Comparison between suction curettage, transvaginal sonography and hysteroscopy for the diagnosis of endometrial polyp

Objective To compare the efficacy of suction curettage, hysteroscopy and transvaginal sonography in the diagnosis of endometrial polyps in both pre‐ and postmenopausal patients. Setting The study was carried out in a private hospital with facilities for endoscopic surgery. Design Comparative clinical study involving different techniques for the diagnosis of endometrial polyps in pre‐ and postmenopausal patients. Subjects 74 patients with endometrial polyps. Interventions Patients with abnormal transvaginal sonograms were submitted to diagnostic hysteroscopy to confirm the presence of polyps. A suction curettage using a 4‐ or 5‐mm Karman curette was carried out after hysteroscopy to obtain fragments of polyps for pathological examination. Polypectomy followed by endometrial resection was performed using the 27F resectoscope after the uterine cavity was aspirated using an 8‐mm Karman curette. Results The percentage of positive histopathological diagnoses of endometrial polyps was low whenever suction curettage was performed with a 4‐mm curette. The value increased to 80% when the 5‐mm curette was used to sample the uterine cavity in patients with a hysteroscopic diagnosis of polyps. The 8‐mm suction curette was effective in removing large fragments of polyps prior to polypectomy in all cases. Conclusion Suction curettage can be used to diagnose endometrial polyps in over 80% of patients, if curettes with diameters equal to or greater than 5 mm are used. Use of suction cannulae of less than 4 mm in diameter leads to the diagnosis of endometrial polyps being missed in 90% of cases.