Corr Bradley R, Carrubba Aakriti, Sheeder Jeanelle, Cheng Georgina, Guntupalli Saketh R
Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO.
Int J Gynecol Cancer. 2017 Feb;27(2):297-301. doi: 10.1097/IGC.0000000000000866.
Preoperative histology is a major component in the perioperative selective lymph node (LN) dissection decision process. Discrepancy between preoperative endometrial sampling and final specimen histopathology is generally accepted. The goals of this project are to determine if discrepancy of histopathology is associated with alteration of adjuvant treatment or outcome.
We performed a retrospective cross-sectional analysis of all patients undergoing surgery for endometrial cancer at a single institution from 2010 to 2014. All patients had preoperative endometrial sampling. Histopathology discrepancy was evaluated for potential in variation of perioperative LN dissection. Criteria for not performing LN dissection was defined as preoperative endometrioid histology, grade 1 or 2 lesion, myometrial invasion of 50% or less, and primary tumor diameter 2 cm or less.
A total of 352 patients were identified; 44 were excluded because of no preoperative pathology or no residual disease on final pathology. Discrepancy of histopathology was noted in 64/308 (20.8%; 95% confidence interval [CI], 16.2%-25.3%) patients. Preoperative endometrioid histology was noted in 272 patients, and 17/272 (6.3%; 95% CI, 3.4%-9.1%) had preoperative sampling reviewed as a grade 1 or 2 endometrioid lesion and final specimen was upgraded to grade 3. Downstaging occurred in 3/272 (1.1%; 95% CI, 0%-2.3%) patients with preoperative grade 3 lesion and final specimen demonstrated grade 1 or 2 disease. All 3 patients' primary tumor diameter was greater than 2 cm and therefore received LN dissection. Histopathological discrepancy that would alter perioperative LN dissection decision based on the aforementioned criteria occurred in 2/272 (0.7%; 95% CI, 0%-1.8%).
Despite a 20% discrepancy of preoperative and postoperative histopathology, discrepancy that would alter a perioperative decision for LN dissection occurs in only 0.7% of cases in this retrospective single-institutional experience. Myometrial invasion and tumor size may be more influential than histology in LN selection criteria.
术前组织学检查是围手术期选择性淋巴结清扫决策过程的重要组成部分。术前子宫内膜取样与最终标本组织病理学之间的差异已被普遍认可。本项目的目的是确定组织病理学差异是否与辅助治疗的改变或预后相关。
我们对2010年至2014年在一家机构接受子宫内膜癌手术的所有患者进行了回顾性横断面分析。所有患者均有术前子宫内膜取样。评估组织病理学差异对围手术期淋巴结清扫变化的可能性。不进行淋巴结清扫的标准定义为术前子宫内膜样组织学、1级或2级病变、肌层浸润50%或更少，以及原发肿瘤直径2 cm或更小。
共确定352例患者；44例因无术前病理或最终病理无残留疾病而被排除。64/308（20.8%；95%置信区间[CI]，16.2%-25.3%）例患者存在组织病理学差异。272例患者术前为子宫内膜样组织学，其中17/272（6.3%；95%CI，3.4%-9.1%）例术前取样为1级或2级子宫内膜样病变，最终标本升级为3级。3/272（1.1%；95%CI，0%-2.3%）例术前为3级病变的患者分期降低，最终标本显示为1级或2级疾病。所有3例患者的原发肿瘤直径均大于2 cm，因此接受了淋巴结清扫。根据上述标准，会改变围手术期淋巴结清扫决策的组织病理学差异发生在2/272（0.7%；95%CI，0%-1.8%）例患者中。
尽管术前和术后组织病理学差异达20%，但在这项回顾性单机构研究中，仅0.7%的病例中组织病理学差异会改变围手术期淋巴结清扫决策。在淋巴结选择标准中，肌层浸润和肿瘤大小可能比组织学更具影响力。
