Garcia Tiago Selbach, Appel Márcia, Rivero Raquel, Kliemann Lúcia, Wender Maria Celeste Osório
*Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul; †Gynecologic Oncology Unit, Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre; ‡Department of Pathology, Universidade Federal do Rio Grande do Sul; and ∥Department of Gynecology and Obstetrics, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Int J Gynecol Cancer. 2017 Mar;27(3):473-478. doi: 10.1097/IGC.0000000000000922.
The aims of the study were to evaluate agreement between preoperative endometrial samples and surgical specimens in endometrial carcinoma and to correlate this agreement with sample and patient characteristics.
Patients who received primary surgical treatment for endometrial carcinoma at a tertiary care center and had undergone preoperative endometrial sampling were included. Medical records were reviewed to collect information from pathology reports and data on patient characteristics.
The study sample comprised 166 patients (mean age, 64.6 years). The histological results of the biopsies were the following: endometrioid cancer (n = 118), nonendometrioid tumor (n = 38), and hyperplasia (n = 10). The agreement rates were 93.2% for endometrioid and 68.9% for nonendometrioid tumors, with a κ coefficient of 0.73 for tumor cell type. Tumor International Federation of Gynecology and Obstetrics (FIGO) grade was distributed as follows: 37.1% G1, 35.7% G2, and 27.1% G3, with agreement rates of 61.5%, 56%, and 78.9%, respectively. The overall κ coefficient for FIGO grading was 0.46. Only 1.9% of the tumors originally classified as G1 were upgraded to G3, whereas 16% of G2 lesions were upgraded. There was no significant difference in agreement rates for tumor cell type and FIGO grade in relation to any of the studied variables, except that biopsy specimens weighing more than 3 g had significantly better agreement in FIGO grading (P = 0.040).
Preoperative biopsy has suboptimal accuracy for prediction of characteristics in the definitive surgical specimen. Caution must be taken when using preoperative information to determine extent of surgical resection, due to the risk of understaging. Additional information must be combined with the biopsy data to help in the decision-making process.
本研究旨在评估子宫内膜癌术前子宫内膜样本与手术标本之间的一致性，并将这种一致性与样本和患者特征相关联。
纳入在三级医疗中心接受子宫内膜癌初次手术治疗且术前进行过子宫内膜采样的患者。查阅病历以收集病理报告中的信息及患者特征数据。
研究样本包括166例患者（平均年龄64.6岁）。活检的组织学结果如下：子宫内膜样癌（n = 118）、非子宫内膜样肿瘤（n = 38）和增生（n = 10）。子宫内膜样肿瘤的一致性率为93.2%，非子宫内膜样肿瘤为68.9%，肿瘤细胞类型的κ系数为0.73。国际妇产科联盟（FIGO）肿瘤分级分布如下：37.1%为G1级，35.7%为G2级，27.1%为G3级，一致性率分别为61.5%、56%和78.9%。FIGO分级的总体κ系数为0.46。最初分类为G1级的肿瘤仅有1.9%升级为G3级，而G2级病变有16%升级。除了重量超过3 g的活检标本在FIGO分级上一致性显著更好（P = 0.040）外，肿瘤细胞类型和FIGO分级的一致性率在任何研究变量方面均无显著差异。
术前活检对确定手术标本特征的预测准确性欠佳。由于存在分期不足的风险，在使用术前信息确定手术切除范围时必须谨慎。必须将其他信息与活检数据相结合以辅助决策过程。
