Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia

Objectives

A significant number of women diagnosed with atypical endometrial hyperplasia (AEH) on endometrial biopsy will be diagnosed with endometrial cancer (EC) on the hysterectomy specimen at permanent section. Surgical treatment for AEH and EC differ substantially. We have assessed the concordance in EC between frozen and permanent sections on patients undergoing hysterectomy for AEH.

Materials and methods

A retrospective review of 66 frozen sections on patients undergoing hysterectomy for AEH was performed. Frozen and permanent section diagnoses were categorized as negative or positive for malignancy. Permanent section carcinomas were classified as low or high risk based on their histopathology, myometrial invasion and differentiation. Correlation between frozen and permanent section and sensitivity, specificity, PPV, NPV and accuracy of frozen section in predicting EC in permanent section were calculated. Likelihood of diagnosing EC on frozen section was compared based on risk stratification at permanent section.

Results

Frozen and permanent sections revealed malignancy in 43.9% and 56% of the patients respectively. 94.1% of high risk carcinomas were identified as EC at frozen section as compared to 55% of low risk EC. Concordance was good (κ = 0.75). Sensitivity, specificity, NPV, PPV and accuracy in predicting EC at frozen section were 73%, 93.1%, 73% and 93.1% respectively. Carcinomas were detected at frozen section significantly more often if they were at high risk.

Conclusions

The substantial agreement between frozen and permanent sections allows minimizing under- and overtreatment of women undergoing hysterectomy for AEH. High risk EC are efficiently identified in frozen section.     

Endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia

OBJECTIVE: Atypical endometrial hyperplasia (AEH) has been associated with the presence of concomitant endometrial carcinoma (EC). The aim of this study is to examine the frequency of coexisting endometrial carcinoma when atypical endometrium hyperplasia was found upon biopsy. We also evaluated the influence of preoperative diagnostic techniques (pipelle and dilation and curettage (D&C)), and the value of transvaginal ultrasound in detecting unexpected tumor invasion. STUDY DESIGN: Between January 1992 and December 2003, at the Department of Obstetrics and Gynecology, University of Parma, and Policlinico S. Matteo, Pavia, 70 consecutive patients subjected to total hysterectomy with a histological diagnosis of AEH were retrospectively selected. 52/70 patients underwent vaginal hysterectomy, with bilateral salpingo-oophorectomy (BSO) whereas 18/70 had abdominal hysterectomy with BSO within 8 weeks since the diagnosis of AEH. RESULTS: We found in 30 of the 70 patients with atypical endometrial hyperplasia in the biopsy coexisting endometrial carcinoma (43%). No differences in diagnostic accuracy between the pipelle method and D&C were found. CONCLUSION: Transvaginal ultrasound was not a feasible method for predicting EC. After a follow-up of an average of 5 years there was, neither in the abdominal operated patients nor in the vaginal operated patients, a recurrence of disease.     

Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia

Objective

To evaluate the prevalence of concurrent endometrial carcinoma in women diagnosed with atypical endometrial hyperplasia (AEH) by endometrial biopsy.

Study design

We retrospectively analyzed the medical records of 126 patients who underwent hysterectomies for AEH diagnosed by endometrial biopsy from 1999 to 2008. AEH was initially diagnosed by dilatation and curettage (98 cases) or endometrial biopsy with a Z-sampler (24 cases). The remaining four cases were diagnosed by hysteroscopic polypectomy. The results of the endometrial biopsies were graded on an ordinal scale and were compared with pathologic features obtained at the hysterectomy.

Results

In patients preoperatively diagnosed with AEH by biopsy, hysterectomy specimens revealed a rate of simple or complex endometrial hyperplasia without atypia of 27% with AEH and normal proliferative phases found in 54.7 and 7.9% of specimens, respectively. The incidence of endometrial carcinoma was considerably high (13/126, 10.3%). Eleven of 13 cases were confined to the endometrium and the remaining two were located at the adenomyosis without myometrial invasion. All patients with endometrial carcinoma displayed coexisting atypical complex hyperplasia following hysterectomy.

