Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology in early-stage endometrial cancer

Abstract

Objective To evaluate the concordance between preoperative European Society for Medical Oncology (ESMO)-European Society of Gynaecological Oncology (ESGO)-European SocieTy for Radiotherapy and Oncology (ESTRO) risk classification in early-stage endometrial cancer (EC) assessed by biopsy and magnetic resonance imaging (MRI) with this classification based on histology of surgical specimen. Methods This bicentric retrospective study included women diagnosed with early-stage EC (≤stage II) who had a complete preoperative assessment and underwent a surgical management from January 2011 to December 2018. Patients were preoperatively classified into 3 degrees of risk of lymph node (LN) involvement based on biopsy and MRI. Based on final histological report, patients were re-classified using the preoperative classification. Concordance between the preoperative assessment and definitive histology was calculated with weighted Cohen's kappa coefficient. Results A total of 333 women were included and kappa coefficient of preoperative risk classification was 0.49. The risk was underestimated and overestimated in 37% and 10% of cases, respectively. Twenty-nine percent of patients had an incomplete LN staging according to the degree of risk of re-classification. The observed discordance in the risk classification was attributed to MRI in 75% of cases, to biopsy in 18% and in 7% to both (p<0.001). Kappa coefficient for concordance was 0.25 for MRI and 0.73 for biopsy. Conclusion Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology is weak. Given that the risk was underestimated in the majority of patients wrongly classified, sentinel LN procedure instead of no LN dissection could be an option offered to preoperative low-risk patients to decrease the indication of second surgery for re-staging and/or to avoid toxicity of adjuvant radiotherapy.

Hybrid PET/MRI in Staging Endometrial Cancer

“…Surgical intervention is commonly planned based on information provided by preoperative biopsy (histotype, tumor grade) and morphological imaging derived data (such as myometrial invasion and lymph node involvement). However, basal histotype may be elusive due to intrinsic tumor heterogeneity which may not be represented in the biopsy sampled tissue [14,15]. Current guidelines also indicate the best adjuvant therapies based on precisely de ned risk groups which derive from histopathology [6,7].…”

Clinical Value and Molecular Function of Circulating MicroRNAs in Endometrial Cancer Regulation: A Systematic Review

“…Recently, a molecular classification has been added to this management [ 39 ]. However, it is known that there is a discrepancy of risk groups between the pre-operative and the final classification, with a risk of over-treatment in 10% of cases and under-treatment in 37% of cases [ 40 ]. MiRs can help in pre-operative management by being associated with certain prognostic factors such as FIGO stage, LNM, LVSI, and survival rates.…”

Assessing the role of low volume disease in endometrial cancer

“…POLE mut patients are characterized by a good prognosis regardless of conventional prognostic factors; while p53 abn patients are characterized by a worse prognosis and deserve to receive adjuvant therapy even in the early stage of disease, regardless of nodal involvement and extra-uterine spread [2]. Potentially, the adoption of a molecular-integrated risk profile to guide the need for adjuvant therapy is of paramount importance for tailoring surgical [33] and adjuvant treatments, especially in patients with low volume disease [34]. In experienced hands, molecular/genomic profiling might represent a useful tool to improve the accuracy of conventional pathological evaluation.…”