Pathologic Evidence of Polyp Versus Office Hysteroscopy: A Retrospective Chart Review

Objective: The goal of this research was to determine the incidence of pathologic evidence of endometrial polyps on Pipelle biopsy without visual evidence of endometrial polyps during office hysteroscopy. Materials and Methods: This study was a retrospective chart review. The setting was an urban, academic medical center outpatient facility. The initial patient cohort was obtained by searching internal office billing records for patients who underwent office hysteroscopic polypectomy between 2010 and 2015. All patients who had pathologic evidence of endometrial polyps on endometrial Pipelle^™ biopsies, who then underwent office hysteroscopy, were included. Data regarding patient variables, imaging, and hysteroscopy findings were collected and analyzed. Results: Reviews were conducted for 1246 patient charts. Inclusion criteria were met by 152 patients; they were found to have Pipelle biopsy evidence of endometrial polyps. Initial endometrial biopsy indications were: postmenopausal bleeding (50%, n = 76); abnormal uterine bleeding (39.5%, n = 60); abnormal Papanicolaou smear (7.9%, n = 12); and abnormal ultrasound results (2.6%, n = 4). Surprisingly, 44 of the 152 patients (28.9%) had polyps noted on Pipelle biopsies but had no polyps visualized during office hysteroscopy. Of these 44 patients, 24 (54.5%) had only thin or atrophic endometrium noted. Repeat biopsy pathology still showed polyps in 16 of these 44 patients although no polyps were visualized. Of these 16 patients, 11 had no abnormal hysteroscopic findings. Conclusions: Despite pathologic evidence of an endometrial polyp, it is important to counsel a patient preoperatively that a polyp might not be visualized during hysteroscopic evaluation.