermore, the 11% failure rate was consistent with our experience in the general population of women with abnormal vaginal bleeding [14]. In an earlier study, we found no significant safety differences between flexible hysteroscopy and sonohysterography [14].…”

“…Furthermore, the 11% failure rate was consistent with our experience in the general population of women with abnormal vaginal bleeding [14]. In an earlier study, we found no significant safety differences between flexible hysteroscopy and sonohysterography [14]. However, the limited number of patients who underwent follow-up hysteroscopies at the recommended time interval (1 year) in the present study leaves some uncertainty regarding safety.…”

“…The rate of failed biopsy collection or interpretation (12%) was not different from that in an earlier study of abnormal bleeding in the overall population of women older than 35 years of age [14,15]. There is general agreement that failed biopsy collection or interpretation is significantly more common in patients with endometrial atrophy.…”

Usefulness of saline infusion sonohysterography and feeding artery imaging in endometrial polyp diagnosis

“…Poorer SIS sensitivity and specificity have been reported [9,18,19]. In the group of 105 patients sonohysteroscopy failed to detect endometrial polyps in 30 cases [18], SIS may also lead to erroneous diagnosis of blood clots as endometrial polyps [20].…”

“…Poorer SIS sensitivity and specificity have been reported [9,18,19]. In the group of 105 patients sonohysteroscopy failed to detect endometrial polyps in 30 cases [18], SIS may also lead to erroneous diagnosis of blood clots as endometrial polyps [20]. Many authors do not regard sonohysterography results as sufficient evidence to confirm or exclude endometrial abnormalities [4,6,12,[21][22][23][24].…”