DIAGNOSTIC ACCURACY OF ENDOMETRIAL SAMPLING AND COLPOSCOPY GUIDED CERVICAL BIOPSY IN WOMEN UNDERGOING HYSTERECTOMY: A SINGLE-CENTER EXPERIENCE
Abstract
OBJECTIVE: This study aims to compare the results of the preoperatively obtained endometrial and cervical biopsies to the histopathological characteristics of the related hysterectomy specimens and, thus in vestigate their consistency.
MATERIAL AND METHODS: This is a retrospective review of 390 hysterectomies performed for both benign and malignant indications as verified by cervical and endometrial biopsies at the study center between 1 January 2017 and 1 January 2023.
RESULTS: Seventy-four hysterectomies (19.0%) had preoperative cervical biopsy results, while 316 had preoperative endometrial biopsy results (81.0%). Only 55.6% agreement (κ=0.011) and no significant correlation between endometrial biopsy results and related hysterectomy specimens for benign lesions (χ2=4.500, p=0.343). There were 85.1% agreement (κ=0.462) and a significant correlation between cervical biopsy results and related hysterectomy specimens for pre-invasive and malignant lesions (χ2=106.349, p=0.001). Endometrial biopsy results presenting polyps had the lowest diagnostic accuracy of 59.3% and endometrial cancer was identified in 52.2% of the patients whose biopsy results revealed complex hyperplasia with atypia.
CONCLUSIONS: The relatively lower diagnostic accuracy of endometrial biopsy suggests that it is not required for definitive diagnosis in patients who are scheduled to have a hysterectomy for benign indications. The relatively higher rate of complex atypical hyperplasia and endometrial cancer co-existence also indicates that hysteroscopy can be performed to visualize the uterine cavity before a hysterectomy is planned for patients with biopsy-based hyperplasia. The relatively higher concordance rate between cervical biopsy results and related hysterectomy specimens supports the significance and validity of colposcopy in the management of pre-invasive and malignant lesions of the cervix.
Keywords
Ethical Statement
The present study is approved by ethical committee of Afyonkarahisar Health Sciences University Hospital where it was undertaken (Grant no:2023/10).
References
- 1. Pickett CM, Seeratan DD, Mol BWJ et al. Surgical approach to hysterectomy for benign gynecological disease. Cochrane Database Syst Rev. 2023; 8(8): CD003677.
- 2. Thurston J, Murji A, Scattolon S, et al. No. 377-Hysterectomy for Benign Gynaecologic Indications. J ObstetGynaecol Can. 2019;41(4): 543-57.
- 3. Backes FJ, Fowler JM. Hysterectomy for the treatment of gynecologic malignancy. Clin Obstet Gynecol 2014;57(1): 115-27.
- 4. Wankhade R, Dawande P. Histopathological Analysis of Hysterectomy Specimens in a Tertiary Care Centre: A Retrospective Study. Cureus 2023;15(12): e50497.
- 5. Nasim O, Hayat MK, Hussain Z, Fahad MS, Jamal A, Khan MAA. Histopathological Account of Obstetrical and Gynecological Specimens: Retrospective Study at a Tertiary Care Center of Peshawar. Cureus. 2021;13(5):e14950.
- 6. Lebduska E, Beshear D, Spataro BM. Abnormal Uterine Bleeding. Med Clin North Am. 2023;107(2):235-46.
- 7. Papakonstantinou E, Adonakis G. Management of pre-, peri-, and post-menopausal abnormal uterine bleeding: When to perform endometrial sampling? Int J GynaecolObstet. 2022;158(2): 252-9.
- 8. Lu KH, Broaddus RR. Endometrial Cancer. N Engl J Med. 2020;383(21):2053-64.
- 9. Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022;399(10333):1412-8.
- 10. Williams PM, Gaddey HL. Endometrial Biopsy: Tips and Pitfalls. Am Fam Physician 2020;101(9): 551-6.
- 11. Long S. Endometrial Biopsy: Indications and Technique. Prim Care. 2021;48(4):555-67.
- 12. Villegas-Hinojosa E, Terán-Figueroa Y, Gallegos-García V et al. Histopathological Diagnosis of Cervical Biopsies: Reduction of Sampling Errors with the Evaluation of a Third Histologic Level. Cancer Manag Res. 2020;12:5099-104.
- 13. Nassiri S, Aminimoghaddam S, Sadaghian MR, Nikandish M, Jamshidnezhad N, Saffarieh E. Evaluation of the diagnostic accuracy of the cervical biopsy under colposcopic vision. Eur J TranslMyol. 2022;32(4):10670.
