Preoperative evaluation of tumor ploidy in endometrial carcinoma - An accurate tool to identify patients at risk for extrauterine disease and recurrence

BACKGROUND. Tumor ploidy is a strong prognostic factor in patients with end ometrial carcinoma, but generally is evaluated only after surgery. The avai lability of a simple and reliable method to determine tumor ploidy before a ny treatment is initiated could be helpful in the selection of patients at high risk for advanced primary disease and subsequent recurrence, with seve ral possible benefits. The objectives of the current study were: 1) to test the accuracy of flow cycometric determination of tumor ploidy from preoper ative outpatient endometrial biopsies compared with standard postoperative evaluation from the surgical specimen and 2) to correlate this preoperative parameter with the local recurrence and extrauterine tumor spread. METHODS, Tumor ploidy from both preoperative biopsy material and the macros copic surgical specimens was evaluated prospectively in 50 consecutive pati ents with endometrial carcinoma. DNA analyses were performed in a blind fas hion. Patients were followed for a median of 26 months (range, 16-46 months ). RESULTS. In 9 of 50 cases (18%) an aneuploid tumor was found by the standar d postoperative analysis. All 9 aneuploid tumors (100%) also were identifie d correctly by the preoperative test on biopsy material. Occult extrauterin e tumor spread was found in 10 patients (20%). The incidence rate of aneupl oidy among these tumors was 50% compared with 10% in surgical International Federation of Gynecology and Obstetrics Stage I tumors (P = 0.01). The rec urrence rate was 55.5% (5 of 9 tumors) in the aneuploid group and 2.4% (1 o f 41 tumors) in the diploid group (P < 0.001). The disease free survival ra tes of patients with diploid and aneuploid tumors were 97.5% and 44.4%, res pectively (P < 0.0001). CONCLUSIONS. Preoperative tumor ploidy determination based on outpatient en dometrial biopsy is as accurate as the standard postoperative evaluation in patients with endometrial carcinoma. Tumor aneuploidy confirms the usefuln ess of this method in selecting patients at risk for occult extrauterine tu mor diffusion and recurrence. (C) 1999 American Cancer Society.