Eligible patients included those diagnosed with hyperplasia without atypia (simple and complex) and atypical hyperplasia (simple and complex). D&C was performed under sedation with fentanyl and midazolam or under monitored anesthesia care using a curette. The aspiration biopsy was performed without anesthesia using the Pipelle device. We reviewed the medical records of 250 patients who had been diagnosed with endometrial hyperplasia either by aspiration biopsy or D&C and had subsequently undergone hysterectomy. This study was retrospectively performed between July 2003 and May 2020 at Seoul National University Bundang Hospital, a tertiary hospital in Korea. The requirement for informed consent was waived. B-2007/627–101) and performed in accordance with the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board of the Seoul National University Bundang Hospital (No.
Therefore, in this study, we aimed to compare the diagnostic accuracy of aspiration biopsy and D&C in patients who were diagnosed with endometrial hyperplasia by one of these methods prior to hysterectomy. They included only a small number of patients with endometrial hyperplasia and fewer than 10 patients with atypical endometrial hyperplasia. In addition, they were limited by their small sample size, especially for evaluating endometrial hyperplasia.
However, all these studies have included patients with various pathological findings such as proliferative endometrium, secretory endometrium, endometrial hyperplasia, atrophic endometrium, and endometrial carcinoma. Numerous studies comparing the diagnostic accuracy of D&C and aspiration biopsy have concluded that aspiration biopsy is as accurate as D&C in the diagnosis of endometrial pathologies. However, there are no reliable data regarding the best method to diagnose endometrial hyperplasia. Endometrial aspiration biopsy has widely replaced D&C as it is easy to perform, safe, and convenient compared to D&C. However, it has become less favorable due to the added risk of anesthesia and complications. Among these, dilatation and curettage (D&C) has been one of the most widely used. There are several endometrial sampling methods used in practice to diagnose endometrial lesions, including endometrial hyperplasia. The World Health Organization (WHO) 94 classifies endometrial hyperplasia into four groups based on glandular complexity and cytological nuclear atypia: simple hyperplasia without atypia, complex hyperplasia without atypia, simple atypical hyperplasia, and complex atypical hyperplasia. The accurate diagnosis of premalignant lesions and the exclusion of coexisting endometrial carcinomas are important aspects of the proper management of endometrial hyperplasia. Endometrial hyperplasia, atypical endometrial hyperplasia in particular, is of clinical significance as it is considered to be a precursor lesion of endometrial cancer. When considering the management strategy for women with an endometrial hyperplasia diagnosis obtained by aspiration biopsy, physicians should consider the significant rate of upgraded diseases with this method of endometrial sampling.Įndometrial hyperplasia is a pathological condition characterized by abnormal proliferation of endometrial glands and stroma. In our study, D&C more accurately reflected the final diagnosis in patients with endometrial hyperplasia than aspiration biopsy based on the histological examination of hysterectomy specimens.
#Endo biopsy upgrade#
In addition, when the final pathological upgrade rate to endometrial carcinoma was evaluated between the two methods of endometrial sampling, significantly fewer cases were noted after D&C than after aspiration biopsy (15.0% vs 27.3% P = 0.022). In particular, significantly fewer patients were upgraded after D&C than after aspiration biopsy in hyperplasia without atypia (12.5% vs 29.0% P = 0.028). Patients whose preoperative specimen was obtained by D&C were upgraded less significantly than those who underwent aspiration biopsy (21.0% vs 36.7% P = 0.008). The overall diagnostic concordance between endometrial sampling specimen including D&C and aspiration biopsy, and hysterectomy specimen was 51.0% (51/100) and 41.3% (62/150), respectively. Pathological findings of hysterectomy specimens of the two groups were compared to preoperative findings. Endometrial sampling was performed by aspiration biopsy ( n = 150) or D&C ( n = 100), followed by hysterectomy within 6 months. We retrospectively reviewed medical records of 250 patients diagnosed with endometrial hyperplasia by endometrial sampling between July 2003 and March 2020. To compare the diagnostic accuracy of aspiration biopsy and dilatation and curettage (D&C) in patients diagnosed with endometrial hyperplasia prior to hysterectomy.
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