Endometrial Sampling for Endometrial Cancer: Still the Gold Standard?

Abstract

Is the most common gynaecological malignancy affecting women in developed countries and the second most common gynaecological malignancy world-wide, due to the higher rates of cervical cancer in the developing world [1]. The incidence of EC is steadily increasing, largely owing to an ageing population and escalating rates of obesity [2]. According to International Federation of Gynecology and Obstetrics (FIGO), EC is a major differential diagnosis of AUB in the reproductive women [3]. Despite the frequency of this disease, awareness amongst the general population is low and EC research is somewhat underfunded relative to its societal burden [4]. In the past, multiple attempts to evaluate the histological grade preoperatively were without significant success [5,6]. Dilation and curettage (D&C) were once the gold standard for endometria sampling and routinely used with an upgrade rate of 17-26%, compared to the final pathology [7-9]. In an attempt to develop a less invasive diagnostic method, office endometrial sampling became progressively popular. However, studies aimed at investigating office biopsies revealed an apparent inaccuracy in histological grading with an upgrade rate of nearly 30-50%, compared to hysterectomy pathology [10]. Cotillo et al. [11] investigated the accuracy of transcervical resectoscope (TCR) and revealed a rather optimistic finding of 97.1% correlation with the final pathology.