- 14. Moradan S, Ghorbani R, Lotfi A. Agreement of histopathological findings of uterine curettage and hysterectomy specimens in women with abnormal uterine bleeding. Saudi Med J. 2017;38(5):497-502.
- 15. Al Nemer AM, Al Bayat MI, Al Qahtani NH. The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding. More conservative therapeutic approaches. Saudi Med J.2019;40(8):815-9.
- 16. Vitale SG, Haimovich S, Laganà AS, Alonso L, et al. From the Global Community of Hysteroscopy Guidelines Committee. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J ObstetGynecolReprod Biol. 2021(13);260: 70-7.
- 17. Raz N, Feinmesser L, Moore O, Haimovich S. Endometrial polyps: diagnosis and treatment options - a review of literature. Minim Invasive Ther Allied Technol. 20;30(5):278-87.
- 18. Radwan P, Radwan M, Kozarzewski M, Polac I, Wilczyński J. Evaluation of sonohysterography in detecting endometrial polyps - 241 cases followed with office hysteroscopies combined with histopathological examination. Wideochir Inne Tech Maloinwazyjne. 2014;9(3):344-50.
- 19. American Association of Gynecologic Laparoscopists. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012;19(1):3-10.
- 20. Gündüz R, Ağaçayak E, Okutucu G, Alabalik U, Evsen MS. Evaluation of definitive histopathological results of patients diagnosed with endometrial polyps: a tertiary care center experience. Afr Health Sci. 2022;22(1):125-32.
- 21. Spoor E, Cross P. Audit of Endometrial Cancer Pathology for a Regional Gynecological Oncology Multidisciplinary Meeting. Int J GynecolPathol 2019;38(6):514-9.
- 22. Kurt S, Demirtaş O, Kopuz A et al. Evaluation of the histopathological diagnosis of patients preoperatively diagnosed with atypical endometrial hyperplasia after hysterectomy. Eur J Gynaecol Oncol. 2012;33(5):459-62.
- 23. Rakha E, Wong SC, Soomro I et al. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol. 2012;36(11):1683-90.
- 24. Erdem B, Aşıcıoğlu O, Seyhan NA, Peker N, Ülker V, Akbayır Ö. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? Int J Surg. 2018;53:350-3.
- 25. Hahn HS, Chun YK, Kwon YI et al. Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia. Eur J ObstetGynecol Reprod Biol.2010;150(1):80-3.
- 26. Zeferino-Toquero M, Bañuelos-Flores J, Maytorena-Córdova G, Reyna-Amaya H, Acevedo-Vega MF. Incidencia de cáncer de endometrioenpacientes con biopsiapreoperatoria de hiperplasia endometrial [Incidence of endometrial cancer in patients with biopsy specimens of endometrial hyperplasia]. GinecolObstet Mex. 2013;81(9):519-24.
- 27. Sakna NA, Elgendi M, Salama MH, Zeinhom A, Labib S, Nabhan AF. Diagnostic accuracy of endometrial sampling tests for detecting endometrial cancer: a systematic review and meta-analysis. BMJ Open. 2023;13(6): e072124.
- 28. Fan A, Zhang L, Wang C, Wang Y, Han C, Xue F. Analysis of clinical factors correlated with the accuracy of colposcopically directed biopsy. Arch Gynecol Obstet. 2017;296(5):965-72.
- 29. Kabaca C, Koleli I, Sariibrahim B et al. Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia? J Low Genit Tract Dis. 2014;18(3):240-5.
- 30. Ren H, Jia M, Zhao S, Li H, Fan S. Factors Correlated with the Accuracy of Colposcopy-Directed Biopsy: A Systematic Review and Meta-analysis. J Invest Surg. 2022;35(2):284-92.
- 31. Siegler E, Bornstein J; Israeli Colposcopy Network. Loop electrosurgical excision procedures in Israel. GynecolObstet Invest. 2011;72(2):85-9.
- 32. Duesing N, Schwarz J, Choschzick M et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet. 2012;286(6):1549-54
HİSTEREKTOMİ YAPILAN KADINLARDA ENDOMETRİYAL BİYOPSİ VE KOLPOSKOPİ DESTEKLİ SERVİKAL BİYOPSİNİN TANI DOĞRULUĞU: TEK MERKEZ DENEYİMİ
Abstract
AMAÇ: Bu çalışmanın amacı, ameliyat öncesi alınan endometriyal ve servikal biyopsi sonuçlarını, ilgili histerektomi örneklerinin histopatolojik özellikleriyle karşılaştırmak ve böylece tutarlılıklarını araştırmaktır.
