Which Endometrial Pathologies Need Intraoperative Frozen Sections?

  • Balik, Gulsah (Obstetrics and Gynecology, Medicine, Recep Tayyip Erdogan University) ;
  • Kagitci, Mehmet (Obstetrics and Gynecology, Medicine, Recep Tayyip Erdogan University) ;
  • Ustuner, Isik (Obstetrics and Gynecology, Medicine, Recep Tayyip Erdogan University) ;
  • Akpinar, Funda (Obstetrics and Gynecology, Medicine, Recep Tayyip Erdogan University) ;
  • Guven, Emine Seda Guvendag (Obstetrics and Gynecology, Medicine, Recep Tayyip Erdogan University)
  • Published : 2013.10.30


Background: Endometrial cancers are the most common gynecologic cancers. Endometrial sampling is a preferred procedure for diagnosis of the endometrial pathology. It is performed routinely in many clinics prior to surgery in order to exclude an endometrial malignancy. We aimed to investigate the accuracy of endometrial sampling in the diagnosis of endometrial pathologies and which findings need intra-operative frozen sections. Materials and Methods: Three hundred nine women applying to a university hospital and undergoing endometrial sampling and hysterectomy between 2010 and 2012 were included to this retrospective study. Data were retrieved from patient files and pathology archives. Results: There was 17 patients with malignancy but endometrial sampling could detect this in only 10 of them. The endometrial sampling sensitivity and specificity of detecting cancer were 58.8% and 100%, with negative and positive predictive values of 97.6%, and 100%, respectively. In 7 patients, the endometrial sampling failed to detect malignancy; 4 of these patients had a preoperative diagnosis of complex atypical endometrial hyperplasia and 2 patients had a post-menopausal endometrial polyps and 1 with simple endometrial hyperplasia. Conclusions: There is an increased risk of malignancy in post-menopausal women especially with endometrial polyps and complex atypia hyperplasia. Endometrial sampling is a good choice for the diagnosis of endometrial pathologies. However, the diagnosis should be confirmed by frozen section in patients with post-menopausal endometrial polyps and complex atypia hyperplasia.


