title: Direct aspiration endometrial biopsy via flexible hysteroscopy.
abstract: OBJECTIVE
  To determine feasibility and efficacy of direct aspiration endometrial biopsy via the fluid channel of a flexible diagnostic hysteroscope.
  
  
  METHODS
  Retrospective review (Canadian Task Force classification II-3).
  
  
  METHODS
  Abnormal uterine bleeding clinic in a tertiary care center.
  
  
  METHODS
  All women who underwent direct aspiration endometrial biopsy from January 2007 through August 2011 via a flexible diagnostic hysteroscope because traditional office-based endometrial biopsy using a suction piston device was not technically possible.
  
  
  METHODS
  Diagnostic hysteroscopy followed by direct aspiration endometrial biopsy, accomplished by applying suction to the fluid channel of a 3.1-mm flexible diagnostic hysteroscope via a 10-mL syringe. The hysteroscope tip was agitated within the uterine cavity to obtain a tissue sample.
  
  
  RESULTS
  The median age of the 32 identified patients was 50 years; 18 women (56%) were nulliparous, and 10 (31%) were postmenopausal. Thirty-one patients underwent hysteroscopy/direct aspiration biopsy because of abnormal uterine bleeding or postmenopausal bleeding. The vaginoscopic approach was used in 19 patients (59%). Indications for direct aspiration endometrial biopsy included cervical stenosis, inability to pass the endometrial biopsy instrument into the uterine cavity, and patient intolerance of endometrial biopsy. Adequate endometrial samples were obtained in 28 patients (87.5%). In 3 of 4 patients in whom direct aspiration endometrial biopsy did not provide sufficient tissue, hysteroscopy revealed an atrophic-appearing endometrium. The direct aspiration endometrial biopsy diagnosis was confirmed in 5 of 7 patients who subsequently underwent dilation and curettage or hysterectomy.
  
  
  CONCLUSIONS
  Direct aspiration endometrial biopsy is a simple and effective endometrial sampling method when traditional office-based endometrial biopsy is not feasible. Further prospective studies including larger populations are needed to confirm these results.
authors.affiliation: Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota 55905, USA. breitkopf.daniel@mayo.edu
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Breitkopf
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hopkins
authors.forename: Shannon K
authors.initials: SK
authors.lastname: Laughlin-Tommaso
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Creedon
authors.forename: Abimbola O
authors.initials: AO
authors.lastname: Famuyide
mesh_terms: D001706:Biopsy / Q000379:methods; D004717:Endometrium / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008796:Metrorrhagia / Q000209:etiology; D008875:Middle Aged; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000150:complications / Q000473:pathology*