Background
endometrial malignancy, endometrial polyps, endometrial malignancies
ENDOMETRIAL POLYPS, PATHOLOGY, POSTMENOPAUSAL BLEEDING
Postmenopausal bleeding (PMB) can be the first clinical sign of endometrial pathology. Women with PMB and an endometrial thickness of more than four mm on ultrasound carry a potential high risk of an endometrial malignancy. The risk for an endometrial malignancy is about 10% in women with PMB and a thickened endometrium. The presence of endometrial polyps is reported in 40% of women with PMB and a thickened endometrium [The endometrial aspiration sample is an accurate test to detect endometrial malignancies, however focal lesions, such as polyps, can be missed [We performed a randomized controlled trial (ESPRESSO trial) in which we analyzed the quality of the aspiration samples in two groups: One group first received the SCSH and subsequently the endometrial aspiration sample, the second group first received the endometrial aspiration sample and subsequently the SCSH. The primary analysis of the ESPRESSO trial showed that the quality of the endometrial sample, classified as sufficient or insufficient following a standard protocol by an in-house pathologist, was not affected by whether SCSH was performed before or after endometrial sampling [However, the quality of the endometrial sample is based on specific histological features. These features were not specifically analyzed in the primary results. For the current study, we assessed these specific histological features of the endometrial samples. We hypothesized that specific histological features of the endometrial samples would be affected by the SCSH. An essential histological feature to evaluate the endometrial aspiration sample based on expert opinions is the tissue context. This context could be disrupted by the saline infusion. We also hypothesized that the endometrial glands would be damaged due to the SCSH. Both factors would potentially affect the quality of the endometrial sample. Furthermore, we wanted to determine which histological features are critical for the quality of the endometrial sample by comparing the histological features of the sufficient and insufficient samples.