Comparison of D&C and hysterectomy pathologic findings in endometrial cancer patients
- 156 Downloads
The objective of this study is to compare the accuracy of tumor grade in endometrial cancer between fractional dilatation and curettage (D&C) and postoperative hysterectomy specimen findings.
From January 2000 to November 2002, 52 women with abnormal vaginal bleeding and diagnosed or suspected endometrial cancer were treated in the Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Second Medical University. The comparison of tumor grades was performed on both D&C and hysterectomy specimens, the relationship between the concordance rate of grade, and the depth of tumor invasion into the myometrium. The expression of estrogen receptor (ER), progesterone receptor (PR), p53, Bcl2, and proliferation cell nuclear antigen (PCNA) in tumor samples were analyzed.
The concordance rates were 20% in grade 1, 61.5% in grade 2, and 77.8% in grade 3. The concordance rates for grade 2 and grade 3 were higher than grade 1 significantly (grade 2 ~ grade 1, P=0.010; grade 3 ~ grade 1, P=0.005). Fourteen out of 52 (26.9%) patients diagnosed with atypical endometrial hyperplasia by D&C had their diagnosis changed to endometrial cancer after being ascertained by hysterectomy specimen. The accuracy of tumor grade diagnosis by D&C was 50%, and 48% of patients were downgraded after comparison of postoperative specimens. The concordance rate of tumor invasion into the outer half of myometrium was higher than in tumors localized in the endometrium (P= 0.030). No association between high concordance rate and the expression of ER, PR, p53, Bcl-2 and PCNA was found.
We concluded that D&C had a high accuracy in the diagnosis of endometrial cancer in grade 3 tumors (77.8%) and tumor invasion into the outer half of the myometrium (75%). Overall, 48% of endometrial cancer patients’ tumor grades seemed to be decreased by D&C evaluation; thus, the diagnosis of endometrial disorders by D&C should not be overlooked.
- 2.Cowles TA, Magrina JF, Masterson BJ, Capen CV (1985) Comparison of clinical and surgical staging in patients with endometrial carcinoma. Obstet Gynecol 66:413–416Google Scholar
- 6.Del Priore G, Williams R, Harbatkin CB, Wan LS, Mittal K, Yang GC (2001) Endometrial brush biopsy for the diagnosis of endometrial cancer. J Reprod Med 46:439–443Google Scholar
- 8.Emanuel MH, Wamsteker K, Lammes FB (1997) Is dilatation and curettage obsolete for diagnosing intrauterine disorders in premenopausal patients with persistent abnormal uterine bleeding? Acta Obstet Gynecol Scand 76:65–68Google Scholar
- 9.Petersen RW, Quinlivan JA, Casper GR, Nicklin JL (2000) Endometrial adenocarcinoma—presenting pathology is a poor guide to surgical management. Aust N Z J Obstet Gynaecol 40:191–194Google Scholar
- 10.Oakley G, Nahhas WA (1989) Endometrial adenocarcinoma: therapeutic impact of preoperative histopathologic examination of endometrial tissue. Eur J Gynaecol Oncol 10:255–260Google Scholar
- 11.Soothill PW, Alcock CJ, MacKenzie IZ (1989) Discrepancy between curettage and hysterectomy histology in patients with stage 1 uterine malignancy. Br J Obstet Gynaecol 96:478–481Google Scholar
- 13.Barakat RR, Gilewski TA, Almadrones L et al (2000) Effect of adjuvant tamoxifen on the endometrium in women with breast cancer: a prospective study using office endometrial biopsy. J Clin Oncol 18:3459–3463Google Scholar
- 14.Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP (2000) The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 89:1765–1772Google Scholar
- 15.Vorgias G, Lekka J, Katsoulis M, Varhalama E, Kalinoglou N, Akrivos T (2003) Diagnostic accuracy of prehysterectomy curettage in determining tumor type and grade in patients with endometrial cancer. MedGenMed 5:7Google Scholar
- 18.Creasman WT, Morrow CP, Bunday BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. Cancer 60:2035–2041Google Scholar
- 20.Mikuta JJ (1995) Preoperative evaluation and staging of endometrial cancer. Cancer 76 [Suppl 10]:2041–2043Google Scholar
- 21.Palmer DC, Muir IM, Alexander AI, Cauchi M, Bennett RC, Quinn MA (1988) The prognostic importance of steroid receptors in endometrial carcinoma. Obstet Gynecol 72:388–393Google Scholar
- 23.Reed JC, Miyashita T, Takayama S et al (1996) BCL2 family proteins: regulators of cell death involved in the pathogenesis of cancer and resistance to therapy. J Cell Biochem 60:23–32Google Scholar