Office-Based Endometrial Sampling
Outpatient biopsy has replaced dilatation and curettage for evaluating most endometrial disorders, including hyperplasia and cancer. The literature is replete with arguments that support its accuracy, convenience to the patient and physician, and cost containment benefits. The most common option for outpatient sampling is the suction biopsy device, best exemplified by the Unimar Pipelle. A meta-analysis of 142 published studies ranked the success of endometrial sampling methods in women with abnormal vaginal bleeding and showed that outpatient endometrial biopsy adequately samples the uterus from 24% to 97% of the time and detects from 67% to nearly 100% of endometrial cancers.
This work presents direct cytological sampling of the uterine cavity as another diagnostic tool available to clinicians and pathologists alike. As with suction biopsy, its purpose is the assurance of endometrial benignity and the detection of endometrial neoplasm. Cytological sampling of the endometrium is a gentle method that is less painful than suction biopsy. Our intention is to show that in experienced hands direct cytological sampling is at least as thorough and as accurate as suction biopsy.
Endometrial sampling is generally performed as a response to abnormal vaginal bleeding of endometrial origin. Abnormal vaginal bleeding may be caused by anything from a physiological event such as dysfunctional uterine bleeding resulting from endometrial atrophy, to a benign tumor such as a polyp or leiomyoma, or neoplastic disease such as endometrial intraepithelial neoplasm (EIN) and cancer. Persistent postmenopausal bleeding in the setting of an endometrial stripe in excess of 4-mm thickness imposes a greater than 60-fold-increased risk for endometrial cancer, and some investigators report that combining suction curettage with endometrial cytology is the best strategy for examining outpatients with abnormal uterine bleeding.
KeywordsEndometrial Cancer Atypical Hyperplasia Cell Block Abnormal Uterine Bleeding Brush Cytology
- Buccoliero AM, Gheri CF, Castiglione F, Garbini F, Fambrini M, Bargelli G, Barbetti A, Pappalardo S, Taddei A, Boddi V, Scarselli GF, Marchionni M, Taddei GL. Liquid-based endometrial cytology in the management of sonographically thickened endometrium. Diagn Cytopathol 2007; 35: 398–402.PubMedCrossRefGoogle Scholar
- Buccoliero AM, Gheri CF, Castiglione F, Garbini F, Barbetti A, Fambrini M, Bargelli G, Pappalardo S, Taddei A, Boddi V, Scarselli GF, Marchionni M, Taddei GL. Liquid-based endometrial cytology: cyto-histological correlation in a population of 917 women. Cytopathology 2007; 18: 241–9.PubMedCrossRefGoogle Scholar
- Critchley HO, Warner P, Lee AJ, Brechin S, Guise J, Graham B. Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess 2004; 8(34): iii–iv, 1–139.Google Scholar
- Gull B, Karlsson B, Milsom I, Granberg S. Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 2003; 188: 401–8.PubMedCrossRefGoogle Scholar