Evaluating the Role of Hysteroscopy Guided Biopsy in Triaging Endometrial Intraepithelial Neoplasia for Subspecialty Referral

Study Objective

To compare the diagnostic accuracy of hysteroscopic sampling versus blind sampling in detecting concurrent endometrial carcinoma (EC) in patients with endometrial intraepithelial neoplasia (EIN).

Design

This is a retrospective cross-sectional cohort study. Statistical data was based on frequency data, with quantitative variables expressed as means and standard deviations. For known confounding variables, univariate and multivariate regression analysis was performed.

Setting

Patients included patients who were diagnosed with EIN in a clinic or operating room setting using hysteroscopy or blind sampling tools.

Patients or Participants

151 patients diagnosed with EIN during endometrial sampling who underwent a hysterectomy within three months in the Mayo Clinic enterprise between January 1, 2018, and January 1, 2023.

Interventions

Those diagnosed with hysteroscopy-directed biopsy (grasp biopsy and global sampling) were compared to blind-sampling methods (pipelle or dilation and curettage) using the pathology results of the hysterectomy specimen as the gold standard comparator.

Measurements and Main Results

The mean (SD) patient age was 60.45 (±11.48) years for the hysteroscopy-directed group (n=76) and 63.95 (±10.73) years for the blind-sampling group (n=75). There was a reduced risk of concurrent EC on the final hysterectomy pathology for women who were diagnosed with EIN via hysteroscopy-directed biopsy (OR=0.44, 95% CI=0.20–0.95, p = 0.033). In univariate analysis, body mass index ≥30 was associated with an elevated risk of EC on final pathology (OR=4.17, 95% CI=1.51-11.51, p = 0.004). The risk of EC was higher in patients >60 years of age (OR=5.56, 95% CI=1.22-35.21, p<0.001). In multivariate analysis, diabetes mellitus was the only independent variable associated with a higher risk of EIN on final pathology (OR=7.01, 95% CI=1.40-35.04, p = 0.018). Age, BMI, and endometrial thickness on pre-biopsy ultrasound were not associated with EC on final hysterectomy pathology on univariate and multivariate analyses.

Conclusion

Hysteroscopic-directed biopsy reduces the risk of missing a concurrent EC during endometrial sampling in women with EIN.