Introduction/Background Endometrial cancer, prevalent in postmenopausal women, poses a significant health concern. Diagnosis primarily relies on endometrial biopsy, yet insufficient results are not uncommon due to atrophy and excess mucus. This study aims to assess the final pathology results, determining the necessity of rebiopsy for cases with insufficient initial biopsies.

Methodology A retrospective study was conducted on postmenopausal patients undergoing endometrial biopsy at Hacettepe University Hospital (2015–2020). Initial biopsies were reviewed, identifying cases of insufficiency. Patients with insufficient biopsies were further evaluated for subsequent biopsies or operations, with results recorded. Statistical significance was assessed using the Chi-square test.

Results Out of 1064 patients, 334 (31.4%) had insufficient initial biopsy results. Among them, 222 (66.5%) were clinically monitored, while 67 (20.0%) underwent a second biopsy, and 45 (13.5%) underwent operations. Second biopsy results included 36 (53.7%) mucoid, 13 (19.4%) normal endometrial tissue, 17 (25.4%) benign polyps, and 1 (1.5%) serous endometrial cancer. Operation outcomes consisted of 29 (64.4%) normal benign results, 9 (20%) benign polyps, 2 (4.4%) endometrial intraepithelial neoplasia, 1 (2.2%) endometrial adenocancer grade 2, 2 (4.4%) endometrial adenocancer grade 1, 1 (2.2%) adenosarcoma, and 1 (2.2%) serous endometrial cancer. Comparing malign and premalign results between insufficient and sufficient groups showed 43 (4%) out of 1064 versus 8 (7.1%) out of 112 (p=0.28,, 95% CI [1.9%, 7.8%]). The rebiopsy group had 1 (1.5%) patient out of 67 (p=0.35, 95% CI [0.46%, 2.52%]), and the operation group had 7 (15.5%) patients out of 45 (p=0.01, 95% CI [8.96%, 22.16%]).

Conclusion Approximately one-third of postmenopausal biopsies yield insufficient results. Clinicians need to discern the malignancy risk in this group. Although our study revealed double the malignancy rates in the insufficient group, the difference was not statistically significant (p=0.28). Notably, the operation group had significantly higher malignancy rates (15.5%, p=0.01, 95% CI [8.96%, 22.16%]).

Disclosures I have no conflict of insterest.