Endometrial biopsy

A. The office endometrial biopsy offers a number of advantages to D&C because it can be done with minimal to no cervical dilation, anesthesia is not required, and the cost is approximately one-tenth of a hospital D&C.

B. Numerous studies have shown that the endometrium is adequately sampled with these techniques.

C. Pipelle endometrial sampling device is the most popular method for sampling the endometrial lining. The device is constructed of flexible polypropylene with an outer sheath measuring 3.1 mm in diameter.

D. The device is placed in the uterus through an undilated cervix. The piston is fully withdrawn to create suction and, while the device is rotated 360 degrees, the distal port is brought from the fundus to the internal os to withdraw a sample. The device is removed and the distal aspect of the instrument is severed, allowing for the expulsion of the sample into formalin.

E. The detection rates for endometrial cancer by Pipelle in postmenopausal and premenopausal women are 99.6 and 91 percent, respectively.

F. D&C should be considered when the endometrial biopsy is nondiagnostic, but a high suspicion of cancer remains (eg, hyperplasia with atypia, presence of necrosis, or pyometra).

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