The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma
Abstract Study Objective To assess the sensitivity of preoperative endometrial biopsy in detection of uterine leiomyosarcoma (ULMS). Study Design Retrospective analysis of a prospectively collected database (Canadian Task Force III). Setting Two academic tertiary referral centers. Patients All cases...
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| Veröffentlicht in: | Journal of minimally invasive gynecology 2016-05, Vol.23 (4), p.567-572 |
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| creator | Hinchcliff, Emily M., MD Esselen, Katharine M., MD, MBA Watkins, Jaclyn C., MD Oduyebo, Titilope, MD Rauh-Hain, J. Alejandro, MD del Carmen, Marcela G., MD Quade, Bradley J., MD, PhD Muto, Michael G., MD |
| description | Abstract Study Objective To assess the sensitivity of preoperative endometrial biopsy in detection of uterine leiomyosarcoma (ULMS). Study Design Retrospective analysis of a prospectively collected database (Canadian Task Force III). Setting Two academic tertiary referral centers. Patients All cases of ULMS treated at participating institutions between January 2005 and August 2012 were identified following IRB approval. Interventions Abstracted data included demographics, preoperative evaluation, presenting symptom, surgical management, pathology and clinical outcomes. Chi-square tests were used for statistical analysis. Measurements and Main Results 329 cases were identified, of which 152 cases had complete pathologic data available for review. Sixty-eight (45%) of 152 patients had endometrial sampling prior to surgery. Patients with postmenopausal bleeding were significantly more likely to be biopsied preoperatively (51.6% vs 9.5%, p = |
| doi_str_mv | 10.1016/j.jmig.2016.01.022 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1785752927</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1553465016000704</els_id><sourcerecordid>1785752927</sourcerecordid><originalsourceid>FETCH-LOGICAL-c411t-fdd8c0d76d85cf70d18d6d0ab9d7447b686653603f2e9f326f804f6a232408e03</originalsourceid><addsrcrecordid>eNp9kU1P3DAQhi3UCijwBzhUOfayYew4dlZClVpKodJKVOXjanntcXFI4sXOIu2_x9ECBw6cZg7P-0rzDCHHFEoKVJy0Zdv7_yXLewm0BMZ2yD6t62rGhZh_ettr2CNfUmoBKgkgdskeE01NOeX75O7mHot_ocMiuOJ8sKHHMXrdFT99WKVN4YdizMTfiGGFUY_-CYtfOKIZfRimzO2I0Q9YLNCHfhOSjib0-pB8drpLePQyD8jt7_Obs8vZ4uriz9mPxcxwSseZs7YxYKWwTW2cBEsbKyzo5dxKzuVSNELUlYDKMZy7ignXAHdCs4pxaBCqA_Jt27uK4XGNaVS9Twa7Tg8Y1klR2dSyZnMmM8q2qIkhpYhOraLvddwoCmryqVo1-VSTTwVUZZ859PWlf73s0b5FXgVm4HQLYL7yyWNUyXgcDFofsyRlg_-4__u7uOn84I3uHnCDqQ3rOGR_iqrEFKjr6aPTQ6kAAAm8egZ0NZrq</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1785752927</pqid></control><display><type>article</type><title>The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Hinchcliff, Emily M., MD ; Esselen, Katharine M., MD, MBA ; Watkins, Jaclyn C., MD ; Oduyebo, Titilope, MD ; Rauh-Hain, J. Alejandro, MD ; del Carmen, Marcela G., MD ; Quade, Bradley J., MD, PhD ; Muto, Michael G., MD</creator><creatorcontrib>Hinchcliff, Emily M., MD ; Esselen, Katharine M., MD, MBA ; Watkins, Jaclyn C., MD ; Oduyebo, Titilope, MD ; Rauh-Hain, J. Alejandro, MD ; del Carmen, Marcela G., MD ; Quade, Bradley J., MD, PhD ; Muto, Michael G., MD</creatorcontrib><description>Abstract Study Objective To assess the sensitivity of preoperative endometrial biopsy in detection of uterine leiomyosarcoma (ULMS). Study Design Retrospective analysis of a prospectively collected database (Canadian Task Force III). Setting Two academic tertiary referral centers. Patients All cases of ULMS treated at participating institutions between January 2005 and August 2012 were identified following IRB approval. Interventions Abstracted data included demographics, preoperative evaluation, presenting symptom, surgical management, pathology and clinical outcomes. Chi-square tests were used for statistical analysis. Measurements and Main Results 329 cases were identified, of which 152 cases had complete pathologic data available for review. Sixty-eight (45%) of 152 patients had endometrial sampling prior to surgery. Patients with postmenopausal