The Diagnostic Accuracy of Endometrial Sampling in Endometrial Hyperplasia

Abstract

OBJECTIVE: Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections). STUDY DESIGN:Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. RESULTS:Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50-79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results. CONCLUSION:The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.

Pathological spectrum of endometrial biopsies in Saudi women with abnormal uterine bleeding

“…The histopathological assessment of the tissue sample by light microscopy is the gold standard for the diagnosis of endometrial cancer and other endometrial pathologies and it has a high accuracy in identifying endometrial hyperplasia and carcinomas. 7 , 8 For endometrial biopsy, the pipelle or dilatation and curettage methods are effective and minimally invasive methods, and in certain cases, curettage may itself be therapeutic. The possible pathological patterns observed in endometrial samples include menstrual, proliferative, secretory, atrophic and disordered proliferative endometrium, endometritis, endometrial polyps, endometrial hyperplasia with or without atypia and endometrial malignancies.…”