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Thickened Endometrium in Postmenopausal Women With an Initial Biopsy of Limited, Benign, Surface Endometrium

Clinical Outcome and Subsequent Pathologic Diagnosis

Dermawan, Josephine K.T., M.D., Ph.D.; Hur, Christine, M.D.; Uberti, Maria G., M.D.; Flyckt, Rebecca, M.D.; Falcone, Tommaso, M.D.; Brainard, Jennifer, M.D.; Abdul-Karim, Fadi W., M.D., M.Ed.

International Journal of Gynecological Pathology: July 2019 - Volume 38 - Issue 4 - p 310–317
doi: 10.1097/PGP.0000000000000525
PATHOLOGY OF THE CORPUS: ORIGINAL ARTICLES
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Endometrial biopsy or curetting is indicated for postmenopausal women with abnormal uterine bleeding and/or thickened endometrium. Often, endometrial biopsy or curetting yields limited benign surface endometrium, which may indicate insufficient sampling. This study addresses the clinical outcome and subsequent pathologic diagnoses in postmenopausal women who received this initial diagnosis. Among a total of 370 endometrial biopsy or curetting between 2012 and 2015, 192 (52%) were diagnosed as limited benign surface endometrial epithelium. The women ranged in age from 55 to 91 yr old. Their clinical presentations mainly included postmenopausal bleeding, pelvic pain, and enlarged uterus. Primarily because the initial report was interpreted as “benign,” 108 (57%) had no subsequent follow-up. Interestingly, women with an increased endometrial thickness were more likely to receive repeat evaluation. Among the 84 women who underwent follow-up endometrial sampling, 6 (7%) had hyperplasia with atypia or malignancy, 21 (25%) had a repeat diagnosis of limited surface sample, 4 (5%) had insufficient materials, and 53 (63%) had other benign findings. Among the subset of women who did receive subsequent follow-up, endometrial atypia or malignancies are more likely found in those with increased body mass index. In conclusion, a slight majority of women with postmenopausal bleeding and/or thickened endometrium had an initial limited surface endometrial sample. Most had no subsequent endometrial sampling. Among those with subsequent follow-up, the majority had benign findings. The study highlights the inconsistencies in adequacy criteria for endometrial sampling and the lack of standardization of subsequent management.

Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute (J.K.T.D., M.G.U., J.B., F.W.A.-K.)

Department of Obstetrics & Gynecology, Obstetrics/Gynecology & Women’s Health Institute (C.H., R.F., T.F.), Cleveland Clinic, Cleveland, Ohio

An abstract based on this study was presented in the 2018 Annual United States and Canadian Academy of Pathology meeting on March 21, 2018 in Vancouver, BC, Canada.

The authors declare no conflict of interest.

Address correspondence and reprint requests to Fadi W. Abdul-Karim, MD, MEd, Department of Pathology, L25, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail: karimf@ccf.org.

©2019International Society of Gynecological Pathologists