Background: pathologies diagnosed from curettage material for pre

Background:
Our
objective was to investigate the conformity between endometrial tissue samples
obtained by preoperative dilatation and curettage (D&C) and those of
post-hysterectomy specimens assessing its adequacy. Methods: This
retrospective cohort study included 829 women who underwent hysterectomy
between January 2010 and June 2017 in Benha University Hospital. The
histopathological examination reports of both D&C as well as hysterectomy
biopsies were analyzed and compared. Results: Dilatation and curettage
provides sensitivity (89.5%), specificity (99.6%), positive (96.2%) and
negative (98.9%) predictive values for malignant endometrial pathologies. The
accuracy was (96.1%) and (99.6%) for malignant pathologies diagnosed from
curettage material for pre and postmenopausal women respectively. There is a
good inter-method agreement (Weighted ?=0.756) between D&C and
hysterectomy samples. Conclusions: D&C continues to be an acceptable
and accurate diagnostic procedure for detecting wide range of endometrial
pathologies, especially malignancies in postmenopausal women.

Key words: Dilatation
and curettage; endometrial biopsy; hysterectomy.

Background 

For years,
gynecologists routinely tend to obtain an endometrial sample before hysterectomy
to detect any asymptomatic pathology as well as to design an effective
management plan. 1 Since dilatation and curettage (D&C) was first
described by Recamier in 1943, it became the tool of choice for routine endometrial
sampling and a frequently used diagnostic procedure worldwide. 2 Although
newer techniques now are available for uterine cavity visualization as
hysteroscopy and endometrial sampling like Pippelle suction curette, D&C
still has a role where these technologies are not available or cannot be
afforded. 3

Although
many reported that D&C is the “gold standard” for endometrial sampling as
it is accurate for the endometrial cancer detection. 4, 5 Others considered
D&C as inaccurate diagnostic tool for intrauterine pathologies management. They
recorded frequently missed focal uterine lesions as endometrial polyps and also
hyperplasia by preoperative D&C. 6, 7 Furthermore, D&C use
necessitates anesthesia administration, adds extra hospital costs and may be
complicated by infection, uterine perforation or cervical tears. 6, 8

As the debate of
obtaining an endometrial sample before hysterectomy by which technique remains
unsolved and the efficacy of D&C is questionable, the aim of the current
study was to examine the validity of performing the pre-hysterectomy D&C.
In addition, we investigated the agreement between the results of the
histopathological examination of the D&C and hysterectomy specimens.