Archives of Gynecology and Obstetrics

, Volume 272, Issue 2, pp 136–141 | Cite as

Comparison of D&C and hysterectomy pathologic findings in endometrial cancer patients

Original Article

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

References

  1. 1.
    Greenlee RT, Murray T, Bolden S, Wingo PA (2000) Cancer statistics, 2000. CA Cancer J Clin 50:7–33PubMedGoogle Scholar
  2. 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
  3. 3.
    Tiitinen A, Forss M, Aho I, Vesterinen E, Nieminen U (1986) Endometrial adenocarcinoma: clinical outcome in 881 patients and analysis of 146 patients whose deaths were due to endometrial cancer. Gynecol Oncol 25:11–19CrossRefGoogle Scholar
  4. 4.
    Epstein E, Skoog L, Valentin L (2001) Comparison of Endorette and dilatation and curettage for sampling of the endometrium in women with postmenopausal bleeding. Acta Obstet Gynecol Scand 80:959–964CrossRefGoogle Scholar
  5. 5.
    Isaacson K (2002) Office hysteroscopy: a valuable but under-utilized technique. Curr Opin Obstet Gynecol 14:381–385CrossRefGoogle Scholar
  6. 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
  7. 7.
    Symonds I (2001) Ultrasound, hysteroscopy and endometrial biopsy in the investigation of endometrial cancer. Best Pract Res Clin Obstet Gynaecol 15:381–391CrossRefGoogle Scholar
  8. 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. 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. 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. 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
  12. 12.
    Mitchard J, Hirschowitz L (2003) Concordance of FIGO grade of endometrial adenocarcinomas in biopsy and hysterectomy specimens. Histopathology 42:372–378CrossRefGoogle Scholar
  13. 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. 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. 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
  16. 16.
    Obermair A, Geramou M, Gucer F et al (1999) Endometrial cancer: accuracy of the finding of a well differentiated tumor at dilatation and curettage compared to the findings at subsequent hysterectomy. Int J Gynecol Cancer 9:383–386CrossRefGoogle Scholar
  17. 17.
    Hendrickson M, Ross J, Eifel PJ, Cox RS, Martinez A, Kempson R (1982) Adenocarcinoma of the endometrium: analysis of 256 cases with carcinoma limited to the uterine corpus. Gynecol Oncol 13:373–392CrossRefGoogle Scholar
  18. 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
  19. 19.
    Xie X, Lu WG, Ye DF, Chen HZ, Fu YF (2002) The value of curettage in diagnosis of endometrial hyperplasia. Gynecol Oncol 84:135–139CrossRefGoogle Scholar
  20. 20.
    Mikuta JJ (1995) Preoperative evaluation and staging of endometrial cancer. Cancer 76 [Suppl 10]:2041–2043Google Scholar
  21. 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
  22. 22.
    Miyashita T, Reed JC (1995) Tumor suppressor p53 is a direct transcriptional activator of the human bax gene. Cell 80:293–299PubMedGoogle Scholar
  23. 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
  24. 24.
    Garzetti GG, Ciavattini A, Goteri G, De Nictolis M, Romanini C (1996) Proliferating cell nuclear antigen in endometrial carcinoma: pretreatment identification of high-risk patients. Gynecol Oncol 61:16–21CrossRefGoogle Scholar
  25. 25.
    Penney G, Vale L, Souter V, Templeton A (1997) Endometrial assessment procedures: an audit of current practice in Scotland. Hum Reprod 12:2041–2045CrossRefGoogle Scholar
  26. 26.
    Gull B, Karlsson B, Milsom I, Granberg S (2003) Can ultrasound replace dilation and curettage? A longitudinal evaluation of postmenopausal bleeding and transvaginal sonographic measurement of the endometrium as predictors of endometrial cancer. Am J Obstet Gynecol 188:401–408CrossRefGoogle Scholar
  27. 27.
    Patai K, Szentmariay IF, Jakab Z, Szilagyi G (2002) Early detection of endometrial cancer by combined use of vaginal ultrasound and endometrial vacuum sampling. Int J Gynecol Cancer 12:261–264CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyRenji Hospital, Shanghai Second Medical UniversityShanghaiPeople’s Republic China

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