Conclusions

Biopsy specimens showing AEH, particularly atypical complex hyperplasia, are associated with a risk of coexisting endometrial carcinoma. When considering management strategies for women with a biopsy diagnosis of AEH, clinicians should take into account the considerable rate of concurrent endometrial cancer and the discrepancy with pathologic diagnosis. Treatment modalities may differ depending on population as the rates of concurrent endometrial cancer with AEH and myometrial invasion vary by geographical location.     

Which surgical procedure for patients with atypical endometrial hyperplasia?

OBJECTIVE: To determine the occult coexistence of endometrial carcinoma in patients with atypical endometrial hyperplasia and to compare histological prognostic factors according to lymph node status in occult endometrial carcinoma. MATERIALS AND METHODS: Two hundred and four patients from two referral centers (during the period 1990-2003) who were operated on within 1 month of endometrial biopsy for symptomatic endometrial hyperplasia without receiving any medical treatment were included retrospectively. Patients having preoperative endometrial biopsy results of concomitant endometrial hyperplasia and carcinoma were excluded from the study. Fifty-six patients having atypia in preoperative biopsy (group I) were compared with 148 patients without atypia (group II). Chi-square and Mann-Whitney U-tests were used for statistical analyses. RESULTS: No significant difference was observed between the two groups according to age or menopausal status. Patients in group II had significantly higher parity than patients in group I. In group I, 62.5% of the patients had endometrial carcinoma, 21.4% had endometrial hyperplasia, and 16.1% had normal endometrium in hysterectomy specimens. In group II, the percentages were 5.4, 38.5, and 56.1%, respectively. Complete surgical staging was performed in 20 patients. Four patients had metastatic lymph nodes. All of them had grade 2 tumors with lymphovascular space involvement. Three of them had nonendometrioid tumors. CONCLUSION: Careful intraoperative and preoperative evaluation of the endometrium must be the sine qua non for patients with atypical endometrial hyperplasia. It is reasonable to do frozen section at the time of hysterectomy for atypical endometrial hyperplasia, and if grade 2/3 of nonendometrioid cancer with lymphovascular space involvement is found, complete surgical staging should be performed.     

Accuracy of endometrial biopsy with the Cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia

OBJECTIVE: To establish the accuracy of endometrial biopsy with the Cornier pipelle in the diagnosis of endometrial cancer and atypical endometrial hyperplasia in our milieu. MATERIAL AND METHOD: We reviewed 1,535 anatomopathologic reports on endometrial biopsies taken from outpatients using the Cornier pipelle between 1997 and 2000, in pre- and postmenopausal patients with abnormal vaginal bleeding. In 168 patients (10.9%), curettage and/or hysterectomy was subsequently carried out. In these cases, the anatomopathologic reports were compared to determine sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio (LR). RESULTS: Sensitivity was 84.2%, specificity was 99.1%, accuracy was 96.9%, PPV was 94.1%, NPV was 93.7% and LR was 93.5. In 249 cases (16.09%) the material was insufficient for study. CONCLUSION: We determined that endometrial biopsy taken with the Cornier pipelle is, as we practice it, an accurate method for diagnosis of endometrial cancer and its precursor, atypical hyperplasia.     

Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C)

Purpose

To compare diagnostic accuracy and adequacy of pipelle endometrial biopsy with dilatation and curettage.

Methods

From October 2007 to November 2009, 673 patients were evaluated with pipelle endometrium biopsy, D&C and hysterectomy in the Department of Obstetrics and Gynecology, Istanbul University Cerrahpasa Medical Faculty. 478 patients underwent pipelle and D&C, 212 patients underwent pipelle and hysterectomy and 161 patients underwent D&C and hysterectomy. Uterine findings were grouped under five headings: normal, hyperplasia, focal lesion, atypia, and atrophy. Histologic sections from pipelle biopsy or D&C specimens were compared with each other and hysterectomy specimens. Chi-square, Mc.Nemar, and Fisher-exact tests were used as appropriate. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each method used in the study.

