New challenges in detecting, grading, and staging endometrial cancer after uterine morcellation

Study objective: To evaluate the accuracy in diagnosing endometrial disease after uterine morcellation.

Design: Prospective case series.

Setting: University medical center.

Patients: Five women undergoing hysterectomy without morcellation because of benign indications and 5 women with endometrial cancer.

Interventions: Uterine specimens were obtained from all 10 study patients. The uteri were sent for pathologic analysis, processed, and fixed according to standard protocols. A single investigator then morcellated all 10 uteri. A single pathologist blinded to specimen group reviewed each specimen.

Main results: The pathologist identified endometrial cancer in 4 of 5 specimens of known cancer. The fifth specimen was interpreted as benign despite the presence of grade 1, stage IA endometrial adenocarcinoma. None of the morcellated specimens could be staged.

Conclusion: The increasing use of uterine morcellation will result in new challenges for gynecologic oncologists secondary to difficulty in detection, and accurate grading and staging of endometrial cancer.