Accuracy of preoperative endometrial sampling diagnosis for predicting the final pathology grading in uterine endometrioid carcinoma

Batista, Thales Paulo; Cavalcanti, Camilla L C; Tejo, A.A.G.; Bezerra, Artur Lício Rocha

doi:10.1016/j.ejso.2016.03.009

Cited by 50 publications

(33 citation statements)

References 25 publications

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“…Kappa statistic of 0.86 (95%CI) was consistent with a “near perfect” level of agreement [19], fulfilling our goal of improvement over previously published data showing poor concordance between pre- and post-operative samples, when assessed for the conventional histopathological parameters of grade and histotype [20-22]. Also shown are the concordance metrics within each molecular subgroup (Table 2c.).…”

Section: Resultssupporting

confidence: 81%

“…MMR and p53 proteins have relatively short half-lives and their detection is therefore dependent on prompt fixation, as is also true for detection of estrogen receptor and HER2 in breast cancer. There have been few studies looking at traditional pathological parameters and molecular features in endometrial biopsies [20-22, 29], but to our knowledge we are the first group to explore molecular classification in these specimens. Our results provide indirect evidence that addresses one of the questions raised by the aforementioned studies demonstrating only moderate agreement of histotype and grade assignment in diagnostic versus hysterectomy specimens i.e.…”

Section: Discussionmentioning

confidence: 99%

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Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment

Talhouk

Hoang

McConechy

et al. 2016

Gynecologic Oncology

158

118

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Objective Categorization and risk stratification of endometrial carcinomas is inadequate; histomorphologic assessment shows considerable interobserver variability, and risk of metastases and recurrence can only be derived after surgical staging. We have developed a Proactive Molecular Risk classification tool for Endometrial cancers (ProMisE) that identifies four distinct prognostic subgroups. Our objective was to assess whether molecular classification could be performed on diagnostic endometrial specimens obtained prior to surgical staging and its concordance with molecular classification performed on the subsequent hysterectomy specimen. Methods Sequencing of tumors for exonuclease domain mutations (EDMs) in POLE and immunohistochemistry for mismatch repair (MMR) proteins and p53 were applied to both pre- and post-staging archival specimens from 60 individuals to identify four molecular subgroups: MMR-D, POLE EDM, p53 wild type, p53 abn(abnormal). Three gynecologic subspecialty pathologists assigned histotype and grade to a subset of samples. Concordance of molecular and clinicopathologic subgroup assignments were determined, comparing biopsy/curetting to hysterectomy specimens. Results Complete molecular and pathologic categorization was achieved in 57 cases. Concordance metrics for pre- vs. post-staging endometrial samples categorized by ProMisE were highly favorable; average per ProMisE class sensitivity(0.9), specificity(0.96), PPV(0.9), NPV(0.96) and kappa statistic 0.86(95%CI, 0.72-0.93), indicating excellent agreement. We observed the highest level of concordance for ‘p53 abn’ tumors, the group associated with the worst prognosis. In contrast, grade and histotype assignment from original pathology reports pre- vs. post-staging showed only moderate levels of agreement (kappa=0.55 and 0.44 respectively); even with subspecialty pathology review only moderate levels of agreement were observed. Conclusion Molecular classification can be achieved on diagnostic endometrial samples and accurately predicts the molecular features in the final hysterectomy specimens, demonstrating concordance superior to grade and histotype . This biologically relevant information, available at initial diagnosis, has the potential to inform management (surgery, adjuvant therapy) from the earliest time point in cancer care.

