A New Paradigm for Evaluating the Endometrium?

Robert W. Rebar, MD reviewing Rotenberg O et al. Obstet Gynecol 2015 Feb.

Simultaneous endometrial biopsy and sonohysterography had high sensitivity and specificity, but prospective studies are warranted.

Although endometrial biopsy represents the gold standard for diagnosing endometrial cancer, the procedure is painful and may miss focal endometrial lesions such as polyps. Saline infusion sonography (SIS) is less painful than biopsy for many women (and has a high sensitivity for identifying polyps and other focal intracavitary lesions), but the diagnostic accuracy of biopsy immediately following SIS is uncertain. Investigators attempted to determine if ultrasound-guided endometrial aspiration for biopsy immediately following SIS had good sensitivity and specificity. Study participants were women aged ≥50 with postmenopausal bleeding who also had thickened endometrium or a suspected polyp on a prior ultrasound scan. Data on surgical outcomes or follow-up for ≥6 months were available for 540 women.

A total of 30 patients had endometrial cancer or hyperplasia. In analysis in which proliferative endometrium on SIS was considered a normal finding on endometrial biopsy, the sensitivity for detecting endometrial hyperplasia or cancer was 87% and the specificity was 100%. If a proliferative endometrium was considered abnormal (a designation that may or may not be appropriate in women around age 50), sensitivity was 100%, but specificity fell to 88%.

Citation(s):

Rotenberg O et al. Simultaneous endometrial aspiration and sonohysterography for the evaluation of endometrial pathology in women aged 50 years and older. Obstet Gynecol 2015 Feb; 125:414.