title: Is the two-tier ovarian serous carcinoma grading system potentially useful in stratifying uterine serous carcinoma? A large multi-institutional analysis.
abstract: OBJECTIVE
  A subset of uterine serous carcinoma (USC) may have better clinical behavior bringing up the possibility that there may be morphologic features, which would help in their categorization. The aim of this study is to evaluate the potential use of the MD Anderson Cancer Center 2-tier grading system for ovarian carcinoma in USC.
  
  
  METHODS
  Tumors assigned a combined score included in this analysis were 1) low-grade: tumors without marked atypia and 12 mitoses/10 high power field (HPF) and 2) high grade: tumors with severe nuclear atypia and >12 mitoses/10 HPF. Clinicopathologic parameters evaluated included patients' age, tumor size, myometrial invasion (MI), lymphovascular invasion (LVI), lymph node (LN), FIGO stage, and patient outcome.
  
  
  RESULTS
  140 patients with USC were included, 30 low grade uterine serous carcinoma (LGUSC) and 110 high grade uterine serous carcinoma (HGUSC). Of all parameters only 2 (MI and stage IA) reached statistical significance. 67% of LGUSC cases showed myometrial invasion versus 93.6% HGUSC cases (p = 0.003). A higher percentage of LGUSC (63.3%) versus HGUSC (32.7%) were in stage IA (p = 0.01). However, by multivariate analysis including age, LVI, stage and tumor grade only stage was an independent prognostic factor.
  
  
  CONCLUSIONS
  The presence of atypia and mitosis across a uterine serous carcinoma is notoriously variable in magnitude and extent, potentially making evaluation of these features difficult and subsequent grading subjective. Our findings thus show that actual prognostic utility of application of MDACC two-tier grading system to uterine serous carcinoma may not be applicable.
authors.affiliation: Wayne State University, Harper University Hospital, Department of Pathology, 3990 John R. Street, Detroit, MI 48201, USA. Electronic address: qahmed@med.wayne.edu.
authors.forename: Quratulain
authors.initials: Q
authors.lastname: Ahmed
authors.affiliation: Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: husseiny@mskcc.org.
authors.forename: Yaser
authors.initials: Y
authors.lastname: Hussein
authors.affiliation: Wayne State University, Harper University Hospital, Department of Pathology, 3990 John R. Street, Detroit, MI 48201, USA. Electronic address: khayek@med.wayne.edu.
authors.forename: Kinda
authors.initials: K
authors.lastname: Hayek
authors.affiliation: Wayne State University, Harper University Hospital, Department of Pathology, 3990 John R. Street, Detroit, MI 48201, USA. Electronic address: sbandyop@med.wayne.edu.
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Bandyopadhyay
authors.affiliation: Karmanos Cancer institute, 4100 John R St, Detroit, MI 48201, USA. Electronic address: asemaan@med.wayne.edu.
authors.forename: Assaad
authors.initials: A
authors.lastname: Semaan
authors.affiliation: Cleveland Clinic Main Campus, Mail Code L25, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: KARIMF@ccf.org.
authors.forename: Fadi
authors.initials: F
authors.lastname: Abdul-Karim
authors.affiliation: Karmanos Cancer institute, 4100 John R St, Detroit, MI 48201, USA. Electronic address: zalwahab@med.wayne.edu.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Al-Wahab
authors.affiliation: Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA. Electronic address: AMUNKAR1@hfhs.org.
authors.forename: Adnan R
authors.initials: AR
authors.lastname: Munkarah
authors.affiliation: Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI 48202, USA. Electronic address: MELSHAI1@hfhs.org.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
authors.affiliation: Wayne State University, Harper University Hospital, Department of Pathology, 3990 John R. Street, Detroit, MI 48201, USA. Electronic address: balosh@med.wayne.edu.
authors.forename: Baraa
authors.initials: B
authors.lastname: Alosh
authors.affiliation: Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: MNUCCI@PARTNERS.ORG.
authors.forename: Marisa R
authors.initials: MR
authors.lastname: Nucci
authors.affiliation: Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. Electronic address: KVANDEVIJVER@PARTNERS.ORG.
authors.forename: Koen K
authors.initials: KK
authors.lastname: Van de Vijver
authors.affiliation: Karmanos Cancer institute, 4100 John R St, Detroit, MI 48201, USA. Electronic address: rmorris@med.wayne.edu.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Morris
authors.affiliation: Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. Electronic address: EOLIVA@partners.org.
authors.forename: Esther
authors.initials: E
authors.lastname: Oliva
authors.affiliation: Wayne State University, Harper University Hospital, Department of Pathology, 3990 John R. Street, Detroit, MI 48201, USA. Electronic address: rali@med.wayne.edu.
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
mesh_terms: D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000145:classification / Q000473:pathology*; D005260:Female; D006801:Humans; D060787:Neoplasm Grading; D011379:Prognosis; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000145:classification / Q000473:pathology*
keywords: 2-tier grading system; Uterine serous carcinoma