INTRODUCTION:
Dilatation and curettage has remained the gold standard for evaluating postmenopausal bleeding. Office endometrial biopsy (EMB) is most times the first step in the investigation. Occasionally, however, the EMB results with insufficient tissue samples, which leads to additional interventions. We correlated EMB results with endometrial thickness and available follow up data to further investigate the presence of cancer.
METHODS:
We took a look at EMB done at our institution over a 12-month span that returned with insufficient tissue sample or scant tissue. For these patients, we also stratified a history of DM or HTN, BMI, and what subsequent procedure they had done afterward.
RESULTS:
We looked at 103 individuals who were 50+ years old with EMB that had insufficient tissue or scant tissue. We then looked at their follow up, specifically at following groups: no further invention, ultrasound, D&C or other surgical procedure. We found that 46 individuals (45%) had no further intervention, 9 women (9%) had a repeat biopsy within 3 months, 58 women (56%) had an ultrasound, 8 individuals (8%) underwent D&C, and 3 (3%) individuals opted for a hysterectomy. Out of these individuals, 1 individual who had a D&C done was diagnosed with endometrial adenocarcinoma. We found that the 58 individuals who had ultrasounds done, 43% of these individuals had an endometrial stripe that was >4mm. Of these 43% of individuals with an endometrial stripe over 4mm, only 4% had a diagnosis of cancer on after a hysteroscopy, D&C was done. This concludes that insufficient tissue samples on EMB rarely lead to serious endometrial pathology and despite endometrial thickness of >4mm on ultrasound done after this type of EMB, most individuals do not have any serious endometrial pathologies.
CONCLUSION:
Insufficient tissue samples on EMB rarely lead to serious endometrial pathology despite the comorbidities that increase the risk of endometrial carcinoma. Despite endometrial thickness of >4mm, most individuals did not have any serious endometrial pathologies.
Fifty-five percent were AH, 26% LH, 17% RH, and 2% vaginal. The proportion of AH performed at JMH and UMH was 66% and 22% (p < .0001), respectively. Between the two hospitals there was no statistically significant difference in age (p = .73), comorbidities (p = .33), BMI (p = .83) and previous abdominal surgeries (p = .11). The RH group had a higher proportion of patients with previous abdominal surgeries (75% vs. 60% in the AH group and 75% vs. 54% in the LH group). There was no difference in the rate of transfusion (p = .2), ICU admission (p = .5), complications (p = .77) and readmission (p = .63). At UMH, the robotic approach had a significant decrease in the mean operative time (143 min vs. 194 min in AH, p < .0001 and 173 min in LH, p = .0002), length of stay (1.1 days vs. 2.4 days in AH, p < .001 and 1.2 days in LH, p = .001) and EBL (79 ml vs. 250 ml in AH, p < .001 and 94 ml in LH, p = .5). Conclusions: Data analysis from the first 18 months of a benign robotic pilot program demonstrated outcomes comparable to laparoscopic and open approach, with reduced hospitalization, blood loss and operative time. If the robotic approach for benign hysterectomies is adopted at JMH, the estimated cost savings per procedure
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