Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil / Características clínicas e desfechos de uma coorte de câncer endometrial de alto grau tratada no Instituto Nacional de Câncer, Brasil

Abstract Objective To analyze the outcomes of a cohort of patients with high-risk histologies of endometrial cancer (EC) treated at Instituto Nacional de Câncer (National Cancer Institute, INCA, in Portuguese), in Brazil. Materials and Methods We reviewed the medical records of patients with high-risk histologies of EC in any stage registered at INCA between 2010 and 2016 to perform a clinical and demographic descriptive analysis and to evaluate the outcomes in terms of recurrence and survival. Results From 2010 to 2016, 2,145 EC patients were registered and treated at INCA, and 466 had high-grade histologies that met the inclusion criteria. The mean age of the patients was 65 years, 44.6% were Caucasian, and 90% had a performance status of 0 or 1. The most common histology was high-grade endometrioid (31.1%), followed by serous carcinoma (25.3%), mixed (20.0%), carcinosarcoma (13.5%), and clear cell carcinoma (9.4%). Considering the 2018 Fédération Internationale de Gynécologie et d'Obstétrique (International Federation of Gynecology and Obstetrics, FIGO, in French) staging system, 44.8%, 12.4%, 29.8%, and 12.9% of the patient were in stages I, II, III or IV respectively. Age (> 60 years), more than 50% of myoinvasion, higher stage, poor performance status, serous and carcinosarcoma histologies, and adjuvant treatment were independent factors associated with recurrence-free survival (RFS) and overall survival (OS) in the multivariate analysis. Conclusion The current findings reinforced the international data showing poor outcomes of these tumors, especially for serous and carcinosarcomas and tumors with advanced stages, with shorter survival and high recurrence rates in distant sites, independently of the FIGO stage. Adjuvant therapy was associated with better survival.

Resumo Objetivo Analisar os desfechos de uma coorte de pacientes com câncer de endométrio (CE) e histologias de alto risco atendida no Instituto Nacional do Câncer (INCA) entre 2010 e 2016. Materiais e Métodos Foram revisados prontuários de pacientes com histologias de alto risco de CE em qualquer estágio cadastradas no INCA entre 2010 e 2016 para realizar uma análise descritiva clínica e demográfica e avaliar os resultados em termos de recorrência e sobrevida. Resultados De 2010 a 2016, 2.145 pacientes com CE foram cadastradas e atendidas no INCA, e 466 tinham histologias de alto grau e atendiam aos critérios de inclusão. A média de idade das pacientes foi de 65 anos, 44,6% eram brancas, e 90% tinham performance status de 0 ou 1. A histologia mais comum foi endometrioide de alto grau (31,1%), seguida de carcinoma seroso (25,3%), misto (20,0%), carcinossarcoma (13,5%) e carcinoma de células claras (9,4%). Considerando o estadiamento da Fédération Internationale de Gynécologie et d'Obstétrique (Federação Internacional de Ginecologia e Obstetrícia, FIGO, em francês) de 2018, 44,8%, 12,4%, 29,8% e 12,9% apresentaram estágios I, II, III ou IV, respectivamente. Idade (> 60 anos), mais de 50% de mioinvasão, estágio avançado, performance status ruim, histologias serosas e carcinossarcoma, e tratamento adjuvante foram fatores independentes associados à sobrevida livre de recorrência e sobrevida global na análise multivariada. Conclusão Os achados atuais reforçam os dados internacionais que demonstram o prognóstico ruim desses tumores, principalmente para as histologias serosas e carcinossarcomas e para estágios avançados, com menor sobrevida e altas taxas de recorrência à distância, independentemente do estágio da FIGO. A terapia adjuvante foi associada a melhor sobrevida.

Qualidade de vida e mapeamento de complicações: avaliação do linfonodo sentinela no câncer de endométrio / Quality of life and complications: evaluation of the sentinel lymph node in endometrial cancer

Objetivo: Avaliar a incidência das complicações pós-operatórias do estadiamento cirúrgico e qualidade de vida relacionada ao protocolo do linfonodo sentinela associado ou não à linfadenectomia sistemática no tratamento do câncer do endométrio. Métodos: Foi conduzida uma coorte prospectiva entre dezembro de 2017 e abril de 2022, incluindo mulheres com carcinoma de endométrio em estágio inicial presumido (doença restrita ao útero) e com estadiamento linfonodal, agrupadas em: Grupo LNS (somente pesquisa do linfonodo sentinela) e Grupo LNS+LND (linfonodo sentinela com adição de linfadenectomia sistemática). Foram incluídas pacientes com baixo e alto risco para metástase linfonodal. As pacientes de alto risco fazem parte do estudo ALICE (NCT03366051), um estudo prospectivo randomizado de não inferioridade. As pacientes foram avaliadas no pré-operatório, 1 mês, 6 e 12 meses, com aplicação de questionário de qualidade de vida (QQV) pelo EORTC QLQ-C30 e Cx24, avaliação clínica e perimetria para avaliar linfedema. Resultados: Foram incluídas 152 mulheres, sendo 113 (74,3%) no grupo LNS e 39 (25,7%) no grupo LNS+LND. Complicações cirúrgicas intraoperatórias ocorreram em 2 (1,3%) casos todas pertencentes ao grupo LNS+LND. Complicações cirúrgicas até 30 dias foram encontradas em 29 (19,1%) casos. As pacientes submetidas a LNS+LND apresentaram taxas gerais de complicações cirúrgicas mais altas em comparação com aquelas submetidas apenas a LNS (33,3% vs. 14,2%; p=0,011). O grupo LNS+LND apresentou maior tempo de cirurgia (p=0,001) e necessidade de UTI (p=0,001). A incidência de linfocele foi encontrada em 8 casos, apenas no grupo LNS+LND (0 vs. 20,5%; p<0,001). Para o linfedema de membros inferiores, não foi encontrada diferença entre os grupos pela avaliação perimétrica do grupo LNS comparado ao LNS+LND (23,2% vs. 13,3%; p= 0,25). O mesmo ocorreu para a avaliação clínica do linfedema, encontrado em 21,2% do grupo LNS e 33,3% do grupo LNS+LND (p=0,14). Entretanto, na avaliação de presença de linfedema pelo score de sintomas do EORTC, houve maior relato de linfedema no grupo LNS+LND (score 23,52) comparado ao grupo LNS (score 12,45) na avaliação de 12 meses (p=0,02). Além disso, encontramos associação entre avaliação clínica e linfedema relatado pelo paciente. O score médio de linfedema foi maior quando este foi detectado por exame clínico em 6 meses (30,10 vs. 7,8; p<0,001) e 12 meses (36,4 vs. 6,0; p<0,001), no entanto sem associação entre perimetria e avaliações clínicas (p=0,76). Em relação à avaliação global de qualidade de vida, não houve diferença entre os grupos aos 12 meses (p=0,21). Conclusões: Houve maior taxa geral de complicações para o grupo submetido a linfadenectomia sistemática, assim como maiores taxas de linfocele e linfedema pelo score de sintomas. Nenhuma diferença foi encontrada em relação à qualidade de vida entre os grupos LNS e LNS+LND

