INTERINSTITUTIONAL SURGICAL PATHOLOGY REVIEW IN GYNECOLOGIC ONCOLOGY-I - CANCER IN ENDOMETRIAL CURETTINGS AND BIOPSIES

We report our experience with an interinstitutional surgical pathology review of endometrial curettings and biopsies originally diagnosed as cancer, Slides were reviewed from 182 women who were diagnosed with c ancer and referred to our institution for further treatment; the slide s had been sent for review at the request of the gynecologic oncologis t. Review diagnoses were retrospectively compared to original diagnose s made on slides from these specimens, and significant discrepancies w ere identified in 43 (23.6%) of the 182 cases. For 16 (8.8%) patients, the diagnosis was downgraded from malignant to: 1) a benign non-hyper plastic process in 4 (2.2%); 2) scanty atypical glandular epithelium, not diagnostic for malignancy, in 2 (1.1%); and 3) endometrial hyperpl asia in 10 (5.5%), including complex atypical hyperplasia in 8 (4.4%). Other significant differences involved histologic tumor classificatio n in 16 (8.8%), degree of differentiation (two grades) in 2 (1.1%), de termination of primary site in 4 (2.2%), and diagnosis of endocervical invasion in 5 (2.7%). Problems in comparison included lack of standar dization of terminology and incomplete information from the original d iagnoses. The high discrepancy rate between review and original diagno ses underscores the difficulty of interpreting these specimens. Review diagnoses of benign processes prevented an unnecessary operation for several women, and allowed those with cancer to undergo the most appro priate therapy. Review diagnoses in women with endometrial cancer cont ribute to quality medical care and have a major impact on a significan t subset of patients.