Problems in pretherapeutical staging of endometrial cancer

Objective: To establish the limitations of pretherapeutical staging and to evaluate the importance of surgical staging in choosing the therapeutical methods in endometrial cancer (EC). Material and method: We've conducted a retrospective analysis on 110 EC cases operated between jan. 2007 and sept. 2012. The diagnosis was made by D& fractioned curettage for: postmenopausal metrorrhage (87%) and menometrorrhage (11%). The group of 60-70 years of age represented the majority of all cases (63%); obesity group 30% and cardio-vascular diseases 15%. Preoperative histopathological findings were: endometrioid EC (70%), EC with adenoscuamous component (20%), scuamo-papillar and clear cell (rare types) - 10%. Preoperative tumoral grading: G1 and G2-90%, G3-10%. Clinical stage I represented the majority (90%) of all cases; stage II cases (10%) have been irradiated. Types of operative techniques: TAH+ BA-93%, type III RH-6%, LAVH -0,5%. In all of the cases where we performed type III RH, lymphadenectomy was associated (with + results in 43%); selective lymphadenectomy was made in 60% of all TAH+BA (endometrial invasion >50%, rare HP types, G3) with + results in 30% of the cases. During the same interval we've analyzed 110 cases of endometrial hiperplasia (TAH+ BA-34%, VH+/- BA-65%) and 73 cases of postmenopausal uterine bleeding due to the persistence of the symptomatology (TAH+ BA- 40%, VH=BA-305, VH-25%, TH+BA+ selective pelvic lymphadenectomy-4,5%, LAVH-0,5%). Results: The preoperative HP form corresponded to the final one in 85% of the cases (in 15% of the cases the endometrioid form was associated to the scuamous component); tumor grade was understaged in 20% of the cases. Endometrial hyperplasia did not associate preoperatively any form of EC. 30% of the patients treated for persistent metrorrhage have had endometrioid carcinoma. Miometrial invasion was underdiagnosed surgically in 40%; cervical invasion was underdiagnosed clinically in 32% and surgically in 21%. Lymphatic invasion was present in 20% of the cases with 50% endometrial neoplastic transformation, 30% of the rare EC types, 17% of the G2-G3 tumor grade cases, 40% of the cases with enlarged lymphonodules, 10% of the ones having cervical invasion. Pretherapeutical staging compared to the surgical one was correct in 51% of the cases, understaged in 28% and overstaged in 5% (in 13% of the cases, EC was not found at the HP exam). Conclusions: The pretherapeutical and the surgical staging are not concordant; simple surgical staging (TAH+ BA) gives correct information to establish the risk groupes and choose the right treatment; there is a satisfactory correlation between the HP form and the tumor grade (pretherapeutical and final), thus the rare HP types and G2,3 could be by themselves mandatory to an advanced surgical stage.