Evaluation of the endometrium for malignant or premalignant disease
- Sarah Feldman, MD, MPH
Sarah Feldman, MD, MPH
- Associate Professor
- Harvard Medical School
- Section Editors
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
Evaluation of the endometrium is the key component in the diagnostic evaluation of women suspected of endometrial cancer or a premalignant endometrial lesion. An endometrial sampling procedure is the gold standard for diagnostic evaluation of women with abnormal uterine bleeding in whom endometrial hyperplasia or carcinoma is a possibility (table 1). (See "Endometrial sampling procedures".)
Endometrial biopsy — The development of equipment and techniques for office-based endometrial biopsy has generally replaced the need for diagnostic dilation and curettage (D&C) performed in the operating room . Advantages of office biopsy include:
●Minimal to no cervical dilation is required.
●Local or no anesthesia is generally required.
●Performing the procedure in an office setting is less expensive than a procedure in the operating room.
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- INVASIVE METHODS
- Endometrial biopsy
- Dilation and curettage
- NONINVASIVE METHODS
- Transvaginal ultrasound
- - Postmenopausal women
- Women with postmenopausal bleeding
- Asymptomatic women with endometrial thickening or fluid
- - Premenopausal women
- - Women on hormone therapy
- - Women on tamoxifen
- Saline infusion sonography
- Other imaging studies
- RISK OF TUMOR DISSEMINATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Initial evaluation
- Evaluation of persistent bleeding