J Gynecol Oncol.  2017 Jan;28(1):e1. 10.3802/jgo.2017.28.e1.

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

• Kim DH
• Seong SJ
• Kim MK
• Bae HS
• Kim ML
• Yun BS
• Jung YW
• Shim JY

• KMID: 2413848
• DOI: http://doi.org/10.3802/jgo.2017.28.e1

Abstract

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.
CONCLUSION
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.

Keyword

Biopsy; Dilatation and Curettage; Endometrial Neoplasms; Levonorgestrel Intrauterine Devices; Progesterone

MeSH Terms

Adenocarcinoma/drug therapy/*pathology
Adult
Antineoplastic Agents, Hormonal/administration & dosage
*Biopsy, Needle
*Dilatation and Curettage
Endometrial Neoplasms/drug therapy/*pathology
Endometrium/pathology
Female
Fertility Preservation
Humans
Intrauterine Devices
Levonorgestrel/*administration & dosage
Medroxyprogesterone Acetate/administration & dosage
Progestins/*administration & dosage
Prospective Studies
Reproducibility of Results
Antineoplastic Agents, Hormonal
Progestins
Levonorgestrel
Medroxyprogesterone Acetate