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Abstract
Introduction/Background Stage II Endometrial cancer (EC) accounts only for 12% of cases. Recent evidences redraw the weight of radicality in this stage as it would seem to have no impact on survival outcomes confining it where free surgical margins are not ensured to be achieved by simple hysterectomy. Thus, an accurate pre-operative evaluation might be crucial. This study aims to estimate the diagnostic power of hysteroscopic biopsy of cervical stroma to predict the stage and parametrial invasion in patients with preoperative stage II EC.
Methodology From January 2020 to November 2023, all patients evaluated at the Department of Gynecology Oncology of Humanitas, Istituto Clinico Catanese, Catania, Italy, with a diagnosis of EC and evidence of cervical stromal diffusion on preoperative MRI and office hysteroscopy evaluation, considered suitable for laparoscopic modified type B hysterectomy, were consecutively included in the study. These underwent endometrial and cervical stroma hysteroscopy biopsy for histological and molecular evaluation before definitive surgery. The data obtained were compared with the definitive histological examination (reference standard).
Results Among eligible patients, 16 met the inclusion/exclusion criteria and were included in the study. The cervical stroma was involved in 7 cases (43.7%) while the parametrium was also reported in 3 cases (18.7%). Compared to the definitive histology, the cervical stroma biopsy showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (95% CI) of 85%, 89%, 85%, 89% and 87% respectively. Considering parametrial invasion, biopsies have shown sensitivity, specificity, PPV, NPV and accuracy (95% CIs) of 66%, 61%, 28%, 89% and 62% respectively.
Conclusion Direct stroma biopsy was accurate in all fields and had a fine NPV to exclude parametrial involvement. Considering the new FIGO staging a preoperative molecular and histological evaluation of the cervical stroma may be useful. Operative hysteroscopy seems to be a feasible and accurate method.
Disclosures The authors declare that they have no relevant or material financial interests that relate to the research described in this paper.
Patient‘s selection process and results reported for Hysteroscopy to reference standard. Legend: hysteroscopic excisional biopsy (HEB)