Determination of endometrial biopsy indications and biopsy methods in premenopausal women

Aim: This study aimed to determine the risk factors for endometrial cancer or endometrial hyperplasia and the diagnostic efficiency of biopsy methods in premenopausal patients. Material and Method: Premenopausal women with endometrial biopsies who applied to the Gynecology and Obstetrics Clinic of Akdeniz University Medical Faculty Hospital between 01.01.2015 and 30.06.2020 were screened retrospectively. Results: The mean age of the sampled 2,054 premenopausal patients was 42.92 ± 6.27 years, mean BMI was 29.21 ± 5.93, mean gravida was 2.59 ± 1.66, and mean parity was 2.06 ± 1.24. While abnormal uterine bleeding was detected in 93.0% of the patients, 47.3% were diagnosed by the pipelle method, 30.6% by hysteroscopy, and 22.2% by the probe method. One unit increase in BMI value increased the risk of endometrial hyperplasia and endometrial cancer by 1.05 times (OR = 1.054, 95% CI = 1.016–1.094, p = 0.005) in premenopausal patients, the presence of HT increased the risk 2 times (OR = 1.992, 95% CI = 1.187–3.341, p = 0.009), and increases in gravida and parity values decreased the risk (OR = 0.877, 95% CI = 0.780–0.986, p = 0.029; OR = 0.840, 95% CI = 0.720–0.980, p = 0.027, respectively). In the detection of endometrial hyperplasia and endometrium cancer, the pipelle method's sensitivity and selectivity were 71.7% and 100%, respectively. The probe method's sensitivity was 82%, and its selectivity was 99.8%, while hysteroscopy's sensitivity was 91.3% and selectivity 100%. Conclusion: In premenopausal patients, the presence of hypertension and a high BMI increases the risk of endometrial hyperplasia and endometrial cancer, while increases in gravida and parity values decrease the risk. Hysteroscopy has the highest diagnostic efficiency in the detection of endometrial hyperplasia and endometrial cancer in premenopausal women with abnormal uterine bleeding. Keywords: Abnormal Uterine Bleeding, Premenopause, Hysteroscopy, Pipelle, Probe