The clinical importance of the microcurettage

H. A M Brölmann, F. P H L J Dijkhuizen, B. W J Mol

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

In this article, office endometrial sampling techniques are reviewed, their feasibility and diagnostic accuracy. The main objective of blind endometrial sampling in perimenopausal patients with abnormal uterine bleeding is detecting premalignant or malignant endometrial disease. As the frequency of postmenopausal bleeding decreases with older age, the risk of endometrial cancer increases, being virtually zero in women under 50 years up to nearly 25% in women over 80 years. In women between 65 and 80 years of age the probability of endometrial cancer was estimated to be 15%. The association between atypical hyperplasia and endometrial cancer is well established. Hyperplasia has a maximal prevalence in symptomatic patients of 15% between 50 and 60 years of age. The sampled material can be examined cytologically and by histology. There are no good studies available to compare the diagnostic accuracy of cytology with histology and results are inconsistent. There is some evidence that the combination of cytology and histology can increase the number of adequate specimens. Sampling techniques that aim at histological examination of the specimen use scraping ('abrasion'), aspiration or lavage or a combination as mechanisms to dislodge endometrial material. The endometrial aspiration, for example by the cannula Pipelle de Cornier combines a fair acceptability with a sufficient tissue yield and diagnostic accuracy regarding (pre)malignant endometrial change. The failure rate of aspiration techniques is approximately 10%, the proportion of inadequate samples is 13% and the proportion of women that report substantial pain is 5%. Regarding the diagnostic accuracy, the aspiration techniques (Pipelle, Vabra, Vakutage) have the best performance in detecting hyperplasia and endometrial carcinoma. However there is evidence that supports the contention that malignant pathology can be missed by outpatient biopsy and, therefore, additional endometrial assessment should be undertaken, especially in case of insufficient material, if symptoms persist or if intrauterine structural abnormalities are suspected. In that case, hysteroscopy and curettage are recommended.

Original languageEnglish
Pages (from-to)58-64
Number of pages7
JournalReviews in Gynaecological Practice
Volume4
Issue number1
DOIs
Publication statusPublished or Issued - 1 Mar 2004

Keywords

  • Abnormal uterine bleeding
  • Endometrial cancer
  • Endometrial cytology
  • Endometrial histology
  • Endometrial hyperplasia
  • Endometrial sampling
  • Microcurettage
  • Office gynaecology
  • Pipelle de Cornier
  • Postmenopausal bleeding

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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