Mini-resectoscopy Endometrial Biopsy Accuracy Respect Dilatation and Curettage in Endometrial Cancer: A Retrospective Analysis

Abstract

<h3>Study Objective</h3> Dilatation and curettage (D&C) biopsy is a "gold standard" to confirm the histology and grade of endometrial cancer but the concordance rate was only 70% between D&C and hysterectomy. <h3>Design</h3> We retrospectively reviewed 187 cases of endometrial cancer that were treated at our institution from January 2017 to June 2019. We analyzed all patients who underwent Trans Cervical mini-Resectoscopy (TCR) or D&C biopsy at our institution and received laparoscopic/laparotomic hysterectomy or staging as the treatment by our surgical team. <h3>Setting</h3> We categorized the patients into the TCR group or the D&C group. For each group, we compared the biopsy histological grade and histology with the final hysterectomy of all patients. <h3>Patients or Participants</h3> We analyzed 187 cases of endometrial cancer aged from 29 to 81 years. <h3>Interventions</h3> TCR was carried out, with lidocaine local cervical injection and awake sedation. Resectoscopy was performed with a 7mm bipolar resectoscope. D&C was carried out in general anesthesia and the cervix is dilated up to 10mm Hegar dilators. Two different pathologies analyzed the initial and hysterectomy specimens. <h3>Measurements and Main Results</h3> Endometrial biopsy was obtained by D&C in 103 (55%) cases and by TCR in 84 (45%) of cases. the median operative time was 17,5 for TCR and 17,41 for D&C without significant differences between the two methods (p<0,99). The second stage was preoperative detective only with the use of TCR biopsy 5 (100% of cases) respect none of D&C. Among 72 patients who underwent TCR biopsy, only 4 patients have been grading misdiagnosed in the final pathology, which gives a rate of 5,5% (K 0,918 IC 95% 0,958-0,878 p<0,001). In the D&C group of 87 patients, 17 (19,5%) patients have been grading misdiagnosed (K 0,699 IC 95% 0,764 - 0,634 p<0,001). <h3>Conclusion</h3> Our data, although retrospective, demonstrate that Trans cervical mini-resectoscopy provides a more accurate reflection of FIGO grade than D&C endometrial sampling.