The current trend for diagnosis in post menopausal bleeding is some form of endometrial sampling by either aspiration biopsy in the rooms, hysteroscopically directed biopsies and a dilatation and curettage.
Studies have shown that these procedures are extremely accurate in determining whether cancer is present. A recent study however suggests that the correlation between histological grading and findings at hysterectomy was not as accurate.
Endometrial cancer is the commonest gynaecological cancer and is usually diagnosed early. The procedures above usually diagnoses the degree of malignancy and the histology usually dictates the surgery the patient may have to undergo.
The majority of these cancers are Stage 1 and stage 2. Advanced cancers are usually treated with adjunctive chemotherapy and radiotherapy however patients with cancer localised to the uterus may undergo just a hysterectomy and salpingo-oophorectomy with no lymph node sampling or excision. However this may prove suboptimal if Stage 3 disease exists. Histological grading was based on differentiation with grade 1 being well differentiated and grade 3 being poorly differentiated. The stage of the disease and histologic degree of differentiation affects both the surgery and the need for adjuvant therapy.
This study was a meta-analysis of 45 studies which involved 12459 patients. The pathologic findings at hysterectomy were compared to the biopsy results (both histology and grading).
The staging was downgraded in 26% of cases (i.e. 26 percent of patients underwent needless lymph node surgery with significantly increased risks and complications). 8% of patients were upgraded.
The correlation was highest in the grade 1 and grade 3 groups and lowest in the grade 2. The Authors suggest using only low grade and high grade and dispensing with medium grade of introducing further immunohistochemical makers to improve this accuracy.