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A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding


Affiliations
1 Department of Obstetrics and Gynecology, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, Netherlands
2 Department of Pathology, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, Netherlands
3 Department of Obstetrics and Gynecology, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam, Netherlands
4 Department of Pathology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
5 Clinical Research Unit, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam, Netherlands
6 The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
7 Department of Obstetrics and Gynecology, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, Netherlands
 

Objective: To determine whether structured assessment of outpatient endometrial biopsies decreases the number of inconclusive samples. Design. Retrospective cohort study. Setting: Single hospital pathology laboratory. Population: Endometrial biopsy samples of 66 women with postmenopausal bleeding, collected during the usual diagnostic work-up and assessed as insufficient for a reliable histological diagnosis. Methods: Endometrial biopsy samples were requested from the pathology laboratories. The retrieved samples were systematically reassessed by a single pathologist specialized in gynecology. Main Outcome Measure: Disagreement between initial assessment and conclusion after structured reassessment. Results: We retrieved 36 of 66 endometrial biopsy samples from six different pathology laboratories. Structured reassessment of the retrieved samples by a single pathologist specialized in gynecology did not change the conclusion in 35 of the 36 samples. The remaining sample contained a large amount of endometrial tissue and the diagnosis at reassessment was endometrial hyperplasia without atypia. All other samples contained insufficient material for a reliable diagnosis. Conclusion: A structured reassessment of endometrial biopsies samples, which were classified as inconclusive due to insufficient material, did not change the conclusion. Although it might be helpful for pathologists to have diagnostic criteria for adequacy and/or inadequacy of an endometrial biopsy sample, the gain in efficiency is likely to be small.
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  • A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding

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Authors

M. C. Breijer
Department of Obstetrics and Gynecology, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, Netherlands
N. C. M. Visser
Department of Pathology, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, Netherlands
N. van Hanegem
Department of Obstetrics and Gynecology, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam, Netherlands
A. A. van derWurff
Department of Pathology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
B. C. Opmeer
Clinical Research Unit, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam, Netherlands
H. C. van Doorn
Department of Obstetrics and Gynecology, Erasmus MC Cancer Institute, Postbus 2040, 3000 CA Rotterdam, Netherlands
B. W. J. Mol
The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide and South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
J. M. A. Pijnenborg
Department of Obstetrics and Gynecology, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, Netherlands
A. Timmermans
Department of Obstetrics and Gynecology, Academic Medical Center, Postbus 22660, 1100 DD Amsterdam, Netherlands

Abstract


Objective: To determine whether structured assessment of outpatient endometrial biopsies decreases the number of inconclusive samples. Design. Retrospective cohort study. Setting: Single hospital pathology laboratory. Population: Endometrial biopsy samples of 66 women with postmenopausal bleeding, collected during the usual diagnostic work-up and assessed as insufficient for a reliable histological diagnosis. Methods: Endometrial biopsy samples were requested from the pathology laboratories. The retrieved samples were systematically reassessed by a single pathologist specialized in gynecology. Main Outcome Measure: Disagreement between initial assessment and conclusion after structured reassessment. Results: We retrieved 36 of 66 endometrial biopsy samples from six different pathology laboratories. Structured reassessment of the retrieved samples by a single pathologist specialized in gynecology did not change the conclusion in 35 of the 36 samples. The remaining sample contained a large amount of endometrial tissue and the diagnosis at reassessment was endometrial hyperplasia without atypia. All other samples contained insufficient material for a reliable diagnosis. Conclusion: A structured reassessment of endometrial biopsies samples, which were classified as inconclusive due to insufficient material, did not change the conclusion. Although it might be helpful for pathologists to have diagnostic criteria for adequacy and/or inadequacy of an endometrial biopsy sample, the gain in efficiency is likely to be small.