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. 2023 Jun 1;11(11):1619.
doi: 10.3390/healthcare11111619.

Diagnostic Utility of Hysteroscopic Biopsy in Cases of Suspected Lobular Endocervical Glandular Hyperplasia and Comparison with Cervical Conization

Reona Shiro  1 , Yasushi Kotani  1 , Mamiko Ohta  1 , Hanako Sato  1 , Yoko Kashima  1 , Kosuke Murakami  1 , Kaoru Kawasaki  1 , Hidekatsu Nakai  1 , Noriomi Matsumura  1
Affiliations

Diagnostic Utility of Hysteroscopic Biopsy in Cases of Suspected Lobular Endocervical Glandular Hyperplasia and Comparison with Cervical Conization

Reona Shiro et al. Healthcare (Basel). .

Abstract

Background: Cervical cystic lesions encompass a range of benign and malignant pathologies. Magnetic resonance imaging or cytology alone cannot provide a definitive diagnosis, and conventional practice involves performing a cervical biopsy by conization to confirm the histology in cases exhibiting potential signs of lobular endocervical glandular hyperplasia (LEGH) or malignancy. However, as postoperative complications resulting from conization can impact future fertility and pregnancy, alternative diagnostic methods are needed for reproductive-age patients. This study aimed to establish the efficacy of a hysteroscopic biopsy for diagnosing cervical cystic lesions and compare it with conization.

Methods: Thirteen patients with cervical cystic lesions suspected of LEGH or malignancy underwent a hysteroscopic biopsy, while 23 underwent conization. Patient background information, preoperative evaluation, histology, and postoperative outcomes were collected and compared retrospectively.

Results: No significant differences were found between the hysteroscopy and conization groups in terms of mean patient age (45 vs. 48 years), operating time (23 vs. 35 min), blood loss (small amount vs. 43 mL), and postoperative hospitalization (1.1 vs. 1.6 days).

Conclusion: A hysteroscopic biopsy allows for targeted resection of the cervix while maintaining diagnostic accuracy. It may serve as an efficient method for diagnosing cervical cystic lesions.

Keywords: conization; hysteroscopic biopsy; lobular endocervical glandular hyperplasia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The images of a hysteroscopic biopsy. (A) The lesions are detected as elevated cysts around the cervical canal. (B) The surfaces of cysts are excised with a loop electrode. (C) The inner cavities of the cysts are exposed, with the mucinous contents leaking out of the cysts. (D) The bleeding sites are coagulated with a ball electrode.
Figure 2
Figure 2
Flowchart of the postoperative pathology results for hysteroscopy surgery and conization. Abbreviations: LEGH: lobular endocervical glandular hyperplasia and AIS: adenocarcinoma in situ.
Figure 3
Figure 3
MRI of the uterine cervix, and images of the lesions by hysteroscopic observation. (A) T2-weighted image, sagittal section. Cystic lesions in the cervix are stretching to the internal os of the uterus (arrows). (B) T2-weighted image, horizontal section. The sizes of the lesions and cysts differ among cases. (C) Cervical cystic lesions observed from inside the cervix by a hysteroscope.
See this image and copyright information in PMC

References

    1. Mikami Y., McCluggage W.G. Endocervical glandular lesions exhibiting gastric differentiation: An emerging spectrum of benign, premalignant, and malignant lesions. Adv. Anat. Pathol. 2013;20:227–237. doi: 10.1097/PAP.0b013e31829c2d66. - DOI - PubMed
    1. Nucci M.R., Clement P.B., Young R.H. Lobular endocervical glandular hyperplasia, not otherwise specified: A clinicopathologic analysis of thirteen cases of a distinctive pseudoneoplastic lesion and comparison with fourteen cases of adenoma malignum. Am. J. Surg. Pathol. 1999;23:886–891. doi: 10.1097/00000478-199908000-00005. - DOI - PubMed
    1. Mikami Y., Kiyokawa T., Hata S., Fujiwara K., Moriya T., Sasano H., Manabe T., Akahira J., Ito K., Tase T., et al. Gastrointestinal immunophenotype in adenocarcinomas of the uterine cervix and related glandular lesions: A possible link between lobular endocervical glandular hyperplasia/pyloric gland metaplasia and ‘adenoma malignum’. Mod. Pathol. 2004;17:962–972. doi: 10.1038/modpathol.3800148. - DOI - PubMed
    1. Takatsu A., Miyamoto T., Fuseya C., Suzuki A., Kashima H., Horiuchi A., Ishii K., Shiozawa T. Clonality analysis suggests that STK11 gene mutations are involved in progression of lobular endocervical glandular hyperplasia (LEGH) to minimal deviation adenocarcinoma (MDA) Virchows Arch. 2013;462:645–651. doi: 10.1007/s00428-013-1417-1. - DOI - PubMed
    1. Mikami Y., Hata S., Fujiwara K., Imajo Y., Kohno I., Manabe T. Florid endocervical glandular hyperplasia with intestinal and pyloric gland metaplasia: Worrisome benign mimic of “adenoma malignum”. Gynecol. Oncol. 1999;74:504–511. doi: 10.1006/gyno.1999.5462. - DOI - PubMed

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