bleeding were significantly more likely to be biopsied preoperatively (51.6% vs 9.5%, p = <.0001). Of those sampled, 43 (63%) underwent endometrial pipelle biopsies and 25 (37%) had dilation and curettage. Endometrial sampling was significantly more likely to detect a concern for malignancy in patients who presented with postmenopausal bleeding (72.7% vs 32.3%, p = 0.002), however it was less likely to detect malignancy in patients with abnormal premenopausal bleeding (31.8% vs 64.3%, p = .02), compared to other presenting symptoms. Overall, 51.5% of patients with ULMS on final pathology had preoperative endometrial biopsies in which leiomyosarcoma or atypical spindle cell proliferation were diagnosed, whereas 35.5% of the pre-operative biopsies identified ULMS specifically. Conclusions The sensitivity of an endometrial biopsy to detect ULMS is low, illustrating the difficulty of diagnosing ULMS preoperatively. As expected, the probability that an endometrial biopsy will detect ULMS or a related worrisome pathological finding is higher for patients with post-menopausal bleeding. Thus, benign endometrial biopsy results, particularly in pre-menopausal patients, should be interpreted with caution if there is suspicion for leiomyosarcoma. However, a positive or suspicious result can play an important role in the subsequent management of patients with ULMS, even if the absolute numbers of affected patients are small.</description><identifier>ISSN: 1553-4650</identifier><identifier>EISSN: 1553-4669</identifier><identifier>DOI: 10.1016/j.jmig.2016.01.022</identifier><identifier>PMID: 26851414</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biopsy ; Endometrial biopsy ; Endometrium - pathology ; Female ; Humans ; Leiomyosarcoma - diagnosis ; Leiomyosarcoma - surgery ; Middle Aged ; Obstetrics and Gynecology ; Retrospective Studies ; Sensitivity and Specificity ; Surgery ; Uterine Hemorrhage - pathology ; Uterine leiomyoma ; Uterine leiomyosarcoma ; Uterine Neoplasms - diagnosis ; Uterine Neoplasms - surgery ; Young Adult</subject><ispartof>Journal of minimally invasive gynecology, 2016-05, Vol.23 (4), p.567-572</ispartof><rights>AAGL</rights><rights>2016 AAGL</rights><rights>Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-fdd8c0d76d85cf70d18d6d0ab9d7447b686653603f2e9f326f804f6a232408e03</citedby><cites>FETCH-LOGICAL-c411t-fdd8c0d76d85cf70d18d6d0ab9d7447b686653603f2e9f326f804f6a232408e03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1553465016000704$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26851414$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hinchcliff, Emily M., MD</creatorcontrib><creatorcontrib>Esselen, Katharine M., MD, MBA</creatorcontrib><creatorcontrib>Watkins, Jaclyn C., MD</creatorcontrib><creatorcontrib>Oduyebo, Titilope, MD</creatorcontrib><creatorcontrib>Rauh-Hain, J. Alejandro, MD</creatorcontrib><creatorcontrib>del Carmen, Marcela G., MD</creatorcontrib><creatorcontrib>Quade, Bradley J., MD, PhD</creatorcontrib><creatorcontrib>Muto, Michael G., MD</creatorcontrib><title>The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma</title><title>Journal of minimally invasive gynecology</title><addtitle>J Minim Invasive Gynecol</addtitle><description>Abstract Study Objective To assess the sensitivity of preoperative endometrial biopsy in detection of uterine leiomyosarcoma (ULMS). Study Design Retrospective analysis of a prospectively collected database (Canadian Task Force III). Setting Two academic tertiary referral centers. Patients All cases of ULMS treated at participating institutions between January 2005 and August 2012 were identified following IRB approval. Interventions Abstracted data included demographics, preoperative evaluation, presenting symptom, surgical management, pathology and clinical outcomes. Chi-square tests were used for statistical analysis. Measurements and Main Results 329 cases were identified, of which 152 cases had complete pathologic data available for review. Sixty-eight (45%) of 152 patients had endometrial sampling prior to surgery. Patients with postmenopausal bleeding were significantly