The Impact of Using Hysteroscopic Morcellation For Benign and Cancerous Endometrial Pathology: An Ex Vivo Study [31G]

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Abstract

INTRODUCTION:

Hysteroscopic morcellation is frequently used to resect endometrial pathology. We assessed the impact of hysteroscopic morcellation on histologic analysis and the accuracy on tissue diagnosis.

METHODS:

A prospective paired-comparison study was performed in consenting women undergoing hysterectomy for benign indications (n=13) or hyperplasia/cancer (n=10). After hysterectomy, a section of the endometrium was removed for ex vivo morcellation using the Hologic® MyoSure hysteroscopic tissue removal system. Morcellated specimens were then processed and compared by two blinded pathologists (Pa, Pb) to the original specimens’ final diagnoses at the end of patient recruitment. Chi square and Cohen’s kappa coefficient were used for analysis.

RESULTS:

Morcellated specimens were readable in 100% (23/23) by Pa and 91.3% (21/23) by Pb. Morcellated specimen diagnoses were concordant with final diagnoses in 86.9% (20/23, k=0.772, p<0.001) for Pa and 80.9% (17/21, k=0.559, p<0.001) for Pb. The majority of benign final diagnoses were concordant with morcellated specimen diagnoses: 100% (13/13, k=1, p=<0.001) for Pa and 90.9% (10/11, k=1, p=<0.001) for Pb. Each pathologist found 70% (7/10) concordance of morcellated specimen diagnoses with malignant final diagnoses (Pa k=0.559, p<0.003 and Pb k=0.394, p<0.014).

CONCLUSION:

The data supports that hysteroscopic morcellation does not adversely impact whether specimen is able to be interpreted by histologic analysis. However, 30% of malignant disease were under-diagnosed on morcellated specimens. Further research is warranted to confirm the findings. Our study emphasizes the importance of vigilance in securing an accurate diagnosis in patients with endometrial pathology as future patient management depends on it.

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