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Necessity of endometrial biopsy in women with enlarged uteri and a preoperative diagnosis of uterine leiomyomata.

OBJECTIVE
To determine the necessity of a preoperative endometrial biopsy when evaluating a patient with symptomatic uterine fibroids.


STUDY DESIGN
This was a retrospective study of 182 cases of hysterectomy for symptomatic uterine fibroids. The patients were stratified into 2 groups: those with uteri weighing between 280 and 500 g and with uteri weighing > 500 g. Charts were reviewed for all patients who did not have an endometrial biopsy and for all cases of malignancy.


RESULTS
Of the patients with menorrhagia, 21-30% did not undergo a preoperative biopsy. In those who did, biopsy failed to detect 2.75% of malignancies. All patients diagnosed postoperatively with malignancy had presented with complaints of bleeding.


CONCLUSION
With complaints other than bleeding, a preoperative endometrial biopsy may be omitted. However, any menstrual complaints warrant an investigation of the endometrium even though the incidence of endometrial carcinoma in these larger uteri is only 1.1%.