Relationship Of Preoperative Biopsy Results With Postoperative Histopathological Grade In Endometrioid Type Endometrium Cancer

Abstract

Objective: To assess the concordance between preoperative endometrial biopsy and final postoperative histopathological findings in patients with endometrioid-type endometrial cancer, and to identify factors associated with diagnostic discrepancies. Materials and Methods: This retrospective study included 134 patients who underwent surgery between 2005 and 2018 following a preoperative diagnosis of endometrioid-type endometrial cancer at a tertiary center. Demographic, clinical, and histopathological data were reviewed. Concordance between preoperative biopsy and final pathology was evaluated using Cohen’s kappa coefficient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated. Results: A statistically significant correlation was observed between preoperative and final tumor grades (p < 0.001). In 35.8% of patients (n = 48), the final pathology revealed a higher grade than the initial biopsy. Grade 3 tumors demonstrated the highest diagnostic accuracy (89.5%), while Grades 1 and 2 showed an overall accuracy of 66.0%. Tumor size greater than 2 cm and lymph node metastasis were significantly associated with grade upgrading (p = 0.014 and p = 0.004, respectively). Conclusion: Preoperative biopsy alone may not be sufficient for accurate risk stratification in patients with endometrial cancer. Tumor upgrading was significantly associated with adverse prognostic indicators such as larger tumor size and nodal involvement. A multimodal diagnostic approach is recommended, particularly in cases initially classified as low-grade.

Keywords

• Endometrial Cancer
• Biopsy
• Histopathology
• Grade Concordance
• Lymph Node Involvement

Endometrioid Endometrium Kanserlerinde Preoperatif Biyopsi Sonucunun Postoperatif Histopatolojik Grade ile İlişkisi

Öz

Amaç: Preoperatif endometrial biyopsi ile postoperatif kesin histopatolojik bulgular arasındaki uyumu değerlendirmek ve endometrioid tip endometrial kanserli hastalarda tanısal uyumsuzluklarla ilişkili faktörleri belirlemek. Gereç ve Yöntemler: Bu retrospektif çalışmaya, 2005–2018 yılları arasında üçüncü basamak bir merkezde preoperatif endometrioid tip endometrium kanseri tanısıyla cerrahi uygulanan 134 hasta dâhil edildi. Hastalara ait demografik, klinik ve histopatolojik veriler incelendi. Preoperatif biyopsi ile kesin patoloji arasındaki uyum Cohen’in kappa katsayısı ile değerlendirildi. Ayrıca duyarlılık, özgüllük, pozitif prediktif değer (PPV) ve negatif prediktif değer (NPV) hesaplandı. Bulgular: Preoperatif ve kesin tümör grade’leri arasında istatistiksel olarak anlamlı bir ilişki saptandı (p < 0.001). Hastaların %35.8’inde (n = 48), kesin patoloji raporunda biyopsi ile kıyaslandığında daha yüksek bir tümör grade’i belirlendi. Grade 3 tümörlerde tanısal doğruluk oranı %89.5 ile en yüksek düzeydeydi; Grade 1 ve 2’de ise genel doğruluk oranı %66.0 idi. Tümör çapının 2 cm’den büyük olması ve lenf nodu metastazı, grade artışı ile anlamlı düzeyde ilişkiliydi (sırasıyla p = 0.014 ve p = 0.004). Sonuç: Preoperatif biyopsi tek başına endometrial kanserli hastalarda doğru risk sınıflaması için yeterli olmayabilir. Tümör grade artışı, daha büyük tümör boyutu ve lenf nodu tutulumu gibi olumsuz prognostik faktörlerle anlamlı ilişki göstermiştir. Özellikle düşük grade olarak sınıflandırılan olgularda, çok yönlü tanısal yaklaşım önerilmektedir.

Anahtar Kelimeler

• Endometrial Kanser
• Biyopsi
• Histopatoloji
• Grade Uyumu
• Lenf Nodu Tutulumu

Kaynakça

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