Endometrial cancer is seldom staged correctly

Almost half of all original pathology reports that analyzed tissue to confirm endometrial cancer contain significant discrepancies, when compared with formal pathology reviews, according to the findings of a recent retrospective Canadian study. And that's after excluding cases of sarcoma and other rare histologic subtypes.

Researchers identified 450 cases of hysterectomy due to endometrial cancer that were subject to formal pathology review by a gynecologic pathologist. Discrepancies existed in 42.7% of the cases, when compared to the original pathology report (95% CI, 38.2%–47.3%). The original stage was changed in almost one quarter of the cases (23.1%). One third (33.1%) of the changes affected women in the intermediate-risk group. Endometrioid grades 2 and 3 tumors were disputed in 39.8% and 50.9% of cases, respectively. Women originally diagnosed with stage IIA disease were most affected; 79.6% of them had their diagnosis changed upon review; 54.5% in fact had cervical stromal invasion instead of endocervical intraepithelial involvement only.

Realizing that a policy of universal pathology review is unfeasible in today's health-care system, the authors of the study recommend pathology review for at least all non–low-risk endometrial cancers.

Kwon JS, Francis JA, Qiu F, et al. When is a pathology review indicated in endometrial cancer? Obstet Gynecol. 2007;110:1224-1230.

Chalas E. Endometrial cancer: what is a clinician to do? Obstet Gynecol. 2007;110:1222-1223.