Microcurettage sampling of the endometrium for histopathological examination--simpler but not safe? Comparison of endometrial histopathology in samples obtained by a disposable mechanical curette and by traditional curettage.

The routine use of dilatation and curettage (D&C) is questioned as a standard procedure for endometrial sampling. Instruments have been developed in order to simplify the procedure. The aim of the present study was to estimate the sensitivity to detect malignancy/premalignancy by histological examination of endometrial samples obtained by microcurettage using a disposable plastic curette, Gynoscann. The histological examination of the combined microcurettage and D&C material was defined as the true diagnosis. All patients undergoing diagnostic D&C at the two participating hospitals were included in the study. The endometrial samples were evaluated at the Department of Pathology as part of their routine work. The microcurettage samples were re-examined independently by two pathologists (observer 1 and observer 2) who did not have access to the rest of the tissue material nor the diagnosis given previously. A total of 902 patients were enrolled in the study. Endometrial cancer was found in four women below 50 years of age. None of these were detected by histological examination of the Gynoscann obtained sample. Among women aged 50 and above, samples from 16 women turned out to have endometrial cancer. The microcurettage samples were correctly classified as malignant/premalignant by observer 1 in 13 cases and by observer 2 in 14 cases. We conclude that diagnostic D&C among women 50 years and below cannot be replaced by histological examination of Gynoscann samples without the risk of overlooking significant pathology.