Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review

Clark, T. Justin

doi:10.1016/s1470-0328(02)01088-1

Cited by 58 publications

(81 citation statements)

References 12 publications

(22 reference statements)

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“…A systematic review of 13 diagnostic evaluations showed that a Pipelle biopsy leads to a high overall diagnostic accuracy when an adequate specimen is obtained (post-test probability of endometrial cancer of 81.7% for a positive test and 0.9% for a negative test). 17 These findings encourage further evaluation in cases of abnormal uterine bleeding where symptoms persist despite negative biopsy. Hysteroscopy tends to be reserved for patients who cannot tolerate outpatient examination and biopsy, patients with cervical stenosis, and patients in whom outpatient biopsy was inadequate.…”

Section: How Is the Diagnosis Made?mentioning

confidence: 84%

Endometrial cancer

Saso

Chatterjee

Georgiou

et al. 2011

BMJ

121

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Srdjan Saso clinical research fellow 1 , Jayanta Chatterjee clinical research fellow 1 , Ektoras Georgiou clinical research fellow 2 , Anthony M Ditri general practitioner 3 , J Richard Smith gynaecological surgeon 4 , Sadaf Ghaem-Maghami senior lecturer and honorary consultant in gynaecological oncology 5The International Agency for Research on Cancer recently estimated that endometrial carcinoma is the commonest gynaecological cancer in the developed world, 1 with a rising incidence in postmenopausal women. In 2007, 7536 new endometrial cancers were diagnosed in the UK, making it the fourth most common cancer in women after breast, lung, and colorectal cancers. 2 Cancer of the endometrium is the commonest cancer of the uterine corpus (about 92%, the remainder being uterine carcinosarcomas and sarcomas), according to the Surveillance, Epidemiology and End Results programme of the US National Cancer Institute, which has collected data on cancer from various locations and sources since 1973. 3 Cure is possible and the overall five year survival rate for all stages is currently around 80%. Most women present early in the course of the disease when cure is more likely, so primary care practitioners need to be vigilant for potential indicators. We discuss the epidemiology, diagnosis, and treatment of endometrial cancer on the basis of a review of observational research, randomised trials, reviews, and meta-analyses. Summary pointsEndometrial cancer is the most common gynaecological cancer in more developed countries and its incidence is increasing in postmenopausal women Postmenopausal bleeding is the hallmark symptomThe main risk factors for the development of endometrioid endometrial carcinoma are obesity and chronic unopposed oestrogen stimulation of the endometrium All women with suspected endometrial cancer require transvaginal ultrasonography and most will undergo endometrial biopsy; more sophisticated radiological examinations are required for accurate preoperative staging.Treatment is usually surgical, comprising total hysterectomy and bilateral salpingo-oophorectomy.Adjuvant therapy with radiotherapy, chemotherapy, or hormonal therapy is considered in more advanced or high risk disease Sources and selection criteriaWe searched PubMed to identify peer reviewed original research articles, meta-analyses, and reviews. Search terms were endometrial cancer, cancer of the endometrium, endometrial adenocarcinoma, neoplasm and endometrium, and endometrial neoplasm. Only papers written in English were considered.

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Section: How Is the Diagnosis Made?mentioning

confidence: 84%

Endometrial cancer

Saso

Chatterjee

Georgiou

et al. 2011

BMJ

121

View full text Add to dashboard Cite

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“…This procedure is successful when adequate specimens are obtained. Insufficient sample on endometrial biopsy was only associated with hysteroscopic finding of endometrial atrophy and ultrasonographically thin endometrium (52). A positive result of endometrial sampling is highly accurate, but a negative result is of limited accuracy and only moderately important (53).…”

Section: Discussionmentioning

confidence: 95%

“…After the removal of these lesions, repeat bleeding and admission of the women for same reasons can be avoided (51). The experience with the diagnostic accuracy of hysteroscopy in endometrial disease is limited and further testing should be indicated (52). Endometrial sampling should follow the hysteroscopic view in all cases showing abnormal or suspicious lesions as well as in all cases with irregularly shaped endometrial lining and/or suboptimal endoscopic vision.…”

Section: Discussionmentioning

confidence: 99%

The contribution of hysteroscopy to the detection malignancy in symptomatic postmenopausal women

Liberis

Tsikouras

Zografou

et al. 2010

Minimally Invasive Therapy & Allied Technologies

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Hysteroscopic evaluation of endometrial cavity is widely used in cases of abnormal uterine bleeding. The aim of the present study is to compare the hysteroscopic and histological findings in women suffering from postmenopausal bleeding. Between 1990 and 2009, 425 women aged 47-83 years were included in the study. None of the women had received hormonal therapy or had any malignancy in the past. All women underwent diagnostic hysteroscopy and histologic sampling of the endometrial cavity. Hysteroscopy was successfully completed in 423 women and was suggestive of malignant lesions in 23 cases, which were confirmed histologically. The hysteroscopic findings in three cases were suggestive of atrophic endometrium, atypical hyperplasia and endometrial carcinoma, and the histologic diagnosis confirmed endometrial carcinoma (two cases) and one uterine sarcoma. Hysteroscopy proves to be a safe and effective technique in the diagnosis and management of abnormal uterine bleeding.

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“…The diagnosis of endometrial cancer is made reliably based on histologic and radiologic evaluation. Endometrial biopsy has high sensitivity for a diagnosis of endometrial carcinoma 23,24 ; however, very few studies have reported its sensitivity in diagnosis of mesenchymal tumors and are limited to small single-institution reports. 11,25 Because of the distribution of sarcomas within the myometrium, the reported sensitivities of 33–67%are not surprising.…”

Section: Accuracy Of Clinical and Radiographic Predictors Of Malignancymentioning

confidence: 99%

A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature

Liu

Galvan-Turner

Pfaendler

et al. 2015

American Journal of Obstetrics and Gynecology

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Uterine sarcomas are rare uterine malignancies that are difficult to diagnose preoperatively. Because of cases of disseminated sarcoma after laparoscopic hysterectomy, the role of power morcellators in gynecologic surgery has been questioned. Morcellation is an integral part of making laparoscopic surgery possible for the removal of large uterine leiomyomata, and the development of power morcellation has increased efficiency during these procedures. Minimally invasive surgery has demonstrated benefits that include improved pain control, decreased infection risk, and faster surgical recovery and return to work. In this review, we examine the risk of incidental sarcoma at the time of surgery, the quality of the data, the accuracy of clinical and radiologic predictors of uterine sarcoma, and the impact of morcellation on the prognosis of uterine sarcoma.

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Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review

Cited by 58 publications

References 12 publications

Endometrial cancer

Endometrial cancer

The contribution of hysteroscopy to the detection malignancy in symptomatic postmenopausal women

A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature

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