Comparing endometrial biopsy results with hysteroscopic pathology in women presenting with abnormal and postmenopausal uterine bleeding

Abstract

The primary objective of this study was to compare endometrial biopsy pathology results with subsequent operative hysteroscopy pathology in women undergoing evaluation for abnormal and postmenopausal uterine bleeding. The secondary objectives were to describe the length of time between the two procedures and to describe intermediate treatments utilized before hysteroscopy. This study is a retrospective cohort study of women presenting for evaluation of abnormal and postmenopausal uterine bleeding within a single hospital system between January 2015 and December 2018. Patients were identified by their Current Procedural Terminology codes for endometrial biopsy and surgical hysteroscopy. Women were included if they underwent endometrial biopsy followed by operative hysteroscopy within 24 months for abnormal uterine or postmenopausal bleeding. Women were excluded if they underwent more than one endometrial biopsy or hysteroscopy up to five years preceding or any time following the procedures, or who underwent endometrial biopsy followed by hysteroscopy after more than 24 months. We identified 2223 records of which 689 met criteria for inclusion. The mean age of the cohort was 49 (±10). 30.1% (206) were postmenopausal. The median duration of abnormal or postmenopausal bleeding leading up to time of biopsy was of 3.5 (1.5-9) months. Of the patients who had hysteroscopic pathology demonstrating endometrial polyp, 30.6% (81) had an endometrial polyp detected on biopsy. Of the patients who had hysteroscopic pathology demonstrating fibroid/smooth muscle/myometrium with fibroid visualized on hysteroscopy, 0% (0) were detected on biopsy. Of the patients who had hyperplasia without atypia on hysteroscopy, 28.6% (4) were detected on biopsy, and of the patients who had hyperplasia with atypia on hysteroscopy, 5.9% (1) was detected on biopsy. There were 12 cases of confirmed or suspected malignancy on hysteroscopic pathology, of which 8.3% (1) was detected on biopsy. Of the patients who had insufficient specimen from endometrial biopsy, 21% (15) had insufficient specimen from hysteroscopy. The median number of days from endometrial biopsy to hysteroscopy was 48 (25-95) days. The most common non-surgical treatments used between time of biopsy and hysteroscopy were daily oral hormonal therapy at 11.3% (78), high dose oral hormonal therapy at 5.7% (39) and tranexamic acid at 1.5% (10). The overall adverse event rate for hysteroscopy was low at 1.3% (9). In this study of women with abnormal or postmenopausal uterine bleeding undergoing evaluation, the majority of endometrial polyps and fibroids found on hysteroscopic evaluation were not detected on endometrial biopsy. Hysteroscopy is a low-risk surgery that can be scheduled within a reasonable amount of time following endometrial biopsy to both evaluate and treat uterine bleeding.