Should endometrial biopsy under direct hysteroscopic visualization using the grasp technique become the new gold standard for the preoperative evaluation of the patient with endometrial cancer?

Sardo, Attilio Di Spiezio; Angelis, Maria Chiara De; Corte, Luigi Della; Carugno, Josè; Zizolfi, Brunella; Guadagno, Elia; Gencarelli, Annarita; Cecchi, Elena; Simoncini, Tommaso; Bifulco, Giuseppe; Zullo, Fulvio; Insabato, Luigi

doi:10.1016/j.ygyno.2020.05.012

Cited by 52 publications

(35 citation statements)

References 21 publications

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“…D&C remains the most extended method at the initial workup of abnormal bleeding, as can also be seen from the size of samples shown in Table 1. A recent study by Di Spiezio Sardo et al (39) confirmed that hysteroscopic guided "grasp" endometrial biopsy provides a more accurate diagnosis of EC histology type and tumor grade compared to blind endometrial biopsy obtained using the Novak curette. Di Spiezio Sardo et al (39) also described the limitations of their study, which are a small sample size and the fact that the study design was retrospective.…”

Section: Discussionmentioning

confidence: 90%

Accuracy of preoperative sampling diagnosis for predicting final pathology in patients with endometrial carcinoma: a review

Lukanović¹,

Matjašič²,

Kobal³

2020

Transl Cancer Res TCR

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Endometrial cancer (EC) is the most common gynecologic cancer. The most frequent symptom of this disease is postmenopausal bleeding. Diagnosis of EC must be histologically confirmed, and there are several methods for endometrial sampling to obtain cells or endometrial tissue. The first step in diagnosis should be ultrasound measurement of endometrial thickness, followed by endometrial sampling, which can be performed by office endometrial biopsy, hysteroscopic biopsy, or dilatation and curettage (D&C). The review in this article was carried out to present previously published studies, comprehensively evaluate method performance (i.e., overall accuracy of preoperative sampling in patients with endometrial carcinoma, and overall agreement on grade and histological subtype between preoperative endometrial sampling and final diagnosis), and determine which sampling method is most accurate on the basis of the statistical data in the studies analyzed. From the literature analyzed and examined, it can be concluded that preoperative endometrial sampling is not always the best predictor of final histology in EC and has its limitations. In surgical decisions based only on preoperative sampling, a biopsy should be made with caution, and it is necessary to take other parameters into account. Inadequate grading leads to suboptimal clinical management, mainly in early-stage tumors. This review showed that, although hysteroscopic biopsy was mainly associated with the highest tumor grade agreement, and although D&C showed the highest overall accuracy in detecting endometrial carcinoma, the data do not therefore reliably indicate which method yields the most precise results. The results of this review indicate that further studies on larger samples and with greater statistical power are needed to accurately define the role and type of preoperative sampling methods.

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Section: Discussionmentioning

confidence: 90%

Accuracy of preoperative sampling diagnosis for predicting final pathology in patients with endometrial carcinoma: a review

Lukanović¹,

Matjašič²,

Kobal³

2020

Transl Cancer Res TCR

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“…Hysteroscopic biopsy is suggested, based on its higher agreement with final diagnosis as compared with dilatation and curettage [270,271]. Although hysteroscopy seems to be associated with a higher rate of positive peritoneal cytology, it seems not to have a negative impact on survival [272].…”

Section: Fertility Preservationmentioning

confidence: 99%

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

Concin

Matías‐Guiu

Vergote

et al. 2021

Radiotherapy and Oncology

169

203

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A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the

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“…Precise cuts are made, avoiding going deep into the myometrium, and the tissue sample is retrieved by grasping with the alligator forceps [ Figure 3 ]. [ 38 ]…”

Section: E Ndometrial S Ampling With H Ysteroscopy Using 5 F R mentioning

confidence: 99%

“…This study's limitations are its retrospective analysis, OH performed only by experienced surgeons, and to add, the armamentarium and training availability in certain parts of the world. [ 38 ]…”

Section: E Ndometrial S Ampling With H Ysteroscopy Using 5 F R mentioning

confidence: 99%

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A Mini-Review of Office Hysteroscopic Techniques for Endometrial Tissue Sampling in Postmenopausal Bleeding

Haimovich

Tanvir

2021

Journal of Mid-Life Health

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Postmenopausal bleeding (PMB) is a common cause for a gynecological visit. Endometrial cancer risk varies from 3% to 25% in women with PMB. There is a significant concern of malignancy of the endometrium and the endocervical canal by a physician in postmenopausal women, and hence, most prefer operating room hysteroscopies with dilation and curettage (D & C) compared to in-office procedures. With increased availablility of miniaturized instruments such as mini- resectoscope and tissue removal systems, there is high likelihood of blind D & C being replaced by hysteroscopic- guided targetted biopsy or visual D & C. The cost-effectiveness of office hysteroscopy is also well demonstrated. In December 2020, an electronic search was performed of PubMed, MEDLINE, and Cochrane Library to look for articles on office hysteroscopic biopsy techniques in postmenopausal women from 2010 to 2020. Relevant studies were included where various office hysteroscopic techniques are used for endometrial sampling in PMB. Studies with 5 Fr scissors, biopsy forceps, crocodile forceps, cup forceps, bipolar electrode, in-office tissue removal system (morcellator), flexible hysteroscope, and mini-resectoscope were included. Standard reference was used as an adequate endometrial sample for histology. The objective of this review is to explore the current evidence on different office hysteroscopic techniques available for endometrial tissue sampling in PMB. Research Question: What are the different available in - office hysteroscopy techniques for obtaining endometrial biopsy? Clinical Importance: Understanding the adequacy of an endometrial tissue sample obtained by different in - office hysteroscopy techniques and their accuracy by histology.

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Should endometrial biopsy under direct hysteroscopic visualization using the grasp technique become the new gold standard for the preoperative evaluation of the patient with endometrial cancer?

Cited by 52 publications

References 21 publications

Accuracy of preoperative sampling diagnosis for predicting final pathology in patients with endometrial carcinoma: a review

Accuracy of preoperative sampling diagnosis for predicting final pathology in patients with endometrial carcinoma: a review

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

A Mini-Review of Office Hysteroscopic Techniques for Endometrial Tissue Sampling in Postmenopausal Bleeding

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