Hysteroscopy to detect Stage IA well-differentiated endometrioid adenocarcinoma of the endometrium

Background. Well-differentiated Stage IA endometrial carcinoma may be managed conservatively with progestin treatment. However, even advanced imaging methods cannot overcome limitations in the correct determination of the absence of early microscopic myometrial invasion by endometrial carcinoma. Hysteroscopy has not yet been investigated as a tool for this purpose. Methods. Of 97 patients with well-differentiated endometrioid adenocarcinoma, 87 whose tumors were clinically confined to the uterine corpus were enrolled for inclusion in this study. The preoperative hysteroscopic appearance was correlated with the histological findings of the hysterectomy specimen. Results. Post-surgical FIGO stage was Stage IA in 36 cases, IB in 29, IC in 16, IIA in one, and Stage IIIA/C in five cases. Before surgery, the growth pattern of the disease was hysteroscopically diagnosed as pedunculated in 69.0% and sessile nodular in 31.0%. Surface ulceration was observed in 23.3% of the pedunculated tumors and in 74.1% of the sessile tumors ( p < 0.0001), and in 39.1% of all tumors. The incidence of absent myometrial invasion was significantly higher in the pedunculated tumors (56.3%) than in the sessile tumors (3.7%) ( p < 0.0001) and was higher in the nonulcerated tumors (64.2%) than in the ulcerated tumors (5.9%) ( p < 0.0001). When the statistical parameters were calculated in combination with the tumor growth pattern and the absence or presence of ulceration, the nonulcerated pedunculated growth pattern had a sensitivity of 92% and a positive predictive value of 72% for correct selection of Stage IA disease with no myometrial invasion. Conclusion. Well-differentiated endometrioid adenocarcinoma was categorized by hysteroscopy into two growth patterns of pedunculated or sessile and with or without surface ulceration. This provided useful pretreatment diagnosis of Stage IA disease confined to the endometrium.