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Hysteroscopic biopsy compared with endometrial curettage to assess the preoperative rate of atypical hyperplasia underestimating endometrial carcinoma

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the rate of atypical hyperplasia (AH) underestimating endometrial cancer (EC) comparing endometrial biopsy (EB) accomplished by hysteroscopic biopsy with dilatation and curettage (D&C). Second, to compare the two techniques to foresee EC grading.

Methods

This trial was based on the findings of two Gynecological Departments within the same Public Utility, sharing pathological service and database but routinely performing EB under hysteroscopic visualization (group A) or hysteroscopy followed by D&C (group B). We retrieved the clinical data of patients showing EC on hysterectomy throughout a 10-year period. The accuracy of hysteroscopic-view diagnosis and EB pathology were compared, having the pathologic findings of hysterectomy as reference.

Results

A total of 161 patients met the inclusion criteria. Among these, 109 and 52 were included in groups A and B, respectively. In group A, 32.1% of patients underwent EB in an out-patient setting. To foresee EC, hysteroscopic view showed a sensitivity of 82.5% and 70.2% in groups A and B, respectively (P = 0.019). An underestimation of EC diagnosed as AH on EB was found in 20 patients (12.4%). Among these, 18 (16.5%) and 2 (3.8%) were included in groups A and B, respectively (P = 0.022). In group A, a fault diagnosis of AH resulted higher when EB was performed as out-patient setting (P = 0.006). EB allowed the grading of EC in 73.3% and 90.3% of patients in groups A and B, respectively. The agreement was 73.7% and 85.1%, leading to moderate (κ = 0.56) and good (κ = 0.77) “κ” coefficient of concordance for groups A and B, respectively.

Conclusions

EB performed by D&C lowers the rate of AH underestimating concurrent EC and improves the grading agreement when compared with hysteroscopic sampling.

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Data availability

The authors confirm that the data supporting the findings of the study are available within the manuscript.

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Acknowledgements

We thank Mrs. Caroline Calnan Sagrada, a native English speaker with expertise in medical manuscripts, for the support in English grammar and style revision of the manuscript

Funding

All the authors declare that no funds, grants or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Obstetrics and Gynecology Department, Hospital of Lodi, Via Savoia 1, 26900, Lodi, Italy

    Giancarlo Garuti, Antonella Frigoli, Ottavia Fornaciari, Andrea Finco & Marco Soligo

  2. Medical Oncology Department, Hospital of Lodi, Via Savoia 1, 26900, Lodi, Italy

    Paola Francesca Sagrada

  3. Department of Pathology, Via Savoia 1, 26900, Lodi, Italy

    Maurizio Mirra

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Contributions

All the authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GG, OF, AF, PFS and MS. Protocol development was performed by GG, AF and MM. The first draft of the manuscript was written by GG, and all the authors commented on previous version of the manuscript. All the authors have read and approved the final manuscript.

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Correspondence to Giancarlo Garuti.

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Conflict of interest

All the authors have neither financial nor non-financial interests to disclose.

Ethical approval

This manuscript was performed according to the principle of the 1964 Declaration of Helsinki with its amendments. Based on the retrospective and observational nature of the manuscript and all the procedures being performed according to routine care, ethical approval was waived by the local Ethics Committee of the Sanitary Public Utility of Lodi.

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Due to the observational and retrospective nature of the manuscript involving a large cohort of individuals, this statement is not applicable.

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Garuti, G., Sagrada, P.F., Frigoli, A. et al. Hysteroscopic biopsy compared with endometrial curettage to assess the preoperative rate of atypical hyperplasia underestimating endometrial carcinoma. Arch Gynecol Obstet 308, 971–979 (2023). https://doi.org/10.1007/s00404-023-07060-2

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