Endometrial adenocarcinoma - presenting pathology is a poor guide to surgical management

We aimed to evaluate the correlation between the histological grade of endo metrial cancer diagnosed on endometrial biopsy or curettage, with the defin itive grade and stage of lesion as determined by surgery and histopathologi cal examination and to make recommendations about the suitability of conser vative surgery based on pre-operative determination of the grade of endomet rial adenocarcinoma. A retrospective review of all patients with endometrial adenocarcinoma pres enting to the Queensland Centre for Gynaecological Cancer from 1 January 19 96 to 31 December 1998 was undertaken. Clinical and pathological data was a bstracted from medical records and case notes of 460 patients. All histolog ical specimens were prospectively reviewed by a panel consisting of gynaeco logic pathologists, gynaecologic oncologists and other doctors involved in the treatment of patients with gynaecological malignancies. The percentage of patients whose management would have been optimised by full surgical sta ging at the time of initial surgery was calculated. Only 60%, 71%, and 84% of the patients with a presenting diagnosis of grade 1, 2 and 3 endometrial adenocarcinomas respectively had this confirmed on final histopathology. F urthermore, using established criteria, 30%, 46% and 100% of patients prese nting with grade 1, 2 and 3 endometrial adenocarcinoma required full surgic al staging at the time of their primary surgery. There is poor correlation between the pre-operative grade of endometrial ca ncer and the grade as determined on analysis of the resected uterus. The co rrelation is poorest with grade 1 endometrial adenocarcinoma, where stronge st consideration is given to conservative surgery and the avoidance of subs pecialty referral. There is a strong argument that all patients with a diag nosis of endometrial cancer made on endometrial biopsy or curettage, regard less of grade of malignancy, should be offered surgery where the option to perform concurrent comprehensive surgical staging is available.