RESUMEN
INTRODUCTION: The decision to offer surgical staging in endometrial cancer is often based on preoperative histology and grade from endometrial biopsy or dilatation and curettage. The primary objective of this study was to evaluate the concordance between preoperative and final pathology from a population-based study of endometrial cancer to address whether preoperative biopsy is a reliable determinant in selecting patients for surgical staging. METHODS: Retrospective cohort study in Ontario, Canada, from 1996 to 2000. The study included all women with a preoperative diagnosis of endometrioid adenocarcinoma on endometrial biopsy or dilatation and curettage, followed by definitive surgery. All other histological types were excluded. Surgical staging rates were compared according to preoperative pathology. Primary outcome measure was the concordance between preoperative and final pathology, expressed as a Spearman correlation coefficient (rho). A multivariable logistic regression estimated the effects of demographic variables and grade on our outcome measure. RESULTS: There were 1804 evaluable cases in this study. For preoperative grades 1, 2, and 3 endometrioid adenocarcinoma, surgical staging rates were 9.1%, 13.7%, and 25.6%, respectively. Concordance rates with final pathology were 73%, 52%, and 53%, respectively. There was only moderate concordance between preoperative and final pathology (rho = 0.52). There was no significant difference in concordance rates according to age, year, or hospital volume, but lower concordance rates among teaching hospitals. CONCLUSION: Preoperative biopsy has only a moderate ability to predict final pathology in endometrial cancer, and therefore, additional factors should be considered in selecting patients for a surgical staging procedure.
Asunto(s)
Carcinoma Endometrioide/patología , Hiperplasia Endometrial/patología , Neoplasias Endometriales/patología , Anciano , Carcinoma Endometrioide/cirugía , Estudios de Cohortes , Hiperplasia Endometrial/cirugía , Neoplasias Endometriales/cirugía , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Selección de Paciente , Cuidados Preoperatorios , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: Discrepancies may exist between an original pathology report and formal pathology review, with subsequent implications for treatment. We conducted a study of pathology review in endometrial cancer from a population-based study to identify areas of discrepancy and effect on treatment. METHODS: This was a retrospective cohort study in Ontario, Canada from 1996 to 2000. We identified hysterectomy cases from patients with endometrial cancer that were subject to formal pathology review by a gynecologic pathologist at one of six tertiary care centers. Sarcomas and other rare histologic subtypes with fewer than five cases were excluded. We evaluated discrepancy between original pathology and review by demographics, stage, grade, and risk group. Four risk groups were defined: 1) low (stage I), 2) intermediate (stage I and II), 3) high-risk (stage I and II), and 4) advanced stage (all stage III and IV). Reclassification from one risk group to another upon pathology review represented a potential change in treatment. Factors associated with significant discrepancy were identified by a multivariable logistic regression model. RESULTS: Formal pathology review was available on 450 cases. There were no differences by age, year, or hospital type. The overall discrepancy rate was 42.7% (95% confidence interval 38.2-47.3%). The intermediate-risk group had the highest rate of reclassification into another group (33.1%). The most significant rates of discrepancy were associated with endometrioid grades 2 and 3 tumors and stage IIA disease (39.8%, 50.9%, and 79.6%, respectively). CONCLUSION: There was significant discrepancy between original pathology and formal review in endometrial cancer, with implications for guidelines on pathology review at a population level. LEVEL OF EVIDENCE: III