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

  • Steven R. LindheimEmail author
  • Kimberly Lincenberg
  • Michelle A. Wood
  • Emily Kemner
  • Megan K. Burns
  • Daniel L. Hood
  • Rose Maxwell
  • Miryoung Lee
Original Article



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.


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).


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.


Abnormal uterine bleeding Uterine polyps Malignancy Hysteroscopic intrauterine morcellation 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest and nothing to disclose. Hologic® supported this study by providing disposable MyoSure hysteroscopic tissue removal systems and uterine model (Polly, Remedy©).


The authors have no financial disclosure to make.

Research Involves

Human subjects.

Informed Consent

Informed consent was obtained from all recruited subjects.


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Copyright information

© Federation of Obstetric & Gynecological Societies of India 2018

Authors and Affiliations

  • Steven R. Lindheim
    • 1
    Email author
  • Kimberly Lincenberg
    • 1
  • Michelle A. Wood
    • 3
  • Emily Kemner
    • 1
    • 2
  • Megan K. Burns
    • 3
  • Daniel L. Hood
    • 4
  • Rose Maxwell
    • 1
  • Miryoung Lee
    • 5
  1. 1.Division of Reproductive Endocrine Infertility, Department of Obstetrics and Gynecology, Boonshoft School of MedicineWright State UniversityDaytonUSA
  2. 2.Department of Obstetrics and Gynecology, Wright-Patterson Medical CenterWright-Patterson Air Force BaseDaytonUSA
  3. 3.Camran Nezhat InstitutePalo AltoUSA
  4. 4.Department of PathologyMiami Valley HospitalDaytonUSA
  5. 5.Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public HealthThe University of Texas Health Science Center at HoustonBrownsvilleUSA

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