Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination

Pasquale De Franciscis, Gaetano Riemma, Antonio Schiattarella, Luigi Cobellis, Maria Guadagno, Salvatore Giovanni Vitale, Lavinia Mosca, Antonio Cianci, Nicola Colacurci, Pasquale De Franciscis, Gaetano Riemma, Antonio Schiattarella, Luigi Cobellis, Maria Guadagno, Salvatore Giovanni Vitale, Lavinia Mosca, Antonio Cianci, Nicola Colacurci

Abstract

The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases.

Keywords: endometrial cancer; endometrial hyperplasia; hysteroscopy; postmenopause.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Litta P., Merlin F., Saccardi C., Pozzan C., Sacco G., Fracas M., Capobianco G., Dessole S. Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding. Maturitas. 2005;50:117–123. doi: 10.1016/j.maturitas.2004.05.003.
    1. Gubbini G., Filoni M., Linsalata I., Stagnozzi R., Stefanetti M., Marabini A. The role of hysteroscopy in the diagnosis and follow-up of endometrial hyperplasia. Minerva Ginecol. 1998;50:125–133.
    1. Abdelazim I.A., Abdelrazak K.M., Elbiaa A.A., Al-Kadi M., Yehia A.H. Accuracy of endometrial sampling compared to conventional dilatation and curettage in women with abnormal uterine bleeding. Arch. Gynecol. Obstet. 2015;291:1121–1126. doi: 10.1007/s00404-014-3523-y.
    1. Bedner R., Rzepka-Gorska I. Hysteroscopy with directed biopsy versus dilatation and curettage for the diagnosis of endometrial hyperplasia and cancer in perimenopausal women. Eur. J. Gynaecol. Oncol. 2007;28:400–402.
    1. Lee D.O., Jung M.H., Kim H.Y. Prospective comparison of biopsy results from curettage and hysteroscopy in postmenopausal uterine bleeding. J. Obstet. Gynaecol. Res. 2011;37:1423–1426. doi: 10.1111/j.1447-0756.2011.01558.x.
    1. Vitale S.G., Capriglione S., Zito G., Lopez S., Gulino F.A., Di Guardo F., Vitagliano A., Noventa M., La Rosa V.L., Sapia F., et al. Management of endometrial, ovarian and cervical cancer in the elderly: Current approach to a challenging condition. Arch. Gynecol. Obstet. 2019;299:299–315. doi: 10.1007/s00404-018-5006-z.
    1. Colacurci N., Caprio F., La Verde E., Trotta C., Ianniello R., Mele D., De Franciscis P. Sequential protocol with urinary-FSH/recombinant-FSH versus standard protocol with recombinant-FSH in women of advanced age undergoing IVF. Gynecol. Endocrinol. 2014;30:730–733. doi: 10.3109/09513590.2014.927856.
    1. Vitale S.G., Padula F., Gulino F.A. Management of uterine fibroids in pregnancy: Recent trends. Curr. Opin. Obstet. Gynecol. 2015;27:432–437. doi: 10.1097/GCO.0000000000000220.
    1. Lagana A.S., Vitale S.G., Stojanovska L., Lambrinoudaki I., Apostolopoulos V., Chiofalo B., Rizzo L., Basile F. Preliminary results of a single-arm pilot study to assess the safety and efficacy of visnadine, prenylflavonoids and bovine colostrum in postmenopausal sexually active women affected by vulvovaginal atrophy. Maturitas. 2018;109:78–80. doi: 10.1016/j.maturitas.2017.12.015.
    1. Torella M., Del Deo F., Grimaldi A., Iervolino S.A., Pezzella M., Tammaro C., Gallo P., Rappa C., De Franciscis P., Colacurci N. Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016;207:125–128. doi: 10.1016/j.ejogrb.2016.10.018.
    1. Lagana A.S., Vergara D., Favilli A., La Rosa V.L., Tinelli A., Gerli S., Noventa M., Vitagliano A., Triolo O., Rapisarda A.M.C., et al. Epigenetic and genetic landscape of uterine leiomyomas: A current view over a common gynecological disease. Arch. Gynecol. Obstet. 2017;296:855–867. doi: 10.1007/s00404-017-4515-5.
    1. Vitale S.G., Sapia F., Rapisarda A.M.C., Valenti G., Santangelo F., Rossetti D., Chiofalo B., Sarpietro G., La Rosa V.L., Triolo O., et al. Hysteroscopic Morcellation of Submucous Myomas: A Systematic Review. BioMed Res. Int. 2017;2017:6848250. doi: 10.1155/2017/6848250.
    1. Agostini A., Collette E., Provansal M., Estrade J.P., Blanc B., Gamerre M. Good practice and accuracy of office hysteroscopy and endometrial biopsy. J. Gynecol. Obstet. Biol. Reprod. 2008;37(Suppl. 8):S343–S348. doi: 10.1016/S0368-2315(08)74774-4.
    1. Gan D.E., Jawan R.A., Moy F.M. Concordance between hysteroscopic impression and endometrial histopathological diagnosis. Prev. Med. 2013;57:S21–S23. doi: 10.1016/j.ypmed.2012.12.026.
    1. Lasmar R.B., Dias R., Barrozo P.R., Oliveira M.A., Coutinho Eda S., da Rosa D.B. Prevalence of hysteroscopic findings and histologic diagnoses in patients with abnormal uterine bleeding. Fertil. Steril. 2008;89:1803–1807. doi: 10.1016/j.fertnstert.2007.05.045.
    1. Clark T.J., Voit D., Gupta J.K., Hyde C., Song F., Khan K.S. Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: A systematic quantitative review. JAMA. 2002;288:1610–1621. doi: 10.1001/jama.288.13.1610.
