The Tumor Grade Discrepancy in Endometrial Cancer Before and Its Clinical Reflection

AIM: Histologic grading in endometrioid endometrial cancer is an important factor in surgical planning and prognosis. This study aimed to compare preoperative tumor grades to subsequent postoperative grades and explore the discrepancies for their possible effects on surgical management. MATERIAL AND METHODS: Medical records of patients with endometrial cancer diagnosis who underwent surgical staging at our institution between the years 2011 and 2016 were reviewed. Sixty seven out of 106 charts were found eligible and were evaluated for preoperative sampling method, preoperative grade, surgical procedure, postoperative grade and final pathology. Preoperative tumor grades were compared to final pathology grades of hysterectomy specimens. RESULTS: Out of 67 eligible cases, preoperative sampling method was endometrial biopsy (Pipelle) in 6 (9 %) and curettage for the rest 61 (91%). Preoperatively 18 (26.8%) of them were regarded as grade 1 (G1), 44 (65.7%) of them as grade 2 (G2), and 5 (7.5%) of them as grade 3 (G3). Percentages for postoperative final grades were 20.9% for G1, 70.1% for G2, and 9% for G3. No significant difference was found between overall preoperative and postoperative grade results. However, 7 patients had a potentially clinical-significant grade discrepancy (10.3%): 4 downgrades (5.9%) (G3 to G2/ G1) and 3 (4.4%) upgrades (G1/G2 to G3). Depth of invasion (DOI) and preoperative-postoperative grade concordance rates were not found to be related either. CONCLUSION: This study revealed that preoperative and postoperative histologic grade discrepancy rates may seem important although not reaching statistically significant levels. Clinical reflection of these rates seemed to be negligible due to other factors affecting management. The extent of the planned surgery must be customized to each patient’s risk category while taking into account of other prognostic markers since the number of significant grade discrepancies alone may not necessarily reflect clinical significance