Accuracy of preoperative endometrial sampling diagnosis of FIGO grade 1 endometrial adenocarcinoma Mario M. Leitao Jr. a, ⁎ , Siobhan Kehoe a , Richard R. Barakat a , Kaled Alektiar b , Leda P. Gattoc d , Catherine Rabbitt a , Dennis S. Chi a , Robert A. Soslow c , Nadeem R. Abu-Rustum a a Department of Surgery, Division of Gynecology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA b Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA c Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA d Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, New York, NY, USA Received 18 June 2008 Available online 27 August 2008 Abstract Objective. To evaluate the ability of a preoperative diagnosis of FIGO grade 1 endometrial adenocarcinoma and intraoperative depth of myoinvasion (DOI) to predict low-risk (LR) and high-risk (HR) final uterine pathology. Methods. We reviewed 1423 consecutive cases of endometrial cancer treated at our institution between 1/1/93 and 5/31/06 to identify cases with a preoperative endometrial biopsy demonstrating FIGO grade 1 endometrial adenocarcinoma. All cases were pathologically reviewed at our institution and underwent surgical therapy at our institution. We excluded equivocal preoperative biopsies as well as those with serous or clear cell histology. Final uterine pathologic findings were grouped into low- and high-risk. Chi-square and Fisher-exact tests were used as appropriate. Results. We identified 490 cases with a median age of 60 years (range 29–90 years). In 482 cases in which final pathologic grade was assessable, FIGO grade was greater in 71 (14.7%) cases; (66 [13.7%] were grade 2, and 5 [1%] were grades 2–3/3). Serous or clear cell histology was diagnosed in 6 (1.2%) additional cases. HR final uterine pathology was seen in 86 (18.5%) cases. Frozen section assessment of DOI, when performed, was associated with HR pathology (p b 0.001). HR pathology was present in 3 (3.6%) of 84 cases with either no tumor or myoinvasion identified on frozen section. Lymph node metastasis was identified in 9 (4.4%) of 205 patients that underwent nodal evaluation. Conclusions. Preoperative FIGO grade 1 diagnosis correlates with final post-hysterectomy grade in 85% of cases. The rate of HR uterine pathology based on preoperative grade 1 alone is 18.5%. Frozen section may help further stratify for the risk of final HR uterine pathology but is not entirely accurate. The rate of HR uterine pathology is 4% if no cancer or myoinvasion is identified on frozen section and 18% if myoinvasion up to 50% is identified. © 2008 Elsevier Inc. All rights reserved. Keywords: Preoperative; FIGO grade 1; Encometrial; Adenocarcinoma; Hysterectomy Introduction Endometrial cancer is the most common gynecologic malignancy and the fourth most common malignancy in women overall in the United States, with an estimated 40,100 new cases diagnosed annually [1]. This high incidence rate is also evident in many other countries, with an estimated 136,000 new cases diagnosed worldwide in 2002 [2]. The International Federation of Gynecology and Obstetrics (FIGO) replaced an inaccurate clinical staging system with a surgically staged system in 1988 [3,4]. The importance of surgical staging was supported by the findings from a large prospective surgical- pathologic study in patients with clinical stage I and II endometrial carcinoma conducted by the Gynecologic Oncol- ogy Group (GOG) [5,6]. Extra-uterine disease, including pelvic and para-aortic lymph node metastasis, was found relatively frequently in this study. The risk of nodal metastasis was associated with both final pathologic FIGO tumor grade and depth of myometrial invasion [5]. Multiple extra-uterine findings were also associated with outcome [6]. These findings led to the change in the FIGO staging system. FIGO stage I was Available online at www.sciencedirect.com Gynecologic Oncology 111 (2008) 244 – 248 www.elsevier.com/locate/ygyno ⁎ Corresponding author. Fax: +1 212 717 3214. E-mail address: gynbreast@mskcc.org (M.M. Leitao). 0090-8258/$ - see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2008.07.033