Enhancing Preoperative Diagnostic Accuracy in Endometrial Hyperplasia: A Comparison of Biopsy Methods

Introduction This study aimed to evaluate the diagnostic accuracy of aspiration biopsy alone versus a combined aspiration biopsy and full curettage for endometrial hyperplasia, focusing on concerns about the underestimation of malignancy with aspiration alone. Methods We compared the pathological diagnoses obtained from aspiration biopsy and full curettage with postoperative diagnoses in 87 surgically treated cases of endometrial hyperplasia at our center (August 2013 to September 2023). The diagnostic accuracy of each preoperative histology method was compared against the final postoperative diagnosis for cases where intraoperative rapid pathology was performed, either with aspiration biopsy alone or with combined aspiration and curettage. Results Aspiration biopsy alone diagnosed 47 cases (54.0%) as endometrial intraepithelial neoplasia (EIN) and 40 cases (46.0%) as endometrial hyperplasia without atypia. Preoperative histological diagnosis was performed by aspiration alone in 63 cases (72.4%) and by aspiration plus full curettage in 24 cases (27.6%). The rate of postoperative upgrade to endometrial cancer was significantly lower when both methods were used (42.9% vs. 16.7%; p = 0.026, Fisher's exact test). Among 33 cases with intraoperative rapid pathology, the upgrade rate was lower in the combined method group than in the aspiration-only group, though the difference was not statistically significant (30.8% vs. 14.3%; p = 0.64). Conclusions Incorporating full curettage alongside aspiration biopsy improves diagnostic accuracy for endometrial hyperplasia, reducing the risk of misdiagnosis and aiding appropriate treatment decisions. These results emphasize the importance of considering both biopsy methods in preoperative diagnosis and management.