Results

We compared the histological results of pipelle biopsy and D&C. Statistically outcomes of pipelle and D&C were concordant with each other. Concordance rate was 67?% between pipelle and hysterectomy and 70?% between D&C and hysterectomy. Sensitivity of pipelle biopsy in detection of hyperplasia and aytpia was 67 and 75?%, respectively. Sensitivity of D&C for detecting hyperplasia and atypia was 62 and 83?%. NPV of pipelle biopsy and D&C was 99?% for malignancy.

Conclusions

Pipelle biopsy and D&C showed almost equal success rate in the diagnosis of endometrial pathologies. Neither pipelle nor D&C is adequate method for focal endometrial pathologies. Both biopsy methods are not perfect, but pipelle biopsy is a cheaper and easy technique compared with D&C, and ultrasonographic findings of endometrium should be considered prior to endometrial biopsy.     

子宫内膜不典型增生患者的内膜癌漏诊因素分析

目的:探讨子宫内膜不典型增生患者子宫内膜癌漏诊的因素及合理治疗方案。方法:回顾分析132例子宫内膜不典型增生子宫切除前后的临床病理资料。根据术前内膜取样方式分为宫腔镜组与诊刮组,比较两种方式的诊断符合率。比较术前病理与术中冰冻病理、术后常规病理,分析其主要临床病理资料。结果:132子宫内膜不典型增生患者中,术后证实为子宫内膜癌者42例(31.82%)。诊刮组的内膜癌漏诊率为32.99%(32/97),高于宫腔镜组28.75%(10/35),但无统计学差异(P0.05)。42例内膜癌患者中,95.24%(40/42)为子宫内膜样腺癌,ⅠA期38例(90.48%),高分化癌34例(80.95%)。术中行冰冻病理检查者115例,其中11例子宫内膜癌漏诊。长期月经紊乱、未生育患者子宫内膜癌漏诊的风险增高。结论:子宫内膜病理诊断为不典型增生的患者有子宫内膜癌漏诊的风险,尤其是长期月经紊乱、未生育的女性。子宫内膜不典型增生的治疗应采取个体化治疗方案。     

人附睾蛋白4在子宫内膜非典型增生患者中筛查子宫内膜癌的临床价值

目的：探讨人附睾蛋白4（human epididymis protein 4,HE4）检测在诊断性刮宫（诊刮）病理为子宫内膜非典型增生（atypical endometrial hyperplasia,AEH）患者中筛查子宫内膜癌（endometrial carcinoma,EC）的临床价值。方法：选取2011年1月—2014年12月在天津市中心妇产科医院诊刮病理为AEH进而行手术治疗的患者,术前采用电化学发光免疫分析法检测患者血清HE4、CA125和CA199水平,根据术后病理分为EC组和AEH组,分析2组患者肿瘤标记物的水平差异。制作受试者工作特征曲线（ROC）,以曲线下面积（AUC）反映肿瘤标记物的诊断价值。结果：入选的118例诊刮病理为AEH的患者中,31例术后被诊断为EC（EC组）,其血清HE4、CA125和CA199水平分别为73.4 pmol/L、31.4 kU/L和23.3 kU/L;87例术后诊断仍为AEH（AEH组）,上述3种肿瘤标记物的水平分别为44.3 pmol/L、17.0 kU/L和19.0 kU/L;EC组HE4和CA125水平高于AEH组,差异有统计学意义（P＜0.05）,而CA199水平差异无统计学意义（P＞0.05）。EC组以AEH组为参照时,HE4和CA125单独检测的AUC分别为0.785和0.706,两者联合检测的AUC为0.867,敏感度为76.6%。结论：EC患者血清HE4和CA125水平明显高于AEH患者,两者联合检测有助于筛查出诊刮病理为AEH人群中漏诊的EC患者。     

Usefulness of pipelle endometrial biopsy in the diagnosis of women at risk for ectopic pregnancy

