Size of Endometrial Adenocarcinoma and Non-Cancerous Tissue in Biopsy Have Predictive Value for Finding Endometrial Adenocarcinoma in Hysterectomy.
Khush Mittal, Shubhangi Sasturkar, Amira Salem. NYU School of Medicine, New York, NY
Background: In a significant number of cases, a hysterectomy following a diagnosis of endometrial adenocarcinoma in endometrial biopsy does not show carcinoma. In this study we evaluated if the amount of carcinoma in biopsy or the presence and extent of non-cancerous tissue in biopsy correlates with the likelihood of finding endometrial adenocarcinoma in hysterectomy. This is of particular interest in Grade I Endometrial adenocarcinoma where conservative management with progestins may be a choice.
Design: Endometrial adenocarcinoma grade I cases diagnosed at NYU Medical center from 2003 to 2006 were reviewed without the knowledge of subsequent hysterectomy findings. The size of tissue with endometrial carcinoma was semi-quantitatively assessed using a ruler placed directly on the slide. The measurements were expressed as approx. aggregate diameter of cancerous tissue present. Similar measurements were taken for the non-cncerous tissue in each biopsy.
Results: The aggregate size of the carcinoma in biopsy was predictive of presence of endometrial carcinoma in hysterectomy specimens. There were a total of 49 cases of endometrial adenocarcinoma. Carcinoma was seen in hysterectomy in 33 of 34 (97%) patients with tumor diameter of 7 mm or greater versus 10 of 15 (66.6%) patients with tumor diameter of less than 7 mm in biopsy (p=0.007).
The extent of benign tissue present in the biopsy also correlated with the likelihood of finding endometrial carcinoma in hysterectomy. Carcinoma was seen in hysterectomy in 30 of 31 patients where only carcinoma was seen in biopsy versus 13 of 18 patients where non-cancerous endometrial tissue was also present (p=0.02). Carcinoma was seen at hysterectomy in only 1 of the 4 cases with non-cancerous tissue with aggregate diameter greater than 15 mm.
Conclusions: The findings of this study suggest that absence of endometrial carcinoma in some hysterectomy specimens where biopsy had previously shown carcinoma may be due to the focal nature and small size of the carcinoma in these particular patients. In endometrial biopsy specimens, the small size of the carcinoma tissue (less than 7 mm in diameter) and the presence of non-cancerous endometrial tissue may be used to identify such cases. The findings of this study may be useful in counseling individual patients with biopsy diagnosis of endometrial carcinoma about the likelihood of finding endometrial carcinoma in hysterectomy.
Category: Gynecologic & Obstetrics
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 148, Wednesday Afternoon