Importance of endometrial biopsy in premenopausal women without risk factors for endometrial cancer

Year 2022, Volume: 19 Issue: 1, 1142 - 1145, 25.03.2022

Zekiye Soykan Sert

https://doi.org/10.38136/jgon.1056016

Abstract

Objective: In women with abnormal uterine bleeding, the appropriate age for endometrial biopsy remains controversial. In this study, we aimed to evaluate the importance of endometrial biopsy in premenopausal women aged 40-49 years who presented with menorrhagia but did not have risk factors for endometrial cancer.
Material And Methods: The records of patients who underwent endometrial biopsy for diagnostic purposes at the gynecology and obstetrics clinic of our hospital between January 1, 2017 and October 31, 2021 were retrospectively reviewed. Among these patients, premenopausal women aged 40-49 years with menorrhagia who had endometrial biopsy results were included in the sample. Patients with risk factors were excluded from the study.
Results: A total of 176 premenopausal patients with menorrhagia were included in the study. According to the biopsy results of these patients without risk factors, no malignancy was detected. Endometrial hyperplasia was present in six patients (3.4%), of whom (0.6%) had hyperplasia with atypia and five (2.8%) had hyperplasia without atypia.
Conclusion: We found a minimal risk of neoplastic and preneoplastic disease in premenopausal women aged 40-49 years with menorrhagia but no risk factors for endometrial cancer. Endometrial biopsy indications should be reviewed in this patient group.

Keywords

Endometrial biopsy, endometrial cancer, menorrhagia, risk factors

Supporting Institution

The authors declared that this study has received no financial support.

Project Number

2021:17-04

Thanks

The authors thank all the participants in this study.

Endometriyum kanseri için risk faktörü olmayan premenopozal kadınlarda endometriyal biyopsinin önemi

Abstract

Amaç: Anormal uterin kanaması olan kadınlarda endometrial biyopsi için uygun yaş tartışmalıdır. Bu çalışmada endometriyum kanser için risk faktörü olmayan ve menorajisi olan 40-49 yaş arası premenopozal kadınlarda endometriyal biyopsinin önemini değerlendirmeyi amaçladık.
Gereçler ve Yöntem: 1 Ocak 2017-31 Ekim 2021 tarihleri arasında hastanemizin Kadın Hastalıkları ve Doğum kliniğinde diagnostik amaçlı endometrial biyopsi yapılan hastaların kayıtları retrospektif olarak incelendi. Bu hastalardan endometrial biyopsi sonuçları olan menorajili 40-49 yaş arası premenopozal kadınlar çalışmaya dahil edildi. Risk faktörü olan hastalar çalışma dışı bırakıldı.
Bulgular: Çalışmaya, menorajisi olan 176 premenopozal hasta dahil edildi. Risk faktörleri olmayan hastaların biyopsi sonuçlarında malignite saptanmadı. Toplam 6 olguda endometrial hiperplazi (EH) (%3.4) saptandı. EH saptanan olguların 1’i (%0.6) atipili hiperplazi, 5’i (%2.8) atipisiz hiperplazi olarak saptandı.
Sonuç: Risk faktörleri olmayan ve menorajisi olan 40-49 yaş arası premenopozal kadınlarda neoplastik ve preneoplastik hastalık riskini minimal olarak tespit ettik. Bu hasta grubunda endometriyal biyopsi endikasyonları gözden geçirilmelidir.

Keywords

Endometrial biyopsi, endometrium kanseri, menoraji, risk faktörleri

Project Number

2021:17-04

References

• 1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
• 2. Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C, et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24:vi33–8.
• 3. McKenney JK, Longacre TA. Low-grade endometrial adenocarcinoma: a diagnostic algorithm for distinguishing atypical endometrial hyperplasia and other benign (and malignant) mimics. Adv Anat Pathol 2009. 16(1): p. 1-22.
• 4. Leitao MM Jr, Kehoe S, Barakat RR, Alektiar K, Gattoc LP, Rabbitt C, et al. Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma. Gynecol Oncol 2009. 113(1): p. 105-8.
• 5. Pennant ME, Mehta R, Moody P, Hackett G, Prentice A, Sharp SJ, et al. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG 2017;124(3):404-411.
• 6. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359–86.
• 7. Wise MR, Gill P, Lensen S, Thompson JM, Farquhar CM. Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women. Am J Obstet Gynecol 2016; 215:598.e1-8.
• 8. Giannella L, Cerami LB, Setti T, Bergamini E, Boselli F. Prediction of endometrial hyperplasia and cancer among premenopausal women with abnormal uterine bleeding. Biomed Res Int 2019; 2019:8598152.
• 9. American Joint Committee on Cancer. Corpus Uteri. In Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, (eds). AJCC Staging Manual, 7th. edition. New York. Springer. 2010. p. 403.
• 10. Aker SŞ, Yüce T, Acar D, Atabekoğlu CS. Anormal Uterin Kanaması olan Kadınlarda Endometrial Örnekleme Sonuçları: 765 Vakanın Retrospektif Analizi. Cukurova Medical Journal 2015;40:306-10.
• 11. Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet lymphocyte ratio in patients with operable colorectal cancer. Biomarkers 2012; 17(3):216- 222.
• 12. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics. CA Cancer J Clin 2014; 64(1): 9-29.
• 13. ACOG Committee on Practice Bulletins Gynecology. Practice bulletin no. 136: Management Of Abnormal Uterine Bleeding Associated With Ovulatory Dysfunction. Obstet Gynecol 2013;122(1):176- 85.
• 14. Murray M.J., Meyer W.R., Zaino R.J., Lessey B.A., Novotny D.B., Ireland K., et al. Acritical analysis of the accuracy, reproducibility, and clinical utility of histologic endometrial dating in fertile women. Fertility and Sterility 2004;81(5):1333-43.
• 15. Ronnett B, Kurman R. Precursor lesions of endometrial carcinoma. Blaustein's Pathology of Female Genital Tract 2002;482.
• 16. Sarı N, Şahin S, Çağlayan EK, Seçkin L, Kara M, Engin Üstün Y. Endometri̇al Örnekleme Sonuçlarımız: 495 Olgunun Analizi. Düzce Tıp Fakültesi Dergisi 2015; 17(2):70-72.
• 17. Jetley S, Rana S, Jairajpuri ZS. Morphological spectrum of endometrial pathology in middle-aged women with atypical uterine bleeding: A study of 219 cases. J. Mid-life Health 2013;4:216-20.