A study recently published in the American Journal of Obstetrics and Gynecology found that compared to patients with normal endometrial biopsy results, those who have an endometrial biopsy that is insufficient or incomplete may be at increased risk of developing endometrial cancer (EC).
Insufficient endometrial biopsies may occur when the physician has difficulty accessing the intrauterine space or when the tissue collected is not of a quality suitable for diagnostic testing. Patients who have never given birth, are older or have a thin endometrium are at a higher risk of an insufficient endometrial biopsy.
Generally, it is recommended that a repeat biopsy be performed following an insufficient biopsy. However, some clinicians may attribute the results to low estrogen after menopause, which leads to thinning of the endometrium. As a result, many patients with insufficient biopsies do not receive follow-up examinations.
In their study, the authors evaluated 80,761 Danish individuals who underwent an endometrial biopsy between January 2013 and December 2017. Of the participants, 17.3% received an insufficient biopsy.
Read more about EC testing and diagnosis
Findings revealed that insufficient biopsy was associated with age, supporting previous findings. While 6.8% of participants aged 40 to 49 years had an insufficient biopsy, 35.1% of participants aged 60 to 69 years had an insufficient endometrial biopsy.
Additionally, the risk of developing EC increased with age. Only 0.8% of those aged 40 to 49 years developed EC, compared to 11.3% of those aged 60 to 69 years.
The authors also found that 43.9% of those who received an insufficient initial endometrial biopsy had a follow-up biopsy performed, with a median follow-up of 24 days. Of these participants, 2.6% were found to have EC at follow-up.
After adjusting for age, patients with an insufficient endometrial biopsy had a 16% higher risk of developing EC compared to those with a normal endometrial biopsy.
“These findings highlight the importance of appropriate follow up for individuals with insufficient biopsy results, particularly among older patients,” the authors concluded. “Future studies should focus on including risk factors and defining pathological criteria for insufficient endometrial biopsies.
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