Comparison of Pre- and Postoperative Histopathology Results in Patients with Endometrial Carcinoma

Background: Preoperative histopathology is considered the most effective method for evaluation of endometrial carcinoma, and plays a crucial role in deciding the extent of surgical resection. In this study, we analysed clinical data to evaluate the accuracy of preoperative diagnosis by comparing preoperative hysteroscopic biopsy results with postoperative histopathological results. Methods: : This was a cross-sectional, retrospective study of patients who underwent hysteroscopic biopsy and subsequent hysterectomy for endometrial carcinoma. Clinical data were collected for 289 patients who were diagnosed with endometrial carcinoma based on hysteroscopy. We compared the histotype and tumour differentiation grade to evaluate the accuracy of diagnosis based on preoperative hysteroscopic biopsy. Results: : Compared with the postoperative histotype results, the overall accuracy of the preoperative histotype results was 94.8%, and the kappa value was 0.725 (p < 0.001). The weighted kappa value for agreement between preoperative and postoperative histopathological grade was 0.616, indicating the level of agreement was “substantial” (95% CI 0.538–0.695). The rate of misdiagnosis based on hysteroscopy was significantly higher for grade 3 cancer than for grade 1 cancer, and there was no significant difference for grade 2 cancer compared with the other two grades. Conclusions: : Hysteroscopy is a reliable method for preoperative diagnosis of endometrial carcinoma. Preoperative assessment of histotype by hysteroscopy showed high consistency with postoperative results. However, there was a significantly higher rate of misdiagnosis for patients with poorly differentiated tumour, which may lead to overtreatment. For these patients, we recommend analysing frozen sections before determining a final treatment strategy.