Clinical Outcome of Patients with Insufficient Sample on Endometrial Biopsy or Curettage
Xiaofang Yang, Yuxin Liu. University of Massachusetts Medical School, Worcester, MA
Background: Two commonly used procedures in the assessment of abnormal uterine bleeding are dilation & curettage and biopsy. As the latter gradually gains in popularity, pathologists face the increasing challenge of making a diagnosis on minute material. In certain instances, the sample is so minimal that pathologists report it as “insufficient for diagnosis". Such report triggers either repeat sampling, follow-up, or even, hysterectomy. Alarmingly, a considerable percentage of patients are lost to follow-up and remain undiagnosed. Therefore, accurate triage of these patients is critical and yet remains problematic. Here we reporte the clinical outcome of 406 such patients at our institute over the past six years.
Design: UMASS database (2005-2010) was searched. The patients' follow-up data extracted from medical records. Histological slides are reviewed.
Results: Result details are showed in Figure 1. A total of 10,800 endometrial biopsies and 4150 curettages were received. “Insufficient” or “nondiagnostic” was reported in 406 cases (3%), including 321 biopsies and 85 curettages.
212 patients were lost to follow-up. The remaining 175 patients repeated sampling. 60 (34%) remained undiagnosed. The other 115 (66 %) acquired a diagnosis: 108 (94%) benign, seven (6%) malignancy. Ninteen patients underwent hysterectomy directly. The outcomes were sixteen benign, three malignancy. In total, ten patients (5%) were found malignancy with additional procedures.
Thirty-six cases reported “rare atypical cells” in additional to “insufficient tissue”. Immunostaining (p53, Ki67) are performed but remain inconclusive. These resulted in 10 patients re-sampling; 12 hysterectomy; 12 lost to follow-up. The outcomes were seven (31%) benign, two (9%) atypical complex hyperplasia, one (4.5%) cervical adenocarcinoma, ten (45%) endometrioid adenocarcinomas, two (9%) serous carcinomas.
Conclusions: Our results outline the potential outcomes of patients with non-diagnostic endometrial sample. A small but significant portion of these patients has malignancy (5%). If rare atypical cells present, the chance of malignancy is significantly higher (69%). For the adequate management of these patients, it is critical to be aware of the risk and to clearly communicate the uncertainty in these cases.
Category: Gynecologic & Obstetrics
Tuesday, March 20, 2012 11:00 AM
Platform Session: Section E, Tuesday Morning