Endometrial adenocarcinoma ‐ presenting pathology is a poor guide to surgical management

Abstract

We aimed to evaluate the correlation between the histological grade of endometrial cancer diagnosed on endometrial biopsy or curettage, with the definitive grade and stage of lesion as determined by surgery and histopathological examination and to make recommendations about the suitability of conservative surgery based on pre-operative determination of the grade of endometrial adenocarcinoma. A retrospective review of all patients with endometrial adenocarcinoma presenting to the Queensland Centre for Gynaecological Cancer from 1 January 1996 to 31 December 1998 was undertaken. Clinical and pathological data was abstracted from medical records and case notes of 460 patients. All histological specimens were prospectively reviewed by a panel consisting of gynaecologic pathologists, gynaecologic oncologists and other doctors involved in the treatment of patients with gynaecological malignancies. The percentage of patients whose management would have been optimised by full surgical staging at the time of initial surgery was calculated. Only 60%, 71%, and 84 % of the patients with a presenting diagnosis of grade 1, 2 and 3 endometrial adenocarcinomas respectively had this confirmed on final histopathology. Furthermore, using established criteria, 30%, 46% and 100% of patients presenting with grade 1, 2 and 3 endometrial adenocarcinoma required full surgical staging at the time of their primary surgery There is poor correlation between the pre-operative grade of endometrial cancer and the grade as determined on analysis of the resected uterus. The correlation is poorest with grade 1 endometrial adenocarcinoma, where strongest consideration is given to conservative surgery and the avoidance of subspecialty referral. There is a strong argument that all patients with a diagnosis of endometrial cancer made on endometrial biopsy or curettage, regardless of grade of malignancy, should be offered surgery where the option to perform concurrent comprehensive surgical staging is available.

Assessment of endometrial sampling as a predictor of final surgical pathology in endometrial cancer.

“…Our data generally corroborates findings in previous studies, quoting rates of 16-40% updgrading from preoperatively diagnosed G1-2 endometrioid adenocarcinomas (Petersen et al, 2000;Frumovitz et al, 2004;Leitao et al, 2008;Neubauer et al, 2009;Leitao et al, 2010). These grade shifts on final pathological assessments may be partly explained by the volume of tissue available for examination, and in fact have been shown to be less frequent when preoperative sampling is done by D&C as compared with office aspiration biopsy (Leitao et al, 2009).…”

Comparison of endometrial biopsy and postoperative hysterectomy specimen findings in patients with atypical endometrial hyperplasia and endometrial cancer

“…The differences between the preoperative histology and the surgical pathology may also result from the lack of representative endometrial samples. Histology findings reported in a number of studies indicate underestimation rather than overestimation of the histological grade of the tumour [12][13][14][15]. One explanation is that pathologists may be wary of overdiagnosing cancer with the resulting burden of extensive surgery and its potential complications for the patient.…”

“…According to the literature, the agreement levels between the endometrial sampling diagnosis and the final surgical pathology range from 30 to 60% [10,11,13,15,21]. The highest level of discrepancy is observed for histological grading [10,11,13,15,21].…”

“…The final surgical pathology confirms the initial diagnosis least frequently in the case of well-differentiated cancers. The concordance level increases with the degree of cancer aggressiveness [10][11][12][13][14][15].…”

“…In cases of a malignant tumour of the uterine corpus, pathological findings in the hysterectomy specimens usually confirm the preoperative diagnosis. Any discrepancies usually concern the histological type and grade of endometrial cancer [10][11][12][13][14][15].…”