Correlation between Preoperative Diagnosis and Final Pathological Diagnosis of Endometrial Cancer Impact on Management

Abstract

Endometrial carcinoma is the fourth most common malignancy in women and most common gynecological cancer in developed countries with an incidence of 15 / 100,000. Most women with endometrial carcinoma present with postmenopausal bleeding. Therefore measurement of the endometrial thickness by transvaginal ultrasound is advocated in all postmenopausal women with vaginal blood loss. Subsequent endometrial sampling is advised in women with an endometrial thickness >4 mm. Objective: To asses retrospectively the impact of the method used in pre-operative diagnosis of endometrial cancer on final diagnosis and plan of management. Methods: This is a retrospective record-based study was done at Ain Shams University Maternity hospital. Women approached were recruited from oncology unit – Ain Shams University Maternity Hospital diagnosed with endometrial carcinoma, in the 6-year period from January 2013 to March 2019. Results: Preoperative endometrioid G3 tumor has the highest accuracy rate to predict postoperative tumor grade (83.3% by D&C, 60% by pipelle and 100 % by hysteroscopy) and 100% in non endometrioid endometrial cancer. The upgrading rates reported for preoperatively diagnosed G1-G2 endometrioid tumor ranged from 10% to 46.7%. Conclusion: Regardless of the method, the preoperative biopsy has limitations to predict the tumor grade in comparison with final surgical specimen in women with endometrioid endometrial cancer at an apparent early stage. This is more likely in the case of preoperative G1 or G2 tumors, as well as in big tumors and the preoperative endometrioid G3 tumor has the highest accuracy rate to predict postoperative tumor grade (83.3% by D&C, 60% by pipelle and 100 % by hysteroscopy) and 100% in non endometrioid endometrial cancer.