The diagnosis of endometrial atypia by hysteroscopy with guided biopsy in postmenopausal patients with hyperplasia: a reliable practice?

Atypical endometrial hyperplasia shows a high propensity to progress to endometrioid adenocarcinoma. Hysteroscopic biopsy represents a valid method for detection of this pre-neoplastic disease. This study assesses the accuracy of histological diagnosis of endometrial atypia in hysteroscopy with blind biopsy, in postmenopausal women with an endometrial thickness (ET) greater than 5 mm. In order, to determine the relationship between ET and atypia more precisely, ET was subdivided in three categories of 5–7 mm, ≥7–9 mm and >9 mm. Ninety-nine postmenopausal patients, aged 51–79 years, with abnormal uterine bleeding and an endometrial thickness >5 mm in whom a diagnosis of endometrial hyperplasia, with or without atypia, was established with hysteroscopy with biopsy, underwent subsequent hysterectomy. Hysteroscopy and biopsy were carried out using a blind endometrial biopsy guided by hysteroscopic findings. The results of biopsies and hysterectomy histology, for the presence of atypia, were compared. Sensitivity and likelihood ratio of hysteroscopic biopsy, as a diagnostic tool for detecting atypia, were calculated. The sensitivity in detecting atypia was 93.3 % corresponding to a negative likelihood ratio equal to 0.06. Univariate analysis did not show a significant association between atypia, age and/or endometrial thickness. The high sensitivity of hysteroscopic biopsy, corresponding to a strong negative likelihood ratio, made it a valid diagnostic tool for detecting atypia in postmenopausal women with abnormal uterine bleeding, hyperplasia and endometrial thickness >5 mm. There was no association between atypia and increase of endometrial thickness from 5 to >9 mm.