GEREÇ VE YÖNTEM: Bu çalışma, 1 Ocak 2017 ile 1 Ocak 2023 tarihleri arasında çalışma merkezinde servikal ve endometriyal biyopsilerle doğrulanan, benign ve malign endikasyonlarla gerçekleştirilen 390 histerektominin retrospektif bir incelemesidir.
BULGULAR: Yetmiş dört histerektominin (%19,0) preoperatif servikal biyopsi sonucu, 316 histerektominin ise preoperatif endometriyal biyopsi sonucu (%81,0) vardı. Benign lezyonlar için endometriyal biyopsi sonuçları ile ilgili histerektomi örnekleri arasında yalnızca %55,6 uyum (κ=0,011) vardı ve anlamlı korelasyon yoktu (χ2=4,500, p=0,343). Preinvaziv ve malign lezyonlar için servikal biyopsi sonuçları ile ilgili histerektomi örnekleri arasında %85,1 uyum (κ=0,462) ve anlamlı korelasyon vardı (χ2=106,349, p=0,001). Polipleri ortaya koyan endometriyal biyopsi sonuçları 59,3 ile en düşük tanısal doğruluğa sahipti. Biyopsi sonuçlarında atipili kompleks hiperplazi saptanan hastaların %52,2'sinde endometriyal kanser tespit edildi.
SONUÇ: Endometriyal biyopsinin göreceli olarak daha düşük tanısal doğruluğu, benign endikasyonlarla histerektomi planlanan hastalarda kesin tanı için gerekli olmadığını düşündürmektedir. Kompleks atipik hiperplazi ve endometriyal kanserin birlikte görülme oranının göreceli olarak daha yüksek olması, biyopsi bazlı hiperplazisi olan hastalarda histerektomi planlanmadan önce rahim boşluğunun görüntülenmesi için histeroskopi yapılabileceğini de göstermektedir. Servikal biyopsi sonuçları ile ilgili histerektomi örnekleri arasındaki uyum oranının nispeten yüksek olması serviksin pre-invaziv ve malign lezyonlarının tedavisinde kolposkopinin önemini ve geçerliliğini desteklemektedir.
Keywords
References
- 1. Pickett CM, Seeratan DD, Mol BWJ et al. Surgical approach to hysterectomy for benign gynecological disease. Cochrane Database Syst Rev. 2023; 8(8): CD003677.
- 2. Thurston J, Murji A, Scattolon S, et al. No. 377-Hysterectomy for Benign Gynaecologic Indications. J ObstetGynaecol Can. 2019;41(4): 543-57.
- 3. Backes FJ, Fowler JM. Hysterectomy for the treatment of gynecologic malignancy. Clin Obstet Gynecol 2014;57(1): 115-27.
- 4. Wankhade R, Dawande P. Histopathological Analysis of Hysterectomy Specimens in a Tertiary Care Centre: A Retrospective Study. Cureus 2023;15(12): e50497.
- 5. Nasim O, Hayat MK, Hussain Z, Fahad MS, Jamal A, Khan MAA. Histopathological Account of Obstetrical and Gynecological Specimens: Retrospective Study at a Tertiary Care Center of Peshawar. Cureus. 2021;13(5):e14950.
- 6. Lebduska E, Beshear D, Spataro BM. Abnormal Uterine Bleeding. Med Clin North Am. 2023;107(2):235-46.
- 7. Papakonstantinou E, Adonakis G. Management of pre-, peri-, and post-menopausal abnormal uterine bleeding: When to perform endometrial sampling? Int J GynaecolObstet. 2022;158(2): 252-9.
- 8. Lu KH, Broaddus RR. Endometrial Cancer. N Engl J Med. 2020;383(21):2053-64.
- 9. Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022;399(10333):1412-8.
- 10. Williams PM, Gaddey HL. Endometrial Biopsy: Tips and Pitfalls. Am Fam Physician 2020;101(9): 551-6.
- 11. Long S. Endometrial Biopsy: Indications and Technique. Prim Care. 2021;48(4):555-67.
- 12. Villegas-Hinojosa E, Terán-Figueroa Y, Gallegos-García V et al. Histopathological Diagnosis of Cervical Biopsies: Reduction of Sampling Errors with the Evaluation of a Third Histologic Level. Cancer Manag Res. 2020;12:5099-104.
- 13. Nassiri S, Aminimoghaddam S, Sadaghian MR, Nikandish M, Jamshidnezhad N, Saffarieh E. Evaluation of the diagnostic accuracy of the cervical biopsy under colposcopic vision. Eur J TranslMyol. 2022;32(4):10670.
