Use of the Cornier pipelle as the only means of presurgical histologic diagnosis in endometrial carcinoma: agreement between initial and final histology

Objective: To test the reliability of the Cornier pipelle as a diagnostic tool for submitting endometrial carcinoma patients directly to surgery, without the additional performance of dilatation and curettage.

Methods: In this prospective study, 56 consecutive patients with the presumptive diagnosis of endometrial carcinoma, based on the analysis of material sampled by means of microcurettage using the Cornier pipelle, were submitted to hysterectomy. The findings of the final pathological report were compared with those of the previous microcurettage. Both were analysed at the same Pathology laboratory throughout the study. The presence of endometrial carcinoma was confirmed intraoperatively in all cases, and, as a consequence, a staging laparotomy was completed in all of them.

Results: Although the initial diagnosis of carcinoma was confirmed in every case (100% sensitivity), the final pathological report revealed discordant histological subtypes in 6 out of the 56 cases (10.7%). Only two, however, represented higher histological risk than initially stated. Discrepant grading values were also found in 3 out of 41 (7.3%) cases of the endometrioid subtype for which tumor grade been established in the microcurettage specimen. Not performing dilatation and curettage under general anesthesia prior to surgery resulted in a significant saving, both in hospitalization costs and bed occupation.

Conclusion: When endometrial sampling by means of the Cornier pipelle yields the diagnosis of carcinoma, it can be confidently relied upon. However, some high-risk cases can be missed due to discordance between initial and final histology, and this could eventually lead to the choice of an inadequate surgical strategy.

Endometrium; Carcinoma; Microcurettage; Pipelle

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