Incidence and risk factors for insufficient endometrial tissue from endometrial sampling

Apiwat Aue-Aungkul, Pilaiwan Kleebkaow, Chumnan Kietpeerakool, Apiwat Aue-Aungkul, Pilaiwan Kleebkaow, Chumnan Kietpeerakool

Abstract

Objective: To assess the incidence of and factors that predict insufficient tissue after endometrial sampling.

Methods: This study reviewed the records of women undergoing endometrial sampling at Khon Kaen University's Srinagarind Hospital between June 2014 and June 2015. It excluded cases in which the device could not be inserted into the uterine cavity due to pain intolerance or equipment failure. The criterion for diagnosing insufficient endometrial tissue was a lack of any intact tissue fragments containing both glands and stroma.

Results: Medical records of 233 women were reviewed. Insufficient tissue following endometrial sampling was noted in 67 cases (28.8%; 95% confidence interval [CI]=23.0-35.0). Histologic results in the remaining 166 women included normal pathological endometrium (121, 51.9%), endometrial polyps (7, 3.0%) endometrial hyperplasia (27, 11.6%), and endometrial cancer (11, 4.7%). According to multivariable analysis, menopausal status (odds ratio [OR] =3.60, 95% CI=1.84-7.05) and endometrial thickness of less than 8 mm (OR=3.91, 95% CI=1.49-10.21) were significant independent predictors for insufficient endometrial tissue after endometrial sampling.

Conclusion: The incidence of insufficient tissue following endometrial sampling was 28.8%. Significant independent factors associated with an increased risk of insufficient tissue were menopausal status and endometrial thickness of less than 8 mm.

Keywords: Endocell®; endometrial sampling; inadequate sampling; insufficient endometrial tissue; sample adequacy.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. du J, Li Y, Lv S, et al. Endometrial sampling devices for early diagnosis of endometrial lesions. J Cancer Res Clin Oncol. 2016;142(12):2515–2522.
    1. Berek JS, Hacker NF. Berek and Hacker’s Gynecologic Oncology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.
    1. Chambers JT, Chambers SK. Endometrial sampling: When? Where? Why? With what? Clin Obstet Gynecol. 1992;35(1):28–39.
    1. Tanriverdi HA, Barut A, Gün BD, et al. Is pipelle biopsy really adequate for diagnosing endometrial disease? Med Sci Monit. 2004;10:CR271–CR274.
    1. Wanijasombutti P, Imruetaicharoenchok A, Tangjitgamol S, et al. Comparison of tissue adequacy for histologic examination from Ipas MVA plus and Wallach Endocell in women with abnormal uterine bleeding. J Obstet Gynaecol Res. 2015;41(8):1246–1254.
    1. van Hanegem N, Prins MM, Bongers MY, et al. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016;197:147–155.
    1. Visser NCM, Reijnen C, Massuger L, et al. Accuracy of Endometrial Sampling in Endometrial Carcinoma: A Systematic Review and Meta-analysis. Obstet Gynecol. 2017;130(4):803–813.
    1. Bakour SH, Khan KS, Gupta JK. Controlled analysis of factors associated with insufficient sample on outpatient endometrial biopsy. BJOG. 2000;107(10):1312–1314.
    1. Gordon SJ, Westgate J. The incidence and management of failed Pipelle sampling in a general outpatient clinic. Aust N Z J Obstet Gynaecol. 1999;39(1):115–118.
    1. Williams AR, Brechin S, Porter AJ, Warner P, Critchley HO. Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG. 2008;115(8):1028–1036.
    1. Xie B, Qian C, Yang B, et al. Risk Factors for Unsuccessful Office-Based Endometrial Biopsy: A Comparative Study of Office-Based Endometrial Biopsy (Pipelle) and Diagnostic Dilation and Curettage. J Minim Invasive Gynecol. 2018;25(4):724–729.
    1. van Doorn HC, Opmeer BC, Burger CW, et al. Inadequate office endometrial sample requires further evaluation in women with postmenopausal bleeding and abnormal ultrasound results. Int J Gynaecol Obstet. 2007;99(2):100–104.
    1. Clark TJ, Mann CH, Shah N, et al. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review. BJOG. 2002;109(3):313–321.
    1. Adwar W, Gadde R, Chitale DA, et al. Management of insufficient endometrial biopsy for women with abnormal uterine bleeding: to further investigate or reassure? Lab Invest. 2016;96:273A.
    1. Tanriverdi HA, Barut A, Gün BD, Kaya E. Is pipelle biopsy really adequate for diagnosing endometrial disease? Med Sci Monit. 2004;10(6):271–274.
    1. Mccluggage WG. My approach to the interpretation of endometrial biopsies and curettings. J Clin Pathol. 2006;59(8):801–812.
    1. Visser NC, Breijer MC, Herman MC, et al. Factors attributing to the failure of endometrial sampling in women with postmenopausal bleeding. Acta Obstet Gynecol Scand. 2013;92(10):1216–1222.
    1. Adambekov S, Goughnour SL, Mansuria S, et al. Patient and provider factors associated with endometrial Pipelle sampling failure. Gynecol Oncol. 2017;144(2):324–328.
    1. Elsandabesee D, Greenwood P. The performance of Pipelle endometrial sampling in a dedicated postmenopausal bleeding clinic. J Obstet Gynaecol. 2005;25(1):32–34.
    1. Kandil D, Yang X, Stockl T, Liu Y. Clinical outcomes of patients with insufficient sample from endometrial biopsy or curettage. Int J Gynecol Pathol. 2014;33(5):500–506.
    1. Deligdisch L. Hormonal pathology of the endometrium. Mod Pathol. 2000;13(3):285.

Source: PubMed

3
Abonnieren