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Endometrial Carcinoma Diagnosis: Use of FIGO Grading and Genomic Subcategories in Clinical Practice: Recommendations of the International Society of Gynecological Pathologists. | LitMetric
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York (R.A.S, K.J.P.) Department of Pathology, Stony Brook Hospital, SUNY, Stony Brook (C.T.), New York Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.M.) Pathology Department, University Hospital Arnau de Vilanova and University Hospital of Bellvitge, Biomedical Research Institute, and Bellvitge Biomedical Institute, University of Lleida, CIBERONC, Spain (X.M.-G.) Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts (E.O.) Department of Pathology, Yale School of Medicine and the Yale School of Public Health, New Haven, Connecticut (V.P.) Department of Oncology-Pathology, Karolinska Institutet and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden (J.C.) Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK (W.G.M.) Department of Pathology and Laboratory Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada (C.B.G.).
Published: January 2019
AI Article Synopsis
Article Abstract
In this review, we sought to address 2 important issues in the diagnosis of endometrial carcinoma: how to grade endometrial endometrioid carcinomas and how to incorporate the 4 genomic subcategories of endometrial carcinoma, as identified through The Cancer Genome Atlas, into clinical practice. The current International Federation of Gynecology and Obstetrics grading scheme provides prognostic information that can be used to guide the extent of surgery and use of adjuvant chemotherapy or radiation therapy. We recommend moving toward a binary scheme to grade endometrial endometrioid carcinomas by considering International Federation of Gynecology and Obstetrics defined grades 1 and 2 tumors as "low grade" and grade 3 tumors as "high grade." The current evidence base does not support the use of a 3-tiered grading system, although this is considered standard by International Federation of Gynecology and Obstetrics, the American College of Obstetricians and Gynecologists, and the College of American Pathologists. As for the 4 genomic subtypes of endometrial carcinoma (copy number low/p53 wild-type, copy number high/p53 abnormal, polymerase E mutant, and mismatch repair deficient), which only recently have been identified, there is accumulating evidence showing these categories can be reproducibly diagnosed and accurately assessed based on biopsy/curettage specimens as well as hysterectomy specimens. Furthermore, this subclassification system can be adapted for current clinical practice and is of prognostic significance independent of conventional variables used for risk assessment in patients with endometrial carcinoma (eg, stage). It is too soon to recommend the routine use of genomic classification in this setting; however, with further evidence, this system may become the basis for the subclassification of all endometrial carcinomas, supplanting (partially or completely) histotype, and grade. These recommendations were developed from the International Society of Gynecological Pathologists Endometrial Carcinoma project.
