An evaluation of endometrial sampling procedures, their corresponding ındications, histopathological distributions and affecting factors in women presenting at Gazi University Hospital during the years 2006-2011

Endometrial sampling is one of the most frequently undertaken procedures in modern day gynaecological settings. It may performed as a means of obtaining histopathological tissue samples, however in some cases its considered as therapeutic approach. Whatever the indication is, its? major goal is rule out malignancy, and to establish a patient specific approach for therapy and follow up. The aim of this study is to evaluate the endometrial sampling indications and outcomes of women in various age groups, and to compare these results according to their ages, symptoms and ultrasonographically measured endometrial thicknesses.Demographic data, clinical presentations, various endometrial sampling procedures undertaken were collected from the hospital database between May 2006 and May 2011. The histopathological results were then analyzed in a retrospective fashion.Amongst the 1646 patients recruited, 1217 were classed as premenopausal. The endometrial pathology most frequently seen in this group was endometrial polyps (33.3%). Nine premenopausal women were diagnosed with endometrial cancer (0.7%). In comparison with premenopausal women with benign pathology, the patients with cancer had a significantly thicker endometrium on ultrasound (p=0.001). The ultrasonographic endometrial cut off value for endometrial hyperplasia and carcinoma was 10.05mm (51.8% sensitivity and 40% specificity). The age cut off for endometrial sampling was found to be 42.5 years. Therefore we recommend endometrial sampling without a trial of medical therapy in women over this age presenting with abnormal uterine bleeding, regardless of their known risks for endometrial carcinoma. Logistic regression analysis of premenopausal women showed a significant decrease in risk of endometrial malignancy with use of antilipidemic agents, oral antidiabetic medication and insulin.Amongst the postmenopausal women endometrial atrophy was the most frequent histopathological finding (23.1%), while the diagnosis of endometrial cancer was established in 9.8% of the patients. Most of the women with hyperplasia and cancer were symptomatic at presentation. The mean endometrial thickness of patients with a diagnosis of endometrial carcinoma was significantly thicker when compared to those with a benign result (p=0.001). The cut off ultrasonographic endometrial thickness for postmenopausal premalignancy and malignancy was 7.05mm.A model combining individual risks along with ultrasonographic appearance and endometrial thickness is warranted to perform a risk analysis for pre- and postmenopausal endometrial malignancy.