Routine prehysterectomy endometrial biopsy in a series of 523 women

From January 1983 to December 1984, 523 women underwent hysterectomy at Tripler Army Medical Center. Four-wall endometrial biopsies using a Novak curette were performed preoperatively in 427 patients, and an additional 13 patients had dilatation and curettage procedures. Adequate tissue for histologic examination was present in 97 percent of the specimens. A prevalence of endometrial adenocarcinoma of 11.47/1000 was found among the 523 patients. Four cases of cancer were reported prior to hysterectomy, and in 2 instances the diagnosis was missed on preoperative sampling. No endometrial adenocarcinoma was found in patients younger than 40 years, who comprised 74 percent of the study population. The prevalence of endometrial adenocarcinoma in patients 40 years of age or older was 44.12/1,000. All patients with adenocarcinoma experienced abnormal uterine bleeding. The prevalence of endometrial hyperplasia was 23.3/1,000 for women younger than 40, and 110.29/1,000 for women 40 years of age or older (p < 0.001). Although a high prevalence of endometrial hyperplasia and adenocarcinoma was seen, these conditions were found more frequently among patients older than 40 years, the majority of whom presented with abnormal uterine bleeding. Routine prehysterectomy endometrial biopsy in all patients results in a low yield and is not cost effective. Efforts should be directed toward high-risk patients, that is those with abnormal uterine bleeding, especially if they are over 40 years old.