Perma Curette and Hysteroscopy: An Observational Study About Endometrial Sampling

Abstract

The role of blind endometrial sampling, in the era of hysteroscopy-guided biopsy, can be only considered as a screening tool or a first-line approach if a hysteroscopy cannot be performed for whatever reason. Several devices are available, with Perma (a sharp-edged spatula sliding inside a flexible cannula) being one of them. Objectives: The aims of this study were to compare the concordance of blind to visual endometrial sampling, and the influence of operators’ experience on the results. Materials and Methods: Women undergoing hysteroscopy were invited to undergo a Perma biopsy as well. If accepted, a Perma sampling was performed before the hysteroscopy and only if there was no cervical dilatation (as an office setting). The operator was randomly chosen between expert (two staff members) and non-expert (two residents) operators. All cases were collected at the AOU Maggiore della Carità, Novara, Italy. Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD. The association between categorical variables was evaluated using Fisher’s exact test. Clinical outcomes were analyzed, and the results were first compared within the same patient and subsequent within the doctors’ group (inter- and intra-variation) in terms of Cohen’s Kappa. Results: 82 women performed both hysteroscopy and Perma. A sensitivity of 81.8% and specificity of 100% was found when Perma was compared to hysteroscopy (the gold standard). The comparison between valid vs. invalid samples in terms of sufficient evaluable tissue was not significant (p = 0.583). There are no statistical associations with body mass index, parity, or previous intrauterine surgery related to the outcomes of hysteroscopy and Perma. Cohen’s Kappa between non-experts was 0.43 (moderate), between experts was 0.30 (fair), with the highest concordance being between one non- and one expert (0.68 = substantial). Perma represents a pragmatic diagnostic tool, which could also be used in outpatient.

Keywords

• Perma curette
• hysteroscopy
• endometrial sampling
• endometrial cancer