more likely to be biopsied preoperatively (51.6% vs 9.5%, p = <.0001). Of those sampled, 43 (63%) underwent endometrial pipelle biopsies and 25 (37%) had dilation and curettage. Endometrial sampling was significantly more likely to detect a concern for malignancy in patients who presented with postmenopausal bleeding (72.7% vs 32.3%, p = 0.002), however it was less likely to detect malignancy in patients with abnormal premenopausal bleeding (31.8% vs 64.3%, p = .02), compared to other presenting symptoms. Overall, 51.5% of patients with ULMS on final pathology had preoperative endometrial biopsies in which leiomyosarcoma or atypical spindle cell proliferation were diagnosed, whereas 35.5% of the pre-operative biopsies identified ULMS specifically. Conclusions The sensitivity of an endometrial biopsy to detect ULMS is low, illustrating the difficulty of diagnosing ULMS preoperatively. As expected, the probability that an endometrial biopsy will detect ULMS or a related worrisome pathological finding is higher for patients with post-menopausal bleeding. Thus, benign endometrial biopsy results, particularly in pre-menopausal patients, should be interpreted with caution if there is suspicion for leiomyosarcoma. However, a positive or suspicious result can play an important role in the subsequent management of patients with ULMS, even if the absolute numbers of affected patients are small.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biopsy</subject><subject>Endometrial biopsy</subject><subject>Endometrium - pathology</subject><subject>Female</subject><subject>Humans</subject><subject>Leiomyosarcoma - diagnosis</subject><subject>Leiomyosarcoma - surgery</subject><subject>Middle Aged</subject><subject>Obstetrics and Gynecology</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Surgery</subject><subject>Uterine Hemorrhage - pathology</subject><subject>Uterine leiomyoma</subject><subject>Uterine leiomyosarcoma</subject><subject>Uterine Neoplasms - diagnosis</subject><subject>Uterine Neoplasms - surgery</subject><subject>Young Adult</subject><issn>1553-4650</issn><issn>1553-4669</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1P3DAQhi3UCijwBzhUOfayYew4dlZClVpKodJKVOXjanntcXFI4sXOIu2_x9ECBw6cZg7P-0rzDCHHFEoKVJy0Zdv7_yXLewm0BMZ2yD6t62rGhZh_ettr2CNfUmoBKgkgdskeE01NOeX75O7mHot_ocMiuOJ8sKHHMXrdFT99WKVN4YdizMTfiGGFUY_-CYtfOKIZfRimzO2I0Q9YLNCHfhOSjib0-pB8drpLePQyD8jt7_Obs8vZ4uriz9mPxcxwSseZs7YxYKWwTW2cBEsbKyzo5dxKzuVSNELUlYDKMZy7ignXAHdCs4pxaBCqA_Jt27uK4XGNaVS9Twa7Tg8Y1klR2dSyZnMmM8q2qIkhpYhOraLvddwoCmryqVo1-VSTTwVUZZ859PWlf73s0b5FXgVm4HQLYL7yyWNUyXgcDFofsyRlg_-4__u7uOn84I3uHnCDqQ3rOGR_iqrEFKjr6aPTQ6kAAAm8egZ0NZrq</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Hinchcliff, Emily M., MD</creator><creator>Esselen, Katharine M., MD, MBA</creator><creator>Watkins, Jaclyn C., MD</creator><creator>Oduyebo, Titilope, MD</creator><creator>Rauh-Hain, J. Alejandro, MD</creator><creator>del Carmen, Marcela G., MD</creator><creator>Quade, Bradley J., MD, PhD</creator><creator>Muto, Michael G., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160501</creationdate><title>The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma</title><author>Hinchcliff, Emily M., MD ; Esselen, Katharine M., MD, MBA ; Watkins, Jaclyn C., MD ; Oduyebo, Titilope, MD ; Rauh-Hain, J. Alejandro, MD ; del Carmen, Marcela G., MD ; Quade, Bradley J., MD, PhD ; Muto, Michael G., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-fdd8c0d76d85cf70d18d6d0ab9d7447b686653603f2e9f326f804f6a232408e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biopsy</topic><topic>Endometrial biopsy</topic><topic>Endometrium - pathology</topic><topic>Female</topic><topic>Humans</topic><topic>Leiomyosarcoma - diagnosis</topic><topic>Leiomyosarcoma - surgery</topic><topic>Middle Aged</topic><topic>Obstetrics and Gynecology</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Surgery</topic><topic>Uterine Hemorrhage - pathology</topic><topic>Uterine leiomyoma</topic><topic>Uterine leiomyosarcoma</topic><topic>Uterine Neoplasms - diagnosis</topic><topic>Uterine Neoplasms - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hinchcliff, Emily M., MD</creatorcontrib><creatorcontrib>Esselen, Katharine M., MD, MBA</creatorcontrib><creatorcontrib>Watkins, Jaclyn C., MD</creatorcontrib><creatorcontrib>Oduyebo, Titilope, MD</creatorcontrib><creatorcontrib>Rauh-Hain, J. Alejandro, MD</creatorcontrib><creatorcontrib>del Carmen, Marcela G., MD</creatorcontrib><creatorcontrib>Quade, Bradley J., MD, PhD</creatorcontrib><creatorcontrib>Muto, Michael G., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of minimally invasive gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hinchcliff, Emily M., MD</au><au>Esselen, Katharine M., MD, MBA</au><au>Watkins, Jaclyn C., MD</au><au>Oduyebo, Titilope, MD</au><au>Rauh-Hain, J. Alejandro, MD</au><au>del Carmen, Marcela G., MD</au><au>Quade, Bradley J., MD, PhD</au><au>Muto, Michael G., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma</atitle><jtitle>Journal of minimally invasive gynecology</jtitle><addtitle>J Minim Invasive Gynecol</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>23</volume><issue>4</issue><spage>567</spage><epage>572</epage><pages>567-572</pages><issn>1553-4650</issn><eissn>1553-4669</eissn><abstract>Abstract Study Objective To assess the sensitivity of preoperative endometrial biopsy in detection of uterine leiomyosarcoma (ULMS). Study Design Retrospective analysis of a prospectively collected database (Canadian Task Force III). Setting Two academic tertiary referral centers. Patients All cases of ULMS treated at participating institutions between January 2005 and August 2012 were identified following IRB approval. Interventions Abstracted data included demographics, preoperative evaluation, presenting symptom, surgical management, pathology and clinical outcomes. Chi-square tests were used for statistical analysis. Measurements and Main Results 329 cases were identified, of which 152 cases had complete pathologic data available for review. Sixty-eight (45%) of 152 patients had endometrial sampling prior to surgery. Patients with postmenopausal bleeding were significantly more likely to be biopsied preoperatively (51.6% vs 9.5%, p = <.0001). Of those sampled, 43 (63%) underwent endometrial pipelle biopsies and 25 (37%) had dilation and curettage. Endometrial sampling was significantly more likely to detect a concern for malignancy in patients who presented with postmenopausal bleeding (72.7% vs 32.3%, p = 0.002), however it was less likely to detect malignancy in patients with abnormal premenopausal bleeding (31.8% vs 64.3%, p = .02), compared to other presenting symptoms. Overall, 51.5% of patients with ULMS on final pathology had preoperative endometrial biopsies in which leiomyosarcoma or atypical spindle cell proliferation were diagnosed, whereas 35.5% of the pre-operative biopsies identified ULMS specifically. Conclusions The sensitivity of an endometrial biopsy to detect ULMS is low, illustrating the difficulty of diagnosing ULMS preoperatively. As expected, the probability that an endometrial biopsy will detect ULMS or a related worrisome pathological finding is higher for patients with post-menopausal bleeding. Thus, benign endometrial biopsy results, particularly in pre-menopausal patients, should be interpreted with caution if there is suspicion for leiomyosarcoma. However, a positive or suspicious result can play an important role in the subsequent management of patients with ULMS, even if the absolute numbers of affected patients are small.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26851414</pmid><doi>10.1016/j.jmig.2016.01.022</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biopsy Endometrial biopsy Endometrium - pathology Female Humans Leiomyosarcoma - diagnosis Leiomyosarcoma - surgery Middle Aged Obstetrics and Gynecology Retrospective Studies Sensitivity and Specificity Surgery Uterine Hemorrhage - pathology Uterine leiomyoma Uterine leiomyosarcoma Uterine Neoplasms - diagnosis Uterine Neoplasms - surgery Young Adult |
| title | The Role of Endometrial Biopsy in the Preoperative Detection of Uterine Leiomyosarcoma |
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