Discrepency in grade between preoperative biopsy and final specimen in stage I carcinoma endometrium: an institutional review

Suhaildeen Kajamohideen, Balasubramanian Venkitaraman, Sridevi V.


Background: Most endometrioid endometrial cancer are well differentiated (Grade I). Grade of the tumor is an important predictor of nodal metastasis and the discordance in histological grade of endometrial cancers between diagnostic biopsy and definitive surgery specimen was analyzed in our Institute.

Methods: Around 221 patients diagnosed with carcinoma endometrium between 2006 and 2014 were taken into study. Histologic differentiation of the tumour between diagnostic biopsy and definitive surgery were analysed. All demographic data, tumor factors, follow up and recurrence were recorded.

Results: Of the 221 patients taken into consideration for analysis, median age of presentation was 57 years with range between 38-77 years. The overall median body mass index was 27.70kg/m2. 66 % of patients had comorbid illness, with 33% having both diabetes and hypertension. Open staging was performed in 150 patients and laparoscopic staging in 71 patients. Mean duration of surgery was 3.06 hrs in laparoscopic staging and 2.74hrs in open staging. The median tumour size was 4cm.The median number of nodes dissected were 13. Discordance in the grade of tumour between diagnostic biopsy and surgical biopsy were 58.8% of grade 1 tumour, 16.2% of grade 2 tumours and 18.9% of grade 3 tumours.

Conclusions: Discrepancies in correlation of the grade of tumour in diagnostic biopsy and tissue obtained at surgery supports the need for surgical staging in all patients.


Carcinoma endometrium, Endometrial biopsy, Grade

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Swaminathan R, Shantha V, Balasubramanian S, Sampath P. Cancer Incidence and mortality in Chennai, India 2006-2008. National Cancer Registry Program, Cancer Institute (WIA), Chennai. Available at:

Parazzini F, LaVecchia C, Bocciolone L, Franceschi S. The epidemiology of endometrial cancer. Gynecol Oncol. 1991;4:1-16.

Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, et al. Carcinoma of the ovary. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. International Journal of Gynecology and Obstetrics. Int J Gynaecol Obstet. 2006 Nov;95 Suppl 1:S161-92.

Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer: a Gynecologic Oncology Group study. Cancer. 1987 Oct 15;60(S8):2035-41.

Boente MP, Yordan Jr EL, McIntosh DG, Grendys Jr EC, Orandi YA, Davies S, et al. Prognostic factors and long-term survival in endometrial adenocarcinoma with cervical involvement. Gynecologic Oncol 1993 Dec 1;51(3):316-22.

Silverberg SG, Kurman RJ. Tumors of the uterine corpus. pathology and genetics of tumours of the breast and female genital organs. Lyon: IARC Press. 2003:217-57.

Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15(1):10-7.

Rose PG. Endometrial carcinoma. N Engl J Med. 1996;335(9):640-9.

Obermair A, Geramou M, Gücer F, Denison U, Graf AH, Kapshammer E, et al. Endometrial cancer: accuracy of the finding of a well differentiated tumor at dilatation and curettage compared to the findings at subsequent hysterectomy. Int J Gynecological Cancer. 1999 Sep 7;9(5):383-6.

Dijkhuizen FP, Mol BW, Brölmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta‐analysis. Cancer. 2000 Oct 15;89(8):1765-72.

Leitao Jr MM, Kehoe S, Barakat RR, Alektiar K, Gattoc LP, Rabbitt C, et al. Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma. Gynecologic oncology. 2009 Apr 1;113(1):105-8.

Frumovitz M, Singh DK, Meyer L, Smith DH, Wertheim I, Resnik E, et al. Predictors of final histology in patients with endometrial cancer. Gynecologic Oncol. 2004 Dec 1;95(3):463-8.