Indications for Endometrial Biopsy
Endometrial biopsy is primarily indicated for the evaluation of abnormal uterine bleeding, particularly in postmenopausal women or premenopausal women with risk factors for endometrial cancer.
Primary Indications
Postmenopausal Women
- Abnormal uterine bleeding (present in 90% of endometrial cancer cases) 1
- Postmenopausal bleeding with endometrial thickness ≥3-4mm on transvaginal ultrasound 1
- Persistent or recurrent undiagnosed bleeding, even with normal initial biopsy results 1, 2
- Asymptomatic women using tamoxifen with endometrial thickness >4mm 3
Premenopausal Women
- Abnormal uterine bleeding with risk factors for endometrial cancer 4, 5
- Risk factors that warrant biopsy include:
Genetic Risk Factors
Other Indications
- Evaluation of infertility 6
- Prevention of endometrial hyperplasia in non-hysterectomized postmenopausal women receiving conjugated estrogens 7
- Secondary amenorrhea 7
Technical Considerations and Limitations
- Office endometrial biopsies have a false-negative rate of approximately 10% 1, 2
- Negative endometrial biopsy in a symptomatic patient should be followed by fractional dilation and curettage (D&C) under anesthesia 1, 2
- Hysteroscopy with directed biopsy is more accurate than blind endometrial sampling for detecting focal lesions 1, 3
- Blind suction techniques are not reliable for diagnosing endometrial polyps 3
- Inadequate samples are more common in postmenopausal women due to endometrial atrophy 6
Common Pitfalls to Avoid
- Relying solely on age rather than BMI for risk stratification in premenopausal women 5
- Failing to follow up on inadequate samples, particularly in women with thickened endometrium 8
- Neglecting family history of endometrial or colorectal cancer 4
- Missing focal lesions with blind sampling techniques 2, 3
Contraindications
- Pregnancy is the only absolute contraindication to endometrial biopsy 2