Intrauterine sponge biopsy: A new technique for the detection of early intrauterine malignancy

Chatfield, William Robertson (1972) Intrauterine sponge biopsy: A new technique for the detection of early intrauterine malignancy. MD thesis, University of Glasgow.

Abstract

This thesis presents a new technique for obtaining samples of endometrium and andocervix, suitable for a histological diagnosis. It employs the principles of sponge biopsy and the introduction of intrauterine contraceptive devices. A piece of dry, abrasive polyvinyl sponge is passed through the cervix within a standard intrauterine contraceptive device introducer. It is expelled into the uterine cavity and withdrawn immediately. The sponge scrapes off pieces of endometrium and endocervix from all sites within the uterus. It absorbs the abrased tissue into itself and the entire sponge containing the biopsies is processed as a routine histological specimen. Endometrial and cervical carcinoma now occur in equal frequency. The decreased incidence of cervical cancer has resulted from the general improvement in the socio-economic status of the population, together with the detection and treatment of preinvasive cancer by asymptomatic population screening with cervical cytology. The incidence of endometrial carcinoma has increased with affluence and has not been affected by attempts at earlier diagnosis. There have been no satisfactory screening techniques for asymptomatic intrauterine cancer. Formal curettage of symptomatic women has failed to improve the survival from endometrial carcinoma in the last thirty years. The previous attempts at detecting early endometrial cancer on a significantly large scale, relied on cytological methods, uterine lavage or limited site biopsy with small curettes. These methods are described and critically reviewed. An acceptable screening procedure must be safe, simple and inexpensive. It must be performed as an outpatient procedure, without anaesthetic, prior dilatation of the cervix or unique discomfort to patient. It must reliably sample the endometrium and detect or suspect malignant or premalignant change if present, by obtaining random samples from the entire uterine savity suitable for a histological diagnosis. To evaluate the suitability of the new technique, intrauterine sponge biopsies were correlated with endometrial biopsies obtained by formal uterine curettage, which is the accepted standard of intrauterine diagnosis. The correlation between the two methods was satisfactory. Sponge biopsy detected or suspected endometrial cancer in all but one case, where the malignant change was at the base of an atrophic endometrial polyp. It readily biopsied hyperplastic and potentially premalignant conditions. Adequate tissue for a histological diagnosis was obtained in 98 per cent of sponge biopsies. In addition to its ability to detect endometrial cancer, the leading "V" of the sponge selectively biopsies the cervical canal as it is withdrawn from the uterus. Cervical biopsies were present in on third of the sponges and these included all cases of invasive cancer of the endocervix and ectocervix. This aspect of the technique overcomes the recognised inability if cervical cytology to reliable detect malignant change of the endocervix and inaccessible ectocervix. The extensive international experience of inserting contraceptive devices in unanaesthetised outpatients, proves that the identical techniques of intrauterine sponge biopsy is an acceptable outpatient procedure of widescale implementation. Sponge biopsy satisfies all the criteria of a screening technique for endometrial cancer and has the additional ability of screening the cervical canal. It is proposed that intrauterine sponge biopsy bears the same relationship to endometrial cancer as cervical cytology has to cervical cancer. In view of the similar roles and objectives of the two techniques it is logical to intergrate sponge biopsy into existing cervical cytology programmes. This would overcome the deficiencies of cervical cytology and would provide the asymptomatic female population with a total uterine cancer screening programme. A pilot study confirms that sponge biopsy can be readily integrated into existing cytology programmes. Without radical changes in the treatment of uterine cancer, the improvement in early diagnosis which will result from a combined screening programme, offers the only real chance of reducing the incidence, the morbidity and mortality of uterine cancer. Other possible applications of intrauterine sponge biopsy technique in gynaecological practice are discussed as an appendix to the thesis.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Additional Information: Adviser: Ian Donald
• Keywords: Medicine, Histology, Obstetrics
• Date of Award: 1972
• Depositing User: Enlighten Team
• Unique ID: glathesis:1972-73877
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 14 Jun 2019 08:56
• Last Modified: 14 Jun 2019 08:56
• URI: https://theses.gla.ac.uk/id/eprint/73877