Endometrial Biopsies with Insufficient Tissue: Descriptive Analysis and Cancer Outcomes in Women aged 50 and Above [26G]

Abstract

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.

Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment

“…Endometrial re-biopsy by D&C associated with hysteroscopy was performed in 32.32% of patients without OAT and in 29.72% of patients with OAT (Table 1). These results are consistent with other reports that established different proportions of insufficient tissue cases for histological examination after D&C, in 17-31.7% of cases [79,80].…”