Reproducibility of measurement of myometrial invasion in endometrial carcinoma

Abstract

Myometrial invasion (MI) as a percentage (%MI), categorized into <50 or ≥50 %, is an important predictor of prognosis in endometrial carcinoma. Recent studies suggest that tumor-free distance (TFD) to serosa and the absolute depth of invasion (DOI) might be stronger predictors of prognosis. Although reproducibility is important in clinical practice for patient prognostication and treatment, reproducibility of these methods for the measurement of MI is largely unknown. One or two slides from 50 patients with FIGO stage I endometrioid endometrial carcinoma were viewed by seven gynecological pathologists, who were requested to measure %MI, TFD, and DOI. We categorized %MI as <50 % (including no MI) or ≥50 %, TFD as ≤1.75 or >1.75 mm (including no MI), ≤7 or >7 mm (including no MI), and ≤10 or >10 mm (including no MI) and DOI as <4 mm (including no MI) or ≥4 mm. Light's kappa for multi-rater agreement was calculated. The %MI, TFD, and DOI could be measured in 88, 83, and 79 % of cases, respectively. Kappa was 0.75 for %MI, 0.77, 0.73, and 0.69 respectively for TFD with cutoffs of 1.75, 7, and 10 mm, and 0.59 for DOI. Pathologists reach substantial agreement when measuring %MI and TFD and moderate agreement when measuring DOI. The %MI can be measured in more cases than TFD and DOI. This supports the use of %MI in daily clinical practice, but future studies should compare %MI and TFD more extensively, including inter-observer variability.

Keywords: Depth of invasion; Endometrial carcinoma; Inter-observer variability; Myometrial invasion; Tumor-free distance.

Fig. 1

Scoring instructions

Fig. 2

Drawing of the different measuring methods in an endometrial carcinoma with <50 % myometrial invasion. The dotted lines show the position of the endometrial/myometrial junction (EMJ), and the line where the tumor would invade half of the myometrium (50 % MI). The arrows show the absolute depth of invasion (A) and tumor-free distance (B) measurements

Fig. 3

Several examples of slides scored in this study. Slides a and b were scored with little agreement concerning the DOI, and it was commented that it was hard to distinguish the endometrial/myometrial junction. Slides c and d on the other hand were scored with perfect agreement for all measurements.