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The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities

BACKGROUND: Even in the face of a substantial increase in the numbers of endometrial cancer cases and in the numbers of women who have risk factors, there is no clear agreement about the indications for assessing the endometria of women with abnormal bleeding or about the tools to use in that assess...

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Autores principales: Nelson, Anita L., Vasquez, Lisa, Tabatabai, Roya, Im, Samuel S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693553/
https://www.ncbi.nlm.nih.gov/pubmed/29201398
http://dx.doi.org/10.1186/s40834-016-0020-7
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author Nelson, Anita L.
Vasquez, Lisa
Tabatabai, Roya
Im, Samuel S.
author_facet Nelson, Anita L.
Vasquez, Lisa
Tabatabai, Roya
Im, Samuel S.
author_sort Nelson, Anita L.
collection PubMed
description BACKGROUND: Even in the face of a substantial increase in the numbers of endometrial cancer cases and in the numbers of women who have risk factors, there is no clear agreement about the indications for assessing the endometria of women with abnormal bleeding or about the tools to use in that assessment. This study sought to determine in a group of high risk women with abnormal uterine bleeding, the probability that an outpatient endometrial aspiration would identify significant pathology. METHODS: Retrospective cohort study of the histology from endometrial aspirations performed from 2001 to 2008 for abnormal uterine bleeding at Harbor-UCLA Medical Center and its satellite public health clinics. Medical records were reviewed in detail to assess risk factors, descriptions of bleeding abnormalities and histologic results. RESULTS: The charts of 1601 women who underwent 1636 endometrial biopsies for a wide variety of abnormal uterine bleeding patterns yielded 73 (4.6 %) cases of endometrial carcinoma, 43 cases of atypical endometrial hyperplasia (2.7 %), for an overall yield of significant pathology of 7.2 %. Hyperplasia without atypia was found in another 83 cases (5.2 %). Obesity, diabetes and postmenopausal age are associated with an increased risk of significant pathology. Bleeding patterns were so poorly documented that analysis of yield by this factor should be viewed with caution. CONCLUSIONS: The probability of detecting significant uterine pathology is greatest among obese, diabetic postmenopausal women with diabetes (26.3 %). Conversely, the probability of identifying significant pathology in younger women without risk factors is less than 2 %. For women who perceive their individualized risk estimate to be too small to justify an endometrial biopsy, it may be possible to offer oral higher dose progestin therapy on the condition that persistent abnormal bleeding will require more intensive evaluation. These estimates of absolute risk of being diagnosed with significant pathology on endometrial biopsy may be helpful to patients as they consider giving informed consent for the procedure.
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spelling pubmed-56935532017-11-30 The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities Nelson, Anita L. Vasquez, Lisa Tabatabai, Roya Im, Samuel S. Contracept Reprod Med Research BACKGROUND: Even in the face of a substantial increase in the numbers of endometrial cancer cases and in the numbers of women who have risk factors, there is no clear agreement about the indications for assessing the endometria of women with abnormal bleeding or about the tools to use in that assessment. This study sought to determine in a group of high risk women with abnormal uterine bleeding, the probability that an outpatient endometrial aspiration would identify significant pathology. METHODS: Retrospective cohort study of the histology from endometrial aspirations performed from 2001 to 2008 for abnormal uterine bleeding at Harbor-UCLA Medical Center and its satellite public health clinics. Medical records were reviewed in detail to assess risk factors, descriptions of bleeding abnormalities and histologic results. RESULTS: The charts of 1601 women who underwent 1636 endometrial biopsies for a wide variety of abnormal uterine bleeding patterns yielded 73 (4.6 %) cases of endometrial carcinoma, 43 cases of atypical endometrial hyperplasia (2.7 %), for an overall yield of significant pathology of 7.2 %. Hyperplasia without atypia was found in another 83 cases (5.2 %). Obesity, diabetes and postmenopausal age are associated with an increased risk of significant pathology. Bleeding patterns were so poorly documented that analysis of yield by this factor should be viewed with caution. CONCLUSIONS: The probability of detecting significant uterine pathology is greatest among obese, diabetic postmenopausal women with diabetes (26.3 %). Conversely, the probability of identifying significant pathology in younger women without risk factors is less than 2 %. For women who perceive their individualized risk estimate to be too small to justify an endometrial biopsy, it may be possible to offer oral higher dose progestin therapy on the condition that persistent abnormal bleeding will require more intensive evaluation. These estimates of absolute risk of being diagnosed with significant pathology on endometrial biopsy may be helpful to patients as they consider giving informed consent for the procedure. BioMed Central 2016-06-08 /pmc/articles/PMC5693553/ /pubmed/29201398 http://dx.doi.org/10.1186/s40834-016-0020-7 Text en © Nelson et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Nelson, Anita L.
Vasquez, Lisa
Tabatabai, Roya
Im, Samuel S.
The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities
title The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities
title_full The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities
title_fullStr The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities
title_full_unstemmed The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities
title_short The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities
title_sort yield of endometrial aspiration in women with various risk factors and bleeding abnormalities
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693553/
https://www.ncbi.nlm.nih.gov/pubmed/29201398
http://dx.doi.org/10.1186/s40834-016-0020-7
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