The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis

Hanegem, Nehalennia van; Prins, Marileen M.C.; Bongers, Marlies Y.; Opmeer, Brent C.; Sahota, Daljit Singh; Mol, Ben Willem J.; Timmermans, Anne

doi:10.1016/j.ejogrb.2015.12.008

Cited by 165 publications

(124 citation statements)

References 34 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…These findings are in line with results of a recent meta‐analysis that demonstrated that endometrial sampling is very accurate in diagnosing endometrial cancer, but less accurate in ruling out endometrial cancer 20. A large randomized controlled trial and two retrospective studies have shown that hysteroscopy contributed to the detection of focal (pre)malignancies in women with postmenopausal bleeding and thickened endometrium with benign histology 21, 22, 23.…”

Section: Discussionsupporting

confidence: 80%

“…Although recent studies suggest that further diagnostic work‐up in case of benign histology is recommended to exclude focal endometrial (pre)malignancy 20, 21, 22, 23, all women in our study that developed endometrial cancer after initial benign histology or hyperplasia without atypia, presented with recurrent postmenopausal bleeding, and were diagnosed with early stage disease. Therefore, based on these data, we cannot yet recommend the need for additional work‐up.…”

Section: Discussionmentioning

confidence: 73%

See 1 more Smart Citation

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

Visser

Sparidaens

Brink

et al. 2016

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

IntroductionWomen with postmenopausal bleeding and endometrial thickness >4 mm undergo endometrial sampling to exclude endometrial cancer. The aim of this study is to investigate the relative risk of developing endometrial cancer in a prospective cohort after initial work‐up for postmenopausal bleeding showing reassuring histology or insufficient sampling.Material and methodsAll women presenting with postmenopausal bleeding were prospectively included from January 2009 to April 2011. Follow‐up data were collected from patient charts and PALGA (Dutch Pathology Registry). Hazard ratios for endometrial cancer were determined by calculating standardized incidence ratios.ResultsA total of 668 women were included and 568 women were available for follow‐up [median follow‐up time 47 (range 7–63) months]. Women who presented with postmenopausal bleeding, endometrial thickness >4 mm and hyperplasia without atypia on biopsy at the first presentation showed a significantly increased risk (standardized incidence ratio 17.15, 95% confidence interval 1.96–61.93) of being diagnosed with endometrial cancer during the first four years of follow up compared with the age‐specific population. All women that developed endometrial cancer after initial reassuring histology presented with recurrent postmenopausal bleeding. None of the women with endometrial thickness >4 mm and no or insufficient sample for histology at the first presentation developed endometrial cancer during the follow up.ConclusionsAlthough in general, women with endometrial hyperplasia without atypia are considered to have a low risk for cancer, we observed a significant long‐term risk of endometrial cancer after postmenopausal bleeding. Whether additional diagnostics or a more stringent follow‐up regimen would be cost‐effective, needs to be studied.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 73%

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

Visser

Sparidaens

Brink

et al. 2016

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…According to the results of recent metaanalysis performed by van Hanegem et al [4], the sensitivity of endometrial sampling in women with postmenopausal bleeding to detect not only endometrial cancer but also atypical hyperplasia or benign endometrial conditions like intrauterine polyps, is lower than previously thought. Endometrial biopsy performed for abnormal uterine bleeding evaluation using Pipelle device has the sensitivity of malignancy detection ranging from 67% to 83.5% [4]. Although endometrial cancer in young women is very rare it can be unexpectedly detected at hysteroscopy during uterine cavity diagnosis due to multiple IVF failures.…”

mentioning

confidence: 95%

“…Appropriate EC staging before operative procedures is mandatory to plan effective and tailored surgical treatment. In case of abnormal uterine bleeding, curettage was regarded to be the gold diagnostic standard for many decades [4]. The aim of our study was to analyze the available current status of knowledge regarding the possibility of neoplastic cell spread in the peritoneal cavity in the course of hysteroscopy performed in women with endometrial cancer.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic hysteroscopy and the risk of malignant cells intraabdominal spread in women with endometrial cancer

Stachowicz

Mazurek

Łoziński³

et al. 2017

Ginekol Pol

View full text Add to dashboard Cite

Although hysteroscopy is currently the undisputed gold standard for the examination of the uterine cavity in women with suspected endometrial cancer, it remains controversial as a procedure that can enhance metastasis spread. Endometrial cancer cells may shed during hysteroscopy and be passively transported with fluid flow into the peritoneal cavity. The paper presents the review of current knowledge regarding the risk of neoplasm metastases in women who had diagnostic hysteroscopy and the conditions that have to be met for the procedure to be safe. We searched PubMed, Ovid, Medline and Scopus databases for data published in the years 1985-2017. The following browsing criteria, the "MeSH headings": hysteroscopy, endometrial cancer, intraperitoneal or metastatic spread were used to find relevant papers. Based on the current data analysis we conclude that: 1) diagnostic hysteroscopy performed in women with endometrial cancer, especially in its early stages, is a very useful, efficient and safe diagnostic method and 2) the distension media used for endoscopic procedures in the uterine cavity must be strictly controlled for relatively low pressures to prevent the increase in risk of endometrial cancer intraperitoneal spread.

show abstract

“…Correct identification and classification of hyperplasia are especially important in endometrial biopsy and curettage specimens because proper diagnosis guides clinical therapy³, which can be very different depending on the type of hyperplasia found. This pathologic entity is detected in up to 25% of women with abnormal bleeding that were submitted to diagnostic hysteroscopy [4][5][6] . The atypical hyperplasias presents a higher risk for adenocarcinoma progression and, in 40% of cases, it can occur with concomitant invasive neoplasia 7 .…”

Section: Introductionmentioning

confidence: 99%

Effect of letrozole in carcinogen-plus-estrogen-induced endometrial hyperplasia in mice

et al. 2016

View full text Add to dashboard Cite

PURPOSE:To evaluate the effects of letrozole (Ltz) in carcinogen+estrogen-induced endometrial hyperplasia. METHODS:BALB/c female mice were divided into four groups of 12 animals each receiving an intrauterine dose of N-ethyl-Nnitrosourea (ENU) and weekly subcutaneous injections of estradiol hexaidrobenzoate (EHB), except for group I(control). The groups were divided in I (control), II (ENU+EHB), III (ENU+EHB+MPA) and IV (ENU+EHB+Ltz). Group III also received intramuscular injections of MPA (medroxy progesterone acetate) every four weeks, while group IV received oral doses of Ltz daily. At the end of 16 weeks, the animals were sacrificed, and blood samples were collected for the measurement of serum estradiol and progesterone levels.Uterine histological sections were made to evaluate the presence of endometrial proliferative lesions. Differences between groups were evaluated with student's t test, ANOVA and chi-square test. RESULTS:Groups ENU+EHB, ENU+EHB+MPA and ENU+EHB+Ltz showed varying degrees of endometrial hyperplasia. The incidence of hyperplasia in groups ENU+EHB and ENU+EHB+Ltz was higher and more severe than in group ENU+EHB+MPA.Control group showed lower levels of serum estradiol than the other groups. CONCLUSION:There was no evidence that letrozole could act as an antiestrogenic drug in the development of endometrial proliferative lesions.

show abstract

The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis

Cited by 165 publications

References 34 publications

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

Long‐term risk of endometrial cancer following postmenopausal bleeding and reassuring endometrial biopsy

Diagnostic hysteroscopy and the risk of malignant cells intraabdominal spread in women with endometrial cancer

Effect of letrozole in carcinogen-plus-estrogen-induced endometrial hyperplasia in mice

Contact Info

Product

Resources

About