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Diagnostic Pathology

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Open Access 01-12-2021 | Endometrial Cancer | Research

Aspiration biopsy versus dilatation and curettage for endometrial hyperplasia prior to hysterectomy

Authors: Woo Yeon Hwang, Dong Hoon Suh, Kidong Kim, Jae Hong No, Yong Beom Kim

Published in: Diagnostic Pathology | Issue 1/2021

Abstract

Background

To compare the diagnostic accuracy of aspiration biopsy and dilatation and curettage (D&C) in patients diagnosed with endometrial hyperplasia prior to hysterectomy.

Methods

We retrospectively reviewed medical records of 250 patients diagnosed with endometrial hyperplasia by endometrial sampling between July 2003 and March 2020. Endometrial sampling was performed by aspiration biopsy (n = 150) or D&C (n = 100), followed by hysterectomy within 6 months. Pathological findings of hysterectomy specimens of the two groups were compared to preoperative findings.

Results

The overall diagnostic concordance between endometrial sampling specimen including D&C and aspiration biopsy, and hysterectomy specimen was 51.0% (51/100) and 41.3% (62/150), respectively. Patients whose preoperative specimen was obtained by D&C were upgraded less significantly than those who underwent aspiration biopsy (21.0% vs 36.7%; P = 0.008). In particular, significantly fewer patients were upgraded after D&C than after aspiration biopsy in hyperplasia without atypia (12.5% vs 29.0%; P = 0.028). In addition, when the final pathological upgrade rate to endometrial carcinoma was evaluated between the two methods of endometrial sampling, significantly fewer cases were noted after D&C than after aspiration biopsy (15.0% vs 27.3%; P = 0.022).

Conclusions

In our study, D&C more accurately reflected the final diagnosis in patients with endometrial hyperplasia than aspiration biopsy based on the histological examination of hysterectomy specimens. When considering the management strategy for women with an endometrial hyperplasia diagnosis obtained by aspiration biopsy, physicians should consider the significant rate of upgraded diseases with this method of endometrial sampling.

Kadirogullari P, Atalay CR, Ozdemir O, Sari ME. Prevalence of co-existing endometrial carcinoma in patients with preoperative diagnosis of endometrial hyperplasia. J Clin Diagn Res. 2015;9(10):Qc10–4. https://doi.org/10.7860/jcdr/2015/12484.6618.CrossRefPubMedPubMedCentral

Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endometrial hyperplasia. J Gynecol Oncol. 2016;27(1):e8. https://doi.org/10.3802/jgo.2016.27.e8.CrossRefPubMed

Kim MK, Seong SJ, Park DC, Hong JH, Roh JW, Kang SB. Comparison of diagnostic accuracy between endometrial curettage and aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean gynecologic oncology group study. J Gynecol Oncol. 2020;31(4):e51. https://doi.org/10.3802/jgo.2020.31.e51.CrossRefPubMedPubMedCentral

Sobczuk K, Sobczuk A. New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Przeglad Menopauzalny Menopause Rev. 2017;16(3):107–11. https://doi.org/10.5114/pm.2017.70589.CrossRef

Abdelazim IA, Aboelezz A, Abdulkareem AF. Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding. J Turkish German Gynecol Assoc. 2013;14(1):1–5. https://doi.org/10.5152/jtgga.2013.01.CrossRef

Demirkiran F, Yavuz E, Erenel H, Bese T, Arvas M, Sanioglu C. Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Arch Gynecol Obstet. 2012;286(5):1277–82. https://doi.org/10.1007/s00404-012-2438-8.CrossRefPubMed

Sanam M, Majid MM. Comparison the diagnostic value of dilatation and curettage versus endometrial biopsy by Pipelle--a clinical trial. Asian Pac J Cancer Prev. 2015;16(12):4971–5. https://doi.org/10.7314/apjcp.2015.16.12.4971.CrossRefPubMed

