Comparison of dilatation & curettage and endometrial aspiration biopsy accuracy in patients treated with high-dose oral progestin plus levonorgestrel intrauterine system for early-stage endometrial cancer
Introduction
Endometrial cancer (EC) is the world's second most common gynecologic malignancy and the incidence is rising steadily [1]. While a majority of cases are diagnosed in post-menopausal women, up to 14% of cases will be in pre-menopausal women, including 4% diagnosed in women younger than 40 years of age. With the recent increase in the number of young patients with EC, the fertility-sparing conservative treatment is attracting growing attention. A number of studies have reported the effectiveness of hormonal therapy using systemic progestin in women clinically diagnosed with early endometrial adenocarcinoma at stage IA, grade 1, who want to maintain reproductive potential [2], [3], [4], [5], [6], [7], [8], [9], [10]. In addition, several recent studies reported the use of a levonorgestrel intrauterine system (LNG-IUS) to reduce systemic adverse effects and increase the local effectiveness to the endometrium [11], [12], [13], [14], [15], [16], [17], [18], [19]. However, there are few reports evaluating the response of the endometrium in follow-up, especially when using LNG-IUS. According to the reported literature, in cases of conservative treatment using LNG-IUS, endometrial response was evaluated by endometrial aspiration biopsy with LNG-IUS in uterus or a dilatation & curettage (D&C) after removal of LNG-IUS [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]. Nevertheless, there has been no report comparing the accuracy of these methods.
Therefore we conducted a prospective observational study to evaluate the diagnostic accuracy of endometrial aspiration biopsy with the LNG-IUS in place in the uterus compared with a D&C after removal of LNG-IUS in the evaluation of endometrial response in patients treated with high-dose oral progestin plus LNG-IUS for early endometrial adenocarcinoma at stage IA, grade 1 or 2.
Section snippets
Patients and methods
A prospective observational study conducted with 11 Patients with FIGO grade 1 or 2, clinical stage I endometrioid adenocarcinoma treated at CHA Gangnam Medical Center, Seoul, Korea from January 2010 to February 2012. Eligible subjects were young women less than 40 years of age, with histologically confirmed grade 1 or 2 endometrioid adenocarcinoma that is presumably confined to the endometrium. Endometrial tissue sampling for diagnosis was carried out by D&C and the clinical stage was
Result
During the study period, we performed 28 endometrial biopsies in 11 patients. Each patient got an average of 2.5 ± 0.9 biopsies (range, 1–4). Table 1 summarizes the clinical characteristics of the patients. The mean age of the subjects was 32.6 ± 3.9 years (range, 29–40 years); there were 10 patients with FIGO grade 1 and 1 patient with FIGO grade 2 tumors. Their mean body mass index (BMI) was 22.1 ± 1.1 kg/m2 (range, 16.8–36.3 kg/m2). Among the 11 patients, 3 women had high BMI > 30 kg/m2 (36.3, 32.0,
Discussion
For young women with early stage EC desiring to preserve their fertility, conservative treatment such as the administration of high-dose oral progesterone has been recommended [2], [3], [4], [5], [6], [7], [8], [9], [10]. In addition, several recent studies reported the use of a LNG-IUS [11], [12], [13], [14], [15], [16], [17], [18], [19]. However, the result is unsatisfactory, especially compared with the high cure rate (> 93%) of surgically treated early-stage EC already noted. Therefore, to
Conflict of interest
The authors report no conflict of interest.
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