Department of Gynecology and Obstetrics, Máxima Medisch Centrum, Veldhoven, The Netherlands.
Department of Obstetrics and Gynecology, GROW- School for Oncology and Reproduction, GMaastricht UMC+, P. Debyelaan 25, HX, 6229, Maastricht, The Netherlands.
BMC Womens Health. 2023 Feb 4;23(1):46. doi: 10.1186/s12905-023-02178-6.
The aim of this study is to analyze the histopathological features of endometrial samples obtained by aspiration when performed before or after the saline contrast sonohysterography in women with postmenopausal bleeding and a thickened endometrium. Hypothetically, the saline infusion could disrupt the tissue and therefore affect the quality of the sample. Furthermore, we want to determine which histological features have impact on the quality of the endometrial sample.
We performed a randomized controlled trial (ESPRESSO trial) in which we analyzed the aspiration samples in two groups. Women were allocated either to saline contrast sonohysterography and subsequent endometrial sampling (SCSH-Sampling group) or to the opposite order (Sampling-SCSH group). Dedicated gyneco-pathologists retrospectively assessed the specimens and recorded the type (blood, mucus, epithelium, intact glands, stroma and tissue context) and quantity (on a scale of 0-3) of material that was found in the specimens.
This analysis consisted of 197 samples, with 101 women in the SCSH-Sampling group and 96 women in the Sampling-SCSH group. No significant differences were found in the histological features between the two groups. All significant histological features differed significantly in the sufficient samples compared to the insufficient samples: higher amounts of blood, more endometrial epithelium, presence of intact endometrial glands, better stroma and tissue context. Oppositely, a significantly higher amount of mucus was found in the insufficient samples.
This study shows that the histological features of the endometrial sample were not affected by the saline contrast sonohysterography, when performed prior to the tissue sampling. Trial registration ESPRESSO TRIAL, NTR5690, registered 16 February 2016, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR5690 .
本研究旨在分析绝经后出血且子宫内膜增厚的患者行盐水造影超声检查前后行宫腔吸引术获取的子宫内膜样本的组织病理学特征。理论上，盐水灌注可能会破坏组织，从而影响样本质量。此外，我们还想确定哪些组织学特征会影响子宫内膜样本的质量。
我们进行了一项随机对照试验（ESPRESSO 试验），在该试验中，我们将抽吸样本分为两组进行分析。将患者分为盐水造影超声检查后行子宫内膜取样（SCSH-取样组）或相反顺序（取样-SCSH 组）。专门的妇科病理学家回顾性评估标本，并记录标本中发现的物质的类型（血液、黏液、上皮、完整腺体、基质和组织背景）和数量（0-3 级）。
本分析共包括 197 个样本，SCSH-取样组 101 例，取样-SCSH 组 96 例。两组间的组织学特征无显著差异。与不充分样本相比，所有有显著意义的组织学特征在充分样本中均有显著差异：血液量较高、子宫内膜上皮较多、存在完整的子宫内膜腺体、基质和组织背景较好。相反，不充分样本中黏液量明显较高。
本研究表明，在组织取样前进行盐水造影超声检查不会影响子宫内膜样本的组织学特征。
ESPRESSO 试验，NTR5690，于 2016 年 2 月 16 日注册，https://trialsearch.who.int/Trial2.aspx?TrialID=NTR5690。