Objectives: To evaluate the incidence of postoperative complications of surgical lymph node staging procedures and quality of life related to the sentinel lymph node protocol associated or not with systemic lymphadenectomy in the treatment of endometrial cancer. Methods: A prospective cohort was conducted between December 2017 and April 2022. Women with presumed early-stage endometrial carcinoma (disease restricted to the uterus) and with lymph node staging were included, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND Group (sentinel lymph node with addition of systematic lymphadenectomy). Patients with low and high risk for lymph node metastasis were included, and high-risk patients were part of the ALICE study (NCT03366051), a prospective randomized non-inferiority study. The patients were assessed preoperatively, 1 month, 6 and 12 months with the application of a quality-of-life questionnaire (QQL) using the EORTC QLQ-C30 and Cx24, clinical evaluation and perimetry to assess lymphedema. Results: 152 women were included, 113 (74.3%) women in the SLN group and 39 (25.7%) in the SLN+LND group. Intraoperative surgical complications occurred in 2 (1.3%) cases, all of them in the SLN+LND group. Surgical complications within 30 days were found in 29 (19.1%) cases. Patients undergoing SLN+LND had higher overall rates of surgical complications compared to women undergoing SLN alone (33.3% vs. 14.2%; p=0.011). The SLN+LND group had longer surgery time (p=0.001) and need for ICU (p=0.001). The incidence of lymphocele was found in 8 cases and only in the SLN+LND group (0 vs. 20.5%; p<0.001). For lower limbs lymphedema, no difference was found between the groups by the perimetric evaluation of the SLN group compared to the SLN+LND (23.2% vs. 13.3%; p=0.25). The same occurred for the clinical evaluation of lymphedema, being found in 21.2% for the SLN group and 33.3% for the SLN+LND group (p=0.14). However, when evaluating the presence of lymphedema using the EORTC symptom score, there was a higher number of lymphedema reports in the SLN+LND group (score 23.52) compared to the SLN group (score 12.45) at the 12-month evaluation (p=0.02). In addition, we found an association between clinical evaluation and lymphedema reported by the patient. The lymphedema score had a higher mean score when lymphedema was detected by clinical examination at 6 months (30.10 vs. 7.8; p<0.001) and 12 months (36.4 vs. 6.0; p<0.001), however with no association between perimetry and clinical evaluations (p=0.76). Regarding the overall assessment of quality of life, there was no difference between the groups at 12 months (p=0.21). Conclusions: There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found regarding quality of life between the LNS and LNS+LND groups

Análisis del cáncer de endometrio en un hospital universitario de Ourense, España / Analysis of endometrial cancer in a university hospital in Ourense, Spain

Resumen OBJETIVO: Describir, de forma retrospectiva, el comportamiento del cáncer de endometrio en pacientes diagnosticadas en el Complexo Hospitalario Universitario de Ourense MATERIALES Y MÉTODOS: Estudio descriptivo, observacional y retrospectivo efectuado en el Complexo Hospitalario Universitario de Ourense entre septiembre de 2014 y enero de 2018. Criterio de inclusión: diagnóstico, tratamiento y seguimiento en nuestro centro. Criterio de exclusión: historia incompleta y diagnóstico o tratamiento en otro centro. Variables de estudio: tipo de tumor y de tratamiento. Se realizó un análisis descriptivo. Las posibles asociaciones se comprobaron mediante χ2, Fisher, t de Student y prueba de Mann-Whitney. RESULTADOS: Se estudiaron 149 pacientes, con edad media al diagnóstico de 69.38 años ± 9.6 años. El 86.6% (n = 129) de las pacientes estaban en la posmenopausia. El 68% (n = 101) eran obesas y el 54.7% (n = 81) hipertensas. El 54.7% (n = 81) se diagnosticaron en estadio IA. El 68.4% de los tumores grado 3 tuvieron infiltración miometrial mayor al 50%, el 28.6% grado 1 (p < 0.001). De las pacientes que recibieron radioterapia o braquiterapia el 46% estaba en estadios avanzados; 76% en estadio IB, 26% en estadio IA (p < 0.001). El 91.3% de los tumores estadio I fueron tipo I, en los estadios avanzados hubo 48.6% de tumores tipo I (p < 0.001). El 87.4% de los tumores grados 1 o 2 se encontraron en estadio I, un 45.2% de los tumores grado 3 en estadio I (p < 0.001). CONCLUSIONES: La mayoría de las pacientes tenía más de 60 años y eran diabéticas, hipertensas y obesas. El cáncer de endometrio suele diagnosticarse en estadios tempranos. La braquiterapia es la coadyuvancia más indicada.

Abstract OBJECTIVE: To retrospectively describe the behavior of endometrial cancer in patients diagnosed at the Complexo Hospitalario Universitario de Ourense. MATERIALS AND METHODS: Descriptive, observational and retrospective study in the Complexo Hospitalario Universitario de Ourense between September 2014 and January 2018. Inclusion criteria: diagnosis, treatment and follow-up in our center. Exclusion criteria: incomplete history and diagnosis or management in another center. Patient, tumor and treatment variables were collected. A descriptive analysis was performed. Possible associations were tested by Chi-square, Fisher, Student's t-test and Mann-Whitney test. RESULTS: 149 patients were studied, with mean age at diagnosis of 69.38 years ± 9.6 years. 86.6% (n = 129) of the patients were postmenopausal. 68% (n = 101) were obese and 54.7% (n = 81) hypertensive. 54.7% (n = 81) were diagnosed at stage IA. 68.4% of grade 3 tumors had myometrial infiltration greater than 50%, 28.6% grade 1 (p < 0.001). Of the patients who received radiotherapy or brachytherapy 46% were advanced stage; 76% stage IB, 26% stage IA (p < 0.001). 91.3% of stage I tumors were type I, in advanced stages there were 48.6% of type I tumors (p < 0.001). 87.4% of grade 1 or 2 tumors were stage I, 45.2% of grade 3 tumors were stage I (p < 0.001). CONCLUSIONS: Most patients were older than 60 years and were diabetic, hypertensive and obese. Endometrial cancer is usually diagnosed at early stages. Brachytherapy is the most indicated adjuvant.

