Selective vs Complete Sampling in Hysterectomy Specimens Performed for Atypical Hyperplasia

Abstract

Objectives: Atypical hyperplasia of the endometrium is a significant risk factor for uterine endometrioid carcinoma (EC) and an indication for hysterectomy. Standard sampling of these specimens includes evaluation of the entire endometrium to identify possible EC. We evaluated a method of selective sampling in an effort to balance resource utilization with diagnostic accuracy in the detection of EC. Methods: Histologic diagnoses based on selective sampling (exclusion of every other block of endometrium) were compared with the original diagnosis based on complete sampling. Results: Double-blinded review of these cases using selective sampling detected EC in 92% of hysterectomies, including all high-grade/high-stage carcinomas. Selective sampling had an 82% agreement with the original diagnoses, with most discordant diagnoses attributable to interobserver variability. Adjusting for interobserver variability increased diagnostic agreement between selective and complete sampling to 96%. Conclusions: Selective sampling is a feasible method to save time and resources while maintaining diagnostic accuracy.