Abstract
OBJECTIVE: To identify patient-specific and procedural factors associated with insufficient office endometrial biopsy. METHODS: We conducted a large retrospective cohort study of adult patients who underwent office endometrial biopsy in 2023 across a large health system. Data on demographics, menopausal status, body mass index (BMI), history of cesarean delivery, leiomyomas, prior loop electrosurgical excision procedure or cold knife cone biopsy, and mental health conditions were examined to determine associations with insufficient endometrial biopsy, defined as insufficient endometrium on pathology examination for diagnosis. RESULTS: Among 27,456 patients, the overall rate of insufficient endometrial biopsies was 12.1%: 7.6% among premenopausal patients and 29.1% among postmenopausal patients. In univariate analysis for the overall cohort, postmenopausal status (defined as age 55 years or older at the time of endometrial biopsy) (29.1% vs 7.6%, P<.001) and history of chronic pain (14.0% vs 11.8%, P<.001) were associated with higher rates of insufficient endometrial biopsies. A BMI of 50 or higher was associated with a lower rate of insufficient endometrial biopsies (8.0% vs 12.3%, P<.001). In a multivariable logistic regression model that adjusted for covariates, postmenopausal status was the highest predictor of insufficiency in our study (adjusted odds ratio 5.27; 95% CI, 4.88-5.70; P<.001). When analysis was stratified by menopausal status, leiomyomas (10.3% vs 7.2%, P<.001) and history of cesarean delivery (9.6% vs 7.2%, P<.001) were associated with insufficient endometrial biopsy in premenopausal patients. In postmenopausal patients, leiomyomas (35.4% vs 28.7%, P=.01) and anxiety (31.7% vs 28.5%, P=.04) were associated with insufficient endometrial biopsy. A BMI of 50 or higher was associated with decreased insufficient endometrial biopsy (15.0% vs 30.0%, P<.001). CONCLUSION: Postmenopausal status, leiomyomas, history of cesarean delivery, chronic pain, and anxiety were associated with higher risk of insufficient endometrial biopsies, whereas BMI 50 or higher was associated with decreased risk. These characteristics may help identify patients who may benefit from additional efforts to optimize visualization and patient tolerance to avoid the need for repeat procedures.