Should Endometrial Biopsy be Used for Diagnosing Polyps? [33E

Abstract

INTRODUCTION: Abnormal uterine bleeding (AUB) accounts for more than 70% of visits to gynecologists. American College of Obstetricians and Gynecologists (ACOG) recommends endometrial sampling for women above age 45. This is done in clinic with an endometrial biopsy. One known limitation of the biopsy is limited sampling as only 4% of the cavity is sampled. Past studies demonstrate limitations in using endometrial biopsy to diagnose polyps, with biopsy missing 15/16 polyps. Our study sought to evaluate when the biopsy diagnoses a polyp. Is the specificity sufficient to proceed to the operating room, or are there other imaging or patient characteristics that can guide management? METHODS: This was a retrospective cohort study that identified patients with AUB who underwent endometrial biopsy and a confirmatory procedure of hysteroscopy or hysterectomy at the University of Colorado Hospital from 2005-2010. Patients were identified as having an endometrial biopsy, hysterectomy, or hysteroscopy with CPT codes, and ICD9 codes were used to eliminate women without AUB. RESULTS: A total of 216 charts were reviewed with mean age of 44 and BMI of 30.49 kg/m^2. The specificity of using endometrial biopsy to diagnose polyps was 87.2%, and we confirmed poor sensitivity at 30%. Vaginal ultrasound had a higher specificity at 94%. Logistic regression analyses will be utilized to identify patient factors, patient bleeding profile, and procedures to determine how best to triage patients for operative management of endometrial polyps. CONCLUSION: Endometrial biopsy should not be the only factor in determining a patient's need for operative management of AUB associated with polyps.