SIMULTANEOUS endometrial aspiration and sonohysterography offer a highly sensitive screening approach for detecting endometrial cancer and hyperplasia in women aged 50 years or older. This combined procedure demonstrates effectiveness as a one-stop outpatient diagnostic tool, potentially improving early detection and patient outcomes.
A prospective study, conducted between February 2014 and October 2020 at an urban academic medical centre, evaluated the diagnostic accuracy of combining sonohysterography with ultrasound-guided endometrial aspiration in 1,635 women. Participants underwent the combined procedure and were followed for up to one year to monitor outcomes. The primary focus was identifying cases of endometrial cancer or hyperplasia during the follow-up period.
Of the 1,170 women who completed the study, 7.0% were diagnosed with endometrial cancer and 3.6% with endometrial hyperplasia. The simultaneous use of both diagnostic methods achieved a sensitivity of 99.1%, specificity of 24.9%, positive predictive value (PPV) of 11.8%, and negative predictive value (NPV) of 99.6%. In a theoretical sequential approach, where endometrial aspiration was performed only on patients flagged as high risk by sonohysterography, sensitivity dropped to 93.4%, while specificity improved significantly to 99.9%, with a PPV of 99.0% and NPV of 99.3%.
The findings suggest that combining endometrial aspiration with sonohysterography enhances the sensitivity of screening while maintaining high negative predictive value, making it a reliable method for ruling out disease. This integrated approach addresses limitations associated with each individual technique, providing a streamlined, efficient screening process that reduces the need for additional diagnostic procedures. In clinical practice, this method could facilitate earlier detection of endometrial abnormalities, thereby enabling timely intervention and improving patient outcomes.
Reference
Rotenberg O et al. Combining Ultrasonography and Endometrial Aspiration as a One-Stop Screening for Endometrial Neoplasia. Obstet Gynecol. 2024;144(6):801-9.
