Role of Dilatation and Curettage for Diagnosing Uterine Tumors: A University Hospital Experience

Abstract

Background and Aims: Endometrial cancer is a common gynecological malignancy, with a chief complaint of vaginal bleeding. Dilation and curettage (D&C) prior to performing definite surgical procedure is the gold standard pre-operative diagnostic method. This is a retrospective comparative study that aims is to determine the accuracy rate of D&C in diagnosing cancer at our institution. Materials and Methods: Endometrial cancers with pre-operative D&C diagnosed and underwent definite surgical procedures at our institution during the last 10 years were included. Corresponding slides for pre-operative D&C and final post surgical diagnosis were reviewed for histopathological characteristics. Any pre-operative cervical smears within one year of diagnosis were also reviewed. Results: 54cases of endometrial cancer were studied. Mean age =62.5 years. 79.6% of patients were menopausal. 32 had available follow up(mean period = 16.5 months). Most common histopathological types were endometrioid carcinoma (74%); followed by serous carcinoma (11%) and 4carcinosarcoma (7.4%). Accuracy rate of D&C was 87 %. Cases with discrepancy were 3 endometrioid cancers, and one each of serous carcinoma, leiomyosarcoma, endometrial stromal sarcoma, and placental site trophoblastic tumor. Conclusions: accuracy rate of D&C in detecting endometrial epithelial cancers is high; but is low for sarcomas. Potential factors that reduce accuracy include interpretation errors, sampling issues, and lack of ancillary immunohistochemistry.