OBJECTIVE: The purpose of this study was to determine the accuracy of endometrial Pipelle (Unimar) biopsy to detect chorionic villi in suspected ectopic pregnancy. STUDY DESIGN: This was a blinded prospective trial that involved 32 women who were in stable condition with suspected ectopic pregnancy. Endometrial pipelle sampling was performed before uterine dilation and curettage. Pipelle and frozen section results were compared with final disease. RESULTS: Ten of 32 patients (31%) had chorionic villi that was consistent with a miscarriage; 22 of 32 patients (69%) had none detected. Pipelle biopsy had a sensitivity of 30% (95% CI, 6.7-65.2), a specificity of 100% (95% CI, 84.5-100), a positive predictive value of 100% (95% CI, 29.2-100), and a negative predictive value of 76% (95% CI, 56.5-87). Frozen section had a sensitivity of 87.5% (95% CI, 47.3-99.7), a specificity of 100% (95% CI, 83.1-100), a positive predictive value of 100% (95% CI, 59-100), and a negative predictive value of 95.3% (95% CI, 76.1-99.8). CONCLUSION: In patients with suspected ectopic pregnancy, Pipelle sampling is not a substitute for curettage because the sensitivity and predictive values are unacceptable.     

Cytologic diagnosis of endometrial adenocarcinoma using the Endo-pap sampler

Six hundred ambulatory women were screened with the Endo-pap cytology sampler in two medical centers. None of the women developed complications from the use of the instrument. Their smears were routinely processed together with cervical cytology smears. One hundred fifty-three of these women had a tissue diagnosis by endometrial biopsy, dilatation and curettage, or hysterectomy. Adequate cytology specimens were obtained in 93% of these patients. In these 153 patients, 32 (18%) had a tissue diagnosis of endometrial adenocarcinoma, and 31 patients had a tissue diagnosis of endometrial hyperplasia. The cytology samples obtained with this device were diagnostic of endometrial adenocarcinoma in 30 (94%) of these 32 patients and ten (32%) of the patients with endometrial hyperplasia. Two patients (1.6%) were diagnosed falsely positive. The Endo-pap cytology sampler is considered a safe and effective screening tool for endometrial adenocarcinoma. Its value in diagnosing endometrial hyperplasia remains to be determined.     

Evaluating cervical cone biopsy specimens with frozen sections at hysterectomy

Frozen section evaluations of cervical cone biopsy specimens were performed at the time of hysterectomy to exclude invasive cervical cancer. During a two-year period we prospectively evaluated 43 cone biopsy specimens. We found all the diagnoses made with frozen sections to be accurate when compared with prospective permanent sections, and all patients received appropriate therapy. Thirty-eight cases showed no evidence of invasion. Two patients had invasive squamous cell cervical cancer, one had invasive cervical adenocarcinoma extending to the endometrial cavity, and two had microinvasion. All invasive cancers were diagnosed correctly with frozen sections and confirmed with permanent sections. When hysterectomy immediately followed conization, no complications occurred, and no significant increase in blood loss was noted. We found frozen section evaluation of a cone biopsy specimen at the time of hysterectomy to be a reliable procedure that saves time, eliminates the risk of additional anesthesia and decreases patients' costs.     

子宫内膜非典型增生行全子宫切除术159例临床分析

目的：探讨子宫内膜非典型增生（AEH）患者的临床特点及行全子宫切除术后病理升级为子宫内膜癌（EC）的危险因素。方法：回顾性分析2015年1月—2018年12月159例因AEH于首都医科大学附属北京妇产医院妇科微创中心行全子宫切除术患者的临床资料,按照术后病理情况分为非EC组134例（84.3%）、EC组25例（15.7%）,分析其术后病理升级的高危因素。结果：与非EC组相比,EC组肥胖、绝经、异常子宫内膜血流信号及糖尿病的发生率差异具有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示,肥胖（OR=3.196,95%CI：1.147～8.902,P=0.026）及糖尿病（OR=3.866,95%CI：1.019～14.673,P=0.047）是AEH患者术后病理升级为EC的危险因素。结论：AEH患者并发EC的发生率较高,对于合并肥胖及糖尿病的患者更应引起重视,术前综合评估,制定个体化治疗方案。     

