Interinstitutional surgical pathology review in gynecologic oncology I. Cancer in endometrial curettings and biopsies

We report our experience with an interinstitutional surgical pathology review of endometrial curettings and biopsies originally diagnosed as cancer, Slides were reviewed from 182 women who were diagnosed with cancer and referred to our institution for further treatment; the slides had been sent for review at the request of the gynecologic oncologist. Review diagnoses were retrospectively compared to original diagnoses made on slides from these specimens, and significant discrepancies were identified in 43 (23.6%) of the 182 cases. For 16 (8.8%) patients, the diagnosis was downgraded from malignant to: 1) a benign non-hyperplastic process in 4 (2.2%); 2) scanty atypical glandular epithelium, not diagnostic for malignancy, in 2 (1.1%); and 3) endometrial hyperplasia in 10 (5.5%), including complex atypical hyperplasia in 8 (4.4%). Other significant differences involved histologic tumor classification in 16 (8.8%), degree of differentiation (two grades) in 2 (1.1%), determination of primary site in 4 (2.2%), and diagnosis of endocervical invasion in 5 (2.7%). Problems in comparison included lack of standardization of terminology and incomplete information from the original diagnoses. The high discrepancy rate between review and original diagnoses underscores the difficulty of interpreting these specimens. Review diagnoses of benign processes prevented an unnecessary operation for several women, and allowed those with cancer to undergo the most appropriate therapy. Review diagnoses in women with endometrial cancer contribute to quality medical care and have a major impact on a significant subset of patients.