CHAPTER 8 192 Incorrect classification by the pathologist, especially for grade 2 and high-grade EC, including interobserver disagreement, could be resolved by standard using IHC or molecular biomarkers, as explained earlier. However, in the future most likely grading issues may be resolved by using artificial intelligence (AI) as assisted tool, which appears already very successful for grading prostate cancer in biopsies.89-92 Primary treatment for patients with grade 2 or high-grade EC could be tailored with the revised ENDORISK model. This will determine the risk of LNM and could be used as a clinical decision tool for patients and doctors, to choose for primary treatment: hysterectomy and bilateral salpingectomy with or without additional SLN or full LND. Figure 2 shows a proposed primary treatment model of the different risk subgroups of LNM, percentages based on Creasman et al.34 In a shared decision concept patients and doctors may of course individualize this proposition, for instance based on comorbidity factors. Figure 2. Clinical decision tool for the primary treatment of endometrial cancer Abbreviations: EC, endometrial cancer; NEEC, non-endometrioid endometrial cancer; EEC, endometrioid endometrial cancer; LNM, lymph node metastasis; BSO, bilateral salpingectomy; SLN, sentinel lymph node; LND, lymph node dissection
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