Clinical Outcomes of Patients With Insufficient Sample From Endometrial Biopsy or Curettage

Abstract

Endometrial biopsy and curettage are widely used uterine sampling procedures. Occasionally, the amount of tissue obtained is so minimal that diagnosis cannot be reached. In published studies, insufficient samples comprise 2% to 60% of endometrial samples and are influenced by multiple contributory factors. To date, specific quantitative criteria for an adequate endometrial sample have not been established in the pathology community. The decision to classify a sample as nondiagnostic is subject to great interobserver variability, especially where elderly patients are concerned. Meanwhile, whether or not to repeat the procedure is the dilemma for clinical management. Herein we studied the clinicopathologic features of 1120 endometrial samples designated as insufficient for diagnosis. Such samples were more commonly encountered in elderly patients than younger ones (14.6% vs. 5.8%). Our pathologists generally required one intact tissue fragment containing both glands and stroma for premenopausal patients and 5 to 10 strips of atrophic endometrial epithelium for postmenopausal patients. By the 12-mo follow-up, 38% of patients with nondiagnostic samples had second sampling procedures and 7% underwent hysterectomy. The second sample was adequate in 75% of patients, 10% of which showed malignant tumor. If any worrisome histologic findings were present in the initial nondiagnostic sample, a high percentage of these patients were found to have uterine malignancy on second procedures (43%). Aims of this study are to bring awareness to this commonly overlooked topic, to validate our diagnostic criteria, and to outline important clinical implications.

Genetic analysis of uterine aspirates improves the diagnostic value and captures the intra-tumor heterogeneity of endometrial cancers

“…In a recent study of 1120 endometrial samples classified as unsuitable for diagnosis, a second biopsy was obtained from 38% of the patients that was suitable for diagnosis in 75% of cases, with 10% having a malignant tumor. 23 Our results show that mutation analysis could indicate the presence of endometrial cancer or at least some pre-malignant anomaly, emphasizing the need for resampling in such cases and providing valuable information to accelerate the diagnosis.…”

“…The histologic analyses of uterine aspirates fail to distinguish the presence or absence of malignancy in around 13% of the cases, either due to the small proportion of representative tumor cells or to the poor quality of the specimen. [21][22][23] To further investigate the potential of genetic analysis of uterine aspirates as an informative tool for endometrial cancer diagnosis, we assessed the tumor mutations that could be detected in uterine aspirates that could not be evaluated on a pathological basis (Figure 2a). Mutational analysis was performed on eight paired samples of non-diagnosable uterine aspirates from patients who turned out to have endometrial cancer and on the corresponding hysterectomy specimens (7 endometrioid endometrial carcinomas and 1 carcinosarcoma).…”

Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

“…The authors underlined that comments of pathologists, especially if any abnormal findings in non-diagnostic specimen were observed, may help in further repeated diagnosis and management. In this study, any abnormal histologic findings in initial, non-diagnostic endometrial sample were associated with uterine malignancy in 43% of patients [22]. In another prospective multicenter study the endometrial sampling in 29.8% was non-diagnostic due to an insufficient amount of endometrial tissue.…”

65 Yaş Üstü Kadınlarda Jinekolojik Sorunlar

“…PMK sıklıkla polip, atrofi gibi benign nedenlerle ortaya çıksa da; altta yatan olası bir endometriyum kanseri ve kanser öncüsü hiperplazinin de semptomu olabileceğinden, bu semptomla başvuran hastalarda endometrium kalınlığı ne olursa olsun dilatasyon küretaj (D&C) ile endometriyal örnekleme yapmanın uygun olacağı düşünülmektedir (19). PMK'lı hastalarda patoloji raporu "yetersiz materyal" gelen hastaları içeren bir çalışmada, bu tanı oranının %14,6 ile en yüksek 60 yaş üstü kadınlarda olduğu vurgulanmıştır (20). Burada önemli nokta, bu hastaların %10'unun tekrarlayan incelemelerde uterin malignite ortaya koymasıdır.…”