Presence of Tumor Necrosis in Endometrial Biopsy Predicts Advanced Stage of Endometrial Adenocarcinoma.
Reda S Saad, Miral Mashhour, Ahmed Shehata, Nadia Ismiil, Sharon Nofech-Mozes, Valerie Dube, Zeina Ghorab, Mahmoud A Khalifa. Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Background: Tumor necrosis and lymphocytic infiltration have been recognized as predictors for tumor behavior and chemotherapy response in some solid tumors. There is no available data regarding the clinical implication of these histopathologic features in endometrial adenocarcinoma. In this study, we investigated the value of the degree of tumor necrosis in a series of endometrial biopsies to predict advanced tumor stage on resection.
Design: Endometrial biopsies with endometrioid adenocarcinoma followed by total hysterectomy and bilateral salpingo-oophorectomy were retrieved from the archives during the period between 2000 and 2008. Cases with missing slides, tumors with non-endometrioid components or carcinosarcoma were excluded. We identified 198 endometrial biopsies eligible for the study. All cases were reviewed at the multiheaded microscope for histologic type and nuclear grades, presence of tumor necrosis and lymphocytic infiltration. The percentage of necrosis and lymphocytic infiltration were graded as follows: 1+ (0-25%), 2+ (26-50%) and 3+ (>50%). Data were analyzed using Cox regression and Spearman correlation test.
Results: Of the 198 biopsies, 88/198 (44%) had 1+ necrosis, 61/198 (31%) had 2+ necrosis and 49/198 (25%) had 3+ necrosis. Both the degree of necrosis and FIGO grade in endometrial biopsies showed a significant correlation with the depth of myometrial invasion, cervical involvement and lymphovascular invasion (Spearman correlation, P< 0.01) in the subsequent resection. While the degree of necrosis was associated with lower uterine segment involvement, FIGO grade was associated with presence of lymph node metastasis. There was a significant correlation among degree of necrosis, FIGO grade and nuclear grade in endometrial biopsies. Tumor lymphocytic infiltration and nuclear grade did not show any significant correlation with other histopathologic prognostic parameters in the hysterectomy.
Conclusions: Degree of tumor necrosis in endometrial biopsy is a predictor for deep myometrial invasion, cervical involvement and presence of lymphovascular invasion in the subsequent resection. Documenting the presence and degree of tumor necrosis in pathology reports of endometrial biopsy in addition to FIGO grade may add insight for the surgical management decision.
Category: Gynecologic & Obstetrics
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 158, Wednesday Afternoon