title: A discordant histological risk classification in preoperative and operative biopsy in endometrial cancer is reflected in metastatic risk and prognosis.
abstract: BACKGROUND
  In endometrial cancer, tissue for histological evaluation is obtained preoperatively (endometrial biopsy) and operatively (hysterectomy specimen). We investigated if a discordant risk classification based on preoperative and operative biopsy is reflected in metastatic risk and prognosis.
  
  
  METHODS
  One thousand three hundred and seventy-four patients were prospectively included in a multicentre setting (Molecular Markers for Treatment of Endometrial Cancer (MoMaTEC) study). Preoperative and operative specimens were classified as high risk if non-endometrioid histology or endometrioid grade 3; otherwise low risk. Disease specific survival differences were calculated by means of Kaplan-Meier and Cox proportional hazard models.
  
  
  RESULTS
  Discordant risk was found in 207 (16%) cases. Lymph node metastases were detected in 7% and 23% of patients with concordant low and high risk respectively versus 14% and 20% in the discordant groups (p<0.001). Five-year disease specific survival in the discordant groups proved intermediate (75-80%) to concordant low (94%) or high (58%) risk. Both operative and preoperative biopsy high-risk results have independent prognostic impact on disease specific survival with adjusted hazard ratios of 2.4 (95% confidence interval (95% CI) 1.5-3.9) and 2.1 (95% CI 1.3-3.2) respectively by Cox analysis.
  
  
  CONCLUSIONS
  Discordant risk in preoperative biopsy and hysterectomy identifies an intermediate group with respect to disease spread and prognosis. Preoperative biopsy results remain important also with the hysterectomy histology available.
authors.affiliation: Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway. hmj_werner@hotmail.com
authors.forename: H M J
authors.initials: HM
authors.lastname: Werner
authors.forename: J
authors.initials: J
authors.lastname: Trovik
authors.forename: J
authors.initials: J
authors.lastname: Marcickiewicz
authors.forename: S
authors.initials: S
authors.lastname: Tingulstad
authors.forename: A C
authors.initials: AC
authors.lastname: Staff
authors.forename: M E
authors.initials: ME
authors.lastname: Engh
authors.forename: K
authors.initials: K
authors.lastname: Oddenes
authors.forename: J A
authors.initials: JA
authors.lastname: Rokne
authors.forename: J
authors.initials: J
authors.lastname: Tjugum
authors.forename: M S
authors.initials: MS
authors.lastname: Lode
authors.forename: F
authors.initials: F
authors.lastname: Amant
authors.forename: H B
authors.initials: HB
authors.lastname: Salvesen
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk