INTRODUCTION
Expired
One-third of patients who visit a gynecologist are there because of abnormal uterine bleeding (AUB), which is believed to account for more than 70% of gynecologic consults in perimenopausal and postmenopausal women.1 Endometrial evaluation has evolved since the introduction of suction piston biopsy instruments in the 1980s. Once adequate for evaluation of women with AUB or postmenopausal bleeding, the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on AUB now states that a negative blind endometrial biopsy is not a stopping point in persistent bleeding.1 Previously, many health care providers avoided in-office “point of care“ direct visualization of the endometrial cavity with hysteroscopy for a variety of reasons. However, newer disposable equipment has resulted in a changing landscape that will allow many gynecologists to add such evaluation to their in-office procedures.
Endometrial Evaluation: Are You Still Relying on a Blind Biopsy?
This activity was planned for obstetricians and gynecologists and women’s health care providers.
Supported by an educational grant from:
CooperSurgical, Inc.
Activity Information
Expired
Date of Original Release: October 1, 2017
Expired
Continuing medical education (CME) credit is awarded upon successful completion of the posttest and evaluation.
To access the posttest and evaluation, visit www.worldclasscme.com/endometrialevaluation
World Class CME is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
World Class CME designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
To access the posttest and evaluation, visit www.worldclasscme.com/endometrialevaluation
Faculty
Program Director
Steven R. Goldstein, MD, CCD, NCMP, FACOG
Professor of Obstetrics and Gynecology
New York University School of Medicine
Director of Gynecological Ultrasound
Co-Director of Bone Densitometry
Department of Obstetrics and Gynecology
New York University Medical Center
New York, New York
Author
Ted L. Anderson, MD, PhD
Betty and Lonnie S. Burnett Professor of Obstetrics and Gynecology
Vice Chair for Gynecology
Vanderbilt University Medical School
Nashville, Tennessee
Learning Objectives
At the conclusion of this activity, the participant will be able to:
- See-realize the shortcomings of blind endometrial sampling and the history of how that has evolved
- Understand how to best evaluate women with abnormal uterine bleeding or postmenopausal bleeding
- Appreciate how to incorporate direct visualization of the endometrial cavity with new disposable equipment
- Understand what “point of care” evaluation means in abnormal uterine bleeding and how to implement it
- Appreciate some “pitfalls and pearls” for evaluating such patients
References
1. Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol. 2012;120(1):197-206.
2. Goldstein SR. Modern evaluation of the endometrium. Obstet Gynecol. 2010;116(1):168-176.
3. Goldstein SR, Zeltser I, Horan CK, Snyder JR, Schwartz LB. Ultrasonog-raphy-based triage for perimenopausal patients with abnormal uterine bleeding. Am J Obstet Gynecol. 1997;177(1):102-108.
4. Stovall TG, Photopulos GJ, Poston WM, Ling FW, Sandles LG. Pipelle endometrial sampling in patients with known endometrial carcinoma. Obstet Gynecol. 1991;77(6):954-956.
5. Guido RS, Kanbour-Shakir A, Rulin MC, Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med. 1995;40(8):553-555.
6. Larson DM, Krawisz BR, Johnson KK, Broste SK. Comparison of the Z-Sampler and Novak endometrial biopsy instruments for in-office diagnosis of endometrial cancer. Gynecol Oncol. 1994;54(1):64-67.
7. Ferry J, Farnsworth A, Webster M, Wren B. The efficacy of the pipelle endometrial biopsy in detecting endometrial carcinoma. Austn N Z J Obstet Gynaecol. 1993;33(1):76-78.
8. Rodriguez MH, Platt LD, Medearis AL, Lacarra M, Lobo RA. The use of transvaginal sonography for evaluation of postmenopausal ovarian size and morphology. Am J Obstet Gynecol. 1988;159(4):810-814.
9. Grimbizis GF, Tsolakidis D, Mikos T, et al. A prospective comparison of transvaginal ultrasound, saline infusion sonohysterography, and diagnostic hysteroscopy in the evaluation of endometrial pathology. Fertil Steril. 2010;94(7):2720-2725.
10. Kelekci S, Kaya E, Alan M, Alan Y, Bilge U, Mollamahmutoglu L. Comparison of transvaginal sonography, saline infusion sonography, and office hysteroscopy in reproductive-aged women with or without abnormal uterine bleeding. Fertil Steril. 2005;84(3):682-686.
11. Moawad NS, Santamaria E, Johnson M, Shuster J. Cost-effectiveness of office hysteroscopy for abnormal uterine bleeding. JSLS. 2014;18(3): doi: 10.4293/JSLS.2014.00393.
12. Shinar S, Bibi G, Barzilay L Rubens P, Almog B, Levin I. The value of diagnostic hysteroscopy before operative hysteroscopy for suspected abnormal intrauterine findings. J Minim Invasive Gynecol. 2014;21(2):228-232.
13. Wortman M. The EndoSee hysteroscope: Initial experience with a selfcontained hand-held hysteroscopy system [abstract]. J Minim Invasive Gynecol. 2013;20(6 suppl):S68.
14. Munro M. Pilot evaluation of the EndoSee hand-held hysteroscopic system for diagnostic hysterocopy [abstract]. J Minim Invasive Gynecol. 2013;20(6 suppl):S68-S69.
Disclosures
Conflict of interest disclosure
Steven R. Goldstein, MD, CCD, NCMP, FACOG
Consultant: CooperSurgical—Consulting fees received
Consultant: Cook OB/GYN—Consulting fees received
Recipient: Philips Ultrasound—Equipment loan
No disclosures to declare
Ted L. Anderson, MD, PhD
Heidi M. Wilson, Course Director