Assessment of endometrial sampling as a predictor of final surgical pathology in endometrial cancer
Assessment of endometrial sampling as a predictor of final surgical pathology in endometrial cancer
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DOI：
10.1038/bjc.2013.766
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发表时间：
2014-02-04
影响因子：
8.8
通讯作者：
Nofech-Mozes, S.
中科院分区：
文献类型：
--
作者：
Helpman, L.;Kupets, R.;Nofech-Mozes, S.
背景：子宫内膜癌的组织学和分级是疾病结局和淋巴结受累可能性的重要预测因素。然而，在大多数中心，手术分期的决定是基于术前活检。本研究的目的是评估术前组织学和子宫切除术标本在子宫内膜cancer.Methods的一致性：患者治疗子宫内膜癌在10年期间，在第三级癌症中心确定从一个前瞻性收集的病理数据库。对所有病理学报告进行审查，以确认原始采样或活检标本的集中报告;排除活检未由治疗中心的专门妇科病理学家审查的患者。收集手术病理学资料，包括组织学、分级、子宫肌层浸润深度、宫颈基质受累和淋巴血管间隙浸润（LVSI）以及术前组织学和分级。术前和最后的肿瘤细胞类型和等级进行了比较，其他高危功能的分布进行了analysed.Results：共1329例连续患者被确定，653例患者有一个集中审查上皮性子宫内膜癌对他们原来的活检，并包括在这项研究中。在255例活检结果为1级（G1）腺癌的患者中，45例（18%）在最终病理学检查中升级为2级（G2），6例（2%）升级为3级（G3），5例（2%）被解读为非类腺瘤高级别组织学。总体而言，在活检时被归类为G1类胶质瘤的255例肿瘤中，74例（29%）被发现为低级别（G1-2）肿瘤伴深肌层浸润，或在最终手术病理学上被重新归类为高级别癌症（G3或非类胶质瘤组织学）。尽管有这些变化，我们计算，省略手术分期术前诊断G1类子宫内膜癌没有深肌层浸润将导致在失踪的淋巴结参与只有1%的cases.Conclusions：术前子宫内膜采样只是一个温和的预测子宫内膜癌的手术病理特征，并可能低估疾病的传播和复发的风险。尽管术后与术前的组织学评估经常发生变化，但采用选择性分期策略的预测淋巴结转移漏诊率仍然很低。
Background: The histology and grade of endometrial cancer are important predictors of disease outcome and of the likelihood of nodal involvement. In most centres, however, surgical staging decisions are based on a preoperative biopsy. The objective of this study was to assess the concordance between the preoperative histology and that of the hysterectomy specimen in endometrial cancer.Methods: Patients treated for endometrial cancer during a 10-year period at a tertiary cancer centre were identified from a prospectively collected pathological database. All pathology reports were reviewed to confirm centralised reporting of the original sampling or biopsy specimens; patients whose biopsies were not reviewed by a dedicated gynaecological pathologist at the treating centre were excluded. Surgical pathology data including histology, grade, depth of myometrial invasion, cervical stromal involvement and lymphovascular space invasion (LVSI) as well as preoperative histology and grade were collected. Preoperative and final tumour cell type and grade were compared and the distribution of other high-risk features was analysed.Results: A total of 1329 consecutive patients were identified; 653 patients had a centrally reviewed epithelial endometrial cancer on their original biopsy, and are included in this study. Of 255 patients whose biopsies were read as grade 1 (G1) adenocarcinoma, 45 (18%) were upgraded to grade 2 (G2) on final pathology, 6 (2%) were upgraded to grade 3 (G3) and 5 (2%) were read as a nonendometrioid high-grade histology. Overall, of 255 tumours classified as G1 endometrioid cancers on biopsy, 74 (29%) were either found to be low-grade (G1-2) tumours with deep myometrial invasion, or were reclassified as high-grade cancers (G3 or nonendometrioid histologies) on final surgical pathology. Despite these shifts, we calculate that omitting surgical staging in preoperatively diagnosed G1 endometrioid cancers without deep myometrial invasion would result in missing nodal involvement in only 1% of cases.Conclusions: Preoperative endometrial sampling is only a modest predictor of surgical pathology features in endometrial cancer and may underestimate the risk of disease spread and recurrence. In spite of frequent shifts in postoperative vs preoperative histological assessment, the predicted rate of missed nodal metastases with a selective staging policy remains low.