Histological sampling by D&CMedical editor Gunnar B. Kristensen MD
Oslo University Hospital
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
- Abrasion tray:
- Broad-spectrum antiseptic (chlorhexidine) 0.5 mg/ml
- Specimen containter with formalin
- Inform the patient about the sampling procedure.
- The sampling is done under general anesthesia.
- The patient lies in a gynecological position during the sampling.
- The vagina and cervix are washed with broad-spectrum antiseptic (chlorhexidine).
- The cervical canal is dilated to Hegar dilator number 9.
- First, scrape the cervical canal with a curette.
- Place the specimen into a specimen container.
- Scrape the uterine cavity with a curette. Thoroughly scrape the entire cavity all around, as well as from the fundus.
- The material is put in a specimen container.
Hysteroscopy may be performed in conjunction with D&C.
- There is a risk for perforation of the uterine wall during this procedure. If this should happen, the patient will be observed at the hospital until the next day due to the risk for bleeding or intestinal perforation.
- Infections can occur.
- Light bleeding can also occur about two weeks after sampling.