Endometrial sampling procedures
- Giuseppe Del Priore, MD, MPH
Giuseppe Del Priore, MD, MPH
- Morehouse School of Medicine
Equipment and techniques for office-based endometrial sampling has generally replaced the need for diagnostic dilation and curettage performed in the hospital . These techniques provide a minimally invasive option for diagnosis of endometrial cancer, hyperplasia, and other endometrial pathology.
Techniques for office procedures for endometrial sampling will be reviewed here. Dilation and curettage and an overview of the diagnostic approach to endometrial evaluation for neoplasia, including both non-invasive and invasive methods, are discussed separately. (See "Dilation and curettage" and "Evaluation of the endometrium for malignant or premalignant disease".)
Office sampling versus dilation and curettage — Endometrial sampling offers a number of advantages compared with dilation and curettage:
●Operative setting is an outpatient clinic, rather than an operating room.
●May be performed without anesthesia or with only local anesthesia.
- Grimes DA. Diagnostic dilation and curettage: a reappraisal. Am J Obstet Gynecol 1982; 142:1.
- Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000; 89:1765.
- Trimble CL, Method M, Leitao M, et al. Management of endometrial precancers. Obstet Gynecol 2012; 120:1160.
- McQueen DB, Bernardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril 2014; 101:1026.
- Dogan E, Celiloglu M, Sarihan E, Demir A. Anesthetic effect of intrauterine lidocaine plus naproxen sodium in endometrial biopsy. Obstet Gynecol 2004; 103:347.
- Trolice MP, Fishburne C Jr, McGrady S. Anesthetic efficacy of intrauterine lidocaine for endometrial biopsy: a randomized double-masked trial. Obstet Gynecol 2000; 95:345.
- Güney M, Oral B, Mungan T. Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy. Int J Gynaecol Obstet 2007; 97:125.
- ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 74. Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2006; 108:225.
- APGO educational series on women's health issues. Clinical management of abnormal uterine bleeding. Association of Professors of Gynecology and Obstetrics, 2006.
- Gordon SJ, Westgate J. The incidence and management of failed Pipelle sampling in a general outpatient clinic. Aust N Z J Obstet Gynaecol 1999; 39:115.
- Wagaarachchi PT, Sirisena J. Efficiency of Pipelle device in sampling endometrium. Acta Obstet Gynecol Scand 2000; 79:793.
- Elsandabesee D, Greenwood P. The performance of Pipelle endometrial sampling in a dedicated postmenopausal bleeding clinic. J Obstet Gynaecol 2005; 25:32.
- Polena V, Mergui JL, Zerat L, Sananes S. The role of Pipelle Mark II sampling in endometrial disease diagnosis. Eur J Obstet Gynecol Reprod Biol 2007; 134:233.
- Moberger B, Nilsson S, Palmstierna S, et al. A multicenter study comparing two endometrial sampling devices--Medscand Endorette and Pipelle de Cornier. Acta Obstet Gynecol Scand 1998; 77:764.
- Sierecki AR, Gudipudi DK, Montemarano N, Del Priore G. Comparison of endometrial aspiration biopsy techniques: specimen adequacy. J Reprod Med 2008; 53:760.
- Kaunitz AM, Masciello A, Ostrowski M, Rovira EZ. Comparison of endometrial biopsy with the endometrial Pipelle and Vabra aspirator. J Reprod Med 1988; 33:427.
- Einerth Y. Vacuum curettage by the Vabrar method. A simple procedure for endometrial diagnosis. Acta Obstet Gynecol Scand 1982; 61:373.
- Suarez RA, Grimes DA, Majmudar B, Benigno BB. Diagnostic endometrial aspiration with the Karman cannula. J Reprod Med 1983; 28:41.
- Del Priore G, Williams R, Harbatkin CB, et al. Endometrial brush biopsy for the diagnosis of endometrial cancer. J Reprod Med 2001; 46:439.
- Critchley HO, Warner P, Lee AJ, et al. Evaluation of abnormal uterine bleeding: comparison of three outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess 2004; 8:iii.
- Yang GC, Wan LS, Del Priore G. Factors influencing the detection of uterine cancer by suction curettage and endometrial brushing. J Reprod Med 2002; 47:1005.
- Yang GC, Wan LS. Endometrial biopsy using the Tao Brush method. A study of 50 women in a general gynecologic practice. J Reprod Med 2000; 45:109.
- Maksem JA. Performance characteristics of the Indiana University Medical Center endometrial sampler (Tao Brush) in an outpatient office setting, first year's outcomes: recognizing histological patterns in cytology preparations of endometrial brushings. Diagn Cytopathol 2000; 22:186.
- Williams AR, Brechin S, Porter AJ, et al. Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG 2008; 115:1028.
- Cooper JM, Erickson ML. Endometrial sampling techniques in the diagnosis of abnormal uterine bleeding. Obstet Gynecol Clin North Am 2000; 27:235.
- Office sampling versus dilation and curettage
- Sample adequacy and condition
- INDICATIONS AND CONTRAINDICATIONS
- PREPROCEDURE PREPARATION
- Cervical preparation and dilation
- Prophylactic antibiotics
- GENERAL PROCEDURE
- ENDOMETRIAL SUCTION DEVICES
- Low-pressure devices
- Higher-pressure devices
- ENDOMETRIAL BRUSH
- SIDE EFFECTS AND COMPLICATIONS
- POSTPROCEDURE CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS