Accuracy of Endometrial Biopsy in Diagnosing Endometrial Polyps [ID: 1343431

Abstract

INTRODUCTION: Endometrial polyps are commonly reported on endometrial biopsies, but accuracy remains uncertain. The purpose of this study was to determine the positive predictive value (PPV) of endometrial polyp findings on endometrial biopsy. METHODS: In this retrospective cohort study, we screened 1,403 patients with endometrial biopsies that indicated presence of endometrial polyp between 2010 and 2020. Patients with concurrent endometrial cancer were excluded. Of the remaining patients, 546 had a subsequent gold-standard (GS) procedure (440 with hysteroscopy and 106 with hysterectomy) and were enrolled. Pathology results of GS procedures were analyzed for confirmation of endometrial polyp, and hysteroscopy operative reports were reviewed to determine intraoperative polyp visualization. RESULTS: Of the 546 patients whose endometrial biopsy reported endometrial polyp, 391 had endometrial polyp confirmed on GS pathology for a PPV of 71.6% (95% CI 67.6–75.4). Of the 440 patients who had hysteroscopy, 351 had endometrial polyp on pathology for a PPV of 79.8% (95% CI 75.7–83.4). Only 292 of the 440 hysteroscopy patients, however, had a polyp visualized by the surgeon, for a PPV of 66.4% (95% CI 61.7–70.8) when based on operative findings. Patients with a polyp on GS pathology were more likely to be postmenopausal (P=.001), have obesity (body mass index >30) (P=<.001), diabetes (P=.015), and hypertension (P=.037). There was no difference based on patient race (P=.182), hormonal therapy use (P=.295), or tamoxifen use (P=.127). Patients with thicker endometrial linings on ultrasound were more likely to have a polyp on GS pathology (P=.002), but uterine cavity length did not affect the PPV (P=.415). CONCLUSION: Endometrial biopsy correctly predicted the diagnosis of endometrial polyp in 72% of cases based on subsequent GS procedures, with the remaining 28% being false positives. Endometrial biopsy was more likely to accurately diagnose endometrial polyps in patients who were postmenopausal, had certain comorbid conditions, and had thicker endometrial linings.