A new technique to obtain endometrial directed biopsy during sonohysterography: the NiGo device

The primary goal of the clinical evaluation of abnormal uterine bleeding is to establish a specific diagnosis in the most efficient and least invasive manner possible. Hysteroscopy (HS) allows physicians to obtain directed biopsy in addition to direct visualization of the uterine cavity and lesions, but often requires ambulatory surgery centers and some anesthesia, or can potentially result in significant patient discomfort. Sonohysterography (SHG) is less invasive than HS but does not allow a histologic sample. A new technique, called the Nicoletti-Gorlero (NiGo) device, was developed and evaluated to obtain histologic results during SHG. This study is a prospective, observational evaluation between the NiGo device technique and standard HS to obtain endometrial samples. The NiGo device was used to obtain an endometrial sample during SHG in 18 women. In a subsequent session, HS was performed to verify the results. From January 2005 through November 2005 both procedures (SHG + biopsy and HS) were performed on 18 patients. The SHG procedures using the NiGo forcep were performed successfully on 15 out of 18 women, and the endometrial sample was obtained in 14 out of 15 patients. In one patient, the endometrial biopsy obtained provided too little tissue to accomplish histologic evaluation. All 13 pathologic results obtained with the NiGo device were identical with those subsequently obtained with HS. The office-based HS procedure was not successful in two women; in these women, an HS procedure performed in the operating room was necessary. The NiGo device technique allows the physician to obtain sonographic-guided biopsies of the entire endometrium during SHG. The technique is less invasive compared with HS. In our small series, there were no complications during the procedure.