Sonohysterography-Guided Biopsy of Focal Endometrial Abnormalities: Technical Feasibility and Diagnostic Accuracy

ABSTRACT

PURPOSE: To assess the feasibility and diagnostic accuracy of a sononohysterography-guided biopsy in an evaluation of focal endometrial lesions. MATERIALS AND METHODS: Sixty-five consecutive patients with focal endometrial lesions detected on baseline sonohysterography were enrolled prospectively. The biopsy was performed under real-time sonohysterography guidance, using a 3.1 mm Pipelle endometrial sampler as the primary biopsy device. The feasibility was evaluated from the technical success rates and the number of "diagnostic" specimen for the histological diagnosis. The diagnostic accuracy was assessed by comparing the biopsy results with the final pathological diagnosis obtained by the surgical procedure. RESULTS: Sonohysterography-guided biopsy was performed successfully in 59(90.8%) out of 65 patients. The reasons for failure in 6 patients were a failure to pass through the cervix (n=3); failure to target a focal lesion (n=2); and inadequate uterine distension (n=1). The biopsy specimen was "diagnostic" in 49 (83.1%) out of 50 patients, and "non-diagnostic" in 10 patients with insufficient tissue (n=6) and indeterminate cellular features for a histological diagnosis (n=4). The cytology results of the sonohysterographically-guided biopsy correlated well with the pathological diagnosis in 35 (92.1%) out of 38 patients who underwent subsequent surgical procedures. CONCLUSION: Sonohysterography-guided biopsy is technically feasible and can be an accurate method for diagnosing focal endometrial lesions. It could be considered to be a reliable office triage as an alternative to hysteroscopic biopsy in patients with focal endometrial abnormalities.