Objective: To assess the concordance between preoperative endometrial biopsy and final postoperative histopathological findings in patients with endometrioid-type endometrial cancer, and to identify factors associated with diagnostic discrepancies. Materials and Methods: This retrospective study included 134 patients who underwent surgery between 2005 and 2018 following a preoperative diagnosis of endometrioid-type endometrial cancer at a tertiary center. Demographic, clinical, and histopathological data were reviewed. Concordance between preoperative biopsy and final pathology was evaluated using Cohen’s kappa coefficient. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated. Results: A statistically significant correlation was observed between preoperative and final tumor grades (p < 0.001). In 35.8% of patients (n = 48), the final pathology revealed a higher grade than the initial biopsy. Grade 3 tumors demonstrated the highest diagnostic accuracy (89.5%), while Grades 1 and 2 showed an overall accuracy of 66.0%. Tumor size greater than 2 cm and lymph node metastasis were significantly associated with grade upgrading (p = 0.014 and p = 0.004, respectively). Conclusion: Preoperative biopsy alone may not be sufficient for accurate risk stratification in patients with endometrial cancer. Tumor upgrading was significantly associated with adverse prognostic indicators such as larger tumor size and nodal involvement. A multimodal diagnostic approach is recommended, particularly in cases initially classified as low-grade.
Şeker et al. (Mon,) studied this question.