Adequacy of Histological Sampling of the Endometri

Abstract

Adequacy of Histological Sampling of the Endometrium: a Comparison between the Manual Vacuum Aspiration and Metal Uterine Curette

Pisit Buranawarodomkul MD*

Veeraphong Trakarnvanich MD**

Likit Rangsirattanakul MD**

* Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration (BMA) General Hospital

** Department of Pathology, Bangkok Metropolitan Administration (BMA) General Hospital

Objectives: To compare the endometrial tissue adequacy and pathological results obtained from manual vacuum aspiration (MVA) and metal uterine curette. A requirement of cervical dilatation prior to the procedure was also compared.

Methods: This is a clinical trial comparing two methods to obtain endometrial tissue in the same women. Ninety women aged over 35 years who had abnormal uterine bleeding and sought for medical consultation at the Department of Gynecology, BMA General Hospital during September 2009 and October 2010 were included into the study. Endometrial tissue was sampled by MVA followed by metal uterine curette. The necessity to do cervical dilatation before insertion of each instrument was recorded.

Results: Median age of the subjects was 47 years (36-74 years) and 31.1% was postmenopausal. Endometrial tissue obtained from MVA was adequate for pathological diagnosis in 80 cases or 88.9% (95% confidence interval (CI), 82.4 - 95.4%) compared to 82 cases or 91.1% (95% CI, 85.2 - 97.0%) obtained from the metal uterine curette. There were 4 cases (4.4%) from whom the metal uterine curette could obtain adequate tissue while the MVA could not and 2 cases (2.2%) from whom the MVA could obtain adequate tissue while the metal uterine curette could not (p-value = 0.687). The pathological reports of the endometrial tissue from both instruments were the same in 73 cases (81.1%). Cervical dilatation was necessary before insertion of both instruments in 1 case (1.1%) and before insertion of only metal uterine curette in 8 cases (8.9%) (p-value = 0.021).

Conclusion: Manual vacuum aspiration could obtain good endometrial sampling comparing to the metal uterine curette. It also had the advantage of lower necessity to do cervical dilatation.

Keywords: endometrial sampling, manual vacuum aspiration, metal uterine curette, endometrial tissue adequacy