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Cohort Study

The diagnostic accuracy of prehysterectomy curettage in determining tumor type and grade in patients with endometrial cancer

Mhmed Ali, Rihan MD

Author Information
IJS: Short Reports: July/September 2022 - Volume 7 - Issue 3 - p e29
doi: 10.1097/SR9.0000000000000029
  • Open

Abstract

Carcinoma of the endometrium is the most common gynecologic malignancy in developed countries1. Bokhman proposed that endometrial carcinoma be divided into 2 types, type I and type II, on the basis of their pathogenesis: one—by far the more common—occurring as a result of excess estrogenic stimulation and developing against a background of endometrial hyperplasia, and the other developing de novo, independent of estrogen stimulation, in older women1. The prototype for type I endometrial carcinoma is low-grade endometrioid carcinoma, while the prototype for type II endometrial carcinoma is serous carcinoma1. It typically occurs in elderly individuals1. Most endometrial adenocarcinomas occurring in women aged 40 years or younger are of endometrioid type, well to moderately differentiated, and early-stage disease1. Well-differentiated tumors may be distinguished from hyperplasias by lack of intervening stroma1. The Pipelle endometrial suction curette is an effective office device for evaluating patients at risk of endometrial cancer; however, tumors localized to a polyp or small area of the endometrium may go undetected2. Endovaginal ultrasound has a high sensitivity for detecting endometrial cancer and other endometrial disease and can reliably identify postmenopausal women with vaginal bleeding who are highly unlikely to have a significant endometrial disease so that endometrial sampling may be unnecessary3. Outpatient endometrial biopsy has a high overall accuracy in diagnosing endometrial cancer when an adequate specimen is obtained. A positive test result is more accurate for ruling in disease than a negative test result is for ruling it out. Therefore, in cases of abnormal uterine bleeding where symptoms persist despite negative biopsy, further evaluation will be warranted4. The problem remains to answer this question that can we rely on the initial report of endometrial curettage in determining the final diagnosis thus the best management for patients of endometrial cancer?

Materials and methods

This is a retrospective cohort study which was done in obstetrics and gynecology university hospital from January 2014 to December 2020, thus, ethical approval and patient consent was not needed. Inclusion criteria were positive testings of endometrial curettage for endometrial cancer. Exclusion criteria were negative testings of endometrial curettage for endometrial cancer, and unavailable hysterectomy after curettage. Total hysterectomy was done for 75 patients diagnosed endometrial cancer depending on endometrial curettage report. This study was reported in line with STROCSS criteria5. We made a comparison of tumor grade and type before and after total hysterectomy using inter-rater reliability test. Also, to study correlations between histologic and clinical findings like (age, tumor stage, tumor grade, tumor type), along with descriptive statistics. We studied the sensitivity and positive predictive value only without specificity and negative predictive value due to inclusion criteria. The corresponding author was who assessed the 2 pathological reports and collected the data. We used Excel 2013, SPSS programs as software tools. We considered P-value equals 0.05 to be statistically significant.

Results

The most common age category was the sixth decade followed by fifth decade (Fig. 1). The most common tumor stage was the first stage followed by second stage (Fig. 2). The most prevalent tumor grade was the second grade followed by third grade (Fig. 3). The most prevalent tumor type was endometrioid carcinoma followed by adenocarcinoma with squamous differentiation (Fig. 4, Tables 1–4).

F1
Figure 1:
This chart reveals 4 categories of patients age.
F2
Figure 2:
This chart reveals 4 categories of tumor stage.
F3
Figure 3:
This chart reveals 4 categories of tumor grade.
F4
Figure 4:
This chart reveals different categories of tumor type.
Table 1 - This table reveals correlation between hysterectomy and curettage regarding to tumor grade.
Reliability Statistics
Cronbach α Cronbach α Based on Standardized Items No. Items
0.248 0.252 2

Table 2 - This table reveals correlation between hysterectomy and curettage regarding to tumor grade.
Inter-item Correlation Matrix
Curettage Tumor Grade Hysterectomy Tumor Grade
Curettage tumor grade 1.000 0.144
Hysterectomy tumor grade 0.144 1.000

Table 3 - This table reveals correlation between hysterectomy and curettage regarding to tumor type.
Reliability Statistics
Cronbach α Cronbach α Based on Standardized Items No. Items
0.552 0.632 2

Table 4 - This table reveals correlation between hysterectomy and curettage regarding to tumor type.
Inter-item Correlation Matrix
Tumor Type of Curettage Tumor Type of Hysterectomy
Tumor type of curettage 1.000 0.463
Tumor type of hysterectomy 0.463 1.000

We did not find significant correlation (P>0.05) in the relationship between the:

Hysterectomy and curettage regarding to tumor grade.

Hysterectomy and curettage regarding to tumor type.

Sensitivity test was done, equals 93% because only 5 specimens were negative for endometrial cancer after hysterectomy.

Positive predictive value was 93%.

Discussion

We evaluated the role of endometrial curettage in determining tumor grade and type in patients of endometrial cancer, and studied correlation with clinical findings like age and tumor stage. In this study, we have found that the endometrioid carcinoma was the most common type and the most consistent with hysterectomy which consists with Turkish study6. The second most common type in the Turkish study6 was the atypical hyperplasia in contrast to this study which was the endometioid carcinoma third grade. We have found also that age of patients correlated significantly with tumor type and tumor stage. Also, tumor stage correlated significantly with tumor grade and tumor type. This study has some limitation like insufficient clinical information and unavailable immunohistochemical stains due to financial difficulties.

Conclusion

Endometrial curettage is a reliable investigation in evaluating endometrial cancer. Determining tumor grade and type are possible on the initial report of endometrial curettage thus, using it for therapeutic management for patients of endometrial cancer.

Ethical approval

None.

Sources of funding

None.

Authors contribution

None.

Conflicts of interest disclosure

The author declares that there is no financial conflict of interest with regard to the content of this report.

Research registration unique identifying number (UIN)

1. Name of the registry: Research Registry.

2. Unique Identifying number or registration ID: Research registry 7023. https://www.researchregistry.com/browse-the-registry#home/.

Guarantor

Rihan Mhmed Ali.

References

1. Goldblum JR, Lamps LW, McKenney JK, et al. Rosai and Ackerman’s Surgical Pathology, 11th ed. Philadelphia, PA: Elsevier; 2018.
2. Guido RS, Kanbour-Shakir AMAL, Rulin MC, et al. Pipelle endometrial sampling. Sensitivity in the detection of endometrial cancer. J Reprod Med 1995;40:553–555.
3. Smith-Bindman R, Kerlikowske K, Feldstein VA, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 1998;280:1510–7.
4. Clark TJ, Mann CH, Shah N, et al. Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review. BJOG 2002;109:313–21.
5. Agha R, Abdall-Razak A, Crossley E, et al. The STROCSS 2019 Guideline: Strengthening the Reporting of Cohort Studies in Surgery. Int J Surg 2019;72:156–65.
6. Kisielewski F, Gajewska ME, Marczewska MJ, et al. Comparison of endometrial biopsy and postoperative hysterectomy specimen findings in patients with atypical endometrial hyperplasia and endometrial cancer. Ginekol Pol 2016;87:488–92.
Keywords:

Tumor type; Tumor grade; Hysterectomy; Endometrial cancer; Endometrial curettage

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of IJS Publishing Group Ltd.