Abstract 2303: If at first you don't succeed: Follow-up care trajectories for women with failed endometrial biopsies
Authors: Linkov Faina , Adambekov Shalkar , Lopa Samia , Edwards Robert P. , Rindos Noah , Mansuria Suketu , Donnellan Nicole , Bovbjerg Dana H. 
Published: September 2020

Abstract
Introduction: Office-based endometrial biopsy (Pipelle) is an important minimally invasive diagnostic modality for endometrial cancer and benign gynecologic disease but does have a substantial failure rate. Little is known about trajectories of care following failure of Pipelle procedures, as studies in this area have been almost exclusively based on review of medical records, which may not include information on failures due to inability to obtain samples to send to pathology.
Methods: Women undergoing a Pipelle biopsy in a tertiary women's care center (n= 121) were recruited from August 2017 to June 2019 with post-menopausal and abnormal bleeding as a biopsy indication in the majority of cases. Patients' relevant demographic and clinical data were extracted from their medical records and from surveys administered to providers immediately after attempted procedures. Overall failure of their Pipelle biopsy was defined by either a failure to obtain a sample at all (sampling failure) or a failure due to having a sample with insufficient tissue for histopathological diagnosis (tissue failure). Participants' medical records are currently being abstracted for a period of one year after the date of the Pipelle procedure to prospectively track their follow-up care trajectories. Descriptive statistics and tests of dichotomous relationships were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA).
Results: The study sample included 35 women (29% of the original cohort) for whom there was an overall failure of Pipelle biopsy (mean age=56, SD=8; mean BMI=33, SD=10). Among women with overall biopsy failures, 63% were due to sampling failures (attributed by providers to stenotic cervix, body habitus, and procedure intolerance), while 37% were due to having insufficient tissue acquired for pathological diagnosis. Follow-up procedures and/or counseling have already been conducted in the majority of patients and found to include: hysteroscopy/D&C (51%), another Pipelle (3%), Pipelle and D&C (3%), hysterectomy without additional endometrial sampling (3%), ultrasound (3%), and CT scan/referral to gynecologic oncologist for cancer care (3%). Among women with follow-up, approximately one third had pathological findings, which included endometrial polyps (29%) and cancer (6%). Participants with sampling failure had a higher likelihood (76%) of D&C follow-up compared to those with tissue failure (24%) (P=0.055).
Conclusions: This study is one of the first to prospectively track follow-up care for women who experienced Pipelle biopsy failures due to sampling failure as well as tissue failure. Considering that D&Cs are invasive and costly, but were used for a majority of the follow-up care for women with Pipelle failures, it is particularly important in future research to determine whether repeat Pipelle, perhaps with supportive care, might prove more successful and reduce the need for invasive procedures.
Citation Format: Faina Linkov, Shalkar Adambekov, Samia Lopa, Robert P. Edwards, Noah Rindos, Suketu Mansuria, Nicole Donnellan, Dana H. Bovbjerg. If at first you don't succeed: Follow-up care trajectories for women with failed endometrial biopsies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2303.