- 14. Moradan S, Ghorbani R, Lotfi A. Agreement of histopathological findings of uterine curettage and hysterectomy specimens in women with abnormal uterine bleeding. Saudi Med J. 2017;38(5):497-502.
- 15. Al Nemer AM, Al Bayat MI, Al Qahtani NH. The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding. More conservative therapeutic approaches. Saudi Med J.2019;40(8):815-9.
- 16. Vitale SG, Haimovich S, Laganà AS, Alonso L, et al. From the Global Community of Hysteroscopy Guidelines Committee. Endometrial polyps. An evidence-based diagnosis and management guide. Eur J ObstetGynecolReprod Biol. 2021(13);260: 70-7.
- 17. Raz N, Feinmesser L, Moore O, Haimovich S. Endometrial polyps: diagnosis and treatment options - a review of literature. Minim Invasive Ther Allied Technol. 20;30(5):278-87.
- 18. Radwan P, Radwan M, Kozarzewski M, Polac I, Wilczyński J. Evaluation of sonohysterography in detecting endometrial polyps - 241 cases followed with office hysteroscopies combined with histopathological examination. Wideochir Inne Tech Maloinwazyjne. 2014;9(3):344-50.
- 19. American Association of Gynecologic Laparoscopists. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012;19(1):3-10.
- 20. Gündüz R, Ağaçayak E, Okutucu G, Alabalik U, Evsen MS. Evaluation of definitive histopathological results of patients diagnosed with endometrial polyps: a tertiary care center experience. Afr Health Sci. 2022;22(1):125-32.
- 21. Spoor E, Cross P. Audit of Endometrial Cancer Pathology for a Regional Gynecological Oncology Multidisciplinary Meeting. Int J GynecolPathol 2019;38(6):514-9.
- 22. Kurt S, Demirtaş O, Kopuz A et al. Evaluation of the histopathological diagnosis of patients preoperatively diagnosed with atypical endometrial hyperplasia after hysterectomy. Eur J Gynaecol Oncol. 2012;33(5):459-62.
- 23. Rakha E, Wong SC, Soomro I et al. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol. 2012;36(11):1683-90.
- 24. Erdem B, Aşıcıoğlu O, Seyhan NA, Peker N, Ülker V, Akbayır Ö. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? Int J Surg. 2018;53:350-3.
- 25. Hahn HS, Chun YK, Kwon YI et al. Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia. Eur J ObstetGynecol Reprod Biol.2010;150(1):80-3.
- 26. Zeferino-Toquero M, Bañuelos-Flores J, Maytorena-Córdova G, Reyna-Amaya H, Acevedo-Vega MF. Incidencia de cáncer de endometrioenpacientes con biopsiapreoperatoria de hiperplasia endometrial [Incidence of endometrial cancer in patients with biopsy specimens of endometrial hyperplasia]. GinecolObstet Mex. 2013;81(9):519-24.
- 27. Sakna NA, Elgendi M, Salama MH, Zeinhom A, Labib S, Nabhan AF. Diagnostic accuracy of endometrial sampling tests for detecting endometrial cancer: a systematic review and meta-analysis. BMJ Open. 2023;13(6): e072124.
- 28. Fan A, Zhang L, Wang C, Wang Y, Han C, Xue F. Analysis of clinical factors correlated with the accuracy of colposcopically directed biopsy. Arch Gynecol Obstet. 2017;296(5):965-72.
- 29. Kabaca C, Koleli I, Sariibrahim B et al. Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia? J Low Genit Tract Dis. 2014;18(3):240-5.
- 30. Ren H, Jia M, Zhao S, Li H, Fan S. Factors Correlated with the Accuracy of Colposcopy-Directed Biopsy: A Systematic Review and Meta-analysis. J Invest Surg. 2022;35(2):284-92.
- 31. Siegler E, Bornstein J; Israeli Colposcopy Network. Loop electrosurgical excision procedures in Israel. GynecolObstet Invest. 2011;72(2):85-9.
- 32. Duesing N, Schwarz J, Choschzick M et al. Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet. 2012;286(6):1549-54
Details
| Primary Language | English |
|---|---|
| Subjects | Gynecologic Oncology Surgery |
| Journal Section | Articles |
| Authors | |
| Publication Date | April 28, 2025 |
| Submission Date | July 27, 2024 |
| Acceptance Date | November 2, 2024 |
| Published in Issue | Year 2025 Volume: 26 Issue: 2 |
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