Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.
Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium.
J Gynecol Oncol. 2021 Jul;32(4):e48. doi: 10.3802/jgo.2021.32.e48. Epub 2021 Apr 5.
To evaluate the concordance between preoperative European Society for Medical Oncology (ESMO)-European Society of Gynaecological Oncology (ESGO)-European SocieTy for Radiotherapy and Oncology (ESTRO) risk classification in early-stage endometrial cancer (EC) assessed by biopsy and magnetic resonance imaging (MRI) with this classification based on histology of surgical specimen.
This bicentric retrospective study included women diagnosed with early-stage EC (≤stage II) who had a complete preoperative assessment and underwent a surgical management from January 2011 to December 2018. Patients were preoperatively classified into 3 degrees of risk of lymph node (LN) involvement based on biopsy and MRI. Based on final histological report, patients were re-classified using the preoperative classification. Concordance between the preoperative assessment and definitive histology was calculated with weighted Cohen's kappa coefficient.
A total of 333 women were included and kappa coefficient of preoperative risk classification was 0.49. The risk was underestimated and overestimated in 37% and 10% of cases, respectively. Twenty-nine percent of patients had an incomplete LN staging according to the degree of risk of re-classification. The observed discordance in the risk classification was attributed to MRI in 75% of cases, to biopsy in 18% and in 7% to both (p<0.001). Kappa coefficient for concordance was 0.25 for MRI and 0.73 for biopsy.
Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology is weak. Given that the risk was underestimated in the majority of patients wrongly classified, sentinel LN procedure instead of no LN dissection could be an option offered to preoperative low-risk patients to decrease the indication of second surgery for re-staging and/or to avoid toxicity of adjuvant radiotherapy.
评估术前欧洲肿瘤内科学会（ESMO）-欧洲妇科肿瘤学会（ESGO）-欧洲放射肿瘤学会（ESTRO）风险分类在早期子宫内膜癌（EC）中的一致性，该分类基于活检和磁共振成像（MRI）评估，与基于手术标本组织学的分类进行比较。
这项双中心回顾性研究纳入了 2011 年 1 月至 2018 年 12 月期间接受完整术前评估并接受手术治疗的早期 EC（≤II 期）患者。患者术前根据活检和 MRI 分为 3 个淋巴结（LN）受累风险程度。基于最终组织学报告，使用术前分类对患者进行重新分类。采用加权 Cohen's kappa 系数计算术前评估与明确组织学之间的一致性。
共纳入 333 例患者，术前风险分类的 kappa 系数为 0.49。风险低估和高估分别占 37%和 10%。根据重新分类的风险程度，29%的患者存在不完全的 LN 分期。风险分类的观察到的不一致归因于 MRI 占 75%，活检占 18%，两者均占 7%（p<0.001）。MRI 一致性的 kappa 系数为 0.25，活检为 0.73。
术前 ESMO-ESGO-ESTRO 风险分类与最终组织学之间的一致性较弱。鉴于大多数被错误分类的患者风险被低估，前哨淋巴结手术而不是无 LN 清扫术可以作为一种选择提供给术前低风险患者，以减少因再次分期而进行二次手术的指征和/或避免辅助放疗的毒性。
