The histopathology of endometrial biopsies performed for abnormal uterine bleeding: an audit in a tertiary care centre in Sri Lanka

Abstract

Introduction: The main indication for endometrial curettage and pipelle aspiration is abnormal uterine bleeding (AUB). Histological assessment is important in determining the various structural and non-structural aetiologies for AUB. Objectives: To describe the histomorphology of the endometrium in different age groups of patients presenting with AUB and to determine the percentage having organic causes for AUB in each of these age groups. Methodology: All the uterine curettage and pipelle aspiration specimens received during a period two years from January 2019 to December 2020 were included in the study. Evacuated products of conception were excluded. The patient characteristics, clinical information and the histopathological findings were obtained. All cases were stratified into age groups 20-39 (reproductive), 40-50 (perimenopausal) and >50 years (postmenopausal). The histological findings were classified as normal pattern (NP), ovulatory dysfunction (OD), exogenous hormonal effects (EHE), endometrial polyp (EP), chronic endometritis (CE), atrophic endometrium (AE), disordered proliferative endometrium (DPE), endometrial hyperplasia (EH) and carcinoma (CA). EP, CE, EH and CA were considered structural/ organic causes. Results: A total of 778 specimens were analysed. The age range of the patients was 25–80 years (reproductive - 98, perimenopausal - 440, postmenopausal - 240). Structural / organic causes were found in 20.41% (20/98) in the 20–39-year age group (EP-15.31%, CE-4.08%, EH-1.02%), 12.95% (57/440) in the 40–50-year age group (EP-6.36%, CE-2.04%, EH-4.09%, CA-0.45%) and 29.58% (71/240) in the >50 age group (EP-14.17%, CA-10.83%, EH-4.58%). The commonest histological finding for AUB in the >50 age group was AE (22.08%,53/240). NP was the commonest in both the perimenopausal (29.55%, 130/440) and reproductive groups (30.61%,30/98).Conclusion: There is a variation in the histomorphological findings for AUB among different age groups, and non-structural findings are commoner than structural / organic causes.