Factores predictores de recurrencia del cáncer de endometrio / Predictors of the endometrium cancer recurrence

Resumen OBJETIVO: Determinar qué factores favorecen la predicción de recurrencia de cáncer de endometrio en diferentes estadios de la enfermedad. MATERIALES Y MÉTODOS: Estudio retrospectivo efectuado en un grupo de pacientes con cáncer de endometrio atendidas entre el 2017 y 2020 en el Hospital Juan Ramón Jiménez de Huelva, España. Variables de análisis: edad, grado de diferenciación tumoral, invasión miometrial, estadio posquirúrgico e infiltración al espacio linfovascular, en todas las pacientes con recidiva. El análisis estadístico se procesó en el programa SPSS v23. Habiéndose realizado un análisis de Kolmogorov- Smirnov y tras haber obtenido un resultado no normal, se utilizó la prueba de χ2 para los datos categóricos paramétricos, e independientemente se aplicó la prueba U de Mann Whitney para los datos no paramétricos. Los valores de p < 0.01 se consideraron estadísticamente significativos. RESULTADOS: Se reunieron 9 pacientes con recidiva tumoral y seguimiento de 5 años luego del diagnóstico primario. Conforme al análisis estadístico no se encontró una relación de dependencia entre las variables recidiva e invasión miometrial (χ2 = 4.780; p = 0.092), recidiva y grado tumoral (χ2 = 7.765; p = 0.051) y recidiva y el estadio posquirúrgico (χ2 = 10.200, p = 0.070). Por el contrario, se observó relación de dependencia entre las variables afectación ganglionar e infiltración al espacio linfovascular positiva (χ2 = 9.954, Cc = 0.235, p < 0.01). En todas las pacientes se evaluó la infiltración al espacio linfovascular. Ésta fue negativa en 141 casos y 4 de estos casos tuvieron recurrencia de la enfermedad. 5 de 9 pacientes con recurrencia de la enfermedad tenían infiltración al espacio linfovascular positiva. CONCLUSIONES: Lo aquí encontrado muestra que más de la mitad de las pacientes con recurrencia de la enfermedad tuvieron infiltración al espacio linfovascular. Cuando ésta fue negativa hubo una reducción del riesgo de 2.8% de padecer una recurrencia.

Abstract OBJECTIVE: To determine which factors favor the prediction of endometrial cancer recurrence at different stages of the disease. MATERIALS AND METHODS: Retrospective study performed in a group of patients with endometrial cancer attended between 2017 and 2020 at the Juan Ramón Jiménez Hospital in Huelva, Spain. Analysis variables: age, degree of tumor differentiation, myometrial invasion, post-surgical stage and infiltration to the lymphovascular space, in all patients with recurrence. The statistical analysis was processed in SPSS v23. Having performed a Kolmogorov-Smirnov analysis and having obtained a non-normal result, a 2 test was used for parametric categorical data, and independently the Mann Whitney U test was used for non-parametric data. Values of p < 0.01 were considered statistically significant. RESULTS: Nine patients with tumor recurrence and 5-year follow-up after primary diagnosis were collected. According to the statistical analysis, no dependency relationship was found between the variables recurrence and myometrial invasion (χ2 = 4.780; p = 0.092), recurrence and tumor grade (χ2 = 7.765; p = 0.051) and recurrence and post-surgical stage (χ2 = 10.200, p = 0.070). In contrast, a dependency relationship was observed between the variables nodal involvement and positive lymphovascular space infiltration (χ2 = 9.954, Cc = 0.235, p < 0.01). The existence of infiltration of the lymphovascular space was evaluated in all patients. This was negative in 141 cases and 4 of these cases had disease recurrence. 5 of 9 patients with disease recurrence had positive lymphovascular space infiltration. CONCLUSIONS: The findings here show that more than half of the patients with disease recurrence have infiltration to the lymphovascular space and, in addition, if the infiltration to the lymphovascular space is negative, there is a 2.8% reduced risk of recurrence.

Hemorragia de vías digestivas altas por presentación atípica de adenocarcinoma endometrial metastásico en el estómago. Tipificación diagnóstica con recursos endoscópicos / Upper gastrointestinal bleeding due to atypical presentation of metastatic endometrial adenocarcinoma in the stomach. Diagnostic typing with endoscopic resources

Resumen El cáncer de endometrio es la neoplasia ginecológica maligna más frecuente en el sexo femenino. Su presentación metastásica se limita principalmente a los órganos vecinos y ganglios cercanos, y es infrecuente la invasión al tubo digestivo superior. En el presente artículo se presenta una paciente que ingresó al servicio de urgencias con cuadro de hemorragia de vías digestivas altas, enfocado inicialmente como un tumor estromal gastrointestinal (GIST) de la pared gástrica, pero que luego de la realización de una adecuada historia clínica, complementada con imágenes diagnósticas y avances ecoendoscópicos, se logró el diagnóstico de metástasis de cáncer de endometrio.

Abstract Endometrial cancer is the most common gynecologic malignancy in women. Its metastatic presentation is mainly limited to neighboring organs and nearby lymph nodes, and infiltration of the upper digestive tract is uncommon. This case report depicts a patient admitted to the emergency department with upper gastrointestinal bleeding symptoms. Initially, a gastrointestinal stromal tumor (GIST) of the gastric wall was suspected, but endometrial cancer metastasis was discovered after a thorough medical examination, diagnostic imaging, and echoendoscopes.

