Bouwman, S.K. (Silke) (2016) The reliability of preoperative histological samples in patients with endometrial carcinoma : A pattern of care study. thesis, Medicine.
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Abstract
Introduction Endometrial carcinoma is the most common gynecological cancer in the Netherlands (incidence of 19 per 100,000 women). To diagnose endometrial cancer, a preoperative endometrial biopsy is taken, which leads to a surgical decision. To confirm the diagnosis of the preoperative biopsy, endometrial tissue is obtained during surgery. The tissue obtained during surgery is considered to be the gold standard for correct diagnosis of endometrial cancer. Previously, several studies have evaluated the differences between the preoperative and postoperative histological diagnosis of endometrial carcinoma. For example, Werner et al performed a large prospective study in Norway to investigate the concordance of the preoperative and postoperative histological diagnosis of endometrial cancer, and found a discrepancy in 16% of patients with different survival. Aim Aim of this population-based study was to investigate the concordance of the preoperative and postoperative risk classifications for endometrial cancer patients in the Netherlands and to evaluate differences in survival between risk classifications. Material and methods Population-based data were retrospectively collected from the preoperative and postoperative pathological assessments of all patients diagnosed with endometrial cancer in the Netherlands, between January 1st and April 1st of every year within the period 2005-2014. Patients were selected from the Netherlands Cancer Registry (NCR) and merged with data from the Dutch Pathology Registry (PALGA). A risk classification was made for each patient prior to surgery (using the preoperative pathological assessment) and after surgery (using the postoperative pathological assessment). Concordance between the preoperative and postoperative pathological assessment implied a correct risk classification was made prior to the operation. Results Data of 4037 patients were retrieved from the NCR. After merging with data from PALGA, both preoperative and postoperative risk classifications could be determined in 1684 patients. Most patients were diagnosed with FIGO stage IA (54%), grade I (41%) and endometrioid type (77%) carcinomas. A discrepancy in risk classification was demonstrated in 10.1% of patients. Of these, 6.1% of patients had a low preoperative and a high postoperative risk, and 4.1% of patients had a high preoperative and low postoperative risk. There was no difference in overall survival between patients with concordant low risk, and those with high preoperative and low postoperative risk (p-value 0.055). Likewise, there was no difference between patients with concordant high risk, and those with low preoperative and high postoperative risk (p-value 0.398). Discussion and conclusions A discrepancy of 10.1% in risk assessments demonstrated high concordance for correct preoperative diagnosis in the Netherlands, compared to similar studies. In this retrospective study a discordant preoperative risk classification did not influence overall survival of patients with endometrial cancer.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Eggink, Drs. F.A. PhD candidate and Nijman, Prof. Dr. H.W. gynaecologist oncologist |
| Supervisor name: | Aa, Dr. M.A. van der senior researcher |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/991 |
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