Use of the endometrial pipelle in the diagnosis of early abnormal gestations

OBJECTIVE: To determine the sensitivity and specificity of the endometrial pipelle (Unimar, Wilton, CT) in detecting intrauterine chorionic villi, as compared to standard suction dilation and curettage (D and C). DESIGN: Prospective clinical study. SETTING: U. S. Navy Hospital near Tokyo, Japan. Small community hospital. PATIENT(S): All patients presenting for the surgical management of an early abnormal gestation were enrolled prospectively. The patient's age, gravidy, parity, estimated gestational age (EGA), diagnosis, preoperative beta human chorionic gonadotropin (betahCG) level, and preoperative transvaginal ultrasound (TVUS) data were recorded.Intervention(s): An endometrial biopsy was performed in the operating room prior to standard suction dilatation and curettage (D and C). MAIN OUTCOME MEASURE(S): The presence of chorionic villi in the endometrial biopsy and curettage specimens were recorded for each patient. RESULT(S): The sensitivity of the endometrial pipelle in detecting intrauterine chorionic villi was 63% and the specificity was 80%. CONCLUSION(S): In the diagnosis of an early abnormal gestation, particularly in excluding an ectopic pregnancy, it would be ideal to replace the more invasive D and C with the outpatient endometrial biopsy in detecting intrauterine chorionic villi. However, the limited sensitivity of the endometrial biopsy limits its application in this clinical scenario. Our results compare with two previous studies and add to the limited patient database on this topic.     

Preoperative and postoperative correlation of histopathological findings in cases of endometrial hyperplasia

OBJECTIVES: To determine the preoperative and postoperative correlation of histopathological findings in cases of endometrial hyperplasia. MATERIAL AND METHODS: One hundred and three patients with endometrial hyperplasia detected by surgical curettage performed due to various gynecologic pathologies were treated by hysterectomy. We compared retrospectively the histopathological diagnoses found on curettage with those found on hysterectomy specimens. The classification scheme endorsed by the International Society of Gynecological Pathologists was used to classify the endometrial hyperplasia. The histologic findings found on the endometrial tissue of curettage specimens were correlated with those from hysterectomy specimens. Histopathologic evaluation was performed by a single skilled gynecologic pathologist. RESULTS: A total number of 103 women--76 (73.8%) premenopausal and 27 (26.2%) postmenopausal--were determined to have endometrial hyperplasia on histopathological evaluation of endometrial tissues obtained by endometrial curettage performed for evaluation of various bleeding abnormalities. These included 94 patients with simple hyperplasia without atypia (91.3%), two patients with simple hyperplasia with atypia (1.9%), five patients with complex hyperplasia without atypia (4.9%), and two patients with complex hyperplasia with atypia (1.9%). Histopathological evaluation of endometrial tissue obtained from hysterectomy specimens (of patients diagnosed with hyperplasia on curettage) revealed a total number of 65 cases (63.1%) with endometrial hyperplasia, and 38 cases (36.9%) with various histopathological findings. The correlation between preoperative and postoperative endometrial histologic findings was found to be statistically insignificant (r = 0.105, p = 0.29). Among 94 patients who were found to have simple hyperplasia without atypia on curettage specimens, 55.3%, were found to have simple hyperplasia without atypia, 1.1% simple hyperplasia with atypia, 5.3% complex hyperplasia without atypia, 9.6% secretory endometrium, 4.3% proliferative endometrium, 21.3% disorganized proliferative endometrium, 1.1% corpus luteum persistency, 1.1% basal endometrium, and 1.1% endometrium cancer on final hysterectomy specimens. CONCLUSION: Postoperative diagnosis of endometrial pathology might be different from that of preoperative especially in cases with simple endometrial hyperplasia without atypia.     

