Inadequate Endometrial Biopsies Follow-Up and Proposed Adequacy Criteria
Mana MoghadamFalahi, Saraswati Pokharel, Houda Alatassi. University of Louisville, Louisville, KY
Background: Endometrial biopsies and curettings are among the most common specimens received in the pathology laboratory. In several aspects, these specimens present a unique challenge for surgical pathologists, and one of them is the adequacy. Since there is no defined criteria for adequacy, pathologists should exercise judgment in reporting adequacy based on the clinical information and age of the patient.
Design: We reviewed all endometrial biopsies from January 2009 to August 2011 that were performed at our institution. We selected the cases that were diagnosed as insufficient or inadequate. The cases with the available follow up were reviewed. The final diagnoses on these cases were evaluated in order to confirm the inadequacy of the samples and to further categorize the causes of inadequate or insufficient diagnosis.
Results: A total of 141 endometrial biopsies were found. 60 cases had available follow up biopsy or curetting. 41 (68%) of these patients were 45 years old or older. In the subsequent follow up, 17 cases (28%) had significant findings, which consisted of 2 cases of endometrial adenocarcinoma, 8 cases (13%) with complex hyperplasia with atypia, and 7 cases (11%) of endometrial polyp. The remainder of the cases revealed benign findings mostly composed of atrophic endometrium in post menopausal status.
From the above 60 cases, 39 cases (65%) showed no endometrial tissue. These biopsies consisted of blood, mucus and endocervical tissue. 15 cases (26%) showed superficial or minimal endometrial tissue and 6 cases (10%) were from the lower uterine segment mixed with endocervical glands.
Conclusions: This study emphasizes the importance of avoiding diagnostic terms such as “no significant pathological findings” and the importance of appropriate description of the microscopic findings. We strongly suggest that the endometrial biopsies be qualitatively and quantitatively evaluated. The absence of enough well preserved endometrial tissue from the body and fundus should be clearly transferred to the clinicians with the appropriate use of terms insufficient, inadequate or unassessable.
In our experience the absence of the above mentioned statements in the final report, can be interpreted as “negative for hyperplasia and malignancy” by some clinicians, and these patients will not be appropriately managed. In our study, the three most common instances which these statements should be used are: 1) No endometrial tissue present, 2) Scant endometrial tissue from the lower uterine segment, or 3) Only endometrial stroma with minute fragments of endometrial glandular strips.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 193, Wednesday Afternoon