Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies

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Abstract

Purpose: To evaluate concordance (C) between pre-operative hysteroscopic-directed sampling and final pathology in uterine cancers. Methods: A retrospective cross-sectional evaluation of prospectively collected data of women who underwent hysterectomy for uterine malignancies and a previous hysteroscopic-guided biopsy was performed. Diagnostic concordance between pre-operative (hysteroscopic biopsy) and postoperative (uterine specimen) histology was evaluated. In endometrioid-endometrial cancers cases Kappa (k) statistics was applied to evaluate agreement for grading (G) between the preoperative and final pathology. Results: A total 101 hysterectomies for uterine malignancies were evaluated. There were 23 non-endometrioid cancers: 7 serous (C:5/7, 71.4%); 10 carcinosarcomas (C:7/10, 70%, remaining 3 cases only epithelial component diagnosed); 3 clear cell (C:3/3, 100%); 3 sarcomas (C:3/3, 100%). In 78 cases an endometrioid endometrial cancer was found. In 63 cases there was a histological C (63/78, 80.8%) between hysteroscopic-guided biopsy and final pathology, while in 15 cases (19.2%) only hyperplasia (with/without atypia) was found preoperatively. Overall accuracy to detect endometrial cancer was 80.2%. In 50 out of 63 endometrial cancers (79.4%) grading was concordant. The overall level of agreement between preoperative and postoperative grading was “substantial” according to Kappa (k) statistics (k 0.64; 95% CI: 0.449–0.83; p < 0.001), as well as for G1 (0.679; 95% CI: 0.432–0.926; p < 0.001) and G3 (0.774; 94% CI: 0.534–1; p < 0.001), while for G2 (0.531; 95% CI: 0.286–0.777; p < 0.001) it was moderate. Conclusions: In our series we found an 80% C between pre-operative hysteroscopic-guided biopsy and final pathology, in uterine malignancies. Moreover, hysteroscopic biopsy accurately predicted endometrial cancer in 80% of cases and “substantially” predicted histological grading. Hysteroscopic-guided uterine sampling could be a useful tool to tailor treatment in patients with uterine malignancies.

Original languageEnglish
Pages (from-to)1275-1279
Number of pages5
JournalJournal of Cancer Research and Clinical Oncology
Volume143
Issue number7
DOIs
Publication statusPublished - Jul 1 2017

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Endometrial Neoplasms
Pathology
Biopsy
Neoplasms
Hysterectomy
Carcinosarcoma
Uterine Neoplasms
Sarcoma
Hyperplasia
Histology
Therapeutics

Keywords

  • Endometrial cancer
  • Endometrial cancer grading
  • Hysteroscopy
  • Surgical pathology
  • Uterine cancers

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{bde28a4095224c9baf9ab26ae5071360,
title = "Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies",
abstract = "Purpose: To evaluate concordance (C) between pre-operative hysteroscopic-directed sampling and final pathology in uterine cancers. Methods: A retrospective cross-sectional evaluation of prospectively collected data of women who underwent hysterectomy for uterine malignancies and a previous hysteroscopic-guided biopsy was performed. Diagnostic concordance between pre-operative (hysteroscopic biopsy) and postoperative (uterine specimen) histology was evaluated. In endometrioid-endometrial cancers cases Kappa (k) statistics was applied to evaluate agreement for grading (G) between the preoperative and final pathology. Results: A total 101 hysterectomies for uterine malignancies were evaluated. There were 23 non-endometrioid cancers: 7 serous (C:5/7, 71.4{\%}); 10 carcinosarcomas (C:7/10, 70{\%}, remaining 3 cases only epithelial component diagnosed); 3 clear cell (C:3/3, 100{\%}); 3 sarcomas (C:3/3, 100{\%}). In 78 cases an endometrioid endometrial cancer was found. In 63 cases there was a histological C (63/78, 80.8{\%}) between hysteroscopic-guided biopsy and final pathology, while in 15 cases (19.2{\%}) only hyperplasia (with/without atypia) was found preoperatively. Overall accuracy to detect endometrial cancer was 80.2{\%}. In 50 out of 63 endometrial cancers (79.4{\%}) grading was concordant. The overall level of agreement between preoperative and postoperative grading was “substantial” according to Kappa (k) statistics (k 0.64; 95{\%} CI: 0.449–0.83; p < 0.001), as well as for G1 (0.679; 95{\%} CI: 0.432–0.926; p < 0.001) and G3 (0.774; 94{\%} CI: 0.534–1; p < 0.001), while for G2 (0.531; 95{\%} CI: 0.286–0.777; p < 0.001) it was moderate. Conclusions: In our series we found an 80{\%} C between pre-operative hysteroscopic-guided biopsy and final pathology, in uterine malignancies. Moreover, hysteroscopic biopsy accurately predicted endometrial cancer in 80{\%} of cases and “substantially” predicted histological grading. Hysteroscopic-guided uterine sampling could be a useful tool to tailor treatment in patients with uterine malignancies.",
keywords = "Endometrial cancer, Endometrial cancer grading, Hysteroscopy, Surgical pathology, Uterine cancers",
author = "Fabio Martinelli and Antonino Ditto and Giorgio Bogani and Mauro Signorelli and Valentina Chiappa and Domenica Lorusso and Edward Haeusler and Francesco Raspagliesi",
year = "2017",
month = "7",
day = "1",
doi = "10.1007/s00432-017-2371-0",
language = "English",
volume = "143",
pages = "1275--1279",
journal = "Journal of Cancer Research and Clinical Oncology",
issn = "0171-5216",
publisher = "Springer Verlag",
number = "7",

