Blind vs. hysteroscopy-guided endometrial biopsy for endometrial pathologies

Aims:The trend toward minimally invasive methods over basic classical techniques in surgical procedures is rapidly increasing.This study aimed to evaluate the sensitivity of blind biopsy (BB) vs. hysteroscopy-guided biopsy (HGB) for diagnosing malignancy in patients with endometrial pathology.Methods: This retrospective study included patients who underwent a BB (Group BB) and HGB (Group HGB) because of persistent uterine bleeding or unaltered ultrasonography findings after the initial biopsy at a tertiary facility from October 2022 through July 2023.Patients with a known history of malignancy were excluded.The primary objectives were to compare the performance of the two procedures and calculate a cut-off of endometrial thickness (ET) for a malignancy diagnosis. Results:The study included 150 patients (mean age: 46.2011.26years in Group BB and 46.989.77years in Group HGB, p=0.520).The frequency of endometrial polyps was higher in group BB (61.3% vs. 35.3%,p<0.001), whereas functional endometrium was more frequent in group HGB (41.2% vs. 22%, p<0.001).Mean ET was similar in the two groups (Group BB vs. Group HGB: 11.214.96mm vs. 10.315.63 mm, p=0.150).The cut-off of ET in predicting endometrial malignancy was 12.5 mm with a sensitivity of 75% and specificity of 74.6% [area under the curve: 0.775, 95% confidence interval: 0.615-0.935;p=0.009]. Conclusions:The presented study showed no difference between HGB and BB in identifying benign endometrial pathologies.A cut-off of 12.5 mm ET was determined to predict malignancies, though the event rate was low to perform robust calculations.