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Section: Resultssupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment

Talhouk

Hoang

McConechy

et al. 2016

Gynecologic Oncology

158

118

View full text Add to dashboard Cite

show abstract

“…In the present study, the analysis of the concordance between preoperative endometrial sampling and postoperative final pathology assessment was interpreted with the Cohen's Kappa statistic, taking the numerical superiority of grade 1 lesions into consideration. The Kappa statistic, which was evaluated for all grades, revealed a minimal concordance between preoperative and postoperative histological grades (K-value = 0.39, p < 0.01), in agreement with a previous study which similarly assessed grade concordance with the Kappa statistic (minimal concordance; K-value = 0.221) [14].…”

Section: Discussionsupporting

confidence: 90%

“…Likewise, Ca 19-9 levels were measured in 169 (51.2%) patients and 36 of them (21.3%) had levels higher than 39 U/ml, though there was no significant correlation with grade concordance (p = 0.774). Batista et al recommended the use of elevated Ca 125 levels for the decision on lymphadenectomy in patients with grade 1 or 2 disease [14]. In the present study, 154 patients were tested for Ca 125 and underwent lymphadenectomy.…”

Section: Discussionmentioning

confidence: 85%

Concordance of preoperative and postoperative histological grades in endometrioid type endometrial cancer

2020

EJGO

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Purpose of Investigation: To investigate concordance between grades determined by endometrial sampling and final pathology, and factors affecting this concordance, in endometrioid type endometrial cancer. Materials and Methods: In this retrospective study, 330 endometrioid type endometrial cancer patients were enrolled. For evaluating the concordance between histological grades in preoperative and postoperative pathology reports, Kappa statistic and comparative analyses were performed. Results: In 230 of 330 (69.7%) patients, the endometrial sampling-determined grade was in concordance with the final histological grade. The concordance was minimal according to the Kappa statistic in all patients (K = 0.390; 95% confidence interval = 0.666-0.047; p < 0.01). There was no significant correlation between diabetes mellitus, cancer antigen (Ca) 125, and Ca 19-9 status, and grade concordance (p = 0.86, p = 0.715, p = 0.774, respectively). Conclusion: In endometrioid type endometrial cancer, concordance between preoperative and postoperative histological grades was minimal. Therefore, histological grading by preoperative sampling alone is insufficient for decisionmaking in pelvic lymphadenectomy.

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“…In contrast to the high inter-observer agreement in histological subtype assignment documented for epithelial ovarian cancers [1,2], major disagreement or complete lack of consensus of histotype assignment has been observed in approximately one-third of high-grade EC cases, with substantial immunophenotype diversity noted [3][4][5][6][7]. Disagreement in grade assignment, both between pathologists and between diagnostic endometrial specimens and final hysterectomy specimens, is also common [8][9][10]. Histology and grade, in addition to stage (determined after surgical staging procedures), form the basis for risk group stratification in EC [11][12][13][14], directing which women should receive adjuvant therapy [radiation (vaginal or external beam), chemotherapy or both] [11,[14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

The rise of a novel classification system for endometrial carcinoma; integration of molecular subclasses

McAlpine

León‐Castillo

Bosse

2018

The Journal of Pathology

174

134

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Endometrial cancer is a clinically heterogeneous disease and it is becoming increasingly clear that this heterogeneity may be a function of the diversity of the underlying molecular alterations. Recent large-scale genomic studies have revealed that endometrial cancer can be divided into at least four distinct molecular subtypes, with well-described underlying genomic aberrations. These subtypes can be reliably delineated and carry significant prognostic as well as predictive information; embracing and incorporating them into clinical practice is thus attractive. The road towards the integration of molecular features into current classification systems is not without obstacles. Collaborative studies engaging research teams from across the world are working to define pragmatic assays, improve risk stratification systems by combining molecular features and traditional clinicopathological parameters, and determine how molecular classification can be optimally utilized to direct patient care. Pathologists and clinicians caring for women with endometrial cancer need to engage with and understand the possibilities and limitations of this new approach, because integration of molecular classification of endometrial cancers is anticipated to become an essential part of gynaecological pathology practice. This review will describe the challenges in current systems of endometrial carcinoma classification, the evolution of new molecular technologies that define prognostically distinct molecular subtypes, and potential applications of molecular classification as a step towards precision medicine and refining care for individuals with the most common gynaecological cancer in the developed world.

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Accuracy of preoperative endometrial sampling diagnosis for predicting the final pathology grading in uterine endometrioid carcinoma

Cited by 50 publications

References 25 publications

Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment

Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment

Concordance of preoperative and postoperative histological grades in endometrioid type endometrial cancer

The rise of a novel classification system for endometrial carcinoma; integration of molecular subclasses

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