Department of Gynecology and obstetrics, University Hospital of Getafe.
Department of Applied Mathematics and Statistics CEU San Pablo University, Madrid.
Int J Gynecol Cancer. 2018 Sep;28(7):1258-1263. doi: 10.1097/IGC.0000000000001304.
This study aimed to identify the correlation between histology tumor grade of the preoperative biopsy using dilatation and curettage (D&C), Pipelle, or hysteroscopy and final surgical specimen in women with endometrioid endometrial cancer.
Patients on whom a preoperative biopsy was performed between 2009 and 2016 were reviewed and cases with apparent early-stage endometrioid endometrial cancer were included in the study. The accuracy of preoperative biopsy performed before hysterectomy using D&C, Pipelle, or hysteroscopy was compared.
A total of 332 patients were included. The diagnostic method was D&C in 43 cases (13%), Pipelle in 102 (31%), and hysteroscopy in 187 (56%). The preoperative diagnosis included G1 tumors in 177 cases (53.3%), G2 in 103 (31%), and G3 in 52 (15.6%). The surgical specimen confirmed endometrioid endometrial tumor in 309 patients (93%).The accuracy rates of preoperative biopsy and surgical specimen were 74.69%, 73.19%, and 89.75% for G1, G2, and G3, respectively. Hysteroscopy showed better κ index (κ = 0.551) than did D&C (κ = 0.392) and Pipelle (κ = 0.430). Tumor diameter greater than 30 mm was the only factor independently associated with absence of correlation between preoperative and postoperative tumor grade (odds ratio [95% confidence interval], 1.959 [1.096-3.504], P = 0.023).
Preoperative biopsy, regardless of the method, has its limitations in predicting the tumor grade compared with final surgical specimen in women with endometrioid endometrial cancer at an apparent early stage. Concordance between the biopsy and hysterectomy specimen is less likely to happen in the case of preoperative G1 or G2 tumors, as well as in big tumors. Although hysteroscopy was associated with the highest tumor grade agreement, no differences in correlation between the 3 methods (D&C, Pipelle, and hysteroscopy) were found.
本研究旨在确定使用扩宫刮宫术（D&C）、Pipelle 或宫腔镜对术前活检组织学肿瘤分级与子宫内膜样腺癌患者最终手术标本之间的相关性。
对 2009 年至 2016 年期间进行术前活检的患者进行了回顾性分析，并将明显早期子宫内膜样腺癌纳入研究。比较了术前 D&C、Pipelle 和宫腔镜检查对子宫切除术的准确性。
共纳入 332 例患者。术前诊断方法为 D&C 43 例（13%）、Pipelle 102 例（31%）、宫腔镜 187 例（56%）。术前诊断包括 G1 肿瘤 177 例（53.3%）、G2 肿瘤 103 例（31%）、G3 肿瘤 52 例（15.6%）。309 例患者（93%）手术标本证实为子宫内膜样腺癌。术前活检和手术标本的准确率分别为 G1、G2 和 G3 的 74.69%、73.19%和 89.75%。与 D&C（κ=0.392）和 Pipelle（κ=0.430）相比，宫腔镜检查的κ 指数更好（κ=0.551）。肿瘤直径大于 30mm 是与术前和术后肿瘤分级无相关性的唯一独立因素（比值比[95%置信区间]，1.959[1.096-3.504]，P=0.023）。
对于明显早期的子宫内膜样腺癌患者，术前活检无论采用何种方法，与最终手术标本相比，在预测肿瘤分级方面都存在局限性。在术前 G1 或 G2 肿瘤以及大肿瘤的情况下，活检与子宫切除术标本之间的一致性不太可能发生。尽管宫腔镜检查与最高的肿瘤分级一致性相关，但 3 种方法（D&C、Pipelle 和宫腔镜检查）之间无相关性差异。
