Pathology is an important part of the
ESGO-ESTRO-ESP Guidelines in endometrial cancer. Several recommendations are performed
in different areas:
1-Identification
and surveillance of women with a pathogenic germline variant in a lynch
syndrome-associated gene
•To identify patients with Lynch syndrome
and triage for germline mutational analysis, MMR IHC (plus analysis of MLH1
promotor methylation status in case of immunohistochemical loss of MLH1/PMS2
expression) or MSI tests should be performed in all endometrial carcinomas,
irrespective of histologic subtype of the tumour.
2- Molecular
markers for endometrial carcinoma diagnosis and as determinants for treatment
decisions
•Molecular classification is encouraged in
all endometrial carcinomas, especially high-grade tumours .
•POLE mutation analysis may be omitted in low-risk and intermediate
risk endometrial carcinoma with low grade histology.
3- Definition
of prognostic risk groups integrating molecular markers
•Histopathological type, grade, myometrial
invasion and LVSI (no/focal/substantial) should be recorded in all patients
with endometrial carcinoma.
•The definition of prognostic risk groups
is presented when Molecular Classification is known or unknown.
4-
Pre- and intra-operative work-up
•Histopathological tumour type and grade in
endometrial biopsy is required.
•Intra-operative frozen section is not
encouraged for myometrial invasion assessment because of poor reproducibility
and interference with adequate pathological processing .
Conclusion: Integration of Conventional
pathology and molecular classification is helpful in risk stratification of
Endometrial Carcinoma