title: Endometrial biopsy in women with abnormal uterine bleeding: inadequate and unassessable categorisation is not clinically relevant.
abstract: OBJECTIVE
  Inadequate endometrial biopsy comprises a dilemma for gynaecologists and histopathologists alike. This study was conducted to assess the clinical merit of classifying scant endometrial biopsy into inadequate and unassessable using McCluggage criteria.
  
  
  METHODS
  We retrospectively classified 268 endometrial biopsies, initially reported as inadequate, into inadequate (n=74) and unassessable (n=174) using McCluggage criteria after excluding 20 cases; all taken from patients aged ≥50 years with abnormal uterine bleeding attending Sandwell and West Birmingham Hospitals, UK from 1 January 2007 until 30 September 2012. The electronic clinical records were reviewed to find out the consequent clinical decisions and final outcomes. The follow-up period was 15 months after including the last patient.
  
  
  RESULTS
  The median age was 57 years (range: 50-97), and the median number of visits to hospital till the diagnosis was achieved was 2 (range: 1-4). The final diagnosis of endometrial hyperplasia or cancer was reported in 9 cases; 5 (7.1%) with an initial finding of inadequate and 4 with unassessable (2.4%); the difference was statistically insignificant (p=0.13). More patients in the inadequate category (82.4%) underwent further investigations when compared with the unassessable category (68.4%); the difference was statistically significant (p=0.029). There was no statistically significant difference in the inadequate to unassessable ratio when the endometrial thickness was ≥5 mm or <5 mm within the Pipelle group (p=0.46) or the curettage group (p=0.34).
  
  
  CONCLUSIONS
  Our findings suggest that categorising scant endometrial specimens into inadequate or unassessable has no clinical implications. The gynaecologist should interpret the histopathology report in the light of clinical scenario.
authors.affiliation: Department of Gynaecology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Ayman A A
authors.initials: AA
authors.lastname: Ewies
authors.affiliation: Department of Gynaecology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Kadry A A
authors.initials: KA
authors.lastname: Shaaban
authors.affiliation: Department of Histopathology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Reena
authors.initials: R
authors.lastname: Merard
authors.affiliation: Department of Histopathology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Ulises
authors.initials: U
authors.lastname: Zanetto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology*; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D008796:Metrorrhagia / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000473:pathology*
keywords: Endometrium; Gynaecological Pathology; Uterus