An alternative to the diagnostic dilatation and curettage - ndometrial

Endometrial aspiration cytology has been shown by multicentre prospective studies to be an acceptable and valuable method of assessing the endometrium. A retrospective study was undertaken over three years' routine use of the Isaacs cell sampler. In 86% of the cases suitable endometrium was obtained, with experience of the technique being the important factor. When compared with histological findings, all 11 cases of malignancy were confirmed, including one ovarian adenocarcinoma. Of the cytological reports of endometrial hyperplasia, 78% were confirmed by the histological findings, with the remainder showing minor degrees of cystic hyperplasia or normal endometrium. In no case was a more abnormal lesion present on histological examination than had been suggested by cytological findings. The use of progestogens in reversing hyperplasia is seen to be effective, though the long term benefit remains uncertain. It is concluded that with an experienced cytologist, Isaacs endometrial aspiration should be used routinely for the primary investigation of dysfunctional uterine bleeding and postmenopausal bleeding. Samaritan Hospital for Women, London NW1 D W POLSON, MB, BS, senior house officer A MORSE, CFIAC, chief medical laboratory scientific officer Department of Obstetrics and Gynaecology, St Mary's Hospital Medical School, London W2 R W BEARD, MD, FRCOG, professor of obstetrics and gynaecology Correspondence to: Professor R W Beard. Introduction Endometrial aspiration using the Isaacs cell sampler has been used regularly at the Samaritan Hospital for eight years as a routine gynaecological outpatient investigation. This technique is simple, quick, safe, and acceptable to the patient,' 2 and several prospective studies have emphasised the diagnostic accuracy of the method.'-4 A retrospective review has been undertaken to confirm that endometrial cytology in routine use is an accurate method of determining the state of the endometrium and to see the effect on management of patients. Patients and methods From January 1980 to December 1982 endometrial aspirates were obtained from 709 women: 607 in the gynaecology clinic at the Samaritan Hospital, 62 from the Raymede Family Planning Clinic, and 40 from private consultations. None of the women received anaesthetics, and the Isaacs endometrial aspirator was used in all cases, as previously described.3 Table I shows the indications for endometrial aspiration. There was a considerable variation in the experience of the medical staff performing the aspiration, from the most junior senior house officer through all the registrar grades to consultant. The cytological findings were reported by a single cytologist; earlier work has clarified the cytological changes during the menstrual TABLE I-Indication for endometrial aspiration in 709 women seen during study period (excluding any patients included in prospective studies)