Doctors don't agree on diagnosis of uterine cancer

A Gynecologic Oncology Group (GOG) study, headed by Cornelia Trimble, M.D. of the Johns Hopkins Kimmel Cancer Center, has revealed that pathologists who evaluate uterine biopsies disagree 60 percent of the time on whether the specimens contain cancerous cells. The authors, expected to present their findings at the 40th annual American Society of Clinical Oncology, say new standards for collecting and classifying biopsies are needed to improve the accuracy of diagnoses.

Cancer of the uterus is the most common cancer affecting the female reproductive tract in the United States. It is diagnosed from biopsied uterine or endometrial cells that indicate the presence of cancer or precancerous lesions called atypical endometrial hyperplasia (AEH).

"This study brought into sharp focus the fact that it is very difficult to make an accurate diagnosis from uterine biopsies," says Trimble, associate professor at the Johns Hopkins Kimmel Cancer Center. " Yet, women receiving a diagnosis of AEH face complete removal of their wombs through hysterectomy. So, we suggest these patients get a second opinion from a pathologist who specializes in gynecology ."

Trimble and colleagues in the national cooperative GOG set out to get a baseline estimate of the percentage of actual cancers found in hysterectomy samples of women diagnosed with AEH biopsies. The baseline, reported to be anywhere from 17 to 52 percent, would provide information needed to design studies to find non-surgical treatments for AEH that preserve fertility in young patients or eliminate the need for surgery in women with diabetes, hypertension or other complicating disorders. But, after reviewing biopsies from 289 patients classified as AEH, they were surprised to find a high degree of disagreement with the initial diagnosis of most of the biopsies.

In their review, the GOG investigators downgraded the biopsy diagnoses to "less than AEH," which denotes a

Contact: Vanessa Wasta
Johns Hopkins Medical Institutions

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