}

TY - JOUR

T1 - Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies

AU - Martinelli, Fabio

AU - Ditto, Antonino

AU - Bogani, Giorgio

AU - Signorelli, Mauro

AU - Chiappa, Valentina

AU - Lorusso, Domenica

AU - Haeusler, Edward

AU - Raspagliesi, Francesco

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Purpose: To evaluate concordance (C) between pre-operative hysteroscopic-directed sampling and final pathology in uterine cancers. Methods: A retrospective cross-sectional evaluation of prospectively collected data of women who underwent hysterectomy for uterine malignancies and a previous hysteroscopic-guided biopsy was performed. Diagnostic concordance between pre-operative (hysteroscopic biopsy) and postoperative (uterine specimen) histology was evaluated. In endometrioid-endometrial cancers cases Kappa (k) statistics was applied to evaluate agreement for grading (G) between the preoperative and final pathology. Results: A total 101 hysterectomies for uterine malignancies were evaluated. There were 23 non-endometrioid cancers: 7 serous (C:5/7, 71.4%); 10 carcinosarcomas (C:7/10, 70%, remaining 3 cases only epithelial component diagnosed); 3 clear cell (C:3/3, 100%); 3 sarcomas (C:3/3, 100%). In 78 cases an endometrioid endometrial cancer was found. In 63 cases there was a histological C (63/78, 80.8%) between hysteroscopic-guided biopsy and final pathology, while in 15 cases (19.2%) only hyperplasia (with/without atypia) was found preoperatively. Overall accuracy to detect endometrial cancer was 80.2%. In 50 out of 63 endometrial cancers (79.4%) grading was concordant. The overall level of agreement between preoperative and postoperative grading was “substantial” according to Kappa (k) statistics (k 0.64; 95% CI: 0.449–0.83; p < 0.001), as well as for G1 (0.679; 95% CI: 0.432–0.926; p < 0.001) and G3 (0.774; 94% CI: 0.534–1; p < 0.001), while for G2 (0.531; 95% CI: 0.286–0.777; p < 0.001) it was moderate. Conclusions: In our series we found an 80% C between pre-operative hysteroscopic-guided biopsy and final pathology, in uterine malignancies. Moreover, hysteroscopic biopsy accurately predicted endometrial cancer in 80% of cases and “substantially” predicted histological grading. Hysteroscopic-guided uterine sampling could be a useful tool to tailor treatment in patients with uterine malignancies.

AB - Purpose: To evaluate concordance (C) between pre-operative hysteroscopic-directed sampling and final pathology in uterine cancers. Methods: A retrospective cross-sectional evaluation of prospectively collected data of women who underwent hysterectomy for uterine malignancies and a previous hysteroscopic-guided biopsy was performed. Diagnostic concordance between pre-operative (hysteroscopic biopsy) and postoperative (uterine specimen) histology was evaluated. In endometrioid-endometrial cancers cases Kappa (k) statistics was applied to evaluate agreement for grading (G) between the preoperative and final pathology. Results: A total 101 hysterectomies for uterine malignancies were evaluated. There were 23 non-endometrioid cancers: 7 serous (C:5/7, 71.4%); 10 carcinosarcomas (C:7/10, 70%, remaining 3 cases only epithelial component diagnosed); 3 clear cell (C:3/3, 100%); 3 sarcomas (C:3/3, 100%). In 78 cases an endometrioid endometrial cancer was found. In 63 cases there was a histological C (63/78, 80.8%) between hysteroscopic-guided biopsy and final pathology, while in 15 cases (19.2%) only hyperplasia (with/without atypia) was found preoperatively. Overall accuracy to detect endometrial cancer was 80.2%. In 50 out of 63 endometrial cancers (79.4%) grading was concordant. The overall level of agreement between preoperative and postoperative grading was “substantial” according to Kappa (k) statistics (k 0.64; 95% CI: 0.449–0.83; p < 0.001), as well as for G1 (0.679; 95% CI: 0.432–0.926; p < 0.001) and G3 (0.774; 94% CI: 0.534–1; p < 0.001), while for G2 (0.531; 95% CI: 0.286–0.777; p < 0.001) it was moderate. Conclusions: In our series we found an 80% C between pre-operative hysteroscopic-guided biopsy and final pathology, in uterine malignancies. Moreover, hysteroscopic biopsy accurately predicted endometrial cancer in 80% of cases and “substantially” predicted histological grading. Hysteroscopic-guided uterine sampling could be a useful tool to tailor treatment in patients with uterine malignancies.

KW - Endometrial cancer

KW - Endometrial cancer grading

KW - Hysteroscopy

KW - Surgical pathology

KW - Uterine cancers

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U2 - 10.1007/s00432-017-2371-0

DO - 10.1007/s00432-017-2371-0

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C2 - 28247037

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JO - Journal of Cancer Research and Clinical Oncology

JF - Journal of Cancer Research and Clinical Oncology

SN - 0171-5216

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ER -