Comparison of D&C and hysterectomy pathologic findings in endometrial cancer patients

The objective of this study is to compare the accuracy of tumor grade in endometrial cancer between fractional dilatation and curettage (D&C) and postoperative hysterectomy specimen findings. From January 2000 to November 2002, 52 women with abnormal vaginal bleeding and diagnosed or suspected endometrial cancer were treated in the Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Second Medical University. The comparison of tumor grades was performed on both D&C and hysterectomy specimens, the relationship between the concordance rate of grade, and the depth of tumor invasion into the myometrium. The expression of estrogen receptor (ER), progesterone receptor (PR), p53, Bcl2, and proliferation cell nuclear antigen (PCNA) in tumor samples were analyzed. The concordance rates were 20% in grade 1, 61.5% in grade 2, and 77.8% in grade 3. The concordance rates for grade 2 and grade 3 were higher than grade 1 significantly (grade 2 approximately grade 1, P=0.010; grade 3 approximately grade 1, P=0.005). Fourteen out of 52 (26.9%) patients diagnosed with atypical endometrial hyperplasia by D&C had their diagnosis changed to endometrial cancer after being ascertained by hysterectomy specimen. The accuracy of tumor grade diagnosis by D&C was 50%, and 48% of patients were downgraded after comparison of postoperative specimens. The concordance rate of tumor invasion into the outer half of myometrium was higher than in tumors localized in the endometrium (P= 0.030). No association between high concordance rate and the expression of ER, PR, p53, Bcl-2 and PCNA was found. We concluded that D&C had a high accuracy in the diagnosis of endometrial cancer in grade 3 tumors (77.8%) and tumor invasion into the outer half of the myometrium (75%). Overall, 48% of endometrial cancer patients' tumor grades seemed to be decreased by D&C evaluation; thus, the diagnosis of endometrial disorders by D&C should not be overlooked.