Residual disease after operative hysteroscopy in patients with endometrioid endometrial cancer associated with polyps / Doença residual após histeroscopia cirúrgica em pacientes com câncer de endométrio endometrioide associado a pólipo endometrial

Abstract Objective To evaluate the presence of residual disease in the uterine specimen after hysteroscopic polypectomy or polyp biopsy in patients with endometrioid endometrial cancer (EC). Methods We analyzed a series of 104 patients (92 cases from the Hospital AC Camargo and 12 from the Hospital do Servidor Público Estadual de São Paulo) with polyps that were diagnosed by hysteroscopy, showing endometrioid EC associated with the polyp or in the final pathological specimen. Patients underwent a surgical approach for endometrial cancer from January 2002 to January 2017. Their clinical and pathological data were retrospectively retrieved from the medical records. Results In78cases (75%), thepolyphad EC, and in 40(38.5%), itwas restricted tothe polyp, without endometrial involvement. The pathologic stage was IA in 96 cases (92.3%) and 90 (86.5%) had histologic grade 1 or 2. In 18 cases (17.3%), there was no residual disease in the final uterine specimen, but only in 9 of them the hysteroscopy suggested that the tumor was restricted to the polyp. In 5 cases (4.8%) from the group without outside of the polyp during hysteroscopy, myometrial invasion was noted in the final uterine specimen. This finding suggests the possibility of disease extrapolation through the base of the polyp. Conclusion Patients with endometrioid EC associated with polyps may have the tumor completely removed during hysteroscopy, but the variables shown in the present study could not safely predict which patient would have no residual disease.

Resumo Objetivo Avaliar a presença de doença residual no exame anatomopatológico definitivo de pacientes com câncer de endométrio endometrioide após polipectomia ou biópsia de pólipo histeroscópica. Métodos Analisamos 104 pacientes (92 casos do Hospital AC Camargo e 12 casos do Hospital do Servidor Público Estadual de São Paulo) com pólipos diagnosticados durante histeroscopia e cuja biópsia histeroscópica ou exame patológico final do útero acusaram câncer de endométrio endometrioide. As pacientes foram submetidas a cirurgia para câncer de endométrio de janeiro de 2002 a janeiro de 2017. Os dados clínicos e anatomopatológicos de cada paciente foram retirados dos prontuários médicos Resultados Em 78 casos (75%), o pólipo continha a neoplasia, e em 40 (38.5%), ela estava restrita ao tecido do pólipo, sem envolvimento endometrial adjacente. O estadio final foi IA em 96 casos (92.3%) e em 90 (86.5%) tratava-se de grau 1 ou 2. Em 18 casos (17.3%), não havia doença residual no espécime uterino, mas emapenas 9 deles a histeroscopia sugeriu doença restrita ao pólipo. Em 5 casos (4.8%), não havia doença aparente extrapólipo na histeroscopia, mas havia invasão miometrial, sugerindo extravasamento do tumor pela base do pólipo. Conclusão Pacientes com câncer de endométrio associado a pólipos podem ter o tumor completamente removido durante a histeroscopia, mas, com as variáveis avaliadas, é difícil predizer com segurança qual paciente ficará sem tumor residual.

Carcinoma endometrioide sincrónico de ovario y endometrio / Ovarian and endometrial synchronous endometrioid carcinoma

ANTECEDENTES: existe una asociación demostrada entre endometriosis y algunas histologías del carcinoma epitelial de ovario. Por otra parte, se ha observado que hasta un 30% de las neoplasias de ovario se presentan de forma concomitante a neoplasias del endometrio. Para considerar la sincronicidad entre estos tumores, estos deben cumplir criterios anatomopatológicos estrictos como los descritos por scully. OBJETIVO: presentar un caso clínico de carcinoma endometrioide sincrónico de ovario y endometrio sobre focos de endometriosis, así como su diagnóstico y manejo. CASO CLÍNICO: paciente de 27 años que consulta por spotting intermenstrual. En la ecografía endocavitaria se observa un pólipo endometrial. Además, se describe un tumor anexial izquierdo de 42mm, trilobulado, con un polo sólido de 17×15mm. Se somete a una polipectomía histeroscópica y quistectomía ovárica laparoscópica. Asimismo, se reseca implante sospechoso en el fondo de saco posterior. El resultado anatomopatológico de las piezas quirúrgicas fue: pólipo endometrial con hiperplasia compleja con atipias y focos de adenocarcinoma endometrioide grado I; el tumor quístico ovárico izquierdo consistente con quiste endometriósico con focos de adenocarcinoma endometrioide. La lesión peritoneal corresponde a un implante de adenocarcinoma endometrioide grado I. El estudio de las características anatomopatológicas y la presencia del implante peritoneal sugieren el diagnóstico de un carcinoma endometrioide ovárico con origen en una lesión endometriósica sincrónico con un carcinoma endometrioide endometrial. CONCLUSIÓN: el diagnóstico diferencial entre la sincronicidad o diseminación de los tumores de ovario y endometrio de estirpe endometrioide supone un reto para el clínico y es fundamental para el correcto manejo de estas neoplasias.

BACKGROUND: there is a demonstrated association between endometriosis and some epithelial ovarian carcinoma histologies. On the other hand, it has been observed that up to 30% of ovarian neoplasms present concomitantly with endometrial neoplasms. To consider synchronicity between these neoplasms, they must meet strict pathological criteria such as those described by scully. OBJECTIVE: to introduce a case of an ovarian and endometrial synchronous endometrioid carcinoma implanted on endometriosis sites, as well as its diagnosis and management. CLINICAL CASE: a 27-year-old patient who consulted because of an intermenstrual spotting. The ultrasound image showed an endometrial polyp. Furthermore, a 42 mm left adnexal trilobal tumor with a 17×15mm solid pole was described. She underwent a hysteroscopic polypectomy and laparoscopic ovarian cystectomy. Likewise, resection of a suspicious implant in the posterior vaginal fornix was done. The pathological result of the surgical pieces was: endometrial polyp with complex hyperplasia with atypia and focal points of grade I endometrioid adenocarcinoma; the left ovarian cystectomy: endometriotic cyst with focal points of endometrioid adenocarcinoma. The peritoneal lesion corresponded to a grade I endometrioid adenocarcinoma implant. The study of the pathological characteristics and the presence of the peritoneal implant suggest the diagnosis of endometrioid ovarian carcinoma originated in a synchronous endometriotic lesion with endometrial endometrioid carcinoma. CONCLUSION: differential diagnosis between the synchronicity or spread of ovarian and endometrial endometrioid cell line carcinomas, is a great challenge and it is essential for the correct management of these neoplasms

Obesidad y cáncer de endometrio: las repercusiones de un problema de salud pública / Obesity and endometrial cancer: The impact of a public health problem

Resumen: OBJETIVO: Describir el incremento en la frecuencia del cáncer de endometrio en un hospital de tercer nivel en las últimas décadas y su asociación con el sobrepeso y la obesidad. MATERIALES Y MÉTODOS: Estudio retrospectivo, comparativo y observacional efectuado con base en la información de los expedientes de pacientes con diagnóstico de cáncer de endometrio atendidas en el servicio de Oncología del Hospital General de México (2000-2017). Los datos se compararon con un estudio previo de 1966-1993. RESULTADOS: Del 2000 al 2017 se registraron 785 pacientes y en el periodo global de 44 años, incluidos en el estudio, 1045 enfermas. En el lapso de 27 años se registraron 260 pacientes, y en el de 17 años: 785 enfermas; es decir, un incremento de 200% en la frecuencia de esta enfermedad. CONCLUSIONES: En esta serie los porcentajes de sobrepeso y obesidad se elevaron de 46 a 72.5%. El cáncer de endometrio en mujeres menores de 48 años aumentó de 19 a 28%. El 30.5% de las pacientes en etapas tempranas de cáncer de endometrio tuvieron factores de riesgo de recurrencia tumoral y 42% de la serie global cursó con neoplasias avanzadas, lo que está demostrado afecta su pronóstico.

Abstract: OBJECTIVE: To describe the increase shown in the frequency of endometrial cancer in a tertiary hospital in the last decades and its association with overweight and obesity. MATERIALS AND METHODS: Retrospective, comparative and observational study based on information from the files of patients with a diagnosis of endometrial cancer attended at the Oncology Service of the General Hospital of Mexico (2000-2017). Data were compared with a previous study from 1966-1993. RESULTS: From 2000 to 2017, 785 patients were registered and in the global period of 44 years, 1045 patients were included in the study. In the 27-year period, 260 patients were registered, and in the 17-year period, 785 patients were registered; that is, a 200% increase in the frequency of this disease. CONCLUSIONS: In this series the percentages of overweight and obesity rose from 46 to 72.5%. Endometrial cancer in women under 48 years of age increased from 19 to 28%. 30.5% of patients in early stages of endometrial cancer had risk factors for tumor recurrence and 42% of the overall series had advanced neoplasms, which is shown to affect their prognosis.

Resultados preliminares en la implementación de una técnica de detección de ganglio centinela en cáncer de cuello uterino y endometrio en un hospital público y centro formador en chile / Preliminary results in the implementation of a sentinel node detection technique in cervical and endometrial cancer in a public hospital and training center in Chile

Resumen Objetivo Evaluar el rendimiento diagnóstico de la técnica de azul patente (disponible en todo el territorio nacional) en el ganglio centinela para la estadificación del cáncer cérvico uterino y en-dometrial. Método Estudio prospectivo realizado entre enero de 2014 y diciembre de 2018. Se evaluó la técnica de azul patente para la detección de ganglio centinela en la estadificación del cáncer cérvico uterino y endometrial, antes de la linfadenectomía pélvica estándar. La inyección del azul patente se aplicó en el cuello uterino (1 cc 1 cm de profundidad y 1 cc superficial) a las 3 y 9 horas, 20 minutos antes del inicio de la cirugía (laparotomía o laparoscópica). La identifica-ción y extracción del ganglio centinela fue realizado por un ginecólogo oncólogo certificado y evaluado mediante histología tradicional con hematoxilina y eosina (H&E). Resultado Se realiza-ron un total de 80 cirugías. El ganglio centinela se identificó en 75 (94%) pacientes, 60 (75%) bilateralmente; Con una detección media de 1,9 nodos por paciente. El sitio de identificación más frecuente fue la fosa obturatriz (43,9%), seguida de los vasos ilíacos externos. Otro 2,6% de los nodos fueron encontrados en sitios poco comunes. Entre los ganglios linfáticos seleccio-nados, 10 casos fueron positivos para el cáncer. No hubo ganglio centinela falso negativo. La tasa de detección fue del 83%, con una especificidad del 95%. Conclusiones Los datos aquí expuestos nos permiten estandarizar e implementar el uso de gan-glio centinela con azul patente. El uso de GC adecua la cirugía a la necesidad de la paciente, con una clara disminución en la incidencia de complicaciones asociadas a la linfadenectomía. Este trabajo forma parte de un estudio inicial el cual se debe complementar con el uso de la tin-ción de verde de indocianina y el estudio anatomo patológico con ultraestadiaje para obtener una validación e implementación adecuada del GC en la etapificación en cáncer de cérvix y endo-metrio.

SUMMARY Objective To assess the diagnostic performance of patent blue dye technique (available in the whole country) in sentinel lymph node for cervical and endometrial cancer staging. Methods A prospective cohort study was conducted between January 2014 to December 2018. Patent blue dye technique was assessed for the detection of sentinel lymph node in cervical and endometrial cancer staging, before standard pelvic lymphadenectomy. Blue dye injection was applied in the cervix (1cc 1cm deep and 1cc superficial) at 3 and 9 hour, 20 minutes prior start-ing a surgery (laparotomy or laparoscopic). The sentinel lymph node was collected by a certified surgeon and assessed by traditional histologic hematoxylin and eosin stain. Results A total of 80 surgeries were performed. The sentinel lymph node was identified in 75 (94%) patients, 60 (75%) bilaterally; with an average detection of 1,9 nodes per patient. The most common site of identifi-cation was the obturator fossa, followed by the external iliac vessels (43,9%). 2,6% of the nodes were found in uncommon sites. 10 lymph nodes were cancer-positive. There were no false neg-ative sentinel node.Overall in our cohort the detection rate was 83% for specificity 95%. Conclusions Our data presented in this publication allow us to safely standardize and implement a sentinel lymph node technique with patent blue. This technique will allow us to adapt the sur-gery for the patient's needs, diminishing the incidence of complications associated with lym-phadenectomy. This is the first stage of our work which we must complement with indocyanine green and pathological study with ultrastaging to obtain an adequate validation and implementa-tion of sentinel node in cervical and endometrial cancer staging.

