Endometrial biopsy: Indications, techniques and recommendations. An evidence-based guideline for clinical practice

This practice guideline provides updated evidence for the gynecologist who performs endometrial biopsy (EB) in gynecologic clinical practice.An international committee of gynecology experts developed the recommendations according to AGREE Reporting Guideline.An adequate tissue sampling is mandatory when performing an EB. Blind methods should not be first choice in patients with suspected endometrial malignancy. Hysteroscopy is the targeted-biopsy method with high-est diagnostic accuracy and cost-effectiveness. Blind suction techniques are not reliable for the diagnosis of endometrial polyps. In low resources settings, and in absence of the capacity to perform office hysteroscopy, blind techniques could be used for EB. Hysteroscopic punch biopsy allows to collect only limited amount of endometrial tissue. grasp biopsy technique should be considered first choice in reproductive aged women, bipolar electrode chip biopsy should be preferred with hypotrophic or atrophic endometrium. EB is required for the final diagnosis of chronic endometritis. There is no consensus regarding which endometrial thickness cut-off should be used for recommending EB in asymptomatic postmenopausal women. EB should be offered to young women with abnormal uterine bleeding and risk factors for endometrial carcinoma. Endometrial pathology should be excluded with EB in nonobese women with unopposed hyperestrogenism. Hysteros-copy with EB is useful in patients with abnormal bleeding even without sonographic evidence of pathology. EB has high sensitivity for detecting intrauterine pathologies. In postmenopausal women with uterine bleed-ing, EB is recommended. Women with sonographic endometrial thickness > 4 mm using tamoxifen should undergo hysteroscopic EB.(c) 2023 Elsevier Masson SAS. All rights reserved.

Automated summary

This practice guideline provides updated evidence for gynecologists who perform endometrial biopsy (EB) and discusses various techniques and considerations for different patient groups. Hysteroscopy is recommended for targeted biopsies, while blind techniques can be used in low-resource settings. The guideline emphasizes the importance of adequate tissue sampling and highlights specific situations where EB is necessary for diagnosis and management. In postmenopausal women, EB is recommended for uterine bleeding, and in women using tamoxifen, hysteroscopic EB should be considered for those with a thickened endometrium.