Diagnostic Yield of Endometrial Sampling by Age in Premenopausal Women with Abnormal Uterine Bleeding: A Retrospective Cross-Sectional Study
9 affiliations
- 1Department of Obstetrics and Gynecology, “Victor Babeș’’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
- 2Department III Functional Sciences, Discipline of Medical Informatics and Biostatistics, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
- 3Doctoral School, “Victor Babeș’’ University of Medicine and Pharmacy Timișoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
- 4Obstetrics-Gynecology Clinic IV, Timișoara Municipal Emergency Clinical Hospital, 300202 Timișoara, Romania
- 5Department XVI, Medical Recovery, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 6Research Center for Assessment of Human Motion and Functionality and Disability, “Victor Babeșs” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- 7“Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu, No. 156, 300723 Timisoara, Romania
- 8Department VI—Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 9Research Centre of Timisoara Institute of Cardiovascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
Abstract
Background: An age of 45 years is often used to guide endometrial assessment in abnormal uterine bleeding (AUB), but age is only one component of clinical risk. We described the relationship between age and histopathological yield among premenopausal women who had undergone endometrial sampling. Methods: This single-centre retrospective cross-sectional study analysed the index sampling episodes of 824 women with AUB documented as premenopausal or perimenopausal (January 2022–May 2026). The clinically more consequential endpoint was endometrial intraepithelial neoplasia (EIN)/atypical hyperplasia or carcinoma; the primary statistical outcome was a broader composite that also included hyperplasia without atypia. Modified Poisson regression estimated the adjusted association between age ≥45 years and the primary outcome. Discrimination of age alone and of an exploratory model using variables available before biopsy was compared in 776 complete cases with bootstrap internal validation. Results: EIN/carcinoma occurred in 4/361 (1.1%) women aged <45 years and 25/463 (5.4%) aged ≥45 years (crude RR 4.87, 95% CI 1.71–13.88). The broad outcome occurred in 24/361 (6.6%) and 57/463 (12.3%), respectively (absolute difference 5.7 percentage points, 95% CI 1.6–9.6; adjusted RR 1.62, 95% CI 1.01–2.61; p = 0.047). Results were similar across sensitivity analyses (adjusted RRs 1.52–1.68). With age coded as ≥45 years in both models, the optimism-corrected AUC was 0.686 for the exploratory pre-biopsy model and 0.575 for age alone (difference 0.111, 95% CI 0.060–0.196). Conclusions: Among premenopausal women selected for endometrial sampling, histopathological yield increased with age, and most EIN/carcinoma cases occurred at age ≥45 years, but the adjusted association for the broad outcome was imprecise, and age alone had limited discrimination. Model performance was assessed only internally and only in sampled women; this study cannot establish a biopsy rule for all women with AUB because women not sampled were not observed.
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BibTeX
@article{erdelean2026diagnostic,
title = {{Diagnostic Yield of Endometrial Sampling by Age in Premenopausal Women with Abnormal Uterine Bleeding: A Retrospective Cross-Sectional Study}},
author = {Izabella Erdelean and Dragoș Erdelean and Răzvan Roșca and Andrei Pescaru and Cosmin Cîtu and Denis Mihai Șerban and Victor Bogdan Buciu and Anca-Raluca Dinu and Nilima Rajpal Kundnani and Sebastian Ciurescu},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218523},
url = {https://www.mdpi.com/2077-0383/15/21/8523},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic Yield of Endometrial Sampling by Age in Premenopausal Women with Abnormal Uterine Bleeding: A Retrospective Cross-Sectional Study
AU - Izabella Erdelean
AU - Dragoș Erdelean
AU - Răzvan Roșca
AU - Andrei Pescaru
AU - Cosmin Cîtu
AU - Denis Mihai Șerban
AU - Victor Bogdan Buciu
AU - Anca-Raluca Dinu
AU - Nilima Rajpal Kundnani
AU - Sebastian Ciurescu
PY - 2026
DA - 2026/11/02
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218523
UR - https://www.mdpi.com/2077-0383/15/21/8523
AB - Background: An age of 45 years is often used to guide endometrial assessment in abnormal uterine bleeding (AUB), but age is only one component of clinical risk. We described the relationship between age and histopathological yield among premenopausal women who had undergone endometrial sampling. Methods: This single-centre retrospective cross-sectional study analysed the index sampling episodes of 824 women with AUB documented as premenopausal or perimenopausal (January 2022–May 2026). The clinically more consequential endpoint was endometrial intraepithelial neoplasia (EIN)/atypical hyperplasia or carcinoma; the primary statistical outcome was a broader composite that also included hyperplasia without atypia. Modified Poisson regression estimated the adjusted association between age ≥45 years and the primary outcome. Discrimination of age alone and of an exploratory model using variables available before biopsy was compared in 776 complete cases with bootstrap internal validation. Results: EIN/carcinoma occurred in 4/361 (1.1%) women aged <45 years and 25/463 (5.4%) aged ≥45 years (crude RR 4.87, 95% CI 1.71–13.88). The broad outcome occurred in 24/361 (6.6%) and 57/463 (12.3%), respectively (absolute difference 5.7 percentage points, 95% CI 1.6–9.6; adjusted RR 1.62, 95% CI 1.01–2.61; p = 0.047). Results were similar across sensitivity analyses (adjusted RRs 1.52–1.68). With age coded as ≥45 years in both models, the optimism-corrected AUC was 0.686 for the exploratory pre-biopsy model and 0.575 for age alone (difference 0.111, 95% CI 0.060–0.196). Conclusions: Among premenopausal women selected for endometrial sampling, histopathological yield increased with age, and most EIN/carcinoma cases occurred at age ≥45 years, but the adjusted association for the broad outcome was imprecise, and age alone had limited discrimination. Model performance was assessed only internally and only in sampled women; this study cannot establish a biopsy rule for all women with AUB because women not sampled were not observed.
SN - 2077-0383
ER -