Re: Atypical
From: Rafael Haciski (haciski@earthlink.net)
Wed Mar 28 22:32:52 2007
Are you comfortable with a 10% miss rate? (and I question the
validity of that statement, thinking that the miss rate may indeed be
higher) because I am not.
And if there is anything not completely normal on the sono, then I
would proceed to at least SHG, or a hysteroscopy.
Flexible, narrow diameter office hysteroscopy is extremely easy, well
tolerated (with a paracervical block) and allows me that extra margin
of safety in the diagnosis.
--
Rafael Haciski MD FACOG
Palmetto, FL.
On Mar 29, 2007, at 12:18 AM, Raymond Stephen wrote:
> I do not think that you can assume that a Pipelle biopsy will
> always necessarily miss a lesion that is not uniformly throughout
> the endometrium. The correlation with curettage has been
> established as very close. This is because it relies to a large
> extent on suction, and, done properly, covers a wide area. I will
> admit though that a negative result is not always to be relied
> upon. Because it is so benign a procedure it has a very useful
> place in the initial investigation of the endometrium. I find that
> the combination of endometrial thickness on sonography with a
> pipelle gives good information.
>
> http://www.medscape.com/viewarticle/417723_5
>
> Steve
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Rafael Haciski
> Sent: Thursday, 29 March 2007 1:52 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Atypical
>
> I do not find endometrial biopsies useful, as the necessary
> assumption is that the changes are uniform and throughout the
> endometrium, which may not be the case. With simple EBx (EMB) you
> stand a very high chance of missing a solitary lesion. And they
> are not benign by any means (when was the last time you had one?).
>
> If the bleeding is related to hormonal manipulation, recent
> changes, etc, then sono is the first line and if good picture is
> obtained with thin lining throughout (2-3 mm, even) then I would
> observe. If I am uncomfortable with the endometrium (poor picture,
> thicker endometrium, irregular) then I go to hysteroscopy at which
> time a directed biopsy of any suspicious lesion is accomplished,
> followed with extensive curettage.
>
> This way I sleep better knowing I had not missed any lesions.
>
> Rafael Haciski MD FACOG
>
> Palmetto, FL.
>
> On Mar 28, 2007, at 8:57 PM, Raymond Stephen wrote:
>
> A pipelle sampling is a benign procedure, and so is an ultrasonically
>
> generated measurement of endometrial thickness.
>
> Steve
>
> -----Original Message-----
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Elrod,
>
> Darryl G Maj 48 MDOS/SGOBO
>
> Sent: Thursday, 29 March 2007 12:54 AM
>
> To: Multiple recipients of list OB-GYN-L
>
> Subject: RE: Atypical
>
> That's why I've asked my esteemed colleagues. I have read about
>
> hyperplasia and atypical hyperplasia but not atypical without
>
> hyperplasia.
>
> She really doesn't want another tissue sampling if at all possible.
>
> I don't want to put her in for a) more risk and b) a worse
> prognosis if
>
> she does have an undiagnosed cancer.
>
> Glen
>
> -----Original Message-----
>
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joe
>
> Cutchin
>
> Sent: Wednesday, March 28, 2007 3:28 PM
>
> To: Multiple recipients of list OB-GYN-L
>
> Subject: Re: Atypical
>
> For me this is an unusual reading in that the term "atypical" is used
>
> but not hyperplasia. I am uncomfortable with this and would get more
>
> tissue. Joe C
>
> Elrod, Darryl G Maj 48 MDOS/SGOBO wrote:
>
>> 69 yo G2P2 with postmenopausal bleeding, not entirely known where the
>>
>> source was at first. Had a colonoscopy and cystoscopy prior to
> getting to me.
>>
>> EMB shows atypical glandular proliferation, no hyperplasia seen.
>>
>> Suggestions for treatment? The patient is not keen on medication or
>>
>> further biopsies and wants definitive treatment.
>>
>> Thanks,
>>
>> Glen
>
> CONFIDENTIALITY NOTICE AND DISCLAIMER
>
> The information in this transmission may be confidential and/or
> protected by legal professional privilege, and is intended only for
> the person or persons to whom it is addressed. If you are not such
> a person, you are warned that any disclosure, copying or
> dissemination of the information is unauthorised. If you have
> received the transmission in error, please immediately contact this
> office by telephone, fax or email, to inform us of the error and to
> enable arrangements to be made for the destruction of the
> transmission, or its return at our cost. No liability is accepted
> for any unauthorised use of the information contained in this
> transmission. If the transmission contains advice, the advice is
> based on instructions in relation to, and is provided to the
> addressee in connection with, the matter mentioned above.
> Responsibility is not accepted for reliance upon it by any other
> person or for any other purpose.
>
> CONFIDENTIALITY NOTICE AND DISCLAIMER
>
> The information in this transmission may be confidential and/or
> protected by legal professional privilege, and is intended only for
> the person or persons to whom it is addressed. If you are not such
> a person, you are warned that any disclosure, copying or
> dissemination of the information is unauthorised. If you have
> received the transmission in error, please immediately contact this
> office by telephone, fax or email, to inform us of the error and to
> enable arrangements to be made for the destruction of the
> transmission, or its return at our cost. No liability is accepted
> for any unauthorised use of the information contained in this
> transmission. If the transmission contains advice, the advice is
> based on instructions in relation to, and is provided to the
> addressee in connection with, the matter mentioned above.
> Responsibility is not accepted for reliance upon it by any other
> person or for any other purpose.
