Comparison of pretreatment assessment of intrauterine tumor spread in endometrial carcinoma using ultrasonography,hysteroscopy, and fractional curettage

Due to their age, patients with endometrial carcinoma are often in an impaired general condition and have other concomitant diseases. To prevent overtreatment or undertreatment, invasive and noninvasive diagnostic procedures such as ultrasonography, hysteroscopy, and fractional curettage were compared with regard to their capacity to assess tumor extent (in) to the cervix. In 75 patients with endometrial carcinoma, the results of transvaginal ultrasonography, diagnostic hysteroscopy, and fractional curettage in assessing tumor spread to the cervix were compared with the final pathology report on the hysterectomy specimen. Cervical involvement was demonstrated in the hysterectomy specimen in 25.3% of the patients (19 of 75). Ultrasound identified evidence of cervical involvement with a sensitivity of 15.8% (3 of 19) and a specificity of 98.1% (53 of 54); hysteroscopy had a sensitivity of 42.9% (6 of 14) and a specificity of 89.5% (34 of 38); and fractional curettage had a sensitivity of 57.9% (11 of 19) and a specificity of 66.1% (37 of 56). None of the procedures on its own is suitable for pretreatment assessment of cervical involvement. However, negative endocervical curettage and hysteroscopical exclusion of cervical infiltration may often identify patients correctly without cervical involvement, thereby avoiding overtreatment.