Facts, views & vision in ObGyn · 2026
Visually directed hysteroscopic biopsy in the evaluation of abnormal uterine bleeding and postmenopausal bleeding: a Joint Society Practice Guideline.
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Joint Society Practice Guideline from AAGL–ESGE–GCH
Аннотация
BACKGROUND: Abnormal uterine bleeding (AUB) and postmenopausal bleeding (PMB) require systematic evaluation to exclude clinically significant intrauterine pathology, including premalignant and malignant endometrial disease.
OBJECTIVES: To provide evidence-based recommendations for the histopathologic evaluation of patients with AUB or PMB undergoing assessment for suspected intrauterine pathology.
METHODS: The American Association of Gynecologic Laparoscopists, European Society of Gynaecological Endoscopy, and Global Community on Hysteroscopy developed a Joint Society Guideline using the PICO framework. Diagnostic hysteroscopy performed in outpatient or inpatient settings, including hysteroscopy alone, hysteroscopy combined with ultrasound, or hysteroscopy with biopsy, was compared with blind endometrial sampling performed without preceding hysteroscopy. Risk of bias and study quality were assessed using established methodological frameworks.
MAIN OUTCOME MEASURES: The primary outcome was diagnostic accuracy, measured by sensitivity and specificity, using histopathology from endometrial sampling or hysterectomy specimens as the reference standard.
RESULTS: Meta-analysis showed that hysteroscopy, with or without concomitant endometrial sampling, had higher diagnostic accuracy than blind endometrial biopsy for detecting and excluding endometrial cancer, endometrial intraepithelial neoplasia, endometrial hyperplasia with or without cytological atypia, endometrial polyps, and submucous myomas. Accuracy estimates were generally higher for detecting than excluding intrauterine pathology. Evidence for endometritis was limited to one comparative study, and no comparative data were available for other conditions, including uterine niches or retained pregnancy tissue.
CONCLUSIONS: Hysteroscopy is a valuable diagnostic modality for AUB and PMB, particularly when focal pathology is suspected or prior imaging or sampling is inconclusive. When endometrial tissue assessment is indicated, visually directed biopsy performed with hysteroscopic evaluation is favored over blind sampling.
WHAT IS NEW?: Hysteroscopy with or without endometrial biopsy is more accurate than blind endometrial sampling alone for benign structural, premalignant and malignant endometrial pathology. This practice guideline recommends that visually directed biopsy is favored over blind biopsy in the evaluation of AUB or PMB.
OBJECTIVES: To provide evidence-based recommendations for the histopathologic evaluation of patients with AUB or PMB undergoing assessment for suspected intrauterine pathology.
METHODS: The American Association of Gynecologic Laparoscopists, European Society of Gynaecological Endoscopy, and Global Community on Hysteroscopy developed a Joint Society Guideline using the PICO framework. Diagnostic hysteroscopy performed in outpatient or inpatient settings, including hysteroscopy alone, hysteroscopy combined with ultrasound, or hysteroscopy with biopsy, was compared with blind endometrial sampling performed without preceding hysteroscopy. Risk of bias and study quality were assessed using established methodological frameworks.
MAIN OUTCOME MEASURES: The primary outcome was diagnostic accuracy, measured by sensitivity and specificity, using histopathology from endometrial sampling or hysterectomy specimens as the reference standard.
RESULTS: Meta-analysis showed that hysteroscopy, with or without concomitant endometrial sampling, had higher diagnostic accuracy than blind endometrial biopsy for detecting and excluding endometrial cancer, endometrial intraepithelial neoplasia, endometrial hyperplasia with or without cytological atypia, endometrial polyps, and submucous myomas. Accuracy estimates were generally higher for detecting than excluding intrauterine pathology. Evidence for endometritis was limited to one comparative study, and no comparative data were available for other conditions, including uterine niches or retained pregnancy tissue.
CONCLUSIONS: Hysteroscopy is a valuable diagnostic modality for AUB and PMB, particularly when focal pathology is suspected or prior imaging or sampling is inconclusive. When endometrial tissue assessment is indicated, visually directed biopsy performed with hysteroscopic evaluation is favored over blind sampling.
WHAT IS NEW?: Hysteroscopy with or without endometrial biopsy is more accurate than blind endometrial sampling alone for benign structural, premalignant and malignant endometrial pathology. This practice guideline recommends that visually directed biopsy is favored over blind biopsy in the evaluation of AUB or PMB.