Cancer should always be considered when a woman has postmenopausal bleeding, even if benign conditions are most common. When postmenopausal bleeding occurs, ultrasound is always performed as well as sampling for histological evaluation. The sample can be taken by pipelle or D&C. The pipelle sampling can be performed on outpatient basis without general anesthesia. D&C requires anesthesia.
Comparative studies have shown a high sensitivity for diagnosing endometrial cancer. Endometrial biopsy is accurate in making the diagnosis in most cases. However, if the endometrial biopsy is negative and a cause of the bleeding has not been determined, a D&C is required. The amount of material collected by the pipelle technique is, however, not always enough to determine the histological type and grade. If the pipelle sampling is too scarce, subsequent fractionated abrasion must be performed under general anesthesia.
- Obtain a representative endometrial sample for hostological evaluation