Assessment of Preoperative Endometrial Histopathological Sampling as a Predictor of Final Surgical Pathology in Endometrial Cancer

Abstract

Objective To evaluate the agreement between the histopathological diagnoses of preoperative endometrial samples and surgical specimens and correlate the agreement between the diagnoses with the impact on surgical management and the survival of patients with endometrial adenocarcinomas. Methods Sixty-two patients treated for endometrial cancer at a university hospital from 2002 to 2011 were retrospectively evaluated. The histopathological findings of preoperative endometrial samples and of surgical specimens were analyzed. The patients were subjected to hysterectomy as well as adjuvant treatment, if necessary, and clinical follow-up, according to the institutional protocol. Lesions were classified as endometrioid tumor (type 1) grades 1, 2, or 3 or non-endometrioid carcinoma (type 2). Results The agreement between the histopathological diagnoses based on preoperative endometrial samples and surgical specimens was fair (Kappa: 0.40; p < 0.001). However, the agreement was very significant for tumor type and grade, in which a higher concordance occurred at a higher grade. The percentage of patients with lymph nodes affected was 19.2%. Although most patients presenting with disease remission or cure were in the early stages (90.5%), there were no significant differences between those patients who had a misdiagnosis (11/16; 68.8%) and those who had a correct diagnosis (25/33; 75.8%) based on preoperative endometrial sampling (p = 0.605). Conclusion Our findings corroborate the literature and confirm the under staging of preoperative endometrial samples based on histopathological assessment, especially for lower grade endometrial tumors. We suggest that the preoperative diagnosis should be complemented with other methods to better plan the surgical management strategy.

Nomograms of Combining Apparent Diffusion Coefficient Value and Radiomics for Preoperative Risk Evaluation in Endometrial Carcinoma

“…Similar results were found in the research of Piotto et al. ( 28 ), which showed that the general consistency between preoperative endometrial specimens and surgical specimens was 46.8% (kappa: 0.279, P < 0.001), and the agreement varied significantly by tumor type and grade (endometrioid adenocarcinoma grade 1, 64.0%; and grade 2, 50.0%; and non-endometrioid adenocarcinoma, 81.8%). A meta-analysis involving 45 studies found that the pooled agreement rate between preoperative endometrial sampling and final diagnosis for tumor grade was 0.67 (95% CI, 0.60–0.75), and Cohen’s k was 0.45 (95% CI 0.34–0.55).…”

“…The study of Batista et al (27) showed that the overall concordance of preoperative histological examination for final surgical pathology grading in EC was 60.75% to 67.24% for G1, 43.75% for G2, and 40% for G3 tumors, which indicated that preoperative endometrial sampling was only a modest predictor of postoperative histological grading. Similar results were found in the research of Piotto et al (28), which showed that the general consistency between preoperative endometrial specimens and surgical specimens was 46.8% (kappa: 0.279, P <0.001), and the agreement varied significantly by tumor type and grade (endometrioid adenocarcinoma grade 1, 64.0%; and grade 2, 50.0%; and non-endometrioid adenocarcinoma, 81.8%). A metaanalysis involving 45 studies found that the pooled agreement rate between preoperative endometrial sampling and final diagnosis for tumor grade was 0.67 (95% CI, 0.60-0.75), and Cohen's k was 0.45 (95% CI 0.34-0.55).…”

Análise de achados histeroscópicos em mulheres com espessamento endometrial à ultrassonografia transvaginal em um hospital público em Minas Gerais: um estudo observacional / Analysis of hysteroscopic findings in women with endometrial thickness seen in transvaginal ultrasonography seen in a public hospital in Minas Gerais: an observational study

“…O câncer de endométrio é a segunda doença maligna ginecológica mais comum, sendo a sexta causa mais comum de morte por neoplasias no sexo feminino 1 . No Brasil, 6540 novos casos foram estimados para o ano de 2020 2 .…”

“…Quando diagnosticado em estágio inicial, esse tipo de neoplasia tem uma sobrevida após 5 anos de 90%, mas em caso de diagnóstico tardio, essa taxa pode cair para até 30%, o que justifica a importância do rastreamento e diagnóstico precoce, tanto do câncer de endométrio em si quanto das suas lesões pré-malignas, como hiperplasia com atipia 1,4 . Dentre a propedêutica disponível para o rastreamento de lesões ginecológicas, a ultrassonografia transvaginal (USTV) é um exame acessível, não invasivo e de boa acurácia e, por isso, frequentemente solicitado por ginecologistas e obstetras.…”

“…Graças à sua alta sensibilidade (91%) e especificidade (98%) diagnóstica, o exame permite a magnificação e fácil identificação das lesões endometriais e, ainda, possibilita a realização de biópsia -aspecto favorável para o diagnóstico precoce de diversas doenças 12 . O diagnóstico exato permite o tratamento adequado e melhora o prognóstico da paciente, garantindo também maior qualidade de vida, e quanto antes ele for dado, menores os custos e gastos para a paciente e sistema de saúde 1,12 .…”