The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: An Australian study and systematic review

Background: The levonorgestrel intrauterine system (LNG-IUS) provides effective contraception and treatment for menorrhagia and is used to prevent endometrial hyperplasia (EH) in women taking unopposed oestrogens.
Aims: The aim of this study was to assess whether the LNG-IUS was also a safe and effective treatment for EH and to conduct a systematic review of the literature.
Methods: A retrospective record review was undertaken in a private gynaecology practice in Brisbane, Australia, and included all women with EH treated with hysterectomy, oral progestins or LNG-IUS between January 2004 and April 2007. Histopathological findings from hysterectomy specimens or endometrial biopsies were used to calculate rates of regression of the EH.
Results: Twenty-one women elected to have a hysterectomy and seven of those (33%) had no persisting hyperplasia at surgery. Twenty-six women had a LNG-IUS inserted at initial hysteroscopy dilatation and curettage or shortly afterwards; seven of those elected to proceed to hysterectomy when their diagnosis was known. Among ten women who used oral progestin treatment, 90% showed initial regression; two with recurrent EH were subsequently treated successfully with LNG-IUS. All 21 women (100%), including one with atypia, treated with LNG-IUS for more than seven weeks had normal endometrial histology on subsequent assessment. No women developed endometrial cancer. Pooled analysis of the published literature gave a 96% regression rate for non-atypical EH treated with LNG-IUS.
Conclusions: These data contribute further evidence that LNG-IUS is a safe and effective method for treating non-atypical EH. Whether LNG-IUS could provide a safe and cost-effective alternative to hysterectomy for atypical EH warrants further examination.     

Transvaginal ultrasound measurement of endometrial thickness and endometrial pipelle sampling as an alternative diagnostic procedure to hysteroscopy and dilatation and curettage in the management of post-menopausal bleeding.

In order to evaluate pipelle endometrial sampling combined with ultrasound measurement of endometrial thickness as an initial diagnostic procedure in the assessment of endometrial pathology in patients presenting with postmenopausal bleeding, 50 consecutive patients were studied prospectively. In each patient measurement of endometrial thickness and pipelle endometrial biopsy were performed as an out-patient procedure before hysteroscopy and dilatation and curettage (D&C). The diagnostic sensitivity with pipelle endometrial sampling alone in detecting endometrial pathology was 25% with a specificity of 100%. The measurement of endometrial thickness had a sensitivity of 62% with a specificity of 87.8%. Pipelle sampling combined with endometrial thickness increased the sensitivity to 87.5% with a specificity of 87.8%. Therefore, we suggest that pipelle sampling combined with sonographic measurement of endometrial thickness is an acceptable, less invasive alternative to hysteroscopy and D&C as a first-line investigation in the management of post-menopausal bleeding.     

Frozen section examination of endometrial curettings in the diagnosis of ectopic pregnancy

BACKGROUND: The aim of our study was to determine the accuracy and validity of frozen section analysis of endometrial curettings in differentiating between abnormal intrauterine and ectopic pregnancies. METHODS: A retrospective analysis of the database of the Department of Obstetrics and Gynecology in our institute was performed from January 1998 to September 1999. In 70 women with a suspected ectopic pregnancy a diagnostic curettage was sent for frozen section examination because products of conception could not be identified macroscopically in the curettings. Routine paraffin fixation specimens were also prepared from the endometrial curettings. A frozen section diagnosis was considered correct if it concurred with the final pathologic diagnosis, and incorrect if it differed. The sensitivity, specificity, positive predictive value and negative predictive value of a frozen section in identification of conception products were calculated. RESULTS: Of the 70 frozen section studies the diagnosis was correct in 63 (90%), and incorrect in 7 (10%) cases. Of 50 specimens interpreted as negative on frozen sections (no products of conception noted), 6 (12%) were found to contain conception products on final pathologic review. One of the 20 (5%) specimens interpreted as positive by a frozen section failed to demonstrate products of conception on a final pathologic section. The sensitivity of frozen sections in the diagnosis of ectopic pregnancy was 76%, specificity 97.8%; positive predictive value 95%; negative predictive value 88% and accuracy 90%. CONCLUSIONS: Frozen section examination is a rapid and accurate method for identifying products of conception in endometrial curettings, and may reduce delay in the diagnosis of an ectopic pregnancy and in the institution of therapy.     

