The Tumor Grade Discrepancy in Endometrial Cancer Before and its Clinical Reflection

Öz

Endometriyum Kanserinde Cerrahi Öncesi ve Sonrası Tümör Grade Uyuşmazlığı ve Klinik Yansıması

Öz

ÖZET

AMAÇ: Endometrioid tip endometriyal kanserde histolojik grade, cerrahi planlamada ve prognoz için önemli bir faktördür. Bu çalışmada operasyon öncesi ve sonrası tümör grade’lerinin karşılaştırılması ve farklılıkların cerrahi yönetimdeki olası etkilerini araştırmayı amaçladık.

GEREÇ VE YÖNTEM: Kurumumuzda 2011 ve 2016 yılları arasında endometriyal kanser tanısı ile cerrahi evreleme yapılan hastaların tıbbi kayıtları gözden geçirildi. Bulunan 106 dosyadan 67’si çalışma kriterlerine uygun bulunarak operasyon öncesi örnekleme metodu, operasyon öncesi grade, cerrahi prosedür, postoperatif grade ve nihai patoloji açısından incelendiler. Operasyon öncesi tümör grade’leri, histerektomi örneklerindeki nihai patolojik evrelerle karşılaştırıldı.

BULGULAR: Uygun bulunan 67 olgudan 6 tanesinde (%9) operasyon öncesi örnekleme metodu biyopsi (Pipelle), ve geri kalan 61 tanesinde (%91) ise küretajdı. Operasyon öncesi 18 olgu (%26.8) grade 1 (G1), 44 olgu grade 2 (G2) (%65.7) ve 5 olgu grade 3 (G3) (%7.5) olarak belirlenmişti. Operasyon sonrası nihai grade yüzdeleri ise G1 için %20.9, G2 için %70.1 ve G3 için ise %9’du. Operasyon öncesi ve sonrası grade yüzdelerinde anlamlı bir farklılık bulunmadı. Ancak, 7 hastada (%10.3) potansiyel olarak klinik-anlamlı grade farklılığı oldu: 4 olguda (%5.9) grade düşürme (G3’ten G2 veya G1’e) ve 3 olguda (%4.4) grade yükseltme (G1/G2’den G3’e). İnvazyon derinliği ile operasyon öncesi ve sonrası grade uyumluluğunun ilişkisi olmadığı izlendi.

SONUÇ: Bu çalışma endometrioid endometriyal kanserde operasyon öncesi ve sonrası histolojik grade uyumsuzluk oranı önemli miktarda gibi görünse de istatistikî anlama ulaşmadığını gösterdi. Bu oranların klinik yansıması da, hastalığın yönetimini etkileyen diğer faktörler yanında ihmal edilebilir düzeyde gibi görülmektedir. Grade uyuşmazlıkları, klinik olarak her zaman anlamlı olmadığından, uygulanacak cerrahi girişimin tarzı hastaların risk grubu ve diğer prognostik faktörleri de göz önünde bulundurarak planlanmalıdır.

Before and After Surgery Tumor Grade Discrepancy in  Endometrial Cancer and Its Clinical Reflection

ABSTRACT

AIM: Histologic grading in endometrioid endometrial cancer is an important factor in surgical planning and prognosis. This study aimed to compare preoperative tumor grades to subsequent postoperative grades and explore the discrepancies for their possible effects on surgical management.

MATERIAL AND METHODS: Medical records of patients with endometrial cancer diagnosis who underwent surgical staging at our institution between the years 2011 and 2016 were reviewed. Sixty seven out of 106 charts were found eligible and were evaluated for preoperative sampling method, preoperative grade, surgical procedure, postoperative grade and final pathology. Preoperative tumor grades were compared to final pathology grades of hysterectomy specimens.

RESULTS: Out of 67 eligible cases, preoperative sampling method was endometrial biopsy (Pipelle) in 6 (9 %) and curettage for the rest 61 (91%). Preoperatively, 18 (26.8%) of them were regarded as grade 1 (G1), 44 (65.7%) of them as grade 2 (G2), and 5 (7.5%) of them as grade 3 (G3). Percentages for postoperative final grades were 20.9% for G1, 70.1% for G2, and 9% for G3. No significant difference was found between overall preoperative and postoperative grade results. However, 7 patients had a potentially clinical-significant grade discrepancy (10.3%): 4 downgrades (5.9%) (G3 to G2/ G1) and 3 (4.4%) upgrades (G1/G2 to G3). Depth of invasion (DOI) and preoperative-postoperative grade concordance rates were not found to be related either.

