Over half of patients for whom an in-office endometrial biopsy provided insufficient sample/tissue subsequently underwent hysteroscopy/dilation and curettage (D&C), according to results of a small study presented at the American Association for Cancer Research (AACR) Virtual Annual Meeting II.

During performance of an endometrial biopsy, a minimally invasive procedure, a long, thin tube is inserted through the cervix and suction is applied to collect a small amount of tissue from the lining of the uterus that is subsequently subjected to histological examination. Specifically, the Pipelle procedure, a common endometrial biopsy method, involves insertion of long, thin, flexible plastic tube with an internal piston that is withdrawn in order to create the suction needed for sample collection.

Because it is not uncommon for either no sample or insufficient tissue for histological evaluation to be obtained during an endometrial biopsy, the aim of this prospective study was to determine the type of follow-up care received by patients experiencing a failure of the Pipelle endometrial biopsy procedure.

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This prospective study enrolled 121 women, most of whom had abnormal uterine bleeding, who underwent a failed Pipelle endometrial biopsy procedure at a tertiary women’s health center between August 2017 and June 2019. Baseline clinical and demographic patient data were abstracted from patient medical records as well as surveys completed by the providers following biopsy failure. Follow-up care was tracked through continued assessments of patient medical records for 1 year following the date of the failed procedure. 

Of the 35 patients included in this analysis, the median patient age was 54 years and the median body mass index (BMI) was 33 kg/m2 at the time the biopsy procedure was performed. For approximately two-thirds of these women, the reason for biopsy failure was related to a sampling problem, with provider rationales including cervical stenosis, body habitus, and inability of the patient to tolerate the procedure. In the remaining approximately one-third of patients experiencing biopsy failure, a biopsy sample was obtained but the tissue was not deemed appropriate for histopathological diagnosis.

A key study finding was that 51% of patients experiencing endometrial biopsy failure for any reason subsequently underwent hysteroscopy/D&C, with 76% and 24% of these patients classified as having experienced a sampling or tissue failure, respectively.

Other follow-up procedures included another Pipelle biopsy (3%), a Pipelle biopsy and a D&C (3%), hysterectomy not proceeded by another endometrial biopsy (3%), ultrasound (3%), and CT scan/referral to gynecologic oncologist (3%).

For those patients who underwent follow-up evaluation, pathological findings were present in approximately one-third, including uterine polyps and cancer observed in 29% and 6% of patients, respectively.

In their concluding remarks, the study authors noted that “considering that D&Cs are invasive and costly, but were used for a majority of the follow-up care for women with Pipelle failures, it is particularly important in future research to determine whether repeat Pipelle, perhaps with supportive care, might prove more successful and reduce the need for invasive procedures.”


Linkov F, Adambekov S, Lopa S. et al.  If at first you don’t succeed: Follow-up care trajectories for women with failed endometrial biopsies. Presented at: American Association for Cancer Research (AACR) Virtual Annual Meeting II; June 22-24, 2020: Abstract 2303.