The Postendometrial Ablation Endometrium: Reassessment With Biopsy and Ultrasonography

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 123 Suppl 1; no. Supplement 1; p. 124S
• Main Authors: Gadzinski, Jill A, Sheran, Jordan, Garbe, Gretchen, Fitzgerald, Garrett, Mueller, Elizabeth, Wagner, Sarah
• Format: Journal Article
• Language: English
• Published: by The American College of Obstetricians and Gynecologists 01.05.2014
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/01.AOG.0000447083.64986.03

INTRODUCTION:The objectives of this study were 1) to describe a series of patients who required endometrial sampling after endometrial ablation; and 2) to examine the feasibility of endometrial sampling after endometrial ablation. METHODS:All patients who underwent an endometrial ablation from January 1, 2005 to December 31, 2012, at a university and community hospital were identified using the electronic medical record. Demographic variables, preablation tissue sampling, and ablation methods were extracted. Postendometrial ablation care for each patient was reviewed including type and success of endometrial sampling, hysterectomy, and pathology reports. Successful sampling was defined as a tissue sample that contained endometrium. Data were tabulated using SPSS 19. RESULTS:Three hundred three patients were identified. Forty-five percent were obese, 70% were hypertensive, and 12% were diabetic. Twenty-nine patients underwent one or more endometrial evaluations with either office endometrial biopsy or dilation and curettage under anesthesia for a combined 43 tissue samples; there was a 40% failure rate. Seventy-four percent of samples were obtained by endometrial biopsy with a 38% failure rate. The remaining samples were by dilation and curettage with a 45% failure rate. Ninety-nine pelvic ultrasound examinations were performed. The endometrial stripe ranged from 2 to 27 mm. In 12% of ultrasound examinations, the endometrial demarcation was inexact; stripe measurement was not reported. Thirty-four patients underwent hysterectomy. All hysterectomy specimens contained endometrial tissue, and one had endometrial cancer not detected by sampling. CONCLUSION:This study suggests that endometrial sampling after an endometrial ablation is frequently infeasible. A 40% failure rate in assessing abnormal bleeding, the most common symptom of endometrial carcinoma, is both high and concerning.