title: Are preoperative histology and MRI useful for classification of endometrial cancer risk?
abstract: The 2010 guidelines of the French National Cancer Institute (INCa) classify patients with endometrial cancer into three risk groups for lymph node invasion and recurrence on the basis of MRI and histological analysis of an endometrial specimen obtained preoperatively. The classification guides therapeutic choices, which may include pelvic and/or para-aortic lymphadenectomy. The purpose of this study was to evaluate the diagnostic performance of preoperative assessment to help identify intermediate- or high-risk patients requiring lymphadenectomy.
  
  
  
  The study included all patients who underwent surgery for endometrial cancer between January 2010 and December 2013 at either Rennes University Hospital or Vannes Regional Hospital. The criteria for eligibility included a preoperative assessment with MRI and histological examination of an endometrial sample. A histological comparison was made between the preoperative and surgical specimens.
  
  
  
  Among the 91 patients who underwent a full preoperative assessment, the diagnosis of intermediate- or high-risk endometrial cancer was established by MRI and histology with a sensitivity of 70 %, specificity of 82 %, positive predictive value (PPV) of 87 %, negative predictive value (NPV) of 61 %, positive likelihood ratio (LR+) of 3.8 and negative likelihood ratio (LR-) of 0.3. The risk group was underestimated in 32 % of patients and overestimated in 7 % of patients. MRI underestimated endometrial cancer stage in 20 % of cases, while endometrial sampling underestimated the histological type in 4 % of cases and the grade in 9 % of cases.
  
  
  
  The preoperative assessment overestimated or underestimated the risk of recurrence in nearly 40 % of cases, with errors in lesion type, grade or stage. Erroneous preoperative risk assessment leads to suboptimal initial surgical management of patients with endometrial cancer.
authors.affiliation: Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.
authors.forename: Noemie
authors.initials: N
authors.lastname: Body
authors.affiliation: Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France. vincent.lavoue@chu-rennes.fr.|Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France. vincent.lavoue@chu-rennes.fr.|University of Rennes 1, Faculty of Medicine, Rennes, France. vincent.lavoue@chu-rennes.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lavoué
authors.affiliation: Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: De Kerdaniel
authors.affiliation: Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.|Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Foucher
authors.affiliation: Pathology Department, CHU Pontchaillou, Rennes University Hospital, Rennes, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Henno
authors.affiliation: Pathology Department, CHU Pontchaillou, Rennes University Hospital, Rennes, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cauchois
authors.affiliation: Clinical Pharmacology Department, Rennes University Hospital, CIC Inserm 0203, Hôpital Pontchaillou, Rennes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Laviolle
authors.affiliation: Gynaecology Department, Bretagne Atlantique Hospital, Vannes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Leblanc
authors.affiliation: Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.|Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France.|University of Rennes 1, Faculty of Medicine, Rennes, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Levêque
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D004717:Endometrium / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors
keywords: Endometrial cancer; Endometrial sample; Lymphadenectomy; MRI; Risk group