Accuracy of preoperative sampling diagnosis for predicting final pathology in patients with endometrial carcinoma: a review

Abstract

Endometrial cancer (EC) is the most common gynecologic cancer. The most frequent symptom of this disease is postmenopausal bleeding. Diagnosis of EC must be histologically confirmed, and there are several methods for endometrial sampling to obtain cells or endometrial tissue. The first step in diagnosis should be ultrasound measurement of endometrial thickness, followed by endometrial sampling, which can be performed by office endometrial biopsy, hysteroscopic biopsy, or dilatation and curettage (D&C). The review in this article was carried out to present previously published studies, comprehensively evaluate method performance (i.e., overall accuracy of preoperative sampling in patients with endometrial carcinoma, and overall agreement on grade and histological subtype between preoperative endometrial sampling and final diagnosis), and determine which sampling method is most accurate on the basis of the statistical data in the studies analyzed. From the literature analyzed and examined, it can be concluded that preoperative endometrial sampling is not always the best predictor of final histology in EC and has its limitations. In surgical decisions based only on preoperative sampling, a biopsy should be made with caution, and it is necessary to take other parameters into account. Inadequate grading leads to suboptimal clinical management, mainly in early-stage tumors. This review showed that, although hysteroscopic biopsy was mainly associated with the highest tumor grade agreement, and although D&C showed the highest overall accuracy in detecting endometrial carcinoma, the data do not therefore reliably indicate which method yields the most precise results. The results of this review indicate that further studies on larger samples and with greater statistical power are needed to accurately define the role and type of preoperative sampling methods.

Multiparametric magnetic resonance imaging-based radiomics nomogram for predicting tumor grade in endometrial cancer

“…A previous meta-analysis showed a 67% (95% CI: 0.60–0.75) agreement rate between preoperative endometrial sampling and final histopathology, with 21% of tumor grades underestimated and 25% of tumor grades overestimated ( 31 ). A recent review ( 6 ) obtained similar results and concluded that preoperative EC sampling is not always the best predictor of the final pathological grade of EC. In this study, we found that the concordance rate between D&C and final pathological diagnosis was approximately 76.2%, 16.8% of the tumor grade was upgraded and approximately 41.7% of the patients with these upgrades were upgraded from low-grade to high-grade, which was not different from the results of previous studies.…”

“…In this study, we found that the concordance rate between D&C and final pathological diagnosis was approximately 76.2%, 16.8% of the tumor grade was upgraded and approximately 41.7% of the patients with these upgrades were upgraded from low-grade to high-grade, which was not different from the results of previous studies. However, inadequate grading may lead gynecologists to incorrectly assess the risk of LNM and select suboptimal treatment plans ( 6 ). In theory, radiomics can noninvasively obtain information about tumors and predict tumor heterogeneity and aggressiveness.…”

“…Almost all patients with EC undergo preoperative dilation and curettage (D&C) or hysteroscopic biopsy. A recent review showed moderate agreement between D&C and the final surgical pathology ( 6 ). The underestimation of the pathological grade will lead to inadequate treatment and risk of LNM in the future, whereas overestimation of the pathological grade will lead to excessive surgical treatment and cause unnecessary complications in patients ( 7 , 8 ).…”

It is not the time to abandon intraoperative frozen section in endometrioid adenocarcinoma: A large‐scale, multi‐center, and retrospective study

“… 31 A previous review reported a discrepancy of 35.9%–7.0% and 20.0%–16.2% on the final diagnosis for the D&C and Hys, respectively. 32 Regarding concordance, similar to the biopsy, there is some discordance between IFS and postoperative pathology. 33 Tumor grade evaluation by IFS has presented sensitivity of 40%–98%, specificity of 53%–98%, accuracy of 83%–89%, and correlation of 58%–88%.…”

Management of endometrial cancer: current insights and future directions

“…In this scenario, novel strategies are arising in order to make diagnosis as earlier as possible ( 6 ), and provide appropriate management for these patients, taking into account the possibility of tailored treatment, even by minimally invasive approach ( 7 ). Indeed, the preoperative assessment ( 8 , 9 ) with imaging techniques ( 10 ) and endometrial biopsy ( 11 ) allows the definition of endometrial cancer stage and grade and its appropriate management ( 12 ), especially taking into account potential risk factors ( 13 - 15 ). In this regard, the current role of hysteroscopy for targeted endometrial biopsy ( 16 ) is pivotal to minimize misdiagnosis of endometrial cancer and erroneous tumor grading classification ( 17 ).…”