2-YEAR FOLLOW-UP OF 263 PATIENTS WITH POST PERIMENOPAUSAL VAGINAL BLEEDING AND NEGATIVE INITIAL BIOPSY

Patients with post- or perimenopausal bleeding (PMB) whose initial end ometrial biopsy or dilation and curettage (D&C) reveals benign or insu fficient tissue may eventually be diagnosed with endometrial cancer or complex endometrial hyperplasia. We studied 286 consecutive patients with PMB who had either an endometrial biopsy or D&C at Brigham and Wo men's Hospital during November 1990 to April 1991 and reviewed their s ubsequent specimens after a minimum of 23 months of follow-up. Of the initial 286 patients with PMB, 6 (2%) had endometrial cancer on their index biopsy, 17 (6%) had complex hyperplasia, and 201 (70%) had other benign findings. Sixty-two (22%) had ''tissue insufficient for diagno sis.'' Excluding the 23 with cancer/complex hyperplasia, there were 26 3 patients in the cohort, 86 of whom (33%) had further endometrial sam pling during the follow-up period. Of these, four (2%) were subsequent ly found to have a uterine malignancy (2 of the benigns, 2 of the insu fficients) and five (2%) were subsequently found to have complex hyper plasia. Of the four patients subsequently found to have cancer, two ha d stage I adenocarcinoma, one had stage IV adenocarcinoma, and one had stage I high-grade stromal sarcoma. (C) 1994 Academic Press, Inc.