Sangrado y terapia hormonal en la menopausia (THM) / Bleeding during menopause hormone therapy (MHT)

La definición de sangrado ginecológico anormal durante terapia hormonal de la menopausia es aquel sangrado no programado durante el uso de la terapia. Este artículo es un pauteo que describe: 1) cuándo diagnosticar unsangrado anormal, ya que difiere según el tipo de esquema hormonal utilizado; 2) eldiagnóstico diferencial del origen del sangrado anormal; 3) los métodos de evaluación para diagnosticar el origen del sangrado. Se destacan los aspectos principales para el diagnóstico diferencial entre patología orgánica versus disrupción endometrial debida al tratamiento hormonal. Además, se describen los ajustes posibles para resolver el sangrado cuando éste se debe a disrupción del endometrio.

Abnormal bleeding related to menopausal hormone therapy is defined as unscheduled bleeding during the use of the therapy. This article outlines when to diagnose an abnormal bleeding -as this differs according to the type of hormonal scheme used-, the differential diagnosis of the origin of abnormal bleeding, and the methods of evaluation to assess the origin of the bleeding. The main aspects are highlighted on the differentiation of organic pathology versus disruption of the endometrium due to treatment. Also, treatment adjustments to resolve bleeding when it is due to disruption of the endometrium are outlined.

Resección ganglionar retroperitoneal en el cáncer ginecológico: utilidad como biomarcador predictivo / Retroperitoneal nodal dissection in gynecological cancer: utility as a predictive biomarker

Resumen Antecedentes: La linfadenectomía retroperitoneal y pélvica es parte del proceso quirúrgico de etapificación del cáncer de endometrio y ovario. La asignación de etapa y tratamiento de pacientes con cáncer cervicouterino es clínica; con radioterapia y quimioterapia concomitante, sin conocer factores pronósticos de la enfermedad local, ni el estado de la enfermedad ganglionar pélvica y retroperitoneal. En cáncer ginecológico la evaluación sistemática patológica de los ganglios retroperitoneales es decisiva para asignar la etapa (en ovario y endometrio), pero en el cáncer de cuello uterino tiene menos aprobación en las guías de tratamiento internacionales y existen menos estudios sólidos que estén a favor de la linfadenectomía etapificadora. Objetivo: Revisar el tema y demostrar la pertinencia y ventajas de la estadificación ganglionar retroperitoneal en las distintas neoplasias malignas ginecológicas. Método: Se revisó la bibliografía en la base de datos PubMed con búsqueda de palabras clave: linfadenectomía en cáncer ginecológico y metástasis ganglionares retroperitoneales en cáncer ginecológico. Resultados: Se localizaron 71 artículos con información de las variables de estudio. Al momento de su análisis sólo se incluyeron documentos con información de estudios con asignación al azar, y con información que incluyera al cáncer de endometrio, ovario o cuello uterino, abarcó 31 artículos para su análisis. Conclusiones: Además de la revisión de artículos se presenta una propuesta para evaluar las metástasis retroperitoneales y su utilidad futura como biomarcador. Con la bibliografía expuesta y nuestra propuesta de evaluación ganglionar retroperitoneal se favorece la estadificación del cáncer ginecológico (endometrio, ovario y cuello uterino).

Abstract Background: Retroperitoneal and pelvic lymphadenectomy is part of the surgical process staging of endometrial and ovarian cancer. The stage assignment and treatment of patients with cervical cancer is clinical; with radiotherapy and chemotherapy concomitant, without knowing prognostic factors of the local disease, neither status of pelvic and retroperitoneal lymph node disease. In gynecological cancer the systematic pathological evaluation of the retroperitoneal ganglia is decisive for stablished the stage (in ovarian and endometrial) but in cervical cancer has less approval in international treatment guidelines and there are fewer studies solids that are in favor of staging lymphadenectomy. Objective: To review the topic and demonstrate the relevance and advantages of staging retroperitoneal ganglionar in the different gynecological malignancies. Method: The bibliography was revised in the PubMed database with search of key words: lymphadenectomy in gynecological cancer and lymph node metastases retroperitoneal in gynecological cancer. Results: 71 articles were finded with information on the study variables. At the time of its analysis only documents with study information were included randomized, and with information that included endometrial cancer, ovary or cervix, covered 31 articles for analysis. Conclusions: In addition to the review of articles, a proposal is presented to evaluate retroperitoneal metastases and their future usefulness as a biomarker. With the exposed literature and our proposed retroperitoneal lymph node evaluation is it favors the staging of gynecological cancer (endometrium, ovary and cervix).

Utilidad de la resonancia magnética en la estadificación pre operatoria del cáncer de endometrio / Utility of magnetic resonance in preoperative staging of endometrial cancer

Objetivo: Evaluar la utilidad de la Resonancia Magnética (RM) para valorar la infiltración tumoral miometrial y del cérvix en el carcinoma de endometrio. Pacientes y métodos: Se evaluaron retrospectivamente los estudios de RM de 26 pacientes con diagnóstico histológico por biopsia de cáncer de endometrio. Se realizó estadificación prequirúrgica y correlación con la estadificación histológica de la pieza operatoria. Se estudió la concordancia, sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) del método, para la profundización del tumor en el espesor miometrial y la invasión del cérvix. Se analizaron las posibles causas de sobrestimación e infraestimación. Resultados: En la evaluación por RM para la infiltración miometrial por estadío e invasión del cérvix se obtuvieron: S de 72,2%, 75%, 66,7%, E de 75%, 72,2%, 95,7%, VPP de 86,7%, 54,5%, 66,7%, VPN de 54,5%, 86,7%, 95,7% (para estadios IA, IB y II respectivamente). Se sobrestimaron 5 casos para infiltración miometrial y 1 para el cérvix, se infraestimaron 2 casos para infiltración miometrial y 1 caso para el cérvix. Se encontró una concordancia moderada para estadio I y buena para estadio II. Conclusión: La RM es una herramienta útil para la estadificación prequirúrgica del carcinoma de endometrio con una fiabilidad moderada a buena, lo que sumado al tipo y grado histológico ayuda a determinar la estrategia terapéutica.

