title: Sono-guided endometrial biopsy: comparison with hysteroscopy biopsy. Sono-guided endometrial biopsy using the Bernard catheter had no impact on endometrial assessment by sonohysterography.
abstract: OBJECTIVE
  To assess the feasibility, tolerance and diagnostic accuracy of endometrial biopsy (EB) during sonohysterography (SH) compared to EB after hysteroscopy (HSC) in endometrial disorders.
  
  
  METHODS
  105 consecutive patients with irregular uterine bleeding were included prospectively in the calendar year 2001. SH and flexible HSC were performed in an office setting, subsequently and in a random order, by two different practitioners blind to the former experiment. SH-EB was performed using a 3.1-mm ultrasound-guided Bernard catheter in the uterine cavity still partly distended and with a gentle 20-ml syringe vacuum aspiration. The biopsy was directed on focal lesions or else randomly when no targets had previously been found. A Cornier Pipelle was used to perform EB after HSC. We investigated all patients by biopsy, independent of the endometrial thickness. HSC-EB was the gold standard.
  
  
  RESULTS
  For both methods, cervical catheterism was impossible in 20 patients, 75 of them successfully underwent both exams. Duration and tolerance were similar. SH was effective in the distinction between normal and pathologic cavities, as well as in the diagnosis of polyps. Endometrium appeared significantly thinner with HSC (1.8 mm) when compared to SH (2.9 mm, p < 0.05). Histological endometrial assessment failed in 30 cases of SH-EB and in 22 cases in HSC-EB (NS). There was a poor correlation of the histological results of both techniques. Hyperplasia has never been diagnosed by SH-EB, whereas 3 EB issued from HSC-EB brought up this diagnosis.
  
  
  CONCLUSIONS
  SH-EB with our technique did not improve the diagnostic potential of SH and severe diagnosis was missed. Histological assessment should fail less when we exclude endometrial atrophy. The diameter of the catheter and the aspiration technique must be revised and the learning curve must be considered. Our technique cannot replace EB by HSC.
authors.affiliation: Service de Chirurgie Gynécologique et Cancérologique, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Metzger
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bernard
authors.forename: Sophie
authors.initials: S
authors.lastname: Camatte
authors.forename: Loïc
authors.initials: L
authors.lastname: Lelièvre
authors.forename: François
authors.initials: F
authors.lastname: Robin
authors.forename: Marie-Aude
authors.initials: MA
authors.lastname: Lefrère-Belda
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lécuru
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation; D004714:Endometrial Hyperplasia / Q000473:pathology; D004717:Endometrium / Q000473:pathology*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000473:pathology*