Endometrial sampling tests for the diagnosis of endometrial carcinoma: a protocol of a diagnostic test accuracy systematic review

Background: Endometrial cancer ranks as the most common gynecological cancer. An accurate detection can dramatically improve patient relevant outcomes.Objectives: To determine the diagnostic accuracy of different endometrial sampling methods for detecting endometrial carcinoma and its precursors.Search strategy: we will search the Cochrane library, Pubmed/MEDLINE, Web of Science, and Scopus. We will search references of relevant studies.Selection criteria: We will include diagnostic test accuracy studies if women had an endometrial sampling followed by verification with histopathology in hysterectomy specimens. The primary target is endometrial carcinoma.Data collection and analysis: Two authors will independently screen studies, extract data, and assess methodological quality. We will use bivariate diagnostic random-effects meta-analysis.Results: This is a protocol of a diagnostic test accuracy systematic review.Conclusions: Evidence will aid in making well-informed decisions for diagnosing endometrial carcinoma. Implications for research will be outlined for future studies.

Endometrial Cut Off Thickness as Predictor of Endometrial Pathology in Perimenopausal Women with Abnormal Uterine Bleeding: A Cross-Sectional Study

Purpose. We aim to determine the predictive value of endometrial thickness by transvaginal ultrasonography (TVS) in diagnosing endometrial pathology and to evaluate whether Doppler complements its diagnostic efficacy in perimenopausal women with abnormal uterine bleeding. Methods. This cross-sectional observational study was conducted among 70 perimenopausal women with AUB who underwent TVS measurement of endometrial thickness (ET) and Doppler flow indices followed by endometrial sampling and histopathological examination (HPE). Results. In HPE, 51 (73%) women had normal diagnosis while 19 (27%) women had neoplastic histology either benign or malignant. They were categorised into group I and group II, respectively. There was a significant difference in age ( P = 0.001 ) and incidence of obesity ( P = 0.01 ) between the two groups. The ETs measured in group I and group II were 7.89 ± 2.62 mm and 14.07 ± 3.96 mm, respectively, with significant difference ( P < 0.001 ). A TVS-ET of 10.5 mm had the highest sensitivity and specificity of 89.5% and 86.3%, respectively, PPV of 70.68%, NPV of 95.68%, LR+ of 6.52, and LR− of 0.12. Doppler flow velocimetric study of endometrial and uterine vessels did not demonstrate a significant difference. Conclusions. Women in perimenopause with AUB should be offered to undergo endometrial sampling for histopathological examination if TVS ET ≥10.5 mm. The coexisting risk factors especially higher age (>45 years) and obesity (BMI>30) significantly escalate the chances of developing endometrial pathology.

Determining a threshold measurement of Endometrial Thickness for Asymptomatic Postmenopausal Women: A single-centre case series

Objective: To determine the endometrial thickness at which endometrial sampling is indicated in asymptomatic post-menopausal women referred with thickened endometrium on ultrasound. Design: Retrospective case series Setting: Mercy Hospital for Women, Melbourne Population: Post-menopausal women without bleeding, undergoing hysteroscopy for thickened endometrium Methods: Logistic regression was used to examine the association between a range of variables and pre-malignant or malignant pathology and endometrial thickness Main outcome measures: The primary outcome was endometrial malignancy/pre-malignancy and its relation to endometrial thickness. Secondary outcomes focused on identifying additional predictors which may influence endometrial malignancy such as ultrasound findings, years since menopause, age, obesity, diabetes, and tamoxifen use. Results: A total of 404 postmenopausal women met the inclusion criteria for this study. The mean (SD) age of patients at presentation was 65 (9.09) years and the mean BMI was 29.86 kg/m2 (6.52). Of these women, nine (2.2%) were diagnosed with endometrial carcinoma and 7 (1.7%) had endometrial hyperplasia with atypia. The most common histopathological finding was of a benign endometrial polyp (153, 37.9%). When including hyperplasia with or without atypia in histopathology of interest, a cut-off of ≥9mm provides the greatest sensitivity (83.3%) and specificity (63.8%) for a diagnosis of pre-malignant or malignant pathology (classification accuracy of 64.8%; AUROC: 0.7358, 95%CI: 0.6439, 0.8278) in this cohort. Conclusions: Using an endometrial thickness of ≥9mm can be safely used as a cut-off for endometrial sampling in post-menopausal women without bleeding. Funding: Norman Beischer Medical Research Foundation, 2018 NBMRF Grant Keywords: Endometrial thickness, Post-menopausal, endometrial hyperplasia

Pipelle Endometrial Biopsy for Abnormal Uterine Bleeding in Daily Clinical Practice: Why the Approach to Patients Should Be Personalized?

