TY - JOUR
T1 - Can we rely on blind endometrial biopsy for detection of focal intrauterine pathology?
AU - Svirsky, Ran
AU - Smorgick, Noam
AU - Rozowski, Uri
AU - Sagiv, Ron
AU - Feingold, Michal
AU - Halperin, Reuvit
AU - Pansky, Moty
PY - 2008/1/1
Y1 - 2008/1/1
N2 - Objective: To compare the diagnostic power of random endometrial biopsy with hysteroscopy for intrauterine lesions. Study Design: A retrospective cohort study of 639 women evaluated by diagnostic office hysteroscopy and endometrial biopsy (Novak curette) was carried out between 10/1997-6/2000. Reasons for evaluation were postmenopausal bleeding, abnormal uterine bleeding, ultrasound or hystero-salpingography findings, intrauterine device removal, suspected retained products of conception, infertility, late abortions and recurrent abortions. Results: The women's mean age was 43.4±13.3 years (range, 18-88). The most prevalent indication for investigation was abnormal uterine bleeding (n=218, 34.1%), followed by sonographic or hystero-salpingographic findings (n=167, 26.1%). Hysteroscopy revealed a normal uterine cavity in 367 (57.4%) women. Endometrial polyps and submucosal fibroids were the most common hysteroscopic findings (in 151 [23.6%] and 72 [11.3%], respectively). The hysteroscopic findings were compared with the pathology results in 558 cases. The sensitivity of the Novak curette for detection of endometrial polyps and submucosal fibroids was only 8.4% and 1.4%, respectively. The positive predictive value (30.9%) and the negative predictive value (57.9%) for both lesions were likewise low. On the other hand, hysteroscopy was not effective in diagnosing the 27 cases of hyperplasia (26 simple and one complex) all without atypia. Conclusion: Random endometrial sampling alone is not effective for diagnosing focal lesions of the uterine cavity and should be combined with other modalities, preferably diagnostic hysteroscopy.
AB - Objective: To compare the diagnostic power of random endometrial biopsy with hysteroscopy for intrauterine lesions. Study Design: A retrospective cohort study of 639 women evaluated by diagnostic office hysteroscopy and endometrial biopsy (Novak curette) was carried out between 10/1997-6/2000. Reasons for evaluation were postmenopausal bleeding, abnormal uterine bleeding, ultrasound or hystero-salpingography findings, intrauterine device removal, suspected retained products of conception, infertility, late abortions and recurrent abortions. Results: The women's mean age was 43.4±13.3 years (range, 18-88). The most prevalent indication for investigation was abnormal uterine bleeding (n=218, 34.1%), followed by sonographic or hystero-salpingographic findings (n=167, 26.1%). Hysteroscopy revealed a normal uterine cavity in 367 (57.4%) women. Endometrial polyps and submucosal fibroids were the most common hysteroscopic findings (in 151 [23.6%] and 72 [11.3%], respectively). The hysteroscopic findings were compared with the pathology results in 558 cases. The sensitivity of the Novak curette for detection of endometrial polyps and submucosal fibroids was only 8.4% and 1.4%, respectively. The positive predictive value (30.9%) and the negative predictive value (57.9%) for both lesions were likewise low. On the other hand, hysteroscopy was not effective in diagnosing the 27 cases of hyperplasia (26 simple and one complex) all without atypia. Conclusion: Random endometrial sampling alone is not effective for diagnosing focal lesions of the uterine cavity and should be combined with other modalities, preferably diagnostic hysteroscopy.
KW - endometrial biopsy
KW - focal intrauterine pathology
KW - hysteroscopy
UR - http://www.scopus.com/inward/record.url?scp=47949110797&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2008.02.015
DO - 10.1016/j.ajog.2008.02.015
M3 - Article
C2 - 18456238
AN - SCOPUS:47949110797
SN - 0002-9378
VL - 199
SP - 115.e1-115.e3
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 2
ER -