Atypical hyperplasia of endometrium and hysteroscopy

OBJECTIVE: To evaluate the risk of discovering an endometrial cancer when atypical hyperplasia was diagnosed by either endometrial samples using the pipelle device or hysteroscopic resection products. PATIENTS AND METHODS: A retrospective monocentric study from january 1990 to july 2000. Twenty-three patients with atypical hyperplasia were included. Initial endometrial status was provided by endometrial biopsyduring diagnosis hysteroscopy (12 cases) or by operative hysteroscopic resection products (11 cases). For 23 patients, operative hysteroscopy and analyse of products resected were performed. For all patients, there was no hysteroscopical aspect evocative of adenocarcinoma. For 23 patients, histopathological analysis of the hysterectomy piece precised the final diagnosis. RESULTS: Among the 23 hysterectomy pieces, 7 adenocarcinomas were diagnosed (30.4%). Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by means of the pipelle biopsy device was 50% (6/12). Risk for discovering adenocarcinoma when atypical hyperplasia was diagnosed by means of operative hysteroscopy resection products was 5.9 % (1/17). DISCUSSION AND CONCLUSION: Atypical endometrial hyperplasia evidenced by pipelle biopsy device is often associated with adenocarcinoma. Diagnosis hysteroscopy however does not show evident pathological aspect of adenocarcinoma in such cases. Operative hysteroscopy allows in most cases correction of endometrial status. Risk of omitting adenocarcinoma when atypical hyperplasia is discovered on hysteroscopic resection pieces is low.     

The accuracy of endometrial biopsy and saline sonohysterography in the determination of the cause of abnormal uterine bleeding

OBJECTIVE: The purpose of this study was to determine the accuracy of outpatient endometrial biopsy and saline sonohysterography for the evaluation of abnormal uterine bleeding. STUDY DESIGN: Eligible participants included women aged 25 to 69 years who complained of persistent uterine bleeding, despite medical treatment. One hundred forty-four patients consented and were followed up prospectively: 1 patient did not successfully complete a saline sonohysterography because of discomfort, 143 patients underwent an endometrial biopsy and saline sonohysterography as outpatients, 113 patients underwent a definitive surgical intervention (hysteroscopy/dilatation and curettage or hysterectomy), 20 patients did not complete a gold standard measure, and 10 patients were lost to follow-up. RESULTS: The combination of endometrial biopsy and saline sonohysterography for the 113 patients who completed the study had a sensitivity and specificity for the detection of abnormal pathologic features of 97.0% (95% CI, 88.6-99.5) and 70.2% (95% CI, 55.0-82.2) and a positive and negative predictive value of 82.1% (95% CI, 71.4-89.5) and 94.3% (95% CI, 79.6-99.0) compared with hysteroscopy/curettage or hysterectomy. CONCLUSION: The high sensitivity and high negative predictive value of saline sonohysterography combined with endometrial biopsy make this technique useful for the evaluation of abnormal uterine bleeding. It may allow some patients to avoid more invasive operative procedures; however, it is important to recognize the limitations in the predictive value of this diagnostic modality.     

细胞学联合组织学在子宫内膜病变无创筛查中的应用价值

目的:探讨联合应用组织学及细胞学的方法筛查子宫内膜病变的临床应用价值。方法:选取62例有异常阴道出血或B超提示子宫内膜异常需行诊断性刮宫的妇女,术前使用一种特制的带有负压吸引装置的子宫内膜取样器进行宫腔细胞学采样,将细胞学及无创组织学的结果与诊断性刮宫后病理结果比较,分析其取材满意度、诊断符合率、出血量及疼痛程度。结果:子宫内膜取样器取材满意率为98.4%,细胞学诊断的敏感性、特异性及符合率分别达到83.3%、93.9%和91.8%;子宫内膜取样器中组织物获得率91.9%,通过取样器获得组织学的患者与其细胞学联合,诊断敏感性、特异性及准确率达到84.6%、95.8%和93.4%。子宫内膜取样器取材操作中出血量平均为(1.2±0.9)ml;诊断性刮宫取材满意率为100%,出血量平均为(6.3±8.3)ml。结论:可通过子宫内膜取样器获得子宫内膜的宫腔细胞学及组织学标本,从而做到简单、安全、可靠地筛查子宫内膜病变。