The Diagnostic Value and Patient Acceptability of Outpatient Endometrial Sampling with Gynoscann

EDITORIAL COMMENT : Several recent reports have suggested that procedures short of curettage under anaesthesia are sufficient to exclude the possibility of intrauterine cancer. Nasri and colleagues (1) found that endometrial thickness, as assessed by vaginal scan, was greater than 5 mm in all of 29 patients with abnormal endometrial histology. Our pathologist reviewer reminded us of a recent patient with a tiny invasive lesion less than 3 mm in depth in a hysterectomy specimen, but he cannot be sure that endometrial thickness did not exceed 5 mm before the curettage that obtained the tissue that indicated the hysterectomy. How expert does the practitioner and his/her equipment need to be for endometrial thickness of 5 mm to be ‘an appropriate cut‐off level for conservative management of women with postmenopausal bleeding’ (1)? The Editorial Committee is reluctant to endorse a policy of not performing curettage for postmenopausal bleeding, and wishes to remind readers that in patients with this symptom, carcinoma of the endocervix or endometrium is found in at least 8–12% of cases in most series. It should be noted that in this report evaluating endometrial sampling, there were very few patients past the menopause. The cervix is more difficult to cannulate in older women which is another factor when considering whether outpatient instrumentation by any means, including hysteroscopy, is sufficient for sampling or assessment of the endometrium. 1. Nasri MN, Shepherd JH, Setchell ME, Lowe DG, Chard T. The role of vaginal scan in measurement of endometrial thickness in postmenopausal women. Br J Obstet Gynaecol 1991; 98: 470–475. Summary Endometrial sampling with Gynoscann was performed in the outpatient department in 70 women with abnormal vaginal bleeding prior to dilatation and curettage (D&C). Successful endometrial sampling was achieved in 62 (89%) patients; Of the samples obtained 44 (71.0%) were adequate for cytological assessment and 46 (74.2%) for histological assessment, compared to 80% of D&C samples being adequate for histological examination. In those patients in whom outpatient endometrial sampling was adequate, both the cytological and histological diagnosis agreed with the D&C. The outpatient endometrial sampling was well tolerated by the patients since the majority (89%) experienced either no or little pain. Vaginal bleeding following the procedure was minimal in all except 1 patient. Endometrial sampling with Gynoscann may be useful for endometrial assessment prior to commencement of hormonal therapy and hysterectomy. It is a potentially useful screening test for early detection of endometrial cancer in patients at risk.