Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR)

Abstract

Endometrial cancer is one of the most common cancers among women. The International Collaboration on Cancer Reporting (ICCR) developed a standardized endometrial cancer data set in 2011, which provided detailed recommendations for the reporting of resection specimens of these neoplasms. A new data set has been developed, which incorporates the updated 2020 World Health Organization Classification of Female Genital Tumors, the Cancer Genome Atlas (TCGA) molecular classification of endometrial cancers, and other major advances in endometrial cancer reporting, all of which necessitated a major revision of the data set. This updated data set has been produced by a panel of expert pathologists and an expert clinician and has been subject to international open consultation. The data set includes core elements which are unanimously agreed upon as essential for cancer diagnosis, clinical management, staging, or prognosis and noncore elements which are clinically important, but not essential. Explanatory notes are provided for each element. Adoption of this updated data set will result in improvements in endometrial cancer patient care.

Tumour grading: communication is the key

“…Binary (low-grade/high-grade) grading of endometrioid endometrial carcinoma has recently been advocated by International Federation of Obstetrics and Gynecology (FIGO), the International Collaboration on Cancer Reporting and the International Society of Gynecological Pathologists and has been recommended in the updated 2020 WHO classification of endometrial carcinomas 2 8–10. This entails grouping together grade 1 and 2 endometrioid carcinomas in the traditional three-tiered FIGO system as low-grade since these are generally treated in a similar manner.…”

Registry-derived stage (RD-Stage) for capturing cancer stage at diagnosis for endometrial cancer: development and validation of business rules and capacity to report at a national level.

“…Since 2013, the International Collaboration on Cancer Reporting (ICCR) has included cancer stage as a required eld in the endometrial cancer pathology minimum dataset (32). Now in its 4th edition,(33) the Royal College of Pathologists (RCPA) strongly endorses and cross references its protocols to the ICCR dataset (34)…”

The 2023 FIGO Staging System for Endometrial Carcinoma

“…The recently published 2023 International Federation of Gynecology and Obstetrics staging system for endometrial carcinoma (FIGO 2023) 1 incorporated several substantive changes to the previous version (FIGO 2009) 2 . These changes are a reflection of the numerous advances that have been made in the intervening period regarding prognostication and risk stratification, recognition of the myriad variables that place a given patient in a particular risk group, and improvements in the pathologic determination of such variables 3–6 . The comparatively more nuanced risk stratification in FIGO 2023 is evidenced by the fact that it is comprised of 4 primary, 12 secondary, 9 tertiary, and 4 quaternary stages, whereas FIGO 2009 was comprised of 4 primary, 7 secondary, 2 tertiary, and 0 quaternary stages 1,2 (Table 1).…”

“…All available slides and pathology reports were reviewed by the authors, and each case was assigned a FIGO 2009 stage 2 as well as a FIGO 2023 stage 1 . Irrespective of archived classifications, pathologic parameters were assigned using contemporary approaches, as outlined in the Fifth Edition of the World Health Organization (WHO) classification of female genital tract tumors, 3 reports from the 2019 International Society of Gynecological Pathologists (ISGyP) endometrial carcinoma project, 5 and the 2022 recommendations from the International Collaboration on Cancer Reporting (ICCR) 6 . For lymphovascular invasion, a parameter for which there is no consensus on the definition of extensiveness/substantiality, 3,5 we used the WHO definition (≥5 vessels involved) 3 as is required in FIGO 2023 1 .…”

“…2 These changes are a reflection of the numerous advances that have been made in the intervening period regarding prognostication and risk stratification, recognition of the myriad variables that place a given patient in a particular risk group, and improvements in the pathologic determination of such variables. [3][4][5][6] The comparatively more nuanced risk stratification in FIGO 2023 is evidenced by the fact that it is comprised of 4 primary, 12 secondary, 9 tertiary, and 4 quaternary stages, whereas FIGO 2009 was comprised of 4 primary, 7 secondary, 2 tertiary, and 0 quaternary stages 1,2 (Table 1). In addition, FIGO 2023 redefines several stages in FIGO 2009, assigns a tertiary-level stage for cases that meet criteria for simultaneous "lowgrade endometrioid carcinomas limited to the uterus and ovary" (IA3), and incorporates anew such variables as histotype/tumor grade, lymphovascular invasion, and extent of nodal involvement into staging determinations.…”