Assessment of Endometrial Sampling and Histopathological Results: Analysis of 4,247 Cases

Abstract

Objective: This study aimed to investigate the relationship between indications and histopathological results in patients undergoing endometrial sampling.Materials and Methods: Data of 4,247 patients undergoing endometrial sampling due to non-obstetric gynecological causes between January 2010 and October 2016 were retrospectively evaluated using the archives of the Gynecology and Obstetrics Clinic of Konya Training and Research Hospital. Results:The mean age of patients was 46.8 ± 8.22 years; the most common indication was menometrorrhagia/menorrhagia (70.66%), and the least common indication was cervical polyp (1.34%). The most common histopathological result was proliferative-secretory endometrium (63.62%); simple hyperplasia with atypia (0.56%) was determined to be the least common result. Endometrial cancer was observed more frequently in the post-menopausal bleeding and increased endometrial thickness group (23.11%). Of patients in whom biopsy was performed, 52.18% had undergone hysterectomy, as a result of which proliferative-secretory endometrium was most commonly (59.52%) and simple hyperplasia with atypia least commonly found as the histopathological diagnosis.Conclusion: Although sampling should be performed following endometrial evaluation in patients with postmenopausal bleeding or increased endometrial thickness, according to the results of our study, routine endometrial biopsy should not be preferred in the other indications. Bulgular: Olguların yaş ortalaması 46,8+8,22 olup en sık endikasyon menometroraji-menoraji (%70,66) iken en az servikal polip (%1,34) idi. Endometriyal biyopsi sonucu proliferatif-sekretuar endometriyum (%63,62) en sık atipili basit hiperplazi (%1,13) en az histopatolojik sonuç olarak tespit edildi. Endometriyum kanseri postmenaposal kanama ya da endometriyal kalınlık grubunda daha fazla oranda gözlendi (%23,11). Biyopsi yapılan olguların %52,18%'ne histerektomi ameliyatı yapılmıştı. Histerektomi sonucu proliferatif-sekretuar endometriyum (%59,52) en sık atipili basit hiperplazi (%1,13) en az histopatolojik sonuç olarak tespit edildi.Sonuç: Postmenapozal kanama ya da endometrial kalınlık artışı olan olgularda endometriyal değerlendirmeyi takiben örnekleme yapılması uygunken, çalışmamız sonuçlarına göre diğer endikasyonlarda rutin olarak endometrial biyopsi tercih edilmemelidir.Anahtar Kelimeler: Endometriyal örnekleme, endometriyum kanseri, histerektomi, histopatolojik inceleme Eurasian

Endometrial sampling at an academic hospital in South Africa: Histological findings, lessons learnt and interesting surprises

“…The frequency of histological diagnoses noted in the entire cohort is similar to findings by Inal et al, 8 with the exception that hyperplasia was diagnosed in fewer patients (2.02% vs their 9.7%). Cervical pathology was noted in some of this cohort’s endometrial biopsies.…”

“… 5 Higher failure rates have been noted in postmenopausal, obese patients, those with advanced age or previous failed pipelle and when sampling was performed by a non-physician. 9 The failure rate for this cohort is higher than some reported failure rates (6.33% – 18.4%) 8 , 9 , 12 and lower than the overall failure rate of 42% reported in a meta-analysis where 11% of cases failed due to technical reasons and 31% had insufficient tissue. 5 These figures need to be interpreted with caution, as the criteria for labelling biopsies as ‘insufficient’ may vary across institutions.…”

“…As per other studies from Canada and Turkey, abnormal bleeding was the most common presenting feature in our study. 8 , 9 The importance of adhering to guidelines or indications for biopsy has been stressed, as endometrial sampling is not without risk. A tendency to over-investigate patients younger than 40 with abnormal bleeding has been shown.…”

“… 3 This study corroborates the findings of others in that the thicker the endometrium in postmenopausal women, the greater the likelihood of obtaining more sample and a malignant diagnosis. 3 , 8 Specificity of endometrial sampling is high, but its sensitivity is low. 5 One study has shown that, following an inadequate or scant biopsy, 10% of patients had hyperplasia, 5% had malignancy on repeat sampling and 15% had malignancy on hysterectomy.…”

Comparative analysis of transcervical resection and loop electrosurgical excision in the treatment of high‐grade cervical intraepithelial neoplasia

“…Hysteroscopy is the gold standard for the diagnosis and treatment of intrauterine diseases because it is associated with high‐quality visualization and has unique electric cutting and coagulation abilities. Considering the lack of an ideal conization method and the above mentioned merits of hysteroscopy, we have explored the potential use of hysteroscopy in the treatment of HSIL.…”