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.
- Author:
Da Hee KIM
1
;
Seok Ju SEONG
;
Mi Kyoung KIM
;
Hyo Sook BAE
;
Mi La KIM
;
Bo Seong YUN
;
Yong Wook JUNG
;
Jeong Yun SHIM
Author Information
- Publication Type:Original Article
- Keywords: Biopsy; Dilatation and Curettage; Endometrial Neoplasms; Levonorgestrel Intrauterine Devices; Progesterone
- MeSH: Biopsy; Biopsy, Needle*; Carcinoma, Endometrioid; Dilatation and Curettage*; Dilatation*; Endometrial Neoplasms*; Female; Fertility; Gynecology; Humans; Hyperplasia; Levonorgestrel*; Medroxyprogesterone Acetate; Observational Study; Obstetrics; Progesterone; Prospective Studies
- From:Journal of Gynecologic Oncology 2017;28(1):e1-
- CountryRepublic of Korea
- Language:English
- 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.
