Abstract
More and more researchers have reported that dilatation and curettage (D&C) or Pipelle had low accuracy, high misdiagnosis, and insufficient rate. Endometrial cytology is often compared with histology and seems to be an efficient method for the diagnosis of endometrial disorders, especially endometrial cancer. We report a case of misdiagnosed endometrial cancer by D&C, but with a positive cytopathological finding. Following that, a meta-analysis including 4,179 patients of endometrial diseases with cyto-histopathological results was performed to assess the value of the endometrial cytological method in endometrial cancer diagnosis. The pooled sensitivity and specificity of the cytological method in detecting endometrial atypical hyperplasia or cancer was 0.91[95% confidence interval (CI) 0.74–0.97] and 0.96 (95% CI 0.90–0.99), respectively. The pooled positive likelihood ratio and negative likelihood ratio was 25.4 (95% CI 8.1–80.1) and 0.10 (95% CI 0.00–0.30), respectively. The diagnostic odds ratio which was usually used to evaluate the diagnostic test performance reached 260 (95% CI 36–1905). So we recommend that D&C and Pipelle are still practical procedures to evaluate the endometrium, cytological examinations should be utilized as an additional endometrial assessment method.
Highlights
Endometrial cancer is becoming the primary reason of female deaths of genital track cancer in developed countries [1]
It has been reported that less than half of the uterine cavity is curetted in 60% of cases [3], and over 40% of women with complex atypical hyperplasia as a preoperative diagnosis have a final confirmation of endometrial cancer during hysterectomy [4, 5]
Endometrial cytology is recently reported as a useful diagnostic method with high sensitivity and specificity in detecting endometrial malignancies [6,7,8,9], but no meta-analysis, which is considered more credible, has yet been performed to evaluate the diagnostic accuracy of endometrial cytology for endometrial carcinoma compared with histological diagnosis
Summary
Endometrial cancer is becoming the primary reason of female deaths of genital track cancer in developed countries [1]. It has been reported that less than half of the uterine cavity is curetted in 60% of cases [3], and over 40% of women with complex atypical hyperplasia as a preoperative diagnosis have a final confirmation of endometrial cancer during hysterectomy [4, 5]. After searching on PubMed, we believe it is the first case report of a misdiagnosis of endometrial cancer detected by cytopathology. A random-effects meta-analysis including 4,179 patients with both cytopathological and histopathological results was performed to assess the value of the endometrial cytology method in the diagnosis of endometrial atypical hyperplasia or cancer
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