title: The reproducibility of a binary tumor grading system for uterine endometrial endometrioid carcinoma, compared with FIGO system and nuclear grading.
abstract: OBJECTIVE
  A binary grading system has been proposed to assess the amount of solid growth, the pattern of invasion, and the presence of necrosis, and thereby divide endometrial endometrioid carcinomas into low- and high-grade tumors. We analyzed this system for predicting the prognosis, with respect to inter- and intraobserver reproducibility and treatment modalities.
  
  
  METHODS
  A total of 200 endometrial carcinomas, based on hysterectomy specimens, were graded according to the binary grading system, for comparison against The International Federation of Gynecology and Obstetrics (FIGO) system and nuclear grading.
  
  
  RESULTS
  Both inter- and intraobserver agreement using the binary grading system (kappa = 0.57; percent agreement: 82% and kappa = 0.62; 84%) were superior compared with the FIGO system (0.50; 60% and 0.62; 73%) and the nuclear grading (0.23; 49% and 0.43; 65%). Patients with early-stage low-grade tumors had a 98% rate for 5-year survival (5YS). Patients with early-stage high-grade tumors, and those with advanced-stage low-grade tumors, had respectively 86% to 87% rates for 5YS. But patients with advanced-stage high-grade tumors had a 49% rate for 5YS. In binary low-grade early-stage tumors, the patient outcome was better with no adjuvant therapy and chemotherapy, compared with other therapies.
  
  
  CONCLUSIONS
  A binary grading system was superior to others in permitting greater reproducibility and predicting the prognosis of endometrial cancer patients.
authors.affiliation: Department of Obstetrics and Gynecology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Sagae
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Saito
authors.forename: Masaaki
authors.initials: M
authors.lastname: Satoh
authors.forename: Tatsuru
authors.initials: T
authors.lastname: Ikeda
authors.forename: Sachiko
authors.initials: S
authors.lastname: Kimura
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Mori
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Sato
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kudo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000628:therapy; D002467:Cell Nucleus / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000473:pathology