An Analysis of Two vs. Three Grades for Endometrial Cancer
September 1, 1999 3 minutes read
An Analysis of Two vs. Three Grades for Endometrial Cancer
Abstract & Commentary
Taylor and associates retrospectively reviewed endometrial biopsy and uterine histology specimens, quantifying the percentage amount of nonsquamous solid tumor by intervals of 10. They then compared these percentage values to other histopathologic prognostic variables. The current grading of uterine endometrioid adenocarcinoma uses a three-grade system based on the amount of nonsquamous solid histologic architecture. Of these three grades, Taylor et al questioned the practical clinical utility of the intermediate grade. Eighty-five stage I and II endometrioid adenocarcinoma patients had their preoperative endometrial curettings and operative hysterectomy pathology specimens reviewed independently by two gynecologic pathologists for surgical staging and outcome with mean follow-up time of six years.
A two-tiered system for assessing uterine tumors found less interobserver variation (k = 0.966) compared to the current three-tiered grading system (k = 0.526). There were no differences between the two- and three-tiered grading systems regarding myometrial invasion, lymph vascular space invasion, and survival. In the diagnosis of endometrial biopsies, the two-tiered system also improved the prediction of uterine histology grade over the three-tiered system, (90% and 63% respectively). Taylor et al concluded that a two-grade architecture system with a delineation value of 20% would be more reliable and less cumbersome and would have the same or better prognostic significance as the currently used three-grade system. (Taylor RR, et al. Gynecol Oncol 1999;74:3-6.)
Comment by David M. Gershenson, MD
Endometrial cancer is the most common gynecologic malignancy and afflicts approximately 40,000 women in the United States annually. Several prognostic factors are associated with outcome, the most important of which are FIGO stage, histopathologic grade, myometrial invasion, and histologic subtype. The most common histologic subtype of endometrial cancer is endometrioid. The current FIGO grading system includes three levels—well differentiated, moderately differentiated, and poorly differentiated. In the present study, Taylor et al suggest that a two-grade system would be more reproducible than a three-grade system. In this small study of 85 early-stage patients, they produce data to support their hypothesis. Seemingly, this type of simplification of the grading system flies in the face of the current trends in oncology. Particularly with the explosion of information about the molecular biology and genetics of gynecologic neoplasms, the current push is to individualize treatment based on the patient’s unique clinicopathologic and molecular profile. However, I personally support the efforts of Taylor et al and happen to agree with their findings. A simpler, more reproducible grading system would not, in my opinion, compromise our efforts toward individualization of treatment; in fact, it might enhance them. Our group at M.D. Anderson Cancer Center has unofficially adopted a similar system for the grading of epithelial ovarian cancer. Clearly, a broader study of this area is necessary, with several participating pathologists and institutions, before the scientific community can embrace such a change.
Major prognostic factors in endometrial adenocarcinoma include all the following except:
a. uterine size.
b. histologic grade.
c. depth of myometrial invasion.
d. FIGO stage.
e. None of the above
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