Adding Endometrial Biopsy to Polypectomy: Is It Worthwhile?

Objective: The purpose of this study was to establish the role of adding endometrial biopsy to polypectomy in the diagnosis of intrauterine pathology. Design: The design was a retrospective study (Canadian Task Force classification II-3). Methods: The study included 133 consecutive patients who underwent hysteroscopic polypectomy with endometrial biopsy from July 1997 through June 2004 at Biocor Hospital. The local Ethics Committee approved the study protocol. Diagnostic hysteroscopy was performed before surgical procedure in all patients. Hysteroscopic diagnosis was compared against standard histopathologic criteria. Endometrial biopsy on the opposite side of the polyp was performed in all cases. Description of the morphologic appearance of the endometrium and polyps, as well as histologic diagnosis, were recorded for all patients. Sensitivity and specificity were calculated and McNemar test was used to test the value of adding biopsy to polypectomy. Results: One hundred and thirty-three polypectomies with conclusive histologic results were analyzed. Mean patient age was 59 years of age (range, 30-85). Endometrial polyp (58.6%) was the main surgical indication. Hysteroscopic view revealed a low sensitivity and specificity in the diagnosis of atypical endometrial hyperplasia and cancer. Adding endometrial biopsy significantly increased the diagnosis of atypical hyperplasia and cancer (p = 0.000) as well as of simple hyperplasia (p = 0.008). The most frequent diagnoses obtained by random biopsy in patients with false negative hysteroscopies were simple endometrial hyperplasia (n = 66), followed by atypical endometrial hyperplasia (n =10), endometrial cancer (n = 3) and myoma (n = 2). Conclusions: Addiing endometrial biopsy to polypectomy significantly increased the diagnosis of concomitant endometrial abnormalities, mainly endometrial hyperplasia and cancer. Therefore, endometrial biopsy should be added to polypectomy.