Etiologies for Postmenopausal Bleeding and Diagnostic Values of Endometrial Biopsy
Orawin Vallibhakara MD1, Artitaya Singwongsa MD1, Areepan Sophonsritsuk MD, PhD1, Sakda Arj-Ong Vallibhakara MD, PhD2
Affiliation : 1 Reproductive Endocrinology & Infertility Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand 2 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : To de(cid:976)ine the etiologies of postmenopausal bleeding [PMB] categorized by clinical (cid:976)inding and endometrial histopathology
and explore the diagnostic performance of endometrial biopsy compared to either fractional curettage [F&C] or hysteroscopic
biopsy or hysterectomy.
Materials and Methods : The retrospective study of 100 consecutive postmenopausal women presenting with PMB at the out-patient
department, Ramathibodi Hospital between January 1 and June 30, 2015. They were investigated for the causes of bleeding by
vaginal examination and endometrial biopsy for histopathologic examination. Some patients received additional investigations or
operations for (cid:976)inal diagnosis, either F&C, directed hysteroscopic biopsy, or hysterectomy. The accuracy, sensitivity, and speci(cid:976)icity
of the endometrial biopsy was analyzed.
Results : From 100 consecutive PMB patients, the bleeding sources were vagina (3%), cervix (2%), and endometrium (95%). The
etiologies of PMB were mostly from endometrial sources, including proliferative and other benign endometrial pathology (45%),
atrophic endometrium (22%), endometrial polyp (12%), endometrial hyperplasia (7%), and endometrial carcinoma (9%). Besides,
a small part of PMB resulted from atrophic vaginitis (3%) and cervical polyp (2%). The pathologic reports of 68 endometrial
samplings revealed proliferative and other benign endometrium (48.5%), atrophic endometrium (14.7%), endometrial polyp (7.3%),
endometrial hyperplasia (8.8%), endometrial cancer (7.3%), and inadequate endometrial tissue (13.2%). Some patients received
further investigations or operations, either F&C, or directed hysteroscopic biopsy or hysterectomy. The discrepancy of the pathology,
between endometrial sampling and further investigation or operations, was found in 37.5% (6 in 16 of patients). The sensitivity and
speci(cid:976)icity of endometrial biopsy for benign and malignant endometrial lesions were 62.5% and 100%, respectively. The positive
predictive value [PPV], the negative predictive value [NPV], and the accuracy were 100%, 72.73%, and 81.25%, respectively.
Conclusion : The most common causes of PMB were benign in nature, however, endometrial carcinoma accounted around 9%.
The diagnostic performance of endometrial biopsy for PMB was relatively low, demonstrated by low sensitivity and some risks of
undetectable endometrial precancerous and cancerous lesion.
Keywords : Postmenopausal bleeding, Endometrial biopsy, Endometrial hyperplasia, Endometrial cancer
