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

• Published in: Journal of gynecologic oncology Vol. 28; no. 1; p. e1
• Main Authors: Kim, Da Hee, Seong, Seok Ju, Kim, Mi Kyoung, Bae, Hyo Sook, Kim, Mi La, Yun, Bo Seong, Jung, Yong Wook, Shim, Jeong Yun
• Format: Journal Article
• Language: English
• Published: Korea (South) Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology 01.01.2017; 대한부인종양학회
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adult; Antineoplastic Agents, Hormonal - administration & dosage; Biopsy, Needle; Dilatation and Curettage; Endometrial Neoplasms - drug therapy; Endometrial Neoplasms - pathology; Endometrium - pathology; Female; Fertility Preservation; Humans; Intrauterine Devices; Levonorgestrel - administration & dosage; Medroxyprogesterone Acetate - administration & dosage; Original; Progestins - administration & dosage; Prospective Studies; Reproducibility of Results; 산부인과학; Dilatation and Curettage; Levonorgestrel Intrauterine Devices; Endometrial Neoplasms; Progesterone; Biopsy
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2017.28.e1

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). 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. 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. 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.