Risk of Endometrial Cancer after Insufficient Endometrial Biopsy – A Retrospective Cohort Study at NICRH

Open Access

Abstract

Background: Endometrial biopsy is the first-line diagnostic tool for abnormal uterine bleeding (AUB) and suspected endometrial pathology. However, insufficient biopsy is a common challenge and may delay diagnosis or mask underlying malignancy. Data from Bangladesh on the clinical significance of inadequate biopsy are limited. Objective: To evaluate the association between insufficient endometrial biopsy and the risk of endometrial cancer, and to assess diagnostic delays among the screened women of different ages who underwent endometrial biopsy. Methods & Materials: This retrospective cohort study included 320 women who underwent outpatient or inpatient endometrial biopsy at the Department of Gynecology and Obstetrics in National Institute of Cancer Research and Hospital (NICRH), Dhaka, Bangladesh, between Decembers 2023 to November 2024. Participants were categorized into adequate biopsy (n=240) and insufficient biopsy (n=80) groups. Baseline characteristics, histopathological outcomes, and time to final diagnosis were collected from hospital and pathology records. Descriptive statistics were calculated, and differences between groups were assessed using t-tests and chi-square tests. Logistic regression was performed to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for endometrial cancer, adjusting for age, menopausal status, BMI, and diabetes. Statistical significance was set at p < 0.05. Results: The mean age of women was 53.7 ± 8.9 years; 214(66.9%) women were ≥50 years, and 198 (61.9%) were postmenopausal. Insufficient biopsy samples were significantly more common in older and postmenopausal women had higher BMI (p<0.05). Endometrial cancer was diagnosed in 54 (16.9%) women, with a higher incidence in the insufficient biopsy group (26/80; 32.5%) versus the adequate biopsy group (28/240; 11.7%) (p<0.001). Insufficient biopsy was independently associated with endometrial cancer (adjusted OR 3.12; 95% CI: 1.62–5.99 (p<0.001). Median time to diagnosis was longer in the insufficient biopsy group (45 vs. 18 days; (p<0.001), and 70% experienced delays >30 days. Age ≥50 years and postmenopausal status were additional independent predictors. Conclusion: Insufficient endometrial biopsy is a strong predictor of endometrial cancer diagnosis and is associated with significant diagnostic delays. Prompt repeat evaluation and standardized follow-up protocols are essential to ensure early detection and timely management in high-risk patients.