CONCLUSION: This study revealed that preoperative and postoperative histologic grade discrepancy rates may seem important although not reaching statistically significant levels. Clinical reflection of these rates seemed to be negligible due to other factors affecting management.  The extent of the planned surgery must be customized to each patient’s risk category while taking into account of other prognostic markers since the number of significant grade discrepancies alone may not necessarily reflect clinical significance.

Anahtar Kelimeler

• Endometrial cancer,Tumor,Grade,Discrepancy,Surgery

Kaynakça

1. 1) Felix AS, Weissfeld JL, Stone RA, Bowser R, Chivukula M, Edwards RP, Linkov F. Factors associated with Type I and Type II endometrial cancer. Cancer Causes Control. 2010 Nov;21(11):1851-6.
2. 2) Grimes DA.Diagnostic dilation and curettage: a reappraisal. Am J Obstet Gynecol. 1982 Jan 1;142(1):1-6.
3. 3) Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987 Oct 15;60(8 Suppl):2035-41.
4. 4) Aalders JG, Thomas G. Endometrial cancer--revisiting the importance of pelvic and para aortic lymph nodes. Gynecol Oncol. 2007 Jan;104(1):222-31.
5. 5) Case AS, Rocconi RP, Straughn JM Jr, Conner M, Novak L, Wang W, Huh WK. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol. 2006 Dec;108(6):1375-9.
6. 6) Larson DM, Johnson KK, Broste SK, Krawisz BR, Kresl JJ. Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer. Obstet Gynecol. 1995 Jul;86(1):38-42.
7. 7) Soothill PW, Alcock CJ, MacKenzie IZ. Discrepancy between curettage and hysterectomy histology in patients with stage 1 uterine malignancy. Br J Obstet Gynaecol. 1989 Apr;96(4):478-81.
8. 8) Leitao MM Jr, Kehoe S, Barakat RR, Alektiar K, Gattoc LP, Rabbitt C, Chi DS, Soslow RA, Abu-Rustum NR. Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma. Gynecol Oncol. 2009 Apr;113(1):105-8.

9. 9) Helpman L, Kupets R, Covens A, Saad RS, Khalifa MA, Ismiil N, Ghorab Z, Dubé V, Nofech-Mozes S. Br J Cancer.Assessment of endometrial sampling as a predictor of final surgical pathology in endometrial cancer. 2014 Feb 4;110(3):609-15.
10. 10) Göksedef BP, Akbayır O, Corbacıoğlu A, Güraslan H, Sencan F, Erol O, Cetin A. Comparison of preoperative endometrial biopsy grade and final pathologic diagnosis in patients with endometrioid endometrial cancer.Comparison of preoperative endometrial biopsy grade and final pathologic diagnosis in patients with endometrioid endometrial cancer. J Turk Ger Gynecol Assoc. 2012 Jun 1;13(2):106-10.
11. 11) Benedet JL, Bender H, Jones H 3rd, Ngan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000 Aug;70(2):209-62.
12. 12) Keys HMKeys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, Pearlman A, Maiman MA, Bell JG; Gynecologic Oncology Group. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004 Mar;92(3):744-51.
13. 13) Myers AP. New strategies in endometrial cancer: targeting the PI3K/mTOR pathway--the devil is in the details. Clin Cancer Res. 2013 Oct 1;19(19):5264-74.
14. 14) Mackay HJ, Eisenhauer EA, Kamel-Reid S, Tsao M, Clarke B, Karakasis K, Werner HM, Trovik J, Akslen LA, Salvesen HB, Tu D, Oza AM. Molecular determinants of outcome with mammalian target of rapamycin inhibition in endometrial cancer. Cancer. 2014 Feb 15;120(4):603-10.
15. 15) Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer. 2000 Oct 15;89(8):1765-72.
16. 16) Mitchard J, Hirschowitz L Concordance of FIGO grade of endometrial adenocarcinomas in biopsy and hysterectomy specimens. Histopathology. 2003 Apr;42(4):372-8.
17. 17) Mavromatis ID, Antonopoulos CN, Matsoukis IL, Frangos CC, Skalkidou A, Creatsas G, Petridou ET. Validity of intraoperative gross examination of myometrial invasion in patients with endometrial cancer: a meta-analysis. Acta Obstet Gynecol Scand. 2012 Jul;91(7):779-93.
18. 18) Case AS, Rocconi RP, Straughn JM Jr, Conner M, Novak L, Wang W, Huh WK.A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol. 2006 Dec;108(6):1375-9.
19. 19) Fanning J, Tsukada Y, Piver MS.Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol. 1990 Apr;37(1):47-50.