Endometrial biopsy is indicated in AUB for which scenario?

Endometrial biopsy is indicated in AUB for which scenario?

• A. In women over 45 with AUB or younger women with risk factors for endometrial cancer
• B. Younger women with new onset heavy menstrual bleeding
• C. Only after imaging shows a mass
• D. Endometrial biopsy is not indicated in AUB

Answer: (C)

Focusing on when tissue confirmation is most necessary, the reason endometrial biopsy is indicated when a mass is seen on imaging is that a visible lesion in the uterus raises strong suspicion for malignancy or a premalignant process. A biopsy provides the definitive histologic diagnosis needed to distinguish cancer, hyperplasia, or benign endometrial pathology, which directly guides management decisions from surgical planning to further testing. If imaging does not reveal a mass, biopsy may not be routinely required for all abnormal uterine bleeding, though it can still be considered in other high-risk situations. The key point here is that a mass detected on imaging creates a clear trigger for obtaining tissue to establish the diagnosis.

Focusing on when tissue confirmation is most necessary, the reason endometrial biopsy is indicated when a mass is seen on imaging is that a visible lesion in the uterus raises strong suspicion for malignancy or a premalignant process. A biopsy provides the definitive histologic diagnosis needed to distinguish cancer, hyperplasia, or benign endometrial pathology, which directly guides management decisions from surgical planning to further testing.

If imaging does not reveal a mass, biopsy may not be routinely required for all abnormal uterine bleeding, though it can still be considered in other high-risk situations. The key point here is that a mass detected on imaging creates a clear trigger for obtaining tissue to establish the diagnosis.