Francis Julie A, Weir Michele M, Ettler Helen C, Qiu Feng, Kwon Janice S
Queen's University, Kingston, Ontario, Canada.
Int J Gynecol Cancer. 2009 Apr;19(3):380-4. doi: 10.1111/IGC.0b013e3181a1a657.
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.
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.
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.
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.
对于子宫内膜癌患者是否进行手术分期的决定通常基于术前子宫内膜活检或刮宫术的组织学检查及分级。本研究的主要目的是通过一项基于人群的子宫内膜癌研究，评估术前病理与最终病理之间的一致性，以探讨术前活检在选择手术分期患者时是否为可靠的决定因素。
对1996年至2000年加拿大安大略省的患者进行回顾性队列研究。该研究纳入了所有术前经子宫内膜活检或刮宫术诊断为子宫内膜样腺癌并随后接受确定性手术的女性。排除所有其他组织学类型。根据术前病理比较手术分期率。主要结局指标是术前病理与最终病理之间的一致性，以Spearman相关系数（rho）表示。多变量逻辑回归估计人口统计学变量和分级对我们结局指标的影响。
本研究中有1804例可评估病例。对于术前1级、2级和3级子宫内膜样腺癌，手术分期率分别为9.1%、13.7%和25.6%。与最终病理的一致性率分别为73%、52%和53%。术前病理与最终病理之间仅有中等程度的一致性（rho = 0.52）。根据年龄、年份或医院规模，一致性率无显著差异，但教学医院的一致性率较低。
术前活检在预测子宫内膜癌最终病理方面能力有限，因此，在选择手术分期患者时应考虑其他因素。