Objective: Evaluate the usefulness of Magnetic Resonance Imaging (MRI) in order to assess myometrial and cervical tumor infiltration in endometrial carcinoma. Patients and Methods: A retrospective review of 26 patient's MRI studies with histological confirmation of endometrial cancer was conducted (diagnosis by endometrial cancer biopsy). Pre-surgical staging and correlation with the histological staging of the operative piece was performed. Concordance, sensitivity (S), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the method for the deepening of the tumor in the myometrial thickness and the invasion of the cervix were studied. The possible causes of overestimation and underestimation were analyzed. Results: MRI evaluation for the myometrial infiltration by stage and cervix invasion generated these results: S of 72.2%, 75%, 66.7%, SP of 75%, 72.2%, 95.7%, PPV of 86.7%, 54.5%, 66.7%, NPV of 54.5%, 86.7%, 95.7% (for stages IA, IB and II respectively). Five cases were overestimated for myometrial infiltration and 1 for the cervix; 2 cases were underestimated for myometrial infiltration and 1 case for the cervix. A moderate concordance was found for stage I and a good concordance for stage II. Conclusion: MRI is a useful tool for pre-surgical staging of endometrial carcinoma with a moderate to good reliability, which added to the type and histological grade, helps to determine the most appropriate therapeutic strategy.

Perfil das pacientes investigadas por sangramento pós-menopausa no Hospital Júlia Kubitschek nos anos de 2010 a 2014 / A survey of the profile of patients investigated for post-menopausal bleeding at Júlia Kubitschek Hospital Between 2010 and 2014

O câncer endometrial é o sexto tipo de câncer mais frequente entre as mulheres e o mais prevalente tipo de neoplasia maligna do trato genital feminino nos países desenvolvidos ocidentais. A pesquisa apresentada traz uma análise de prontuários das pacientes submetidas a procedimento diagnóstico para avaliação do endométrio entre os anos de 2010 a 2014, no no Hospital Júlia Kubitschek, para identificar em que faixa de espessamento endometrial há mais casos de câncer de endométrio e traçar um perfil das pacientes submetidas aos procedimentos de amostragem de endométrio. Os resultados sugeriram que o método diagnóstico mais utilizado para investigação foi a histeroscopia cirúrgica.

Endometrial cancer is the sixth most frequent type of cancer among women and the most prevalent type of malignancy of the female genital tract in Western developed countries. The present research brings an analysis of medical records of patients submitted to a diagnostic procedure to evaluate the endometrium between the years 2010 to 2014, in the Hospital Júlia Kubitschek, to identify in which endometrial thickening range there are more cases of endometrial cancer and to draw a profile of patients submitted to endometrial sampling procedures. The results suggested that the most used diagnostic method for investigation was surgical hysteroscopy.

Nuevas perspectivas de la citología en diagnóstico molecular del cáncer epitelial de ovario y endometrio / New perspectives of cytology in molecular diagnosis of ovarian and endometrial epithelial cancer

Resumen OBJETIVO: describir la bibliografía donde se identificaron biomarcadores moleculares en muestras de citología cervical en base líquida para detectar cáncer epitelial de endometrio y ovario. METODOLOGÍA: búsqueda electrónica en las principales bases de datos de artículos relacionados con la detección de cáncer de ovario y de endometrio con los siguientes términos: citología en base líquida, cáncer epitelial de ovario, cáncer epitelial de endometrio, biomarcadores moleculares. RESULTADOS: los cánceres epitelial de ovario y de endometrio son enfermedades que carecen de un método de tamizaje eficaz. La citología en base líquida ofrece una manera eficaz de detectar alteraciones celulares y moleculares. Mediante la asociación entre la citología en base líquida y los métodos moleculares en el aparato genital inferior es posible identificar biomarcadores específicos; esto abre la posibilidad de desarrollar métodos de tamizaje para cáncer epitelial de endometrio y ovario. CONCLUSIONES: mediante el uso de la citología en base líquida es posible detectar cáncer epitelial de endometrio y ovario.

Abstract OBJECTIVE: To describe the literature that has identified molecular biomarkers in liquid-based cervical cytology samples to detect endometrial and ovary epithelial cancer. METHODOLOGY: An electronic search was conducted in the main databases in articles related to the detection of ovarian and endometrial cancer with the following search terms: liquid-based cytology, ovarian epithelial cancer, endometrial epithelial cáncer, molecular biomarkers. RESULTS: Epithelial ovarian and endometrial cancer are diseases that lack an effective screening method. Liquid-based cytology provides an effective way to detect cellular and molecular alterations in the detection of these neoplasms. Through the association between liquid-based cytology and molecular methods it is possible to identify specific biomarkers in the lower genital tract, opening up the possibility of developing screening methods for endometrial and ovary epithelial cancer. CONCLUSIONS: It is possible the detection of endometrial cancer and, to a lesser extent of epithelial ovarian cancer by using liquid-based Pap test.

Relación neutrófilos-linfocitos preoperatoria como factor pronóstico en pacientes con cáncer de endometrio

Objetivo: Determinar la relación entre un marcador inflamatorio preoperatorio: relación neutrófiloslinfocitos en pacientes con cáncer de endometrio como factor pronóstico, en el período comprendido entre enero 2002 a enero 2010. Métodos: Estudio observacional descriptivo. La relación neutrófilos-linfocitos se calculó dividiendo el valor de recuento absoluto de neutrófilos entre el valor de recuento absoluto de linfocitos y se definió un umbral de 2,2 para mal pronóstico. Resultados: Se revisaron un total de 134 historias de pacientes con cáncer de endometrio, 44 pacientes se incluyeron en el estudio. El 68,2 % tenían buen pronóstico y el 31,8 % mal pronóstico. Al relacionar los estadios FIGO con el pronóstico según el valor de la relación neutrófilos-linfocitos, el 80 % de las pacientes en Estadio I se ubicó dentro de la categoría “buen pronóstico” y el 100 % de las pacientes en Estadio IV se ubicó dentro de la categoría “mal pronóstico”, (P= 0,046). Al relacionar tipo histológico con el pronóstico según el valor de la relación neutrófilos-linfocitos, 75,6 % de las pacientes con adenocarcinoma endometrioide se ubicó dentro de la categoría “buen pronóstico”. El 66,2 % de las pacientes con adenocarcinoma de células claras y 74,7 % de las pacientes con adenocarcinoma seroso papilar se ubicó dentro de la categoría “mal pronóstico” (P= 0,015). Siendo todos los datos estadísticamente significativos. Conclusión: La relación neutrófilos-linfocitos preoperatoria representó un marcador pronóstico, siendo un método sencillo y rentable para la identificación preoperatoria de estadios precoces y avanzados de cáncer de endometrio.

