Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system.
OBJECTIVE
To determine whether less invasive endometrial (EM) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage (D&C) biopsy in early-stage endometrial cancer (EC) patients treated with high dose oral progestin and levonorgestrel intrauterine system (LNG-IUS).


METHODS
We conducted a prospective observational study with patients younger than 40 years who were diagnosed with clinical stage IA, The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility. The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS. Treatment responses were evaluated every 3 months. EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue samples were histologically compared. The diagnostic concordance rate of the two tests was examined with κ statistics.


RESULTS
Twenty-eight pairs of EM samples were obtained from five patients. The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3% (κ value=0.26). Of the seven samples diagnosed as normal with D&C, three (42.8%) were diagnosed as normal by using EM aspiration biopsy. Of the eight samples diagnosed with endometrioid adenocarcinoma by using D&C, three (37.5%) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy. Of the 13 complex EM hyperplasia samples diagnosed with the D&C, five (38.5%) were diagnosed with EM hyperplasia by using EM aspiration biopsy. Of the samples obtained through EM aspiration, 46.4% were insufficient for histological evaluation.


CONCLUSIONS
To evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS, D&C should be conducted after LNG-IUS removal.
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Da Hee
http://orcid.org/0000-0001-6737-5219
DH
Kim
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea. sjseongcheil@naver.com.
Seok Ju
http://orcid.org/0000-0003-3820-3412
SJ
Seong
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Mi Kyoung
http://orcid.org/0000-0002-9520-2339
MK
Kim
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Hyo Sook
http://orcid.org/0000-0001-8829-6480
HS
Bae
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Mi La
http://orcid.org/0000-0003-1011-5664
M
Kim
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Bo Seong
http://orcid.org/0000-0003-4352-1693
BS
Yun
Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Yong Wook
http://orcid.org/0000-0003-2098-8143
YW
Jung
Department of Pathology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
Jeong Yun
http://orcid.org/0000-0001-9367-2233
JY
Shim
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology*; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D001707:Biopsy, Needle; D004107:Dilatation and Curettage; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology*; D004717:Endometrium / Q000473:pathology; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage*; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D011372:Progestins / Q000008:administration & dosage*; D011446:Prospective Studies; D015203:Reproducibility of Results
D018931:Antineoplastic Agents, Hormonal; D011372:Progestins; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate
Biopsy; Dilatation and Curettage; Endometrial Neoplasms; Levonorgestrel Intrauterine Devices; Progesterone
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