Abstract
Objective
To quantify the rate of inconsistency in histopathological reporting between endometrial
biopsy specimens (obtained by Pipelle® endometrial sampler or curettage) and hysterectomy
specimens using the World Health Organization classification criteria.
Study design
A retrospective review of the records of 280 women with a histopathological diagnosis
of endometrial hyperplasia treated in Ipswich Hospital NHS Trust, UK from 1 January
1998 to 31 May 2009.
Results
Discrepancy was found between the histopathological results of endometrial samples
and hysterectomy specimens. The discrepancy was doubled for specimens obtained using
a Pipelle® endometrial sampler, with false-positive (i.e. overdiagnosis when the hysterectomy
specimen showed a better diagnosis) and false-negative (i.e. underdiagnosis when the
hysterectomy specimen showed a worse diagnosis) rates of 5.3% and 22.6%, respectively.
For curettage specimens, the false-positive and false-negative rates were 1.8% and
13.2%, respectively. All cases of curettage were performed under general or regional
anaesthesia, and were preceded by hysteroscopy. Apart from age, no risk factors were
associated with a worse diagnosis. The association of age differed between types of
endometrial hyperplasia and cancer; the strongest association was seen for cancer
and the weakest association was seen for simple hyperplasia.
Conclusion
Hysteroscopy and curettage may be considered when simple or complex hyperplasia is
diagnosed from a specimen obtained with a Pipelle® endometrial sampler. When a diagnosis
of atypical hyperplasia is made, irrespective of the method of endometrial sampling,
the gynaecologist must be concerned that endometrial carcinoma exists concomitantly
within the uterus.
Keywords
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Article info
Publication history
Published online: June 27, 2011
Accepted:
June 9,
2011
Received in revised form:
April 2,
2011
Received:
December 5,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
