Comparison between Clinical and Surgical Staging for Endometrial Cancer in Thailand

Objectives: To compare preoperative clinico-pathological findings and clinical staging of endometrial cancers(EMC) with postoperative surgico-pathological findings and final surgical staging. Materials and
Methods: AllEMC patients who underwent surgical staging between January 1993 and December 2008 were identified fromthe 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 clinicalstage assignments before the operation, and compared to the surgico-pathological findings.
Results: Two hundredand thirty five EMC patients were included in this study. Mean age was 55.8±9.9 years. All except one hadclinical stage I and II disease. The most common preoperative histopathology of endometrial tissue wasendometrioid adenocarcinoma, with or without squamous differentiation (164 cases or 69.8%), while grade IItumors accounted for 107 cases (46.7%). Cervical involvement was evidenced from endocervical curettage in58/235 cases (24.7%). From the final surgico-pathologic findings, the surgical stages were the same as clinicalstage 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 175cases (74.5%), without change in preoperative grading in 155 (67.6%), upgrading in 57 (25%) and downgradingin 17 (7.4%).
Conclusion: Clinical staging was comparable to surgical staging in approximately 61.7% and finalsurgical staging change was evident in 38.3%, with postoperative histopathological change in 25.5%. Preoperativeendocervical curettage had false positive and false negative rates of 60.3% and 14.1% respectively. Thus cliniciansshould be aware of these possibilities in preoperative counseling for patients and planning surgical procedures.