1. An endometrial biopsy should be performed in all women with abnormal uterine bleeding in whom endometrial hyperplasia or carcinoma is a possibility. There is an excellent correlation between Novak or Pipelle biopsy instruments and curettage.
2. In addition, atypical glandular cells on a Papanicolaou (Pap) smear should be investigated with an endometrial biopsy to determine whether endometrial hyperplasia or carcinoma is the cause.
3. Endometrial biopsy is also recommended for women with any endometrial cells on a Papanicolaou (Pap) smear.
4. Additional endometrial assessment should be performed if abnormal uterine bleeding persists after a benign endometrial biopsy. Transvaginal sonography with or without hysteroscopy and directed biopsy should be considered to rule out an occult malignancy.
C. Hysteroscopy and curettage. If endometrial hyperplasia with atypia is diagnosed by blind biopsy, further evaluation is needed to exclude a coexistent endometrial adenocarcinoma, which is present in 25 percent. Hysteroscopy with curet-tage is recommended.
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