Objective: To compare the differences between clinical (FIGO 1971) and surgical-pathological (FIGO 1989) stagings of endometrial carcinoma and to investigate the advantage and the feasibility of the surgical-pathological staging.
Methods: Clinical and pathological data of 290 patients with endometrial carcinoma surgically treated from 1989 to 1995 were retrospectively reviewed. The clinical and surgical-pathologic staging of these patients were compared. The stagings were analyzed with regards to the prognostic factors of endometrial cancer.
Results: The differences between clinical and surgical-pathologic staging in stage I and II were 19.7% and 80.5% respectively. 4.2% with metastases to the lymph node, 10.6% with positive peritoneal cytology and 60.5% with myometrial invasion were found in clinical stage I. 51.4% with metastases to the lymph nodes, 46.9% with positive peritoneal cytology and 100.0% of myometrial invasion were observed in clinical stage II. The causes of the differences between these two staging systems are: (1) it was impossible before operation to accurately detect metastases of the lymph nodes and malignant cells in the pelvic-peritoneal cavity; (2) when the dilation and curettage was done before operation, the lesions of an involved cervix might be missed or an uninvolved cervix misdiagnosed as metastatic lesion; (3) there were already cancer cells disseminated in the peritoneal cavity.
Conclusions: The surgical-pathologic staging defines the real extent of endometrial carcinoma. It is advised that at the initial operation attention should be paid to areas beyond the extent of the intended surgery itself. During the initial operation, peritoneal cytology and pelvic and para-aortic lymph node samplings should be done for the purpose of surgical-pathologic staging of the selection of postoperative adjuvant therapy and of providing a clinico-pathological basis for the prediction of prognosis. Since there is a high percentage of misdiagnosis in clinical stage II endometrial carcinoma, special attention is needed in diagnosing and treating such patients.