[The reliability of study methods of the endometrium. A comparative study of 178 patients]

Abstract

Objective: To compare the reliability of different methods for investigating the endometrium.

Design: A prospective study from November 1990 to October 1991.

Setting: Department of surgery and gynaecology Diaconesses Hospital, Paris.

Subjects and interventions: In a total of 178 symptomatic patients, hysteroscopy with curettage in a day-centre under general anesthesia was performed. Before this operation, 79 women had had endometrial cytology, 98 women had had endometrial biopsy with the endometrial Pipelle, 112 women had ultrasonography and 120 women hysterography.

Main outcome measures: Endometrial cytology and biopsy, ultrasonography, hysterography and hysteroscopy were correlated with curettage.

Results: the Pipelle's diagnostic accuracy appeared better than that of cytology. The hysteroscopic diagnosis agreed with the histologic diagnosis showed by the curettage except for atypical hyperplasia. The positive predictive value for identifying endometrial atrophy with ultrasonography is 100%. A vaginal ultrasonographic examination showing an endometrial thickness of < or = 5 mm can be used to exclude endometrial carcinoma as the cause of post menopausal bleeding.

Conclusions: The combination of hysteroscopy and endometrial biopsy is the diagnostic method of choice for the endometrium. It is possible to avoid some useless curettages for diagnosis in women with abnormal uterine bleeding.