AMOUNT OF PREOPERATIVE ENDOMETRIAL TISSUE 37 2 B. A. C. Figure 3 A-C. Kaplan-Meier survival curves of disease-specific survival A. Disease-specific survival of concordant low-grade endometrial cancer (EC), concordant high-grade EC, downgraded and upgraded patients. B. Disease-specific survival of concordant low-grade EC and downgraded patients. C. Disease-specific survival of concordant high-grade EC and upgraded patients. Numerous studies stated that preoperative endometrial sampling is poorly correlated with final tumor grade and histological subtype.19-21 On the contrary, Sany et al. mentioned good agreement between preoperative and final pathology with sensitivities of 96.5% for EECs and 86.5% for NEECs.22 Our study findings are in line with Visser et al. who reported an overall moderate concordance of 67% on tumor grade.11 Clinically relevant downgrading was reported in 26% of the included patient samples and upgrading in 8%.11 Our results show similar clinically relevant downgrading of 26.7% and upgrading in 7.8%. Several studies note that the diagnostic consensuses of tumor grade and histological subtype based on morphology alone are overall moderate. Performing immunohistochemical (IHC) markers on preoperative tissue could help to improve the degree of concordance between pre- and postoperative diagnosis, especially for preoperative grade 2 and grade 3 EC with the lowest concordance.11, 23-26 For preoperative grade 2, a panel of progesterone (PR) and p53 biomarkers has been recommended, and, for grade 3/high-grade EC additional PR, IMP3 and L1CAM.26 Whether combined pathologic and molecular classification might further improve preoperative classification for high-grade EC needs to be determined.27
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