  1. Bokhman Ya, Tkeshelashvili VT, Vishnevsky AS, Volkova AT (1988). Myoma uterus as a marker of oncogynecological pathology in preand post-menopause. Eur J Gynaecol Oncol, 9, 355-9.
  2. Acs G (2002). Intraoperative consultation in gynecologic pathology. Semin Diagn Pathol, 19, 237-54.
  3. Anastasiadis PG, Koutlaki NG, Skaphida PG, et al (2000). Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol, 21, 180-3.
  4. Antonsen SL, Ulrich L, Hogdall C (2012). Patients with atypical hyperplasia of the endometrium should be treated in oncological centers. Gynecol Oncol, 125, 124-8.
  5. Bilgin T, Ozuysal S, Ozan H, et al (2004). Coexisting endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. J Obstet Gynaecol Res, 30, 205-9.
  6. Carlson JW, Mutter GL (2008). Endometrial intraepithelial neoplasia is associated with polyps and frequently has metaplastic change. Histopathol, 53, 325-32.
  7. Coffey D, Kaplan AL, Ramzy I (2005). Intraoperative consultation in gynecologic pathology. Arch Pathol Lab Med, 129, 1544-57.
  8. Costa-Paiva L, Godoy CE Jr, Antunes A Jr, et al (2011). Risk of malignancy in endometrial polyps in premenopausal and postmenopausal women according to clinicopathologic characteristics. Menopause, 18, 1278-82.
  9. Coeman D, Van Belle Y, Vanderick G, De Muylder X, De Muylder E (1993). Hysteroscopic findings in patients with a cervical polyp. Am J Obstet Gynecol, 169, 1563-5.
  10. Creasman W (2009). Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet, 105, 109.
  11. Epstein E, Ramirez A, Skoog L, Valentin L (2001). Dilatation and curettage fails to detect most focal lesions in the uterine cavity in women with postmenopausal bleeding. Acta Obstet Gynecol Scand, 80, 1131-6.
  12. Demirkiran F, Yavuz E, Erenel H, et al (2012). Which is the best technique for endometrial sampling? Aspiration (pipelle) versus dilatation and curettage (D&C). Arch Gynecol Obstet, 286, 1277-82.
  13. Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP (2000). The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia. Cancer, 89, 1765-72.<1765::AID-CNCR17>3.0.CO;2-F
  14. Dreisler E, Stampe Sorensen S, Ibsen PH, Lose G (2009). Prevalence of endometrial polyps and abnormal uterine bleeding in a Danish population aged 20-74 years. Ultrasound Obstet Gynecol, 33, 102-8.
  15. Goldstein SR, Monteagudo A, Popiolek D, Mayberry P, Timor-Tritsch I (2002). Evaluation of endometrial polyps. Am J Obstet Gynecol, 186, 669-74.
  16. Gundem G, Sendag F, Kazandi M (2003). Preoperative and postoperative correlation of histopathological findings in cases of endometrial hyperplasia. Eur J Gynaecol Oncol, 24, 330-3.
  17. Hileeto D, Fadare O, Martel M, Zheng W (2005). Age dependent association of endometrial polyps with increased risk of cancer involvement. W J Surg Oncol, 3, 8.
  18. Farquhar C, Steiner CA (2002). Hysterectomy rates in the United States. Obstet Gynecol, 99, 229-34.
  19. Indermaur M, Shoup B, Tebes S (2007). The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy. Am J Obstet Gynecol, 196, 40-2.
  20. Lax S (2011). Precursor lesions of endometrial carcinoma: diagnostic approach and molecular pathology. Pathologe, 32, 255-64.
  21. Kendall BS, Ronnett BM, Isacson C, et al (1998). Reproducibility of the diagnosis of endometrial hyperplasia, atypical hyperplasia, and well-differentiated carcinoma. Am J Surg Pathol, 22, 1012-9.
  22. Kurman RJ, Kaminski PF, Norris HJ (1985). The behavior of endometrial hyperplasia. A long term study of 'untreated' hyperplasia in 170 patients. Cancer, 56, 403-12.<403::AID-CNCR2820560233>3.0.CO;2-X
  23. Lambert B, Muteganya D, Lepage Y, et al (1994). Complex hyperplasia of the endometrium: predictive value of curettage vs. hysterectomy specimens. J Reprod Med, 39, 639-42.
  24. Litta P, Bartolucci C, Saccardi C, et al (2013). Atypical endometrial lesions: hysteroscopic resection as an alternative to hysterectomy. Eur J Gynaecol Oncol, 34, 51-3.
  25. Morotti M, Menada MV, Moioli M, et al (2012). Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Gynecol Oncol, 125, 536-40.
  26. Newell S, Overton C (2012). Postmenopausal bleeding should be referred urgently, 256, 13-5.
  27. Quinlivan JA, Petersen RW, Nicklin JL (2001). Accuracy of frozen section for the operative management of endometrial cancer. BJOG, 108, 798-803.
  28. Perri T, Rahimi K, Ramanakumar AV, et al (2010). Are endometrial polyps true cancer precursors? Am J Obstet Gynecol, 203, 232.
  29. Salman MC, Usubutun A, Dogan NU, Yuce K (2009). The accuracy of frozen section analysis at hysterectomy in patients with atypical endometrial hyperplasia. Clin Exp Obstet Gynecol, 36, 31-4.
  30. Valenzuela P, Sanz JM, Keller J (2003). Atypical endometrial hyperplasia: grounds for possiblem is diagnosis of endometrial adenocarcinoma. Gynecol Obstet Invest, 56, 163-7.
  31. Savelli L, De Iaco P, Santini D, et al (2003). Histopathologic features and risk factors for benignity, hyperplasia and cancer in endometrial polyps. Am J Obstet Gynecol, 188, 927-31.
  32. Saygili H (2006). Histopathologic correlation of dilatation and curettage and hysterectomy specimens in patients with postmenopausal bleeding. Eur J Gynaecol Oncol, 27, 182-4.
  33. Stovall TG, Solomon SK, Ling FW (1989). Endometrial sampling prior to hysterectomy. Obstet Gynecol, 73, 405-9.
  34. Vilodre L-CF, Bertat R, Petters R, Reis FM (1997). Cervical polyp as risk factor for hysteroscopically diagnosed endometrial polyps. Gynecol Obstet Invest, 44, 191-5.
  35. Zaino RJ, Kauderer J, Trimble CL, et al (2006). Reproducibilityof the diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer, 106, 804-11.
  36. Surico N, Viale S, Crivello T, Amedeo MC, Porcelli A (1988). How many endometrial cancer may develop from hyperplasia? Panminerva Med, 30, 225-30.

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