Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan.
Int J Gynecol Cancer. 2019 Jun;29(5):886-889. doi: 10.1136/ijgc-2018-000041. Epub 2019 Jan 4.
We conducted a retrospective study to evaluate the correlation between pre-operative and post-operative histological diagnoses on endometrial cancer, and to describe the treatments and outcomes when post-operative diagnoses are downgraded from pre-operative histology.
Patients who underwent surgery for endometrial cancer in our facility between 2010 and 2013 were enrolled in the study. The definition of downgrade discordance is in accordance with the following criteria: 1) the pre-operative and post-operative histological diagnoses were both endometrioid and the final pathology was a lower grade than the pre-operative pathology and 2) the pre-operative diagnosis was not endometrioid, whereas the post-operative diagnosis was endometrioid grade 2 or less.
A total of 250 patients were enrolled, and the concordance rates were 56% for endometrioid adenocarcinoma grade 1 (EMG1), 67% for EMG2, 67% for EMG3, 82% for carcinosarcoma, 71% for serous carcinoma, and 67% for clear cell carcinoma. Eighteen cases (6.6%) were identified as downgrade discordancy. Of the 18 patients, the triage for adjuvant therapy remained the same for 15 cases (83%), all of whom had no evidence of disease at their last visit. Three cases had discordances with respect to triage for adjuvant therapy; the therapies were triaged based on post-operative diagnosis. Of these patients one had a recurrence.
Good correlation was observed between pre-operative and final histological diagnoses of endometrioid carcinoma (56%-67%) and type 2 carcinoma (67%-82%). Approximately 7% (18/250) of patients had downgrade discordancy; however, triage for adjuvant therapy did not change for approximately 80% (15/18) of the patients with downgrade discordancy. Further studies are needed to evaluate the effectiveness of triages that are based on post-operative diagnoses.
我们进行了一项回顾性研究，以评估子宫内膜癌的术前和术后组织学诊断之间的相关性，并描述当术后诊断较术前组织学诊断降级时的治疗和结局。
本研究纳入了 2010 年至 2013 年在我院接受手术治疗的子宫内膜癌患者。降级不一致的定义符合以下标准：1）术前和术后的组织学诊断均为子宫内膜样腺癌，且最终病理分级低于术前病理分级，2）术前诊断不是子宫内膜样癌，而术后诊断为子宫内膜样癌 2 级或更低级别。
共纳入 250 例患者，其中子宫内膜样腺癌 1 级（EMG1）的一致性率为 56%，EMG2 为 67%，EMG3 为 67%，癌肉瘤为 82%，浆液性癌为 71%，透明细胞癌为 67%。18 例（6.6%）被确定为降级不一致。在 18 例患者中，15 例（83%）辅助治疗的分诊仍然相同，所有患者在最后一次就诊时均无疾病证据。有 3 例患者的辅助治疗分诊存在不一致，治疗方案基于术后诊断。这些患者中有 1 例复发。
子宫内膜样癌（56%-67%）和 2 型癌（67%-82%）的术前和最终组织学诊断具有良好的相关性。约 7%（18/250）的患者存在降级不一致，但约 80%（15/18）的降级不一致患者的辅助治疗分诊未发生改变。需要进一步研究来评估基于术后诊断的分诊的有效性。
