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Rev Bras Ginecol Obstet. 2020;42(10):642-648
, , , , , To evaluate the agreement between the histopathological diagnoses of preoperative endometrial samples and surgical specimens and correlate the agreement between the diagnoses with the impact on surgical management and the survival of patients with endometrial adenocarcinomas.
Sixty-two patients treated for endometrial cancer at a university hospital from 2002 to 2011 were retrospectively evaluated. The histopathological findings of preoperative endometrial samples and of surgical specimens were analyzed. The patients were subjected to hysterectomy as well as adjuvant treatment, if necessary, and clinical follow-up, according to the institutional protocol. Lesions were classified as endometrioid tumor (type 1) grades 1, 2, or 3 or non-endometrioid carcinoma (type 2).
The agreement between the histopathological diagnoses based on preoperative endometrial samples and surgical specimens was fair (Kappa: 0.40; p < 0.001). However, the agreement was very significant for tumor type and grade, in which a higher concordance occurred at a higher grade. The percentage of patients with lymph nodes affected was 19.2%;. Although most patients presenting with disease remission or cure were in the early stages (90.5%;), there were no significant differences between those patients who had a misdiagnosis (11/16; 68.8%;) and those who had a correct diagnosis (25/33; 75.8%;) based on preoperative endometrial sampling (p = 0.605).
Our findings corroborate the literature and confirm the under staging of preoperative endometrial samples based on histopathological assessment, especially for lower grade endometrial tumors. We suggest that the preoperative diagnosis should be complemented with other methods to better plan the surgical management strategy.
Summary
Rev Bras Ginecol Obstet. 2020;42(10):642-648
, , , , , To evaluate the agreement between the histopathological diagnoses of preoperative endometrial samples and surgical specimens and correlate the agreement between the diagnoses with the impact on surgical management and the survival of patients with endometrial adenocarcinomas.
Sixty-two patients treated for endometrial cancer at a university hospital from 2002 to 2011 were retrospectively evaluated. The histopathological findings of preoperative endometrial samples and of surgical specimens were analyzed. The patients were subjected to hysterectomy as well as adjuvant treatment, if necessary, and clinical follow-up, according to the institutional protocol. Lesions were classified as endometrioid tumor (type 1) grades 1, 2, or 3 or non-endometrioid carcinoma (type 2).
The agreement between the histopathological diagnoses based on preoperative endometrial samples and surgical specimens was fair (Kappa: 0.40; p < 0.001). However, the agreement was very significant for tumor type and grade, in which a higher concordance occurred at a higher grade. The percentage of patients with lymph nodes affected was 19.2%;. Although most patients presenting with disease remission or cure were in the early stages (90.5%;), there were no significant differences between those patients who had a misdiagnosis (11/16; 68.8%;) and those who had a correct diagnosis (25/33; 75.8%;) based on preoperative endometrial sampling (p = 0.605).
Our findings corroborate the literature and confirm the under staging of preoperative endometrial samples based on histopathological assessment, especially for lower grade endometrial tumors. We suggest that the preoperative diagnosis should be complemented with other methods to better plan the surgical management strategy.
Summary
Rev Bras Ginecol Obstet. 2003;25(9):667-672
DOI 10.1590/S0100-72032003000900008
PURPOSE: to compare the results of hysterosonography with those of hysteroscopy and the histopathologic study in postmenopausal women. METHODS: hysterosonography, hysteroscopy and endometrial biopsy were performed in 59 women who had an endometrial echo over 4 mm, age above 40 years and amenorrhea over one year, and whose follicle-stimulating hormone levels were over 35 mIU/mL. Patients using hormones were excluded, as well those in whom it was impossible to perform histerosonography, histeroscopy or endometrial biopsy. The statistical analysis was performed using the nonparametric "G"-Cochran and McNemar tests. In addition, sensitivity and specificity, as well as positive and negative predictive values were determined. The value of 0.05 or 5% for rejection level of the null hypothesis was applied. RESULTS: the agreement rates of hysterosonographic results compared to hysteroscopy and histopatology were 94.8 ande 77.6%, respectively. Sensitivity and specificity of hysterosonographic evaluation of the abnormal endometrial cavity were 98 and 75%, respectively, when compared to hysteroscopy. In addittion, positive and negative predictive values of hysterosonography were 96 and 86%, respectively. When the histopathologic study was used as the gold standard, sensitivity and specificity were 98 and 33%, with positive predictive value of 76% and negative predictive value of 86%, for the detection of the endometrial cavitary changes. One great concern were the histopathologic results of two patients with uterine synechia who showed endometrial hyperplasia. Also, one patient was diagnosed as normal using histerosonography and the histopatological result showed simple hyperplasia. CONCLUSIONS: our data suggest that hysterosonography presented good sensitivity as compared with hysteroscopy. However, uterine synechia is the great limitation of this method as compared with histopathology.
Summary
Rev Bras Ginecol Obstet. 2003;25(9):667-672
DOI 10.1590/S0100-72032003000900008
PURPOSE: to compare the results of hysterosonography with those of hysteroscopy and the histopathologic study in postmenopausal women. METHODS: hysterosonography, hysteroscopy and endometrial biopsy were performed in 59 women who had an endometrial echo over 4 mm, age above 40 years and amenorrhea over one year, and whose follicle-stimulating hormone levels were over 35 mIU/mL. Patients using hormones were excluded, as well those in whom it was impossible to perform histerosonography, histeroscopy or endometrial biopsy. The statistical analysis was performed using the nonparametric "G"-Cochran and McNemar tests. In addition, sensitivity and specificity, as well as positive and negative predictive values were determined. The value of 0.05 or 5% for rejection level of the null hypothesis was applied. RESULTS: the agreement rates of hysterosonographic results compared to hysteroscopy and histopatology were 94.8 ande 77.6%, respectively. Sensitivity and specificity of hysterosonographic evaluation of the abnormal endometrial cavity were 98 and 75%, respectively, when compared to hysteroscopy. In addittion, positive and negative predictive values of hysterosonography were 96 and 86%, respectively. When the histopathologic study was used as the gold standard, sensitivity and specificity were 98 and 33%, with positive predictive value of 76% and negative predictive value of 86%, for the detection of the endometrial cavitary changes. One great concern were the histopathologic results of two patients with uterine synechia who showed endometrial hyperplasia. Also, one patient was diagnosed as normal using histerosonography and the histopatological result showed simple hyperplasia. CONCLUSIONS: our data suggest that hysterosonography presented good sensitivity as compared with hysteroscopy. However, uterine synechia is the great limitation of this method as compared with histopathology.