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Multicenter Study
. 2020 Jul;31(4):e51.
doi: 10.3802/jgo.2020.31.e51. Epub 2020 Feb 7.

Comparison of diagnostic accuracy between endometrial curettage and aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean Gynecologic Oncology Group study

Mi Kyoung Kim  1 , Seok Ju Seong  2 , Dong Choon Park  3 , Jin Hwa Hong  4 , Ju Won Roh  5 , Soon Beom Kang  6
Affiliations
Multicenter Study

Comparison of diagnostic accuracy between endometrial curettage and aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean Gynecologic Oncology Group study

Mi Kyoung Kim et al. J Gynecol Oncol. 2020 Jul.

Abstract

Objective: To compare the diagnostic accuracy of dilatation and curettage (D&C) versus endometrial aspiration biopsy in follow-up evaluation of patients treated with progestin for endometrial hyperplasia (EH).

Methods: A prospective multicenter study was conducted from 2015 to 2018. Patients with EH were treated with progestin, one of the following three treatment regimens: oral medroxyprogesterone acetate (MPA) 10 mg/day for 14 days per cycle, continuous MPA 10 mg/day or the levonorgestrel-releasing intrauterine system (LNG-IUS). At 3 or 6 months of treatment, endometrial tissues were obtained via 2 methods in each patient: aspiration biopsy, followed by D&C. The primary outcome was the consistency of the histologic results between the 2 methods. The secondary outcome was the regression rate at 6 months of treatment.

Results: The study population comprised 65 patients (55 with non-atypical hyperplasia, 10 with atypical hyperplasia). During the follow-up, a comparison of the pathologic results from aspiration biopsy and D&C was carried out for the 65 cases. Thirty-eight cases were diagnosed as EH by D&C. Among these, only 24 were diagnosed with EH from aspiration biopsy, for a diagnostic concordance of 63.2% (κ=0.59). Forty-four patients were followed up at 6 months, and the regression rate was 31.8% (14/44). Responses were obtained for 41.7% (5/12) of the cyclic MPA group, 58.3% (7/12) of the continuous MPA group and 10% (2/20) of the LNG-IUS group.

Conclusion: As a follow-up evaluation of patients treated with progestin for EH, aspiration biopsy is less accurate than D&C and might not be a reliable method.

Trial registration: ClinicalTrials.gov Identifier: NCT02412072.

Keywords: Biopsy; Dilatation and Curettage; Endometrial Hyperplasia; Intrauterine Device; Levonorgestrel; Progesterone.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Study design and flow diagram.
D&C, dilation and curettage; LNG-IUS, levonorgestrel-releasing intrauterine system; MPA, medroxyprogesterone acetate.
Fig. 2
Fig. 2. Flowchart of treatment outcomes.
LNG-IUS, levonorgestrel-releasing intrauterine system; MPA, medroxyprogesterone acetate.
See this image and copyright information in PMC

Comment in

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