Endometrioid Endometrium Kanserlerinde Preoperatif Biyopsi Sonucunun Postoperatif Histopatolojik Grade ile İlişkisi
Abstract
Amaç: Preoperatif endometrial biyopsi ile postoperatif kesin histopatolojik bulgular arasındaki uyumu değerlendirmek ve endometrioid tip endometrial kanserli hastalarda tanısal uyumsuzluklarla ilişkili faktörleri belirlemek.
Gereç ve Yöntemler: Bu retrospektif çalışmaya, 2005–2018 yılları arasında üçüncü basamak bir merkezde preoperatif endometrioid tip endometrium kanseri tanısıyla cerrahi uygulanan 134 hasta dâhil edildi. Hastalara ait demografik, klinik ve histopatolojik veriler incelendi. Preoperatif biyopsi ile kesin patoloji arasındaki uyum Cohen’in kappa katsayısı ile değerlendirildi. Ayrıca duyarlılık, özgüllük, pozitif prediktif değer (PPV) ve negatif prediktif değer (NPV) hesaplandı.
Bulgular: Preoperatif ve kesin tümör grade’leri arasında istatistiksel olarak anlamlı bir ilişki saptandı (p < 0.001). Hastaların %35.8’inde (n = 48), kesin patoloji raporunda biyopsi ile kıyaslandığında daha yüksek bir tümör grade’i belirlendi. Grade 3 tümörlerde tanısal doğruluk oranı %89.5 ile en yüksek düzeydeydi; Grade 1 ve 2’de ise genel doğruluk oranı %66.0 idi. Tümör çapının 2 cm’den büyük olması ve lenf nodu metastazı, grade artışı ile anlamlı düzeyde ilişkiliydi (sırasıyla p = 0.014 ve p = 0.004).
Sonuç: Preoperatif biyopsi tek başına endometrial kanserli hastalarda doğru risk sınıflaması için yeterli olmayabilir. Tümör grade artışı, daha büyük tümör boyutu ve lenf nodu tutulumu gibi olumsuz prognostik faktörlerle anlamlı ilişki göstermiştir. Özellikle düşük grade olarak sınıflandırılan olgularda, çok yönlü tanısal yaklaşım önerilmektedir.
References
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- 4. Jo HC, Baek JC, Lee SM, Park JE, Cho IA, Sung JH. Clinicopathological and ultrasound features of endometrial cancer in postmenopausal women: a retrospective study in a single institute in South Korea. Pan Afr Med J. 2021;38:148. [Crossref]
- 5. Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC study group. Post operative radiation therapy in endometrial carcinoma. Lancet. 2000;355(9213):1404-11. [Crossref]
- 6. Yi Y, Bryce CL, Adambekov S, Edwards RP, Goughnour SL, Linkov F. Cost-effectiveness analysis of biopsy strategies for endometrial cancer diagnosis in women with postmenopausal bleeding: Pipelle sampling curette versus dilatation & curettage. Gynecol Oncol. 2018;150(1):112-8. [Crossref]
- 7.Quintana-Berto R, Padilla-Iserte P, Gil-Moreno A, et al. Oncological safety of hysteroscopy in endometrial cancer. Int J Gynecol Cancer. 2022;32:1395-1401. [Crossref]
- 8.Kalampokas E, Giannis G, Kalampokas T, et al. Current approaches to the management of patients with endometrial cancer. cancers (basel). 2022;14(18),4500. [Crossref]
- 9. Clarke BA, Gilks CB. Endometrial carcinoma: controversies in histopathological assessment of grade and tumour cell type. J Clin Pathol. 2010;63(5):410-5. [Crossref]
- 10. Tanaka K, Kobayashi Y, Sugiyama J, et al. Histologic grade and peritoneal cytology as prognostic factors in type 1 endometrial cancer. Int J Clin Oncol. 2017;22(3):533-40. [Crossref]
- 11. Colombo N, Preti E, Landoni F, et al. Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(6):33-8. [Crossref]
- 12. Kılıç S. Kappa testi. Journal of mood disorders. 2015;5(3):142-4. [Crossref]
- 13. Lee JY, Jung DC, Park SH, et al. Preoperative prediction model of lymph node metastasis in endometrial cancer. Int J Gynecol Cancer. 2010;20(8):1350-5. [Crossref]
- 14.Lago V, Martin B, Ballesteros E, Cardenas-Rebollo JM, Minig L. Tumor grade correlation between preoperative biopsy and final surgical specimen in endometrial cancer: the use of different diagnostic methods and analysis of associated factors. Int J Gynecol Cancer. 2018;28(7):1258-63. [Crossref]
- 15. Goksedef BP, Akbayir O, Corbacioglu A, et al. Comparison of preoperative endometrial biopsy grade and final pathologic diagnosis in patients with endometrioid endometrial cancer. J Turk Ger Gynecol Assoc. 2012;13(2):106-10. [Crossref] 16. Lee JY, Kim YH, Lee JM, et al. Role of preoperative magnetic resonance imaging and histological assessment in identifying patients with a low risk of endometrial cancer: a Korean Gynecologic Oncology Group ancillary study. Oncotarget. 2017;8(62):106009-16. [Crossref]
- 17. Visser NCM, Reijnen C, Massuger L, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis. Obstet Gynecol. 2017;130(4):803-13. [Crossref]
Relationship Of Preoperative Biopsy Results With Postoperative Histopathological Grade In Endometrioid Type Endometrium Cancer
Abstract
Objective: To assess the concordance between preoperative endometrial biopsy and final postoperative histopathological findings in patients with endometrioid-type endometrial cancer, and to identify factors associated with diagnostic discrepancies.
