Comparison of tissue adequacy for histologic examination from Ipas MVA plus and Wallach Endocell in women with abnormal uterine bleeding

Insufficient and Scant Endometrial Samples: Determining Clinicopathologic Outcomes and Consistency in Reporting

There are no widely accepted pathologic criteria for reporting endometrial samples with limited tissue and no consensus on the clinical follow-up of patients with these samples. Our study compares clinicopathologic outcomes and determines reporting consistency for these samples. This was done in 3 parts: (1) retrospective chart review of all patients with reported insufficient or scant endometrial samples from 2010 to 2013 at our center to determine repeat sampling and final pathologic diagnosis; (2) survey of gynecologists about their practice for managing patients with these samples; (3) blind review of 99 cases of previously reported scant or insufficient samples in which 4 reviewers separately reassigned cases as scant, insufficient, or diagnostic. Agreement was determined across reviewers. For part (1): 1149 patients had insufficient (49%) or scant (51%) samples with no significant difference in repeat biopsy rate (33% vs. 31%; P=0.33). Final diagnosis of uterine malignancy was higher in patients with a previous insufficient sample than with scant (19% and 9%, respectively), but this was not statistically significant. For part (2): among gynecologists surveyed, 4 of 5 reported managing patients with insufficient or scant samples similarly. For part (3): complete consensus across raters occurred in 57% of cases (Fleiss κ, 0.4891). Similar repeat biopsy rates between scant and insufficient samples suggest that our clinicians choose similar management for both terminologies. As such, distinction between insufficient and scant samples may not be necessary in pathologic reporting. Given the malignancy outcomes, both groups merit repeat sampling in the appropriate context.

Incidence and risk factors for insufficient endometrial tissue from endometrial sampling

Objective

To assess the incidence of and factors that predict insufficient tissue after endometrial sampling.

Methods

This study reviewed the records of women undergoing endometrial sampling at Khon Kaen University’s Srinagarind Hospital between June 2014 and June 2015. It excluded cases in which the device could not be inserted into the uterine cavity due to pain intolerance or equipment failure. The criterion for diagnosing insufficient endometrial tissue was a lack of any intact tissue fragments containing both glands and stroma.

Results

Medical records of 233 women were reviewed. Insufficient tissue following endometrial sampling was noted in 67 cases (28.8%; 95% confidence interval [CI]=23.0–35.0). Histologic results in the remaining 166 women included normal pathological endometrium (121, 51.9%), endometrial polyps (7, 3.0%) endometrial hyperplasia (27, 11.6%), and endometrial cancer (11, 4.7%). According to multivariable analysis, menopausal status (odds ratio [OR] =3.60, 95% CI=1.84–7.05) and endometrial thickness of less than 8 mm (OR=3.91, 95% CI=1.49–10.21) were significant independent predictors for insufficient endometrial tissue after endometrial sampling.

Conclusion

The incidence of insufficient tissue following endometrial sampling was 28.8%. Significant independent factors associated with an increased risk of insufficient tissue were menopausal status and endometrial thickness of less than 8 mm.