The use of ultrasound guidance for endometrial sampling in patient populations with known or suspected cervical stenosis: A retrospective case review

Objective: To assess the safety, efficacy, and diagnostic adequacy of ultrasound-guided endometrial sampling (UGES) in patients with known or suspected cervical stenosis. Methods: We reviewed records of patients who underwent UGES (under general anesthesia) due to cervical stenosis at our center between 1999 and 2024. Of 181 patients identified, 155 were included. Key outcomes included success rate, complication rates, and histopathological findings. Results: The most common indications for sampling included postmenopausal bleeding (72 of 155, 46.5%), abnormal imaging findings (40 of 155, 25.8%), abnormal Papanicolaou test (16 of 155, 10.3%), and neocervix creation after treatment for cervical cancer (10 of 155, 6.5%). The overall success rate of UGES in gaining access to the endometrial canal for assessment of underlying pathology was 93.5% (145 of 155). Of 155 patients, 150 underwent UGES for histopathologic diagnosis; 131 (84.5%) provided adequate tissue for pathologic analysis, 15 (10%) had a sample obtained but had insufficient tissue for pathologic analysis, and 4 (2.7%) failed to provide a tissue sample due to inability to access the endometrial cavity. Overall, 109 of 155 samples (70.3%) were benign and 18 (11.6%) were malignant. All 5 procedures performed for therapeutic reasons were successful. Seven patients (4.5%) experienced a minor adverse event from UGES. No major complications occurred. Conclusions: UGES appears to be an effective and safe technique for patients with cervical stenosis. We observed a low complication rate and a high diagnostic yield, suggesting UGES may be a valuable alternative for endometrial evaluation in this challenging setting.