![]() ![]() The aim of this study was to assess the sensitivity of hysteroscopy view and hysteroscopic sampling in diagnosing or excluding EEC. Despite this assumption, a recent meta-analysis showed that hysteroscopically guided biopsy provides a high rate of failure with respect to D&C and endometrial resection, in underestimating AH instead of concurrent EEC. Nevertheless, allowing the direct visual assessment of endometrium, hysteroscopy is now considered the golden standard for the diagnosis of endometrial pathology, overcoming the limits of procedures based on blind tissue sampling and allowing targeted biopsies. Current data suggest that with respect to the other biopsy techniques, dilatation and curettage (D&C) yields the better sensitivity in distinguishing preoperatively AH from EEC, by lowering to about 30% the rate of unexpected EEC. In the last two decades, many reports demonstrated the unreliability of endometrial biopsy pathology showing an AH to exclude a synchronous EEC, with an underestimation of EEC in up to 50% of women. Depending from clinical background, simple hysterectomy or fertility-sparing management such as endometrial resection and/or medical treatments may be considered in women with ascertained AH, whereas in patients with EEC, an oncological surgical staging is recommended even if in very selected cases a conservative approach could be considered. The differential diagnosis between AH and EEC on endometrial biopsy is clinically significant. While it seems reasonable that hysteroscopy is the preferred technique for diagnosing and treating a benign pathology of the uterus, it could play a major role even in the diagnosis of a malignancy.Įndometrioid endometrial carcinoma (EEC) is the most common gynecological malignancy occurring in western countries, and atypical hyperplasia (AH) is considered its biological precursor. Hysteroscopy-driven biopsies have excellent sensitivity and accuracy in the diagnosis of EEC, and the advantages of using hysteroscopy for making a diagnosis can improve the management of the patients with EEC. Our study showed that EEC diagnosis via hysteroscopy diagnosis could be improved through the implementation of operator training. AH pathology was reported in 19% of the cases. Hysteroscopy-driven biopsy presented a sensitivity of 76.2%, a specificity of 52.8%, and an accuracy of 75.3%. We evidenced an important difference of the results comparing the centers involved. Moreover, hysteroscopic view was significantly able to distinguish carcinoma from hyperplasia ( p < 0.001). Hysteroscopy view showed a sensitivity of 54.2%, a specificity of 47.2%, and an accuracy of 54% in the diagnosis of EC. Nine hundred forty-eight patients (age 65.83 ± 10.43) resulted eligible for analysis. As primary outcome, we calculated the sensitivity of hysteroscopy view and biopsy pathology on hysteroscopically driven sampling in the diagnostic workup of EC. Eligible patients were identified as those women in whom either a pathologic report of EEC was found on hysterectomy specimen and a preoperative hysteroscopy assessment with endometrial biopsy targeted under vision had been performed. Materials and methodsĪ multicenter, retrospective, observational trial was conducted between January 2012 and December 2018 in 14 Italian gynecological units (university-affiliated or public hospitals). The aim of this study was to assess the sensitivity of hysteroscopy view and hysteroscopic sampling in diagnosing EEC. However, a recent meta-analysis showed that hysteroscopically guided biopsy provides a high rate of failure with respect to dilatation and curettage (D&C) and endometrial resection, in underestimating AH instead of concurrent EC. Hysteroscopy is now considered the standard diagnostic tool for endometrial pathology. ![]() In the last two decades, many reports demonstrated the unreliability of endometrial biopsy pathology showing an AH (atypical hyperplasia) to exclude a synchronous EEC (endometrioid endometrial carcinoma), with an underestimation of EEC in up to 50% of women. ![]()
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