title: [Should we perform intra-operative endometrial biopsy during pelvic reconstructive surgery with uterine preservation?].
abstract: OBJECTIVE
  To evaluate the interest of systematic endometrial biopsy at the time of vaginal reconstructive surgery with uterine preservation.
  
  
  METHODS
  We performed a retrospective monocentric study on all women who had vaginal reconstructive surgery with uterine preservation from 2005 to 2012. All following parameters have been studied: baseline characteristics (age, parity, BMI, hormonal status, medical history), prolapse stage using the POP-Q, preoperative pelvic ultrasound (endometrial thickness), and type of surgery. Women with previous hysterectomy were excluded.
  
  
  RESULTS
  Four hundred and fourteen patients were operated during this period, and 268 have uterine preservation (64.7%). Baseline characteristics were mean age 64.7±10.7 (39 to 92), mean parity 2.6±1.5, mean BMI 25.5±4.2, menopause 238 (88.8%), HRT 32 (12%), previous breast cancer 16 (6%), diabetes mellitus 31 (11.6%), and hypertension 87 (32.5%). Prolapse were at stage II in 127 (47.3%), stage III in 99 (36.9%) and stage IV in 17 (6.3%). Preoperative pelvic ultrasound has been done in 255 patients (95.2%), and mean endometrial thickness was 5.1mm (range 1.6-16). Overall, 152 intra-operative endometrial biopsies were assessable (56.7%). In 24 cases (15.8%), samples were too small to be interpretable. Finally, the 128 interpretable biopsies (82.2%) have shown one carcinoma (0.8%), four hyperplasia (3.2%), two endometrial polyps (1.6%), and 121 normal endometria (94.5%). The only cancer was discovered on a 77 year old patient, with a history of previous breast cancer, and with a preoperative endometrial thickness of 7 mm. No patient with normal preoperative ultrasound endometrial screening had abnormal endometrial biopsy.
  
  
  CONCLUSIONS
  Vaginal reconstructive surgery with uterine preservation implicates a preoperative endometrial evaluation by ultrasound. Intra-operative endometrial biopsy does not seem to be justified.
authors.affiliation: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France; Service de gynécologie-obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire.
authors.forename: E
authors.initials: E
authors.lastname: Bohoussou
authors.affiliation: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France; Service de gynécologie-obstétrique, CHU de Yopougon, Abidjan, Côte d'Ivoire.
authors.forename: S A
authors.initials: SA
authors.lastname: Adjoussou
authors.affiliation: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France.
authors.forename: V
authors.initials: V
authors.lastname: Letouzey
authors.affiliation: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Fatton
authors.affiliation: Service de gynécologie-obstétrique, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France. Electronic address: renaud.detayrac@chu-nimes.fr.
authors.forename: R
authors.initials: R
authors.lastname: de Tayrac
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data; D004717:Endometrium / Q000473:pathology*; D005260:Female; D059247:Fertility Preservation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods* / Q000706:statistics & numerical data; D010298:Parity; D010388:Pelvis / Q000601:surgery; D011237:Predictive Value of Tests; D011247:Pregnancy; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014596:Uterine Prolapse / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*
keywords: Biospie endométriale; Chirurgie vaginale; Conservation utérine; Endometrial biopsy; Genital prolapse; Prolapsus génital; Uterine preservation; Vaginal surgery