A Mini-Review of Office Hysteroscopic Techniques for Endometrial Tissue Sampling in Postmenopausal Bleeding

Abstract

Postmenopausal bleeding (PMB) is a common cause for a gynecological visit. Endometrial cancer risk varies from 3% to 25% in women with PMB. There is a significant concern of malignancy of the endometrium and the endocervical canal by a physician in postmenopausal women, and hence, most prefer operating room hysteroscopies with dilation and curettage (D & C) compared to in-office procedures. With increased availablility of miniaturized instruments such as mini- resectoscope and tissue removal systems, there is high likelihood of blind D & C being replaced by hysteroscopic- guided targetted biopsy or visual D & C. The cost-effectiveness of office hysteroscopy is also well demonstrated. In December 2020, an electronic search was performed of PubMed, MEDLINE, and Cochrane Library to look for articles on office hysteroscopic biopsy techniques in postmenopausal women from 2010 to 2020. Relevant studies were included where various office hysteroscopic techniques are used for endometrial sampling in PMB. Studies with 5 Fr scissors, biopsy forceps, crocodile forceps, cup forceps, bipolar electrode, in-office tissue removal system (morcellator), flexible hysteroscope, and mini-resectoscope were included. Standard reference was used as an adequate endometrial sample for histology. The objective of this review is to explore the current evidence on different office hysteroscopic techniques available for endometrial tissue sampling in PMB. Research Question: What are the different available in - office hysteroscopy techniques for obtaining endometrial biopsy? Clinical Importance: Understanding the adequacy of an endometrial tissue sample obtained by different in - office hysteroscopy techniques and their accuracy by histology.

Correlations between hysteroscopy and histopathology to consider for the diagnosis of impaired inflammatory states of the endometrium: a narrative review

“…It requires multiple sampling, which implies more manipulation of the endometrium ultimately adding iatrogenic inflammation. The grasp biopsy however allows larger amount of tissue compared to the punch technique [13,39,40]. In post-menopausal patients, scissors and bipolar electrodes are preferred due to the fibrotic stroma in this context especially in case of atrophy, making the grasping technique difficult to perform [13].…”

“…The grasp biopsy however allows larger amount of tissue compared to the punch technique [13,39,40]. In post-menopausal patients, scissors and bipolar electrodes are preferred due to the fibrotic stroma in this context especially in case of atrophy, making the grasping technique difficult to perform [13]. Conclusion: blind biopsy with a Pipelle or Novak are impertinent in inflammatory disorders because in addition to their commonly focal character, these tools could blindly sample the isthmus, the basalis or a scratched endometrium without a surface epithelium, thus compromising the histopathological examination.…”

“…In a uterine cavity free of organic anomalies like polyps, fibroids or malignancies, there are to date no specific guidelines for a targeted biopsy allowing op-timal sampling. Only the technique is stressed, not the morphological patterns of the biopsy site [13][14][15]. In an "empty uterine cavity", hysteroscopy is usually conducted in a "come in-come out" fashion, and blind biopsies with Pipelle or Novak continue to be used [16].…”