Challenges to Intraoperative Evaluation of Endometrial Cancer
Alexandra Giglio1, Briana Miller2, Erin Curcio1
1Department of Obstetrics and Gynecology.
Summary
Intraoperative evaluation of endometrial cancer using Mayo Clinic Criteria showed significant discordance in grade, tumor size, and myometrial invasion depth. These criteria require further validation in diverse settings before universal adoption for predicting lymph node spread.
Area of Science:
- Gynecologic Oncology
- Surgical Pathology
- Cancer Staging
Background:
- Intraoperative uterine evaluation aids in predicting lymph node metastasis risk in endometrial cancer.
- The Mayo Clinic validated four criteria: histopathology, grade, tumor size, and myometrial invasion depth.
Purpose of the Study:
- To assess the accuracy of intraoperative evaluation using Mayo Clinic Criteria in a university-affiliated teaching hospital setting.
- To determine the concordance between intraoperative and postoperative assessments of key prognostic factors.
Main Methods:
- Retrospective chart review of 105 patients with endometrial cancer undergoing robotic-assisted staging.
- Analysis of 75 cases comparing intraoperative findings with final pathology reports for grade, tumor size, and depth of myometrial invasion.
Main Results:
- Significant discordance was observed between intraoperative and postoperative grading (19.4%) and depth of myometrial invasion (17.1%).
- Tumor size assessment resulted in an 11.7% upstaging from low-risk to high-risk categories, with 20% of cases deferring size evaluation to final pathology.
- Statistical analysis revealed significant disagreements for all assessed criteria (P < .05).
Conclusions:
- The Mayo Clinic Criteria demonstrated significant discordance in a university-affiliated teaching setting.
- Universal adoption of these criteria is not recommended until further validation in prospective studies across institutions with varying resources is completed.
