Comparison between clinical and surgical staging for endometrial cancer in Thailand

To compare preoperative clinico-pathological findings and clinical staging of endometrial cancers (EMC) with postoperative surgico-pathological findings and final surgical staging.

All EMC patients who underwent surgical staging between January 1993 and December 2008 were identified from the tumor registry of the Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, of our institution. Clinico-pathological data were extracted from the patients' charts and pathological reports, including clinical stage assignments before the operation, and compared to the surgico-pathological findings.

Two hundred and thirty five EMC patients were included in this study. Mean age was 55.8-/+9.9 years. All except one had clinical stage I and II disease. The most common preoperative histopathology of endometrial tissue was endometrioid adenocarcinoma, with or without squamous differentiation (164 cases or 69.8%), while grade II tumors accounted for 107 cases (46.7%). Cervical involvement was evidenced from endocervical curettage in 58/235 cases (24.7%). From the final surgico-pathologic findings, the surgical stages were the same as clinical stage in 145 patients (61.7%), sixty patients (25.5%) being upstaged and 30 patients (12.8%) downstaged. Histopathology of endometrial cancer from hysterectomy was the same as for the preoperative tissues in 175 cases (74.5%), without change in preoperative grading in 155 (67.6%), upgrading in 57 (25%) and downgrading in 17 (7.4%).

Clinical staging was comparable to surgical staging in approximately 61.7% and final surgical staging change was evident in 38.3%, with postoperative histopathological change in 25.5%. Preoperative endocervical curettage had false positive and false negative rates of 60.3% and 14.1% respectively. Thus clinicians should be aware of these possibilities in preoperative counseling for patients and planning surgical procedures.