Blind endometrial biopsies: insufficient for diagnosis in women with intrauterine pathology

Objective To evaluate blind and directed endometrial biopsies for histological diagnosis in the presence of intrauterine pathology. Design A prospective study comparing the information obtained at outpatient hysteroscopy with undirected endometrial biopsy with subsequent pathological findings obtained after transcervical resection (TCR) of intrauterine polyps. Setting The Department of Obstetrics and Gynaecology, The Royal Surrey County Hospital, Guildford, 1991-1996. Subjects 414 women who were diagnosed as having intrauterine abnormalities, 177 of whom opted for transcervical resection. Main outcome measures Outcomes of referrals to a 'one-visit clinic', with particular reference to that group of patients undergoing TCR. Comparisons between the histological findings obtained from blind endometrial biopsy and those from TCR specimens. Results 414/1022 women had intrauterine abnormalities identified by flexible hysteroscopy, and 177 (42.8%) opted for TCR. The histological findings from the TCR specimens differed from the endometrial biopsies by 30% overall, and the discrepancies included two carcinomas and three complex hyperplasias with atypia. Conclusion We suggest that, in women with abnormal uterine bleeding, the use of blind endometrial biopsy alone as a screening technique should be questioned. Outpatient hysteroscopy should be offered to women with abnormal uterine bleeding;, with directed biopsy or transcervical resection for those in whom jntrauterine polyps have been identified.