Endometrial cancer: accuracy of the finding of a well differentiated tumor at dilatation and curettage compared to the findings at subsequent hysterectomy

Abstract

The objective of this study was to examine the accuracy of the finding of a histologically well differentiated endometrial carcinoma at dilatation and curettage (D & C) prior to hysterectomy. A retrospective multicentric chart review of 137 endometrial cancer patients was conducted, including all patients in whom a well differentiated endometrial carcinoma had been diagnosed by D & C. Histopathologic grading as determined by D & C was compared with the grading established at the final histologic examination after hysterectomy. Seventy-eight percent of all cases in which a well differentiated tumor was diagnosed with D & C were confirmed as well differentiated endometrial carcinomas, whereas 20.4% had to be upgraded as moderately differentiated tumors after evaluation of the hysterectomy specimen. In one case in which a uterine adenocarcinoma was diagnosed by D & C, a well differentiated adenocarcinoma was found to be combined with a carcinosarcoma in the hysterectomy specimen. In order to avoid false findings of a well differentiated tumor, the histologic grade should be confirmed by intraoperative frozen section examination. This is especially important in cases in which surgical staging was not planned initially.

Comparison of endometrial biopsy and postoperative hysterectomy specimen findings in patients with atypical endometrial hyperplasia and endometrial cancer

“…The final surgical pathology confirms the initial diagnosis least frequently in the case of well-differentiated cancers. The concordance level increases with the degree of cancer aggressiveness [10][11][12][13][14][15].…”

“…The differences between the preoperative histology and the surgical pathology may also result from the lack of representative endometrial samples. Histology findings reported in a number of studies indicate underestimation rather than overestimation of the histological grade of the tumour [12][13][14][15]. One explanation is that pathologists may be wary of overdiagnosing cancer with the resulting burden of extensive surgery and its potential complications for the patient.…”

“…The diagnosis is based on the histological examination of endometrial samples. However, discrepancy between histological findings before and after surgery is well-documented [8][9][10][11][12]. The clinical implications are serious considering the potential effects on surgical staging www.…”

“…In cases of a malignant tumour of the uterine corpus, pathological findings in the hysterectomy specimens usually confirm the preoperative diagnosis. Any discrepancies usually concern the histological type and grade of endometrial cancer [10][11][12][13][14][15].…”

Diagnostic test of endometrial cytobrush in cases of perimenopausal and postmenopausal hemorrhage

“…Dilatation and curettage have a reasonably good accuracy, approximately 78%, compared with specimen of hysterectomy. 5 The results of both examinations were compared with each either. Endometrial cytology was carried out using cytobrush, which was put into IUD shell (this shell was aimed to protect cytobrush from the false positive possibility because of contamination of abnormality in the endocervix.).…”