Screening and diagnosis of endometrial cancer (review) - JS Afonso

This link was last updated on October 01, 2000 and review on July 20, 2005.

This article should be cited as:

Afonso JS. Screening and diagnosis of endometrial cancer (review). In: http://www.histeroscopia.med.br/. Access in:

keywords: hysteroscopy, endometrial, cancer, screening.

Dr. José Sebastião Afonso

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The peak of incidence of endometrial cancer occurs in 60 to 70 year-old patients, the occurrence of the disease being rather unusual in the forties. In most cases the disease will only be diagnosed after abnormal vaginal bleeding.

Papa smear cytology (pap-test)

Sensibility is around 30 to 50%, becoming more intense in the cases of G2, G3 and in more advanced stages.

Endometrial Cytology

Sensibility is around 80 to 85%. It becomes difficult to make a pathological interpretation of material composed of isolated masses of endometrial cells. The samples are obtained through washing, suction and brushing.

Indications (IVERSEN and SEGADAL): 45 year-old patients and over presenting no symptoms

1) high risk

Isolated estrogenic therapy

2) Moderate risk

Hypertension, obesity, diabetes mellitus, hyper-estrogenic condition.

3) low risk.

Mass Screening (it is an inexpensive method as it takes advantage from the papa smear cytology collection structure).

Progesterone

"Progesterone tests can be used for population screening in the detection of precursory lesions and carcinoma of the endometrium. A test with negative results will present a high level of accuracy. However, false-positive results can reach only s much as 56%" (Bortoletto, 1994).

Ultrasonography

It is a screening method. The normal thickness of the endometrial echo in the post-menopause period will be no more than 4/5 mm without hormonal replacement, and up to 8 mm with hormonal replacement. Regularity is also evaluated When the endometrium is not identified in the largest sagital axis, perpendicular to the largest transducer axis, or if the interface is distorted for any reason, evaluation will be rendered impossible.

Endometrial biopsy

Sensibility will be around 85 to 95% with the use if a suction curette (Novak or Randall). It offers a good material for histologic diagnosis. The rate of accuracy of biopsy techniques is basically identical to that of surgical curettage, as long as the removal of samples from all portions of the uterine cavity is carefully carried out. Strict accuracy is hardly achieved with patients who are reluctant to collaborate, the obese and those with a cervical stenosis condition.

Fractional uterine curettage

Sensibility is around 90%. The cervical involvement reaches a false-positive rate of around 47%.

Hysteroscopy

Sensibility is around 90% and specificity around 84%. Taken as an isolated method, the hysteroscopy will fail in to diagnose the endometrial cancer when it no relation with hyperplasia. It becomes rather limited in the presence of bleeding and in advanced stages. Hysteroscopy is a good pre-operative procedure to assess cervical invasion. It is recommended to associate it with directed and indirect biopsy (Novak).

Conclusions

In some cases, hysteroscopy will prevent a hyper clinical staging (I/II), thus allowing for a less radical surgery.

In the cases of atypical hyperplasia and of adenocarcinoma, the sensibility of hysterocopy, endometrial biopsy techniques and D&C will be quite similar.

Directed biopsy is indicated for those cases where negative biopsy or negative D&C is carried out in patients suspected of having the disease.

Directed biopsy can enhance accuracy in the detection of adenomatous hyperplasia and of early carcinoma.

Hysteroscopic images are sometimes of difficult interpretation or even misleading (e.g., adenocarcinoma when it no relation with hyperplasia).

There is the danger of peritoneal or intravascular dissemination of tumorous cells as a result of the high pressure used to distend the uterine cavity and the distension liquid.

For a method to be regarded as socially effective it will have to take into account the possibility of universal access.

Added to the fact that no method is 100% foolproof, there is also the possibility of failure on the part of the people who manipulate them. As a whole, an association of different methods would be the most suitable approach of all.

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