Background. Abnormal uterine bleeding (AUB) is a common gynecologic condition, and proper management is based on the histological evaluation of an adequate endometrial sample obtained via biopsy. The aims of this study were to evaluate factors influencing the reliability and success rate of Pipelle endometrial sampling for histopathological diagnosis. Methods. One hundred and eighty patients with AUB underwent endometrial sampling using both Pipelle and dilatation and curettage (D&C) procedures at the Clinical Academic Department of Women’s Health, University Medical Center between January 2019 and April 2021. We analyzed the effects of age, menopausal status, ethnicity, body mass index (BMI), provider experience, and procedure indication on the success and reliability of each procedure. Results. Pipelle sampling was successful in 144 (80.56%) women, while D&C was successful in 164 (91.11%) women. Analysis using Fisher’s exact test showed that age, menopausal status, and biopsy indication were factors affecting the success rate of both methods, while ethnicity, BMI, and physician experience had no influence. Overall concordance in the histopathological results between Pipelle and D&C was 91.72%. Conclusion. Pipelle sampling was found to be reliable for the detection of endometrial carcinoma and endometrial hyperplasia, while its reliability was low in cases of endometrial polyps. The endometrial sampling approach should be personalized in daily clinical practice for women with AUB, and Pipelle sampling is not suitable for all patients. If an endometrial polyp is suspected, the physician should consider other diagnostic tools, bearing in mind all of the factors influencing endometrial sampling success and reliability rates.

Adenomyosis: Is It A Confounder Or An Innocent Companion In Patients With Endometrial Hyperplasia?

Purpose: To evaluate the effect of adenomyosis on the discordance of pathologic findings in patients with endometrial hyperplasia (EH) before hysterectomy.Methods: Two hundred seventeen patients who were diagnosed as having EH via endometrial sampling and underwent hysterectomy within 3 months were included in this retrospective study. The patients’ preoperative and postoperative pathologic findings were compared and discordant results were defined as overdiagnosed and underdiagnosed.Results: The rate of concurrent endometrial carcinoma (EC) among all EH was 22.11%, whereas this rate was 41.4% in EH with atypia. There was no difference between EH subtypes in terms of demographic characteristics and coexisting myometrial lesions. The discordance between preoperative endometrial sampling and final hysterectomy specimen results was evaluated, and patients with underdiagnosis were older (60.5 years, p<0.001), had a higher BMI (30.84 kg/m2, p<0.001), were mostly postmenopausal (p<0.001), had lower parity numbers (median=2, p=0.002), and had a lower rate of co-existing adenomyosis (p=0.009). The rates of co-existing leiomyomas between the groups were not different. No effect of other demographic characteristics was observed in the multivariate regression analysis; however, the presence of adenomyosis was a significant independent risk factor affecting a 5.8-fold increase in overdiagnosis (-1.50; OR: 0.17 (0.05-0.50) p=0.002) and 4.5-fold increase in underdiagnosis (-1.50; p=0.005).Conclusion: Co-existing adenomyosis could lead to discordance of the pathologic findings in women with EH diagnoses before hysterectomy.

Comparison of endometrial sampling with pipelle versus conventional dilatation and curettage in abnormal uterine bleeding.

Objective: To compare the adequacy of endometrial sampling with pipelle versus conventional dilatation and curettage in patients with abnormal uterine bleeding. Study Design: Randomized Control Trial. Settings: Department of Obstetrics and Gynecology Madina Teaching Hospital affiliated with University Medical and Dental College Faisalabad. Period: July 2019 to June 2020. Material & Methods: A total of 90 patients with abnormal uterine bleeding were included in the study. Patients in Group A underwent endometrial sampling in OPD without anesthesia using pipelle. Patients in Group B were admitted, dilatation and curettage was done in operation theatre under anesthesia, endometrial tissue sent for histopathology. Patients were called in OPD on follow up visit with histopathology report. Results: Comparison of adequacy of endometrial sampling with pipelle versus conventional dilatation and curettage in abnormal uterine bleeding shows that 84.44% (n=38) in Group A and 91.11% (n=41) in Group B have adequate sample. P value was 0.33, showing insignificant difference. Conclusion: Pipelle has acceptable adequacy for endometrial sampling as compare to dilatation and curettage. It is an outpatient procedure, no need of anesthesia and cervical dilatation. Pipelle can be safely used as an alternative to conventional dilatation and curettage.

False Endometrial Thickening in Postmenopausal Patients Using Anticoagulants or Antiplatelets Agents

Objective There is no report that anticoagulant or antiplatelet use may lead to abnormal endometrial sonographic findings. This retrospective study reports our first results associated with endometrial sampling in asymptomatic postmenopausal women using anticoagulants or antiplatelet. Materials methods A total of 268 postmenopausal patients who applied to our gynecology outpatient clinic for any reasons except postmenopausal bleeding were included in the study. Patients were divided into three groups according to using drug status: first healty control group [HCG], second anticoagulants agents group [ACG], and third antiplatelet agents group [APG]. The effects of anticoagulant and antiplatelet agents on endometrial thickness were compared with histopathological findings. Results The mean endometrial thickness was significantly greater in group ACG [5.2 mm] and APG [4.1 m] than in group HCG [3.3 mm]. No significant differences were found in the mean endometrial thickness between groups HCG and APG. However, it is noteworthy that the average endomeric thickness in the ACG group is more than the other two groups and this is statistically significant [p < 0.05]. Conclusion If the thickness of the endometrium was > 4 mm. endometrial sampling may be recommended in in asymptomatic postmenopausal women using anticoagulants or antiplatelet agents.