Accuracy of Endometrial Sampling in Endometrial Carcinoma

Visser, Nicole C.M.; Reijnen, Casper; Massuger, Leon F.A.G.; Nagtegaal, Irıs D.; Bulten, Johan; Pijnenborg, Johanna M.A.

doi:10.1097/aog.0000000000002261

Cited by 132 publications

(137 citation statements)

References 69 publications

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“…). Furthermore, in up to 33% of all patients, preoperative histology is discordant with postoperative histology, resulting in a subsequent incorrect risk estimation of LNM .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

et al. 2019

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Background In endometrial carcinoma (EC), preoperative classification is based on histopathological criteria, with only moderate diagnostic performance for the risk of lymph node metastasis (LNM). So far, existing molecular classification systems have not been evaluated for prediction of LNM. Optimized use of clinical biomarkers as recommended by international guidelines might be a first step to improve tailored treatment, awaiting future molecular biomarkers. Aim To determine the diagnostic accuracy of preoperative clinical biomarkers for the prediction of LNM in endometrial cancer. Methods A systematic review was performed according to the Meta‐analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Studies identified in MEDLINE and EMBASE were selected by two independent reviewers. Included biomarkers were based on recommended guidelines (cancer antigen 125 [Ca‐125], lymphadenopathy on magnetic resonance imaging, computed tomography, and 18F‐fluorodeoxyglucose positron emission tomography/computed tomography [18FDG PET‐CT]) or obtained by physical examination (body mass index, cervical cytology, blood cell counts). Pooled sensitivity, specificity, area under the curve (AUC), and likelihood ratios were calculated with bivariate random‐effects meta‐analysis. Likelihood ratios were classified into small (0.5–1.0 or 1–2.0), moderate (0.2–0.5 or 2.0–5.0) or large (0.1–0.2 or ≥ 5.0) impact. Results Eighty‐three studies, comprising 18,205 patients, were included. Elevated Ca‐125 and thrombocytosis were associated with a moderate increase in risk of LNM; lymphadenopathy on imaging with a large increase. Normal Ca‐125, cytology, and no lymphadenopathy on 18FDG PET‐CT were associated with a moderate decrease. AUCs were above 0.75 for these biomarkers. Other biomarkers had an AUC <0.75 and incurred only small impact. Conclusion Ca‐125, thrombocytosis, and imaging had a large and moderate impact on risk of LNM and could improve preoperative risk stratification. Implications for Practice Routine lymphadenectomy in clinical early‐stage endometrial carcinoma does not improve outcome and is associated with 15%–20% surgery‐related morbidity, underlining the need for improved preoperative risk stratification. New molecular classification systems are emerging but have not yet been evaluated for the prediction of lymph node metastasis. This article provides a robust overview of diagnostic performance of all clinical biomarkers recommended by international guidelines. Based on these, at least measurement of cancer antigen 125 serum level, assessment of thrombocytosis, and imaging focused on lymphadenopathy should complement current preoperative risk stratification in order to better stratify these patients by risk.

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“…). Furthermore, in up to 33% of all patients, preoperative histology is discordant with postoperative histology, resulting in a subsequent incorrect risk estimation of LNM .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

et al. 2019

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“…The standard strategy to diagnose endometrial cancer consists on office‐based pelvic ultrasonography plus endometrial pipelle sampling in cases of increased endometrial thickness (screening criterion 3, Table ), and a hysteroscopy is recommended when diagnosis is uncertain . Sensitivity of pipelle to diagnose endometrial cancer ranges from 62% to 99%, while agreement rates on tumor grade and pathology diagnosis are moderate (67 and 73%, respectively) . Limitations include sample insufficiency in 20–30% of the cases, unsuccessful insertions (in occasions due to cervical stenosis or prolapse), and as well an abnormal sonographic appearance of the endometrium …”

