Prediction of preoperative and postoperative FIGO grade concordance in patients with endometrial cancer

Aims: To determine the factors leading to upgrading in the final pathology result in cases with endometrial cancer. Methods: We retrospectively analyzed the records of patients with endometrioid endometrial adenocarcinoma to evaluate the concordance between FIGO grade in preoperative endometrial sampling and postoperative final pathology grade. As a result of endometrial sampling, FIGO grade was reported as up-grading if it was lower than final pathology report, and as down-grading, if it was higher than final pathology report. The effects of tumor size, degree of myometrial invasion, lymphovascular invasion, FIGO stage, tumor localization, and additional uterine/endometrial pathologies on up-grading were evaluated. Results: A total of 151 patients remained eligible for final analysis. The overall down-grading percentage was 8.6%, and the up-grading percentage was 25.2%. In preoperative endometrial sampling, the up-grading rates for FIGO grades 1 and 2 were analyzed as 30.5% and 20.0%. The concordance rates between preoperative endometrial sampling results and postoperative definitive pathology results were calculated as 69.5%, 55.6%, and 81.8% for FIGO grade 1,2,3, respectively.It was found that patients with more than 50% myometrial invasion (p=0.048), and those with advanced FIGO stages were more up-grading than those with earlier stages (p=0.005). Conclusion: There is a substantial difference between the grade of preoperative endometrial sampling material and the postoperative final pathology grade in patients with endometrioid-type endometrial cancer.In the preoperative evaluation, assessment of additional markers in combination with magnetic resonance imaging may reduce misconceptions in the diagnosis, given that 25% of the patients were up-grading.