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Erschienen in: The Journal of Obstetrics and Gynecology of India 2/2019

11.09.2018 | Original Article

The Impact of Hysteroscopic Tissue Removal Systems on Histopathologic Analysis for Benign and Cancerous Endometrial Pathology: An Ex Vivo Study

verfasst von: Steven R. Lindheim, Kimberly Lincenberg, Michelle A. Wood, Emily Kemner, Megan K. Burns, Daniel L. Hood, Rose Maxwell, Miryoung Lee

Erschienen in: The Journal of Obstetrics and Gynecology of India | Sonderheft 2/2019

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Abstract

Objective

To assess the impact of hysteroscopic tissue removal systems (TRS) on histopathology tissue diagnosis.

Measurements and Methods

This is a paired-comparison ex vivo study in which 23 endometrial sections from hysterectomized uteri (13 benign and 10 hyperplasia/cancer) were analyzed in a simulation laboratory center at a university teaching hospital. After routine tissue processing, a section of endometrium was provided for ex vivo TRS with suture mounting to a uterine model (Polly, Remedy). Morcellated specimens using the Hologic® MyoSure hysteroscopic device were processed for histopathologic analysis by two blinded pathologists (Pa and Pb) and compared to the original specimens’ tissue diagnoses.

Results

Sufficient tissue for evaluation was found in 100% (23/23) of TRS specimens by Pa and 91.3% by Pb. TRS specimen diagnoses were concordant with routine histologic diagnosis 86.9% (20/23, k = 0.76) for Pa and 80.9% (17/21, k = 0.68) for Pb. Sensitivity and specificity were 70%/100% for Pa and 80%/91% for Pb, respectively. The false-positive (overdiagnosed) and false-negative rates (underdiagnosed) were 0%/30% and 9%/20% for Pa and Pb. Both Pa and Pb underdiagnosed most specimens confirmed by routine tissue diagnosis. TRS specimen diagnoses between Pa and Pb were concordant in 76.2% (16/21, k = 0.60).

Conclusion

TRS may adversely impact the ability to provide a histologic tissue analysis. Up to 30% of samples were overdiagnosed and 20% underdiagnosed. If confirmed, pathologists may need to reassess workflows to better offset potential underdiagnosis of malignant specimens as findings may be obscured through TRS. Additionally, surgeons may need to reconsider specimen handling, so highest yield specimens are provided to pathology.
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Metadaten
Titel
The Impact of Hysteroscopic Tissue Removal Systems on Histopathologic Analysis for Benign and Cancerous Endometrial Pathology: An Ex Vivo Study
verfasst von
Steven R. Lindheim
Kimberly Lincenberg
Michelle A. Wood
Emily Kemner
Megan K. Burns
Daniel L. Hood
Rose Maxwell
Miryoung Lee
Publikationsdatum
11.09.2018
Verlag
Springer India
Erschienen in
The Journal of Obstetrics and Gynecology of India / Ausgabe Sonderheft 2/2019
Print ISSN: 0971-9202
Elektronische ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-018-1177-6

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