Section: Natural History Of Endometrial Cancermentioning

confidence: 99%

“…1 Sensitivity of pipelle to diagnose endometrial cancer ranges from 62% to 99%, 11 while agreement rates on tumor grade and pathology diagnosis are moderate (67 and 73%, respectively). 12 Limitations include sample insufficiency in 20-30% of the cases, 13 unsuccessful insertions (in occasions due to cervical stenosis or prolapse), and as well an abnormal sonographic appearance of the endometrium. 11,14 The different types of endometrial cancers derive from different precursor lesions (screening criterion 4; Table 1 and Fig.…”

Section: Natural History Of Endometrial Cancermentioning

confidence: 99%

New perspectives on screening and early detection of endometrial cancer

Costas

Frias-Gomez

Guardiola

et al. 2019

Intl Journal of Cancer

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Due to the anatomical continuity of the uterine cavity with the cervix, genomic exploitation of material from routine Pap smears and other noninvasive sampling methods represent a unique opportunity to detect signs of disease using biological material shed from the upper genital tract. Recent research findings offer a promising perspective in the detection of endometrial cancer, but certain questions need to be addressed in order to accelerate the implementation of novel technologies in a routine screening or clinical setting. We discuss here new perspectives on detection of endometrial cancer using genomic and other biomarkers in minimally invasive sampling methods with a special focus on public health classic screening criteria, highlighting current gaps in knowledge.

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“…2 Endometrial sampling by aspiration with a cornier pipelle is the preferred method to obtain an endometrial biopsy, as it is minimally invasive, reliable and can be performed in an out-patient setting. [3][4][5][6] However, this procedure is reported to have a mean Visual Analogue Scale pain score of 6.5 in postmenopausal women. 4 Moreover, pipelle endometrial biopsies leave up to 30% of patients temporarily undiagnosed due to technical failure (8%) or an inadequate amount of tissue (22%).…”

Section: Introductionmentioning

confidence: 99%

Mutational analysis of cervical cytology improves diagnosis of endometrial cancer: A prospective multicentre cohort study

Reijnen

Putten

Bulten

et al. 2019

Intl Journal of Cancer

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Endometrial carcinoma (EC) is traditionally diagnosed by a histopathological assessment of an endometrial biopsy, leaving up to 30% of patients undiagnosed due to technical failure or an inadequate amount of tissue. The aim of the current study is to assess whether mutational analysis of cervical cytology or pipelle endometrial biopsies improves the diagnostic accuracy of traditional histopathological diagnosis of EC. This prospective multicentre cohort study included patients surgically treated for EC or a benign gynaecological condition (control group). A Pap brush sample, cervicovaginal self‐sample, pipelle endometrial biopsy and surgical specimen of either the EC or normal endometrium were obtained. A targeted next‐generation sequencing panel was used to analyse these samples for mutations in eight genes. Sensitivity, specificity and predictive values were calculated. Fifty‐nine EC patients and 31 control patients were included. In these patients, traditional histopathological diagnosis by pipelle had a sensitivity of 79% and a specificity of 100%. For EC patients, 97% of surgical specimens contained at least one mutation. Mutational analysis of Pap brush samples, self‐samples and pipelle endometrial biopsies yielded a sensitivity of 78, 67 and 96% with a specificity of 97, 97 and 94%, respectively. Combining one of these three methods with histopathological pipelle endometrial biopsy evaluations yielded a sensitivity of 96, 93 and 96%, respectively. Our study has shown that mutational analysis of either cervical cytology or pipelle endometrial biopsies improves diagnosis of EC. Prospective validation will support implementation in clinical practice.

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Accuracy of Endometrial Sampling in Endometrial Carcinoma

Abstract: Overall there is only moderate agreement on tumor grade between preoperative endometrial sampling and final diagnosis with the lowest agreement for grade 2 carcinomas.

Cited by 132 publications

References 69 publications

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

Diagnostic Accuracy of Clinical Biomarkers for Preoperative Prediction of Lymph Node Metastasis in Endometrial Carcinoma: A Systematic Review and Meta-Analysis

New perspectives on screening and early detection of endometrial cancer

Mutational analysis of cervical cytology improves diagnosis of endometrial cancer: A prospective multicentre cohort study

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