Effects of pipelle endometrial biopsy on pretreatment tumor sampling for advanced ovarian, fallopian tube, and primary peritoneal cancers

Abstract

Background There have been several reports of ovarian cancer cells being detected on endometrial cytology. Recently, pipelle endometrial biopsy has been widely performed as an effective, minimally invasive, and low-cost test for endometrial diseases. However, the effectiveness of pretreatment pipelle endometrial biopsy in the ovarian, fallopian tube, and peritoneal cancers remains unexplored. Methods We performed pretreatment pipelle endometrial biopsy for 90 patients with ovarian, fallopian tube, and primary peritoneal cancers from January 2014 to November 2021. We retrospectively analyzed the association between the results of pipelle endometrial biopsy and clinicopathological data. Results 25/61 (41.0%) cases with clinical stage II or higher were diagnosed with pipelle endometrial biopsy-positive (Pipelle-positive) and Pipelle-positive was not observed in 29 cases with clinical stage I. Pipelle-positive had significantly more high-grade serous carcinomas (p = 0.005), positive peritoneal cytology (p < 0.001), positive endometrial cytology (p < 0.001), and positive cervical cytology (p < 0.001) than pipelle endometrial biopsy-negative cases. In 23 Pippele-positive patients, we confirmed surgical pathology, and 17/23 (74.0%) had a completely same diagnosis with pipelle endometrial biopsy. Conversely, 6/23 (26.0%) showed a minor diagnostic discrepancy between pipelle endometrial biopsy and surgical pathology. Companion diagnostic tests (myChoice CDx and microsatellite instability test) were performed using pipelle endometrial biopsy samples in four primarily inoperable high-grade serous carcinoma patients and all tests were evaluable. Conclusion Pipelle endometrial biopsy is useful as a minimally invasive tumor sampling method for some advanced ovarian, fallopian tube, and peritoneal cancers. It may allow for prompt histological diagnosis and initiation of chemotherapy while collecting tumor tissue for genetic testing in primarily inoperable patients.