Endometrial sampling prior to hysterectomy

Many gynecologists use routine endometrial sampling prior to hysterectomy to detect an unsuspected endometrial carcinoma. Gynecologists who formerly performed uterine curettage under anesthesia before hysterectomy now often use an outpatient endometrial sampling technique. Although safe, this procedure is complicated by discomfort, cost, and the risk of infection or uterine perforation. The purpose of this study was to determine the utility of pre-hysterectomy endometrial sampling. Between 1981-1985, 619 patients undergoing hysterectomy had preoperative endometrial sampling using Vabra aspiration, the Novak curette, or D&C. The endometrial sampling histology was compared with that in the hysterectomy specimen. There were 30 instances in which the endometrial sampling failed to identify either endometrial hyperplasia or carcinoma. In the two cases of endometrial carcinoma, D&C was the sampling method used. The findings of this study indicate that these three techniques of endometrial sampling are equal in their diagnostic capabilities. The results confirm the need for biopsy in patients with postmenopausal bleeding or with abnormal uterine bleeding at age 35 years or older. Our findings do not support routine endometrial sampling prior to hysterectomy.