Materials and Methods: This retrospective study included 134 patients who underwent surgery between 2005 and 2018 following a preoperative diagnosis of endometrioid-type endometrial cancer at a tertiary center. Demographic, clinical, and histopathological data were reviewed. Concordance between preoperative biopsy and final pathology was evaluated using Cohen’s kappa coefficient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated.
Results: A statistically significant correlation was observed between preoperative and final tumor grades (p < 0.001). In 35.8% of patients (n = 48), the final pathology revealed a higher grade than the initial biopsy. Grade 3 tumors demonstrated the highest diagnostic accuracy (89.5%), while Grades 1 and 2 showed an overall accuracy of 66.0%. Tumor size greater than 2 cm and lymph node metastasis were significantly associated with grade upgrading (p = 0.014 and p = 0.004, respectively).
Conclusion: Preoperative biopsy alone may not be sufficient for accurate risk stratification in patients with endometrial cancer. Tumor upgrading was significantly associated with adverse prognostic indicators such as larger tumor size and nodal involvement. A multimodal diagnostic approach is recommended, particularly in cases initially classified as low-grade.
References
- 1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108. [Crossref]
- 2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. [Crossref]
- 3. Felix AS, Bower JK, Pfeiffer RM, Raman SV, Cohn DE, Sherman ME. High cardiovascular disease mortality after endometrial cancer diagnosis: Results from the Surveillance, Epidemiology, and End Results (SEER) Database. Int J Cancer. 2017;140(3):555-64. [Crossref]
- 4. Jo HC, Baek JC, Lee SM, Park JE, Cho IA, Sung JH. Clinicopathological and ultrasound features of endometrial cancer in postmenopausal women: a retrospective study in a single institute in South Korea. Pan Afr Med J. 2021;38:148. [Crossref]
- 5. Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC study group. Post operative radiation therapy in endometrial carcinoma. Lancet. 2000;355(9213):1404-11. [Crossref]
- 6. Yi Y, Bryce CL, Adambekov S, Edwards RP, Goughnour SL, Linkov F. Cost-effectiveness analysis of biopsy strategies for endometrial cancer diagnosis in women with postmenopausal bleeding: Pipelle sampling curette versus dilatation & curettage. Gynecol Oncol. 2018;150(1):112-8. [Crossref]
- 7.Quintana-Berto R, Padilla-Iserte P, Gil-Moreno A, et al. Oncological safety of hysteroscopy in endometrial cancer. Int J Gynecol Cancer. 2022;32:1395-1401. [Crossref]
- 8.Kalampokas E, Giannis G, Kalampokas T, et al. Current approaches to the management of patients with endometrial cancer. cancers (basel). 2022;14(18),4500. [Crossref]
- 9. Clarke BA, Gilks CB. Endometrial carcinoma: controversies in histopathological assessment of grade and tumour cell type. J Clin Pathol. 2010;63(5):410-5. [Crossref]
- 10. Tanaka K, Kobayashi Y, Sugiyama J, et al. Histologic grade and peritoneal cytology as prognostic factors in type 1 endometrial cancer. Int J Clin Oncol. 2017;22(3):533-40. [Crossref]
- 11. Colombo N, Preti E, Landoni F, et al. Endometrial cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(6):33-8. [Crossref]
- 12. Kılıç S. Kappa testi. Journal of mood disorders. 2015;5(3):142-4. [Crossref]
- 13. Lee JY, Jung DC, Park SH, et al. Preoperative prediction model of lymph node metastasis in endometrial cancer. Int J Gynecol Cancer. 2010;20(8):1350-5. [Crossref]
- 14.Lago V, Martin B, Ballesteros E, Cardenas-Rebollo JM, Minig L. Tumor grade correlation between preoperative biopsy and final surgical specimen in endometrial cancer: the use of different diagnostic methods and analysis of associated factors. Int J Gynecol Cancer. 2018;28(7):1258-63. [Crossref]
- 15. Goksedef BP, Akbayir O, Corbacioglu A, et al. Comparison of preoperative endometrial biopsy grade and final pathologic diagnosis in patients with endometrioid endometrial cancer. J Turk Ger Gynecol Assoc. 2012;13(2):106-10. [Crossref] 16. Lee JY, Kim YH, Lee JM, et al. Role of preoperative magnetic resonance imaging and histological assessment in identifying patients with a low risk of endometrial cancer: a Korean Gynecologic Oncology Group ancillary study. Oncotarget. 2017;8(62):106009-16. [Crossref]
- 17. Visser NCM, Reijnen C, Massuger L, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis. Obstet Gynecol. 2017;130(4):803-13. [Crossref]
Details
| Primary Language | English |
|---|---|
| Subjects | Gynecologic Oncology Surgery |
| Journal Section | Articles |
| Authors | |
| Publication Date | June 30, 2025 |
| Submission Date | December 4, 2024 |
| Acceptance Date | May 31, 2025 |
| Published in Issue | Year 2025 Volume: 8 Issue: 2 |
