Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma.
OBJECTIVE
To compare the accuracy of D&C vs office endometrial biopsy in predicting final post-hysterectomy FIGO grade in patients diagnosed with a preoperative FIGO grade 1 endometrial adenocarcinoma.


METHODS
We reviewed 1423 consecutive cases of endometrial cancer treated at our institution between 1/1/93 and 5/31/06 and identified cases with an unequivocal preoperative endometrial biopsy demonstrating FIGO grade 1 endometrial adenocarcinoma. All cases were pathologically confirmed and underwent surgical therapy at our institution. FIGO grade and histology diagnosed in the hysterectomy specimen were noted. The findings in the hysterectomy specimen were then compared between those patients who had a preoperative D&C vs an office endometrial sampling. Chi-square and Fisher-exact test were used as appropriate.


RESULTS
We identified 490 cases with a preoperative FIGO grade 1 endometrial adenocarcinoma. In 482 cases, FIGO grade was determined to be greater in 71 (14.7%) cases; in the final hysterectomy specimen, 66 (13.7%) were found to be grade 2 and 5 (1%) were found to be grades 2-3/3. Serous or clear cell histology was diagnosed in 6 (1.2%) additional cases. D&C was performed in 187 (38.6%) cases and office endometrial sampling in 298 (61.4%); in 5 cases the method used was not discernible. The final post-hysterectomy FIGO grade was higher in 16/187 (8.7%) cases diagnosed by D&C compared to 52/298 (17.4%) diagnosed by office endometrial sampling (P=0.007).


CONCLUSIONS
Preoperative FIGO grade 1 diagnosis correlates with final grade diagnosis in 85% of cases. While D&C more accurately reflects final FIGO grade, a higher grade will be found in 8.7% of the cases at the time of hysterectomy.
Leitao
Mario M
MM
Department of Surgery, Division of Gynecology, Memorial Sloan-Kettering Cancer Center 1275 York Avenue New York, NY 10065, USA. gynbreast@mskcc.org
Kehoe
Siobhan
S
Barakat
Richard R
RR
Alektiar
Kaled
K
Gattoc
Leda P
LP
Rabbitt
Catherine
C
Chi
Dennis S
DS
Soslow
Robert A
RA
Abu-Rustum
Nadeem R
NR
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged