The Clinical Relevance of Fractional Curettage in the Diagnostic Management of Primary Endometrial Cancer

Abstract

<b><i>Objective:</i></b> Hysteroscopy and fractional curettage are commonly utilized techniques for the diagnosis of postmenopausal abnormal uterine bleeding and histopathological verification of primary endometrial cancer (EC). This study delves into the clinical significance of procuring preoperative endocervical tissue in conjunction with corpus fractions through fractional curettage. <b><i>Design:</i></b> This retrospective study encompassed a cohort of 84 patients diagnosed with T1 stage EC and 55 patients diagnosed with T2 stage EC, who underwent primary treatment between the years 2011 and 2021 at the University Hospital Frankfurt or Jung-Stilling Hospital Siegen. <b><i>Materials, Setting, Methods:</i></b> Among the postoperative T2 stage EC patients, a stratification was performed based on preoperative endocervical curettage (ECC) results obtained through fractional curettage. Categorical and continuous variables were compared utilizing the Pearson χ² test, while for multivariate analyses and regression modeling, the Kaplan-Meier method and Cox regression models were respectively employed. <b><i>Results:</i></b> The median age of patients with pT2 stage EC was 64 years (range: 38–85). A predominant majority of these patients exhibited the endometrioid subtype of EC (90.9%). Upon conducting comparative analysis between groups, a notably higher frequency of laparotomies was observed (<i>p</i> = 0.002) among patients in whom preoperatively detected positive ECC was evident. The detection performance of fractional curettage in identifying positive ECC yielded a sensitivity of 70.9% and a specificity of 73.8%. In multivariate analysis, age at diagnosis (<i>p</i> = 0.022), positive ECC observed during fractional curettage (<i>p</i> = 0.036), and the FIGO stage (<i>p</i> = 0.036) emerged as prognostic determinant for progression-free survival. Independent prognostic factors for overall survival (OS) were age at diagnosis (<i>p</i> = 0.003), positive ECC (<i>p</i> = 0.008), histological grading (<i>p</i> = 0.016), and the FIGO stage (<i>p</i> = 0.022). A significant difference in OS was evident between patients characterized by preoperative negative ECC and those displaying positive ECC (81.8 vs. 59.5 months, <i>p</i> = 0.019). <b><i>Limitations:</i></b> Limitations include the retrospective design of the study as well as a small number of patients<i>.</i> <b><i>Conclusions:</i></b> Preoperative determination of endocervical involvement of primary T2 stage EC could be a prognostic indicator in decision-making to treat EC. The conduct of prospective trials is necessary to definitively establish the routine application and associated benefits of fractional curettage in the context of primary EC.