Objective: To determine the neutrophil-lymphocyte ratio preoperative endometrial cancer patients hospitalized in the Department of Gynecology IAHULA in Merida, between January 2002 - January 2010. Methods: An observational descriptive study. The neutrophil-lymphocyte ratio was calculated by dividing the value of absolute neutrophil count between the value of absolute lymphocyte count and defined a threshold for 2.2 for wrong prognosis. Results: A total of 134 records of patients with endometrial cancer were reviewed, 44 patients were included in the study. 68.2 % had good prognosis and poor prognosis 31.8 %. FIGO stage to relate to the forecast based on the value of the neutrophil-lymphocyte ratio, 80 % of patients with stage I was within the category of “good prognosis” and 100 % of patients with stage IV was within the category “poor prognosis” (p = 0.046). By linking histological type according to the forecast value of the neutrophil-lymphocyte ratio, 75.6.% of patients with endometrioid adenocarcinoma was within the category of “good prognosis”. 66.2.% of patients with clear cell adenocarcinoma and 74.7 % of patients with serous papillary adenocarcinoma was within the category of “poor prognosis” (P = 0.015). Being all statistically significant data. Conclusion: The preoperative neutrophil-lymphocyte ratio represented a simple and cost effective method for identifying early and advanced stages of endometrial cancer.

Características clínico-epidemiológicas y manejo del cáncer endometrial (2010-2013) / Clinical-epidemiological characteristics and management of endometrial cancer (2010-2013)

Introducción: el cáncer de endometrio ha incrementado su incidencia y se asocia a factores de riesgo presentes en muchas mujeres en la perimenopausia. El síntoma más común es el sangramiento y la modalidad de tratamiento más empleada es la cirugía. Objetivo: caracterizar el cáncer endometrial en el Hospital América Arias desde enero de 2010 hasta junio de 2013. Métodos: se realizó un estudio descriptivo en el Hospital América Arias, desde 1ro de enero de 2010 hasta el 30 de junio de 2013. Se incluyó el total las pacientes con sangramiento uterino anormal en la etapa peri y posmenopáusico a partir de 40 años de edad. Las pacientes con diagnóstico histopatológico de cáncer endometrial constituyeron la muestra (n= 49). Resultados: la edad promedio de las pacientes fue de 60,8 ± 9,9 años. Presentaban sobrepeso 30,6 por ciento, y 44,9 por ciento eran obesas. El examen histopatológico posquirúrgico muestra que la lesión estuvo limitada al endometrio en 14,3 por ciento de las pacientes; pero hubo invasión de los dos tercios externos del miometrio en 61,2 por ciento de ellas. La extensión al cuello y a los anejos uterinos fue de 38,8 por ciento y 22,4 por ciento respectivamente. Conclusiones: existe una tendencia a la aparición del adenocarcinoma endometrial en edades cada vez más avanzadas. Se asocia a factores de riesgo como obesidad, infertilidad y el uso de terapia hormonal de remplazo. Además de la cirugía, algunas pacientes requirieron tratamiento oncológico específico(AU)

Introduction: The incidence of endometrial cancer has increased and it is associated with risk factors present in many perimenopausewomen. The most common symptom is bleeding and the most widely used treatment modality is surgery. Objective: Characterize endometrial cancer at America Arias Hospital from January 2010 to June 2013. Methods: A descriptive study was conductedat America Arias Hospital, from 1 January 2010 to 30 June 2013. The total included over 40 year patients with abnormal uterine bleeding in perimenopausal and postmenopausal. Patients with histopathologic diagnosis of endometrial cancer constituted the sample (n= 49). Results: The mean age of patients was 60.8 ± 9.9 years. 30.6 percent were overweight and 44.9 percent were obese. Postoperative histopathologic examination shows that the lesion was limited to the endometrium in 14.3 percent of patients, but there was invasion of the two outer thirds of the myometrium in 61.2 percent. The extension cervix and adnexa was 38.8 percent and 22.4 percent, respectively. Conclusions: There is a tendency to the appearance of endometrial adenocarcinoma at increasingly advanced ages. It is associated with risk factors such as obesity, infertility, and the use of hormone replacement therapy. In addition to surgery, some patients required specific cancer treatment(AU)

Rendimiento de la biopsia por aspirado en el diagnóstico del carcinoma de endometrio / Performance of aspirate biopsy in the diagnosis of endometrial carcinoma

OBJETIVO: Analizar la concordancia histológica pre y postoperatoria del cáncer de endometrio (CE) diagnosticado por cánula de biopsia tipo Cornier. MÉTODOS: Se incluyen 82 pacientes sometidas a biopsia ambulatoria a ciegas por aspirado con diagnóstico anatomo-patológico final de CE en la pieza de histerectomía. Se estudia la concordancia atendiendo al tipo y al grado histológico haciendo dos grupos para cada análisis: CE endometrioide/no endometrioide y Ce de bajo/alto grado. RESULTADOS: La sensibilidad de la biopsia para detectar malignidad fue del 100%. El grado de concordancia atendiendo al tipo histológico fue de 94% (96,7% para los tipo endometrioide y del 85% para los tipos no endometrioides). En cuanto al grado histológico la precisión en el diagnóstico fue del 90,2% (94,3% en los tumores de bajo grado y 82,7% en los de alto grado) con una tasa de subestimación del grado tumoral del 6%. CONCLUSIONES: La biopsia por aspiración con cánula tipo Cornier detecta adecuadamente el CE y la concordancia entre la biopsia preoperatoria y la pieza quirúrgica es alta, por lo que puede considerarse una técnica fiable en el diagnóstico del cáncer de endometrio y precisa en la valoración del grado y tipo histológicos. El grupo más discordante es el CE G3 de tipo endometrioide.

OBJECTIVE: Analyze pre and post operative histological concordance of endometrial cancer (EC) diagnosed by Cornier biopsy cannula. METHODS: 82 patients under going out patient biopsy aspirate blindly with EC in the hysterectomy specimen. We study the type and histological grade accuracy by two groups for each analysis: EC endometrioid/non-endometrioid and low/high grade. RESULTS: The sensitivity for detecting malignancy was 100%. The histological type agreement was 94% (96.7% for the endometrioid type and 85% for non-endometrioid type). The histological grade accuracy was 90.2% (94.3% in low-grade tumors and 82.7% in high grade) with a rate of under estimation of tumor grade of 6%. CONCLUSIONS: Cornier aspiration biopsy is safe in the diagnosis of EC. Grade and histological type accuracy between preoperative biopsy and surgical specimen is high. The most discordant is EC G3 endometrioid type.