Diagnostic accuracy of prehysterectomy curettage in determining tumor type and grade in patients with endometrial cancer.

OBJECTIVES: We sought to determine the reliability of tumor typing and grading at the prehysterectomy curettage biopsy in patients with endometrial carcinoma. We also wanted to evaluate the overall rate of false-negative diagnosis in the detection of the disease. METHODS: The final pathologic reports of 263 patients whose diagnosis was endometrial carcinoma were compared with their prehysterectomy curettage reports. We searched for discrepancies between the 2 diagnoses. We also evaluated whether discrepancies varied with respect to the histologic type and tumor grade (endometrioid vs aggressive variant tumours). RESULTS: Although the statistical analysis predicted accuracy rates of DC diagnosis that exceeded 90%, the true figures proved to be more limited. DC pathology accurately predicted the final histologic result in 67.3% (177/263) of patients and the final tumor grade in 55.5% (146/263). Regarding the latter, we found 37.3% (98/263) of patients with undergraded tumors and 7.2% (19/263) with overgraded ones. The histologic type of the carcinoma crucially affected the diagnostic reliability of DC. Nevertheless, the overall false-negative rate in establishing the diagnosis of carcinoma was 7.6% (20/263). CONCLUSIONS: DC is a reliable procedure for establishing the diagnosis of endometrial cancer. Its capability to correctly characterize the final histologic type varies significantly but is satisfactory overall and captures approximately three quarters of the patients; however, the procedure significantly underestimates tumor grade. The limitations of DC are due to the blindness of the sampling procedure.