Cancer is always suspected when a woman has postmenopausal bleeding, even if benign conditions are most common. When postmenopausal bleeding occurs, ultrasound is always performed as well as endometrial sampling for histological evaluation. The tissue sample can be taken with either a pipelle or equivalent instrument, or by fractionated abrasion. The endometrial sampling can be done as an outpatient procedure without anesthesia, however, fractionated abrasion requires anesthesia.
A meta-analysis (10) has shown a 97–99% sensitivity and 98–100% specificity of pipelle or vabra methods in diagnosing endometrial cancer. The amount of material obtained by pipelle is sometimes minimal to determine the histological type and grade. In such cases, we choose to do fractionated abrasion under general anesthesia.
- To obtain a representative endometrial sample for histological evaluation.