Comparison of dilatation & curettage and endometrial aspiration biopsy accuracy in patients treated with high-dose oral progestin plus levonorgestrel intrauterine system for early-stage endometrial cancer.

Abstract

OBJECTIVE:

To compare the diagnostic accuracy of dilatation & curettage (D&C) vs. endometrial aspiration biopsy in follow-up evaluation of patients treated with high-dose oral progestin plus levonorgestrel intrauterine system (LNG-IUS) for early-stage endometrial cancer (EC).

METHOD:

A prospective observational study was conducted with 11 patients with FIGO grade 1 or 2, clinical stage IA endometrioid adenocarcinoma. Patients were aged up to 40 years wishing to preserve fertility treated with high-dose oral progestin plus LNG-IUS. Treatment response assessment was done at three month intervals. Endometrial tissues were obtained via endometrial aspiration biopsy with LNG-IUS in place and D&C after removal of LNG-IUS. We identified 28 cases; the histologic results were compared. Kappa statistics were used to assess the agreement of two methods.

RESULTS:

Diagnostic concordance between examinations was assessed for 9 out of 28 cases examined (32.1%). These consisted of three cases with both examination results of normal, 3 cases with endometrioid adenocarcinoma, 1 case with complex endometrial hyperplasia, 2 cases with material insufficient for diagnosis. Endometrioid adenocarcinoma on D&C was diagnosed in 9 out of 28 cases, but from endometrial aspiration biopsy, only 3 of these 9 cases were diagnosed with endometrioid adenocarcinoma, giving the diagnostic concordance at 33% (kappa value=0.27). From endometrial aspiration biopsy, 17 out of 28 cases (60.7%) had material insufficiency for diagnosis.

CONCLUSION:

In patients treated with high-dose oral progestin plus LNG-IUS for early-stage EC, endometrial aspiration biopsy with LNG-IUS in place may be not reliable as a follow-up evaluation method.

• Authors: Mi Kyoung Kim, Seok Ju Seong, Taejong Song, Mi-La Kim, Bo Sung Yoon, Hye Sun Jun, Gun Ho Lee, Yoon Hee Lee
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 130 Issue 3 Pg. 470-3 (Sep 2013) ISSN: 1095-6859 [Electronic] United States
• PMID: 23822890 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2013. Published by Elsevier Inc. All rights reserved.

Chemical References

• Progestins
• Levonorgestrel

Topics

• Adenocarcinoma (drug therapy, pathology)
• Adult
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Biopsy, Fine-Needle
• Dilatation and Curettage
• Endometrial Neoplasms (drug therapy, pathology)
• Endometrium (pathology)
• Female
• Fertility Preservation
• Follow-Up Studies
• Humans
• Intrauterine Devices, Medicated
• Levonorgestrel (administration & dosage)
• Neoplasm Staging
• Organ Sparing Treatments
• Progestins (administration & dosage)
• Prospective Studies