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Randomized Controlled Trial
. 2021 Jul;100(7):1258-1264.
doi: 10.1111/aogs.14086. Epub 2021 Feb 7.

Endometrial sampling before or after saline contrast sonohysterography in women with postmenopausal bleeding (ESPRESSO trial): A multicenter randomized controlled trial

Albertine J Vroom  1   2 , Luca Aerts  2 , Marlies Y Bongers  1   2 , Arianne C Lim  2 , Bart J Pielkenrood  3 , Peggy M A J Geomini  1 , Nehalennia van Hanegem  4
Affiliations
Randomized Controlled Trial

Endometrial sampling before or after saline contrast sonohysterography in women with postmenopausal bleeding (ESPRESSO trial): A multicenter randomized controlled trial

Albertine J Vroom et al. Acta Obstet Gynecol Scand. 2021 Jul.

Abstract

Introduction: The aim of this study is to evaluate the quality of the endometrial sample obtained by office endometrial aspiration when performed before or after saline contrast sonohysterography (SCSH) in women with postmenopausal bleeding and a thickened endometrium. To conduct a complete, minimally invasive and cost-effective diagnostic workup in women with postmenopausal bleeding and a thickened endometrium, ideally both the office endometrial sampling and SCSH are performed. However, it is not known whether both tests affect each other when performed one after another.

Material and methods: Women with postmenopausal bleeding and an endometrial thickness >4 mm were eligible. Women were randomized into two groups: one group received endometrial aspiration before SCSH, the other group received SCSH before endometrial aspiration. The primary outcome was the proportion of sufficient endometrial samples. Reliability of the SCSH images and pain during procedures were secondary outcomes.

Results: During the inclusion period, 513 eligible women with postmenopausal bleeding visited the participating hospitals, 293 of whom received information about the study. Of these women, 232 (79%) agreed to participate. In the SCSH-aspiration group, 65 women (59%) had a sufficient endometrial sample compared with 70 (67%) in the aspiration-SCSH group (odds ratio 1.46, 95% CI 0.83-2.54, P = .19). The proportion of reliable sonographic images was significantly higher in the SCSH-aspiration group (n = 88, 87%) compared with the aspiration-SCSH group (n = 71, 74%) (OR 2.38, 95% CI 1.38-4.99, P = .02) in the per protocol analysis.

Conclusions: This study shows that the quality of an endometrial sample in women with postmenopausal bleeding is not affected by SCSH. Both procedures can be performed in one outpatient visit to perform an optimal diagnostic workup.

Keywords: biopsy; endometrial neoplasms; postmenopausal bleeding; postmenopause; saline contrast sonohysterography; ultrasound.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Flowchart of inclusion and treatment allocation. HRT, hormone replacement therapy; SCSH, saline contrast sonohysterography
See this image and copyright information in PMC

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