title: Prognosis and reproducibility of new and existing binary grading systems for endometrial carcinoma compared to FIGO grading in hysterectomy specimens.
abstract: BACKGROUND
  The current International Federation of Gynecology and Obstetrics (FIGO) grade in endometrial carcinomas requires the evaluation of histologic features with proven prognostic value but with questionable reproducibility. This study tests the prognostic power and reproducibility of a new binary grading system.
  
  
  METHODS
  Specimens from 254 hysterectomies were graded according to the new 3- and 2-tiered FIGO grading systems described by Alkushi et al. The selected morphologic parameters for the new grading system included the presence of predominant solid or papillary architecture pattern, severe nuclear atypia, tumor necrosis, and vascular invasion. The Cox proportional hazards and κ statistics were used for comparisons.
  
  
  RESULTS
  On multivariate analysis, and looking at all tumor cell types, the 4 tested grading systems were independent predictors of survival, with the 3-tiered FIGO grading system being the most predictive (P = 0.005). In the subset of endometrioid tumors, the 3- and 2-tiered FIGO grading systems and the new grading system retained their statistical significance as predictors of survival (P = 0.004, P = 0.03, and P = 0.007, respectively), whereas the grading system of Alkushi et al did not (P = 0.1). In nonendometrioid tumors, the new grading system proved to be the best predictor of survival, reaching near statistical significance (P = 0.06). The new grading system had acceptable intraobserver and interobserver reproducibility assessment (κ = 0.87 and κ = 0.45, respectively).
  
  
  CONCLUSIONS
  The 3-tiered FIGO grading system retained its superior prognostic power. However, available binary grading systems remain an attractive option by being highly reproducible and by eliminating the clinical ambiguity of intermediate grades of disease.
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, Detroit, MI 48201, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Guan
authors.forename: Assaad
authors.initials: A
authors.lastname: Semaan
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Bandyopadhyay
authors.forename: Haitham
authors.initials: H
authors.lastname: Arabi
authors.forename: Jining
authors.initials: J
authors.lastname: Feng
authors.forename: Lamia
authors.initials: L
authors.lastname: Fathallah
authors.forename: Vaishali
authors.initials: V
authors.lastname: Pansare
authors.forename: Aamer
authors.initials: A
authors.lastname: Qazi
authors.forename: Fadi
authors.initials: F
authors.lastname: Abdul-Karim
authors.forename: Robert T
authors.initials: RT
authors.lastname: Morris
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000592:standards / Q000639:trends; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design; D012189:Retrospective Studies; D013048:Specimen Handling; D016019:Survival Analysis; D055815:Young Adult