Hysteroscopy with directed biopsy versus dilatation and curettage for the diagnosis of endometrial hyperplasia and cancer in perimenopausal women.
BACKGROUND
The present study was undertaken to compare the effectiveness of dilatation and curretage (D&C) with hysteroscopy and guided biopsy (H+B) for the collection of endometrial samples adequate for histological examination in perimenopausal women at risk of endometrial hyperplasia or cancer.


METHODS
We performed hysteroscopy and biopsy followed by dilatation and curettage in 734 patients with abnormal perimenopausal bleeding or sonographically revealed endometrial pathology. Two hundred and ninety-two patients in whom lesions were totally removed during hysteroscopy were excluded from further study.


RESULTS
Using both methods we disclosed 64 cases of endometrial polyps, 60 cases of endometrial hyperplasia, and 49 cases of endometrial cancer. Hysteroscopy left just four cases of endometrial pathology undiagnosed as opposed to 21 cases using dilatation and curettage. Histology could not be performed on material obtained with hysteroscopy in four cases and with curettage in 23 cases.


CONCLUSIONS
1) Hysteroscopy with directed biopsy is more sensitive in disclosing all types of uterine lesions than dilatation and curettage. 2) Curettage done after hysteroscopy and directed biopsy does not improve the detection of endometrial cancer.
Bedner
R
R
Clinic of Surgical Gynecology and Oncology of Adults and Children, Pomeranian University of Medicine, Szczecin, Poland.
Rzepka-Górska
I
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004107:Dilatation and Curettage; D004714:Endometrial Hyperplasia / Q000175:diagnosis*; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008593:Menopause; D008875:Middle Aged