Histopathological pattern of endometrial biopsies in patients with abnormal uterine bleeding in a tertiary referral hospital in Jordan

Abstract

Background: Abnormal uterine bleeding (AUB) is a symptom that deviates from the normal menstrual cycle. AUB is characterized by changes in the frequency, volume, and duration of the menstrual flow. The etiology of AUB, which varies with age, may be attributed to both structural and non-structural causes.

Objectives: Determine the histopathological pattern of endometrial biopsies in patients with AUB across different age and parity groups who have undergone dilation and curettage (D&C), along with the discrepancy between D&C and histopathological findings after hysterectomy.

Design: Retrospective chart review SETTING: Tertiary referral hospital PATIENTS AND METHODS: We collected data on all patients diagnosed with AUB between January 2015 and December 2020. Histopathological findings of all D&C endometrial biopsy samples were examined after being categorized by age and parity groups. Sensitivity, specificity, positive predictive value, and NPV were calculated to evaluate the diagnostic accuracy of D&C.

Main outcome measures: Histopathological pattern of D&C endometrial biopsies by age and parity groups.

Sample size: 3233 patients.

Results: Most patients were in the 18-39 year age group, with normal cyclical findings being the most common histopathological finding. Malignant lesions were observed in 42 patients with a majority being older than 50 years. In 13.3% (42/316) of patients, D&C failed to detect intrauterine disorder that was found on hysterectomy. The overall accuracy of D&C in determining the existence of normal versus pathological findings was 75.60%, the sensitivity was 72.90%, the specificity was 77.90%, the positive predictive value was 73.86% and the NPV was 77.05% in our patients.

Conclusion: Normal cyclic changes account for the highest proportion of histopathological findings. However, hyperplasia and malignancies are important causes of perimenopausal and postmenopausal bleeding. While the use of D&C as a sampling tool for AUB cases remains questionable, the use of D&C in diagnosing premalignant and malignant cases is highly effective.

Limitations: Single-center, retrospective design, incomplete medical records, and inter-rater reliability could not be determined.

Conflict of interest: None.

Figure 1.

This is a microscopic examination at medium power of a complete hydatidiform mole showing markedly hydropic villi with cistern formation. This biopsy exhibits circumferential trophoblastic hyperplasia.

Figure 2.

This image of FIGO grade 1 endometrioid carcinoma illustrates its complex architecture composed of confluent fused glands, and little intervening stroma. This biopsy exhibited glandular growth predominantly with <5% nonsquamous solid components.