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

Objective To evaluate blind and directed endometrial biopsies for histologi cal diagnosis in the presence of intrauterine pathology. Design A prospective study comparing the information obtained at outpatient hysteroscopy with undirected endometrial biopsy with subsequent pathologic al findings obtained after transcervical resection (TCR) of intrauterine po lyps. Setting The Department of Obstetrics and Gynaecology, The Royal Surrey Coun ty 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 p articular reference to that group of patients undergoing TCR. Comparisons b etween the histological findings obtained from blind endometrial biopsy and those from TCR specimens. Results 414/1022 women had intrauterine abnormalities identified by flexibl e hysteroscopy, and 177 (42.8%) opted for TCR. The histological findings fr om the TCR specimens differed from the endometrial biopsies by 30% overall, and the discrepancies included two carcinomas and three complex hyperplasi as with atypia. Conclusion We suggest that, in women with abnormal uterine bleeding, the us e of blind endometrial biopsy alone as a screening technique should be ques tioned. Outpatient hysteroscopy should be offered to women with abnormal ut erine bleeding;, with directed biopsy or transcervical resection for those in whom jntrauterine polyps have been identified.