    1. Clarke M.A., Long B.J., Del Mar Morillo A., Arbyn M., Bakkum-Gamez J.N., Wentzensen N. Association of Endometrial Cancer Risk with Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern. Med. 2018;178:1210–1222. doi: 10.1001/jamainternmed.2018.2820.
    1. Trojano G., Damiani G.R., Casavola V.C., Loiacono R., Malvasi A., Pellegrino A., Siciliano V., Cicinelli E., Salerno M.G., Battini L. The Role of Hysteroscopy in Evaluating Postmenopausal Asymptomatic Women with Thickened Endometrium. Gynecol. Minim. Invasive Ther. 2018;7:6–9.
    1. Gkrozou F., Dimakopoulos G., Vrekoussis T., Lavasidis L., Koutlas A., Navrozoglou I., Stefos T., Paschopoulos M. Hysteroscopy in women with abnormal uterine bleeding: A meta-analysis on four major endometrial pathologies. Arch. Gynecol. Obstet. 2015;291:1347–1354. doi: 10.1007/s00404-014-3585-x.
    1. Bourdel N., Chauvet P., Tognazza E., Pereira B., Botchorishvili R., Canis M. Sampling in Atypical Endometrial Hyperplasia: Which Method Results in the Lowest Underestimation of Endometrial Cancer? A Systematic Review and Meta-analysis. J. Minim. Invasive Gynecol. 2016;23:692–701. doi: 10.1016/j.jmig.2016.03.017.
    1. Sarkar P., Mikhail E., Schickler R., Plosker S., Imudia A.N. Optimal Order of Successive Office Hysteroscopy and Endometrial Biopsy for the Evaluation of Abnormal Uterine Bleeding: A Randomized Controlled Trial. Obstet. Gynecol. 2017;130:565–572. doi: 10.1097/AOG.0000000000002202.
    1. Nappi C., Di Spiezio Sardo A. State-of-the-Art Hysteroscopic Approaches to Pathologies of the Genital Tract. Endo-Press; Dublin, Ireland: 2014.
    1. Ghoubara A., Sundar S., Ewies A.A.A. Predictors of malignancy in endometrial polyps: Study of 421 women with postmenopausal bleeding. Climacteric. 2018;21:82–87. doi: 10.1080/13697137.2017.1410783.
    1. Trimble C.L., Kauderer J., Zaino R., Silverberg S., Lim P.C., Burke J.J., 2nd, Alberts D., Curtin J. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study. Cancer. 2006;106:812–819. doi: 10.1002/cncr.21650.
    1. Trimble C.L., Method M., Leitao M., Lu K., Ioffe O., Hampton M., Higgins R., Zaino R., Mutter G.L. Society of Gynecologic Oncology Clinical Practice Committee. Management of endometrial precancers. Obstet. Gynecol. 2012;120:1160–1175.
    1. Siciliano R.A., Mazzeo M.F., Spada V., Facchiano A., d’Acierno A., Stocchero M., De Franciscis P., Colacurci N., Sannolo N., Miraglia N. Rapid peptidomic profiling of peritoneal fluid by MALDI-TOF mass spectrometry for the identification of biomarkers of endometriosis. Gynecol. Endocrinol. 2014;30:872–876. doi: 10.3109/09513590.2014.943718.
    1. Van Hanegem N., Prins M.M., Bongers M.Y., Opmeer B.C., Sahota D.S., Mol B.W., Timmermans A. The accuracy of endometrial sampling in women with postmenopausal bleeding: A systematic review and meta-analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016;197:147–155. doi: 10.1016/j.ejogrb.2015.12.008.
    1. De Franciscis P., Cobellis L., Fornaro F., Sepe E., Torella M., Colacurci N. Low-dose hormone therapy in the perimenopause. Int. J. Gynaecol. Obstet. 2007;98:138–142. doi: 10.1016/j.ijgo.2007.04.008.
    1. Kurt S., Demirtas O., Kopuz A., Beyan E., Demirtas G., Besler A., Altinboga O. Evaluation of the histopathological diagnosis of patients preoperatively diagnosed with atypical endometrial hyperplasia after hysterectomy. Eur. J. Gynaecol. Oncol. 2012;33:459–462.
    1. Vitale S.G., Capriglione S., Peterlunger I., La Rosa V.L., Vitagliano A., Noventa M., Valenti G., Sapia F., Angioli R., Lopez S., et al. The Role of Oxidative Stress and Membrane Transport Systems during Endometriosis: A Fresh Look at a Busy Corner. Oxid. Med. Cell. Longev. 2018;2018:7924021. doi: 10.1155/2018/7924021.
    1. Campitiello M.R., De Franciscis P., Mele D., Izzo G., Sinisi A., Delrio G., Colacurci N. Endometrial LGR7 expression during menstrual cycle. Fertil. Steril. 2011;95:2511–2514. doi: 10.1016/j.fertnstert.2011.01.124.
    1. Loffer F.D. Hysteroscopy with selective endometrial sampling compared with D&C for abnormal uterine bleeding: The value of a negative hysteroscopic view. Obstet. Gynecol. 1989;73:16–20.
    1. Machado F., Moreno J., Carazo M., Leon J., Fiol G., Serna R. Accuracy of endometrial biopsy with the Cornier pipelle for diagnosis of endometrial cancer and atypical hyperplasia. Eur. J. Gynaecol. Oncol. 2003;24:279–281.
    1. Socolov D., Socolov R., Rugina V., Gabia R.O., Caraueanu D.M., Lupascu I.A., Carauleanu A. A Thin and Regular Endometrium in Endometrial Cancer—Endovaginal Ultrasound Assessment. Rev. Med. Chir. Soc. Med. Nat. Iasi. 2016;120:604–610.

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