Hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma

Diagnostic hysteroscopy and directed biopsy has been widely used to evaluate abnormal uterine bleeding. We aimed to explore the value of hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma.

Two hundred and eighty-seven patients with endometrial carcinoma who were treated in Beijing University People's Hospital, Beijing, China were distributed into 2 groups: Group A (90 patients) was examined using hysteroscopy and directed biopsy, and Group B (197 patients) was examined using fractional dilatation and curettage (D&C). The diagnostic veracity of the two methods, the rate of positive peritoneal cytology and the prognosis of the 2 groups were compared.

In Group A, 97.8% (88/90) of patients were diagnosed pathologically before surgery; the rate was 88.8% (175/197) for Group B. The difference between the 2 groups was statistically significant (P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value for the two methods for detecting cervical involvement were 77.8%, 100%, 100% and 97.6% for Group A and 65.3%, 92.6%, 74.4% and 90.0% for Group B, respectively. The positive peritoneal cytology rate was 5.6% (5/90) in Group A and 6.09% (12/197) in Group B. The difference was not statistically significant (P > 0.05). The 3-year and 5-year overall survival rates were 91.4% (33/36) and 82.4% (14/17) for Group A and 95.6% (87/91) and 86.7% (39/45) for Group B. There were no statistically significant differences between the two groups' survival rates (P > 0.05).

Compared with fractional D&C, hysteroscopy and directed biopsy offered improved pathological diagnostic accuracy before surgery and discovered cervical involvement more precisely in endometrial carcinoma patients, but it did not increase the positive peritoneal cytology rate or affect the prognosis of these patients.