Is there a benefit to a histopathological review of currettings or biopsy prior to treatment in low and high risk apparent early stage endometrial cancer?

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Is there a benefit to a histopathological review of currettings or biopsy prior to treatment in low and high risk apparent early stage endometrial cancer?

Preoperative assessment

Review of endometrial biopsies or curettings

The allocation of endometrial cancer to low and high risk is dependent on a number of features, only two of which are assessable pre-operatively, namely the histological type and grade. Histological review may change the preoperative diagnosis of the type and grade of tumour, from possibly low risk (grade 1-2 endometrioid tumours) to definitely high risk (grade 3 tumours, serous, clear cell carcinoma or to carcinosarcomas). Many gynaecological oncologists routinely review histopathological specimens from endometrial sampling with a gynaecological pathologist, prior to treatment. In many cases, the original diagnosis has been made in general pathology departments in regional or other metropolitan hospitals.

Only one retrospective study has studied the frequency of change in diagnosis after review of endometrial curettings and biopsy in detail.[1] Of 182 specimens, 16 (8.8%) were reclassified from malignant to premalignant or benign; in another 16 cases (8.8%), the histological type of tumour was changed significantly. Eleven of these 16 cases involved a change between endometrioid carcinoma and serous carcinoma, with another five cases (2.7%) reclassified from carcinocarcinoma to other sarcomas or carcinomas. The primary site of disease was changed from endometrium to cervix in three patients (1.6%) and vice versa in one patient. Overall, 23.6% showed major discrepancies. A study by Khalifa et al showed a reclassification of endometrial cancer histological type in 9.4%,[2] consistent with data from the study by Jaques.

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Evidence summary and recommendations

Evidence summary Level References
Pre-operative pathology review resulted in a change in histological type in 9%, downgrading of diagnosis to benign in 9%, change in differentiation (by 2 grades) in 1% and change in primary site in 2% of patients, resulting in significant changes in management. III-2 [1], [2]
Evidence-based recommendationQuestion mark transparent.png Grade
Pre-operative review of uterine curettings or endometrial biopsies by a specialist gynaecological pathologist is recommended to assist in the accurate tailoring of treatment.
C


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References

  1. 1.0 1.1 Jacques SM, Qureshi F, Munkarah A, Lawrence D. Interinstitutional surgical pathology review in gynecologic oncology. I. Cancer in Endometrial Curettings and Biopsies. Int J Gynecol Path 1998;17:36-41.
  2. 2.0 2.1 Khalifa MA, Dodge J, Covens A, Osborne R, Ackerman I. Slide review in gynecologic oncology ensures completeness of reporting and diagnostic accuracy. Gynecologic Oncology 2003;90:425-430.

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Supporting material

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