Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer

To compare the accuracy of D&C and office Z-sampler endometrial biopsy in predicting hysterectomy tumor grade in women with endometrial cancer. Between September 1987 and July 1994, 183 women with endometrial cancer had D&C or office Z-sampler endometrial biopsy before hysterectomy. One hundred thirty-one patients (72%) had Z-sampler biopsies and 52 (28%) had D&C. The Z-sampler correctly identified the hysterectomy tumor grade in 76 of 131 patients (58%), compared with 40 of 52 (77%) with D&C, a significant difference ( P = .024). The major difference observed was an increased fraction of lesions undergraded (ie, a lower grade tumor found in the biopsy than in the hysterectomy specimen) by the Z-sampler (34 of 131, 26%) versus D&C (five of 52, 10%). Dilation and curettage was more accurate in identifying hysterectomy tumor grade and less likely to miss a higher-grade tumor than was Z-sampler biopsy. However, the inaccuracy of D&C alone necessitates further preoperative and intraoperative assessment for other risk factors to determine the aggressiveness with which an individual patient should be staged surgically.