Aspiration and microscopy in the diagnosis of ectopic pregnancy

Objective: To compare Karman cannula aspiration followed by dissecting micr oscopy with suction curettage and permanent histology in obtaining and iden tifying chorionic villi. Methods: Karman cannula aspiration was performed b efore standard curettage for failed intrauterine pregnancies (N = 22) or po ssible ectopic gestation (N = 24). Dissection microscopy for chorionic vill i was performed on aspirates before submission for permanent histology. Sen sitivity, specificity, positive and negative predictive value of each metho d in obtaining and identifying villi was determined. Results: Overall, all methods were only moderately sensitive in detecting chorionic villi (50-76% ). If failed intrauterine pregnancies were excluded, all methods had poor s ensitivity (25-64%). However, if villi were detected, the positive predicti ve value of all methods was high (> 80%). Conclusions: Karman cannula aspir ation followed by dissecting microscope examination or permanent histology may offer an alternative to traditional curettage in the diagnosis of ectop ic gestations. A larger trial to validate these findings seems justified. ( C) 1998 International Federation of Gynecology and Obstetrics.