Nair R, Bandhe S, Ganorkar OK, Saha S, Sial S, Nair A. A comparative evaluation of the three different antioxidant treatments on the bond strength of composite resin to bleached enamel: an in vitro study. J Conservative Dentistry. 2019;22(1):82–6. https://doi.org/10.4103/jcd.Jcd_193_18.CrossRef

Kim MK, Seong SJ, Lee TS, Ki K-D, Lim MC, Kim YH, Kim K, Joo WD. Comparison of diagnostic accuracy between endometrial curettage and pipelle aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean gynecologic oncology group study (KGOG 2019). Jpn J Clin Oncol. 2015;45(10):980–2. https://doi.org/10.1093/jjco/hyv106.

10.

Merisio C, Berretta R, De Ioris A, Pultrone DC, Rolla M, Giordano G, Tateo S, Melpignano M. Endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Eur J Obstet Gynecol Reprod Biol. 2005;122(1):107–11. https://doi.org/10.1016/j.ejogrb.2005.01.001.CrossRefPubMed

11.

Yi Y, Bryce CL, Adambekov S, Edwards RP, Goughnour SL, Linkov F. Cost-effectiveness analysis of biopsy strategies for endometrial cancer diagnosis in women with postmenopausal bleeding: Pipelle sampling curette versus dilatation & curettage. Gynecol Oncol. 2018;150(1):112–8. https://doi.org/10.1016/j.ygyno.2018.04.565.CrossRefPubMed

12.

Suh-Burgmann E, Hung YY, Armstrong MA. Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage. Obstet Gynecol. 2009;114(3):523–9. https://doi.org/10.1097/AOG.0b013e3181b190d5.CrossRefPubMed

13.

Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer. 2000;89(8):1765–72.CrossRef

14.

Stovall TG, Photopulos GJ, Poston WM, Ling FW, Sandles LG. Pipelle endometrial sampling in patients with known endometrial carcinoma. Obstet Gynecol. 1991;77(6):954–6.PubMed

15.

Ferry J, Farnsworth A, Webster M, Wren B. The efficacy of the pipelle endometrial biopsy in detecting endometrial carcinoma. Aust N Z J Obstet Gynaecol. 1993;33(1):76–8. https://doi.org/10.1111/j.1479-828x.1993.tb02060.x.CrossRefPubMed

16.

Zorlu CG, Cobanoglu O, Işik AZ, Kutluay L, Kuşçu E. Accuracy of pipelle endometrial sampling in endometrial carcinoma. Gynecol Obstet Investig. 1994;38(4):272–5. https://doi.org/10.1159/000292495.CrossRef

17.

Guido RS, Kanbour-Shakir A, Rulin MC, Christopherson WA. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med. 1995;40(8):553–5.PubMed

18.

Antoni J, Folch E, Costa J, Foradada CM, Cayuela E, Combalia N, Rué M. Comparison of cytospat and pipelle endometrial biopsy instruments. Eur J Obstet Gynecol Reprod Biol. 1997;72(1):57–61. https://doi.org/10.1016/s0301-2115(96)02658-9.CrossRefPubMed

19.

The American College of Obstetricians and Gynecologists Committee Opinion no. 631. Endometrial intraepithelial neoplasia. Obstet Gynecol. 2015;125(5):1272–8. https://doi.org/10.1097/01.Aog.0000465189.50026.20.CrossRef

Title: Aspiration biopsy versus dilatation and curettage for endometrial hyperplasia prior to hysterectomy
Authors: Woo Yeon Hwang
Dong Hoon Suh
Kidong Kim
Jae Hong No
Yong Beom Kim
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Endometrial Cancer
Foreign Body Aspiration
Foreign Body Aspiration
Aspiration
Endometrial Cancer
Hysterectomy
Published in: Diagnostic Pathology / Issue 1/2021
Electronic ISSN: 1746-1596
DOI: https://doi.org/10.1186/s13000-020-01065-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Aspiration biopsy versus dilatation and curettage for endometrial hyperplasia prior to hysterectomy

Abstract

Background

Methods

Results

Conclusions

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Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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