![]() Today the most widely used device is the disposable Pipelle® also known as Pipelle de Cornier®.Ĭan now be performed without prior cervical dilatation and can be undertaken as an outpatient procedure or in general practice.Subsequently, the Vabra® curette was introduced, which required a vacuum source and also caused significant cramping.This caused significant cramping during removal. As the cannula was rotated during removal, a strip of endometrium was peeled off and sucked into the syringe.Introduced in the 1930s, originally using a narrow metal cannula with side opening with serrated edges and syringe attached for suction as the instrument was removed.If the endometrial sample is normal but the bleeding persists, further sampling is recommended. This strategy is the most cost-effective for the UK where the prevalence of endometrial cancer is below 15%. If a thickness of >4 or 5 mm is found, the next step is to obtain an endometrial sample for histology. Greater thickness is associated with an increased risk of endometrial pathology - cancer, hyperplasia and polyps, and the thicker the endometrium, the greater the risk. The British Gynaecological Cancer Society 2021 guidelines suggest a threshold of 4 mm. However, there is a false positive rate of over 70%. Several meta-analyses that have used a cutoff measurement of 5 mm or less had a 96% sensitivity and a post-test probability of 2.5% for endometrial cancer in postmenopausal women. There is some uncertainty regarding the optimal cutoff for endometrial thickness. Transvaginal ultrasound measurement of endometrial thickness has become a routine procedure and an initial investigation in most patients with abnormal uterine bleeding (see guidelines above).Greater than 5 mm endometrial thickness has been the standard threshold for the symptomatic postmenopausal patient having ultrasound scanning in the UK and the USA. Ĭlinical scenarios Postmenopausal woman with symptoms (vaginal bleeding) Family history of endometrial or colonic cancer - Lynch syndrome.Anovulatory cycles - eg, polycystic ovary syndrome.Insulin resistance and hyperinsulinaemia.The majority of women are unaware of the link between obesity and endometrial cancer.Endometrial cancer has the greatest association with obesity of all cancers, with a relative risk of 6.25.70-90% of women with endometrial cancer are obese.
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