Risk of endometrial cancer after insufficient endometrial biopsy: a retrospective cohort study

Endometrial biopsies are used to diagnose abnormalities in the endometrium, but the biopsies are sometimes insufficient.

To evaluate the risk of detecting endometrial cancer in individuals with an insufficient endometrial index biopsy compared to individuals with a normal index biopsy.

In this retrospective cohort study, we used the Danish Pathology Register to identify individuals with endometrial biopsies between 2013 and 2017. We categorized initial and follow-up samples as normal, insufficient, hyperplastic, or cancer by using Systematized Nomenclature of Medicine codes. We had 4 years of follow-up until December 31, 2021, and we compared categories with Kaplan-Meier analysis, a log-rank test, and Cox regression.

A total of 80,761 Danish individuals were included. Of these, 13,964 (17.3%) had an insufficient endometrial index biopsy, meaning the index sample contained too little tissue for a definitive diagnosis. From this group, 6130 (43.9%) individuals had a follow-up endometrial biopsy performed. Unadjusted for age (hazard ratio, 3.7; 95% confidence interval, 3.56-3.84), the incidence of endometrial cancer (n=368; 2.6%) was higher in individuals with an insufficient index biopsy compared to those with a normal index biopsy (n=423; 0.7%). However, when we adjusted for age, the hazard for endometrial cancer was only slightly higher after an insufficient biopsy compared to a normal biopsy (hazard ratio, 1.16; 95% confidence interval, 1.02-1.31).

We found an increased risk of detecting endometrial cancer in individuals with an insufficient index biopsy compared to individuals with a normal index biopsy. After adjusting for age, the risk was only slightly increased.