Endometriyum Kanserinde Cerrahi Öncesi ve Sonrası Tümör Grade Uyuşmazlığı ve Klinik Yansıması

OZET AMAC: Endometrioid tip endometriyal kanserde histolojik grade, cerrahi planlamada ve prognoz icin onemli bir faktordur. Bu calismada operasyon oncesi ve sonrasi tumor grade’lerinin karsilastirilmasi ve farkliliklarin cerrahi yonetimdeki olasi etkilerini arastirmayi amacladik. GEREC VE YONTEM: Kurumumuzda 2011 ve 2016 yillari arasinda endometriyal kanser tanisi ile cerrahi evreleme yapilan hastalarin tibbi kayitlari gozden gecirildi. Bulunan 106 dosyadan 67’si calisma kriterlerine uygun bulunarak operasyon oncesi ornekleme metodu, operasyon oncesi grade, cerrahi prosedur, postoperatif grade ve nihai patoloji acisindan incelendiler. Operasyon oncesi tumor grade’leri, histerektomi orneklerindeki nihai patolojik evrelerle karsilastirildi. BULGULAR: Uygun bulunan 67 olgudan 6 tanesinde (%9) operasyon oncesi ornekleme metodu biyopsi (Pipelle), ve geri kalan 61 tanesinde (%91) ise kuretajdi. Operasyon oncesi 18 olgu (%26.8) grade 1 (G1), 44 olgu grade 2 (G2) (%65.7) ve 5 olgu grade 3 (G3) (%7.5) olarak belirlenmisti. Operasyon sonrasi nihai grade yuzdeleri ise G1 icin %20.9, G2 icin %70.1 ve G3 icin ise %9’du. Operasyon oncesi ve sonrasi grade yuzdelerinde anlamli bir farklilik bulunmadi. Ancak, 7 hastada (%10.3) potansiyel olarak klinik-anlamli grade farkliligi oldu: 4 olguda (%5.9) grade dusurme (G3’ten G2 veya G1’e) ve 3 olguda (%4.4) grade yukseltme (G1/G2’den G3’e). Invazyon derinligi ile operasyon oncesi ve sonrasi grade uyumlulugunun iliskisi olmadigi izlendi. SONUC: Bu calisma endometrioid endometriyal kanserde operasyon oncesi ve sonrasi histolojik grade uyumsuzluk orani onemli miktarda gibi gorunse de istatistiki anlama ulasmadigini gosterdi. Bu oranlarin klinik yansimasi da, hastaligin yonetimini etkileyen diger faktorler yaninda ihmal edilebilir duzeyde gibi gorulmektedir. Grade uyusmazliklari, klinik olarak her zaman anlamli olmadigindan, uygulanacak cerrahi girisimin tarzi hastalarin risk grubu ve diger prognostik faktorleri de goz onunde bulundurarak planlanmalidir. Before and After Surgery Tumor Grade Discrepancy in  Endometrial Cancer and Its Clinical Reflection ABSTRACT AIM: Histologic grading in endometrioid endometrial cancer is an important factor in surgical planning and prognosis. This study aimed to compare preoperative tumor grades to subsequent postoperative grades and explore the discrepancies for their possible effects on surgical management. MATERIAL AND METHODS: Medical records of patients with endometrial cancer diagnosis who underwent surgical staging at our institution between the years 2011 and 2016 were reviewed. Sixty seven out of 106 charts were found eligible and were evaluated for preoperative sampling method, preoperative grade, surgical procedure, postoperative grade and final pathology. Preoperative tumor grades were compared to final pathology grades of hysterectomy specimens. RESULTS: Out of 67 eligible cases, preoperative sampling method was endometrial biopsy (Pipelle) in 6 (9 %) and curettage for the rest 61 (91%). Preoperatively, 18 (26.8%) of them were regarded as grade 1 (G1), 44 (65.7%) of them as grade 2 (G2), and 5 (7.5%) of them as grade 3 (G3). Percentages for postoperative final grades were 20.9% for G1, 70.1% for G2, and 9% for G3. No significant difference was found between overall preoperative and postoperative grade results. However, 7 patients had a potentially clinical-significant grade discrepancy (10.3%): 4 downgrades (5.9%) (G3 to G2/ G1) and 3 (4.4%) upgrades (G1/G2 to G3). Depth of invasion (DOI) and preoperative-postoperative grade concordance rates were not found to be related either. CONCLUSION: This study revealed that preoperative and postoperative histologic grade discrepancy rates may seem important although not reaching statistically significant levels. Clinical reflection of these rates seemed to be negligible due to other factors affecting management.  The extent of the planned surgery must be customized to each patient’s risk category while taking into account of other prognostic markers since the number of significant grade discrepancies alone may not necessarily reflect clinical significance.