Article Text

Download PDFPDF
Prognosis and Reproducibility of New and Existing Binary Grading Systems for Endometrial Carcinoma Compared to FIGO Grading in Hysterectomy Specimens
  1. Hui Guan, MD, PhD*,
  2. Assaad Semaan, MD,
  3. Sudeshna Bandyopadhyay, MD*,
  4. Haitham Arabi, MD*,
  5. Jining Feng, MD, PhD*,
  6. Lamia Fathallah, MD,
  7. Vaishali Pansare, MD§,
  8. Aamer Qazi, PhD,
  9. Fadi Abdul-Karim, MD,
  10. Robert T. Morris, MD,
  11. Adnan R. Munkarah, MD# and
  12. Rouba Ali-Fehmi, MD*
  1. * Departments of Pathology, and
  2. Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI;
  3. Department of Pathology, Saint John Health System, Detroit, MI;
  4. § Department of Pathology, Beaumont Hospital, Grosse Pointe, MI;
  5. Department of Surgery, Wayne State University, Detroit, MI;
  6. Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH; and
  7. # Department of Women's Health Services, Henry Ford Health Systems, Detroit, MI.
  1. Address correspondence and reprint requests to Rouba Ali-Fehmi, MD, Associate Professor, Department of Pathology, Wayne State University School of Medicine, Detroit, MI 48201. E-mail: rali{at}


Background: The current International Federation of Gynecology and Obstetrics (FIGO) grade in endometrial carcinomas requires the evaluation of histologic features with proven prognostic value but with questionable reproducibility. This study tests the prognostic power and reproducibility of a new binary grading system.

Study Design: Specimens from 254 hysterectomies were graded according to the new 3- and 2-tiered FIGO grading systems described by Alkushi et al. The selected morphologic parameters for the new grading system included the presence of predominant solid or papillary architecture pattern, severe nuclear atypia, tumor necrosis, and vascular invasion. The Cox proportional hazards and κ statistics were used for comparisons.

Results: On multivariate analysis, and looking at all tumor cell types, the 4 tested grading systems were independent predictors of survival, with the 3-tiered FIGO grading system being the most predictive (P = 0.005). In the subset of endometrioid tumors, the 3- and 2-tiered FIGO grading systems and the new grading system retained their statistical significance as predictors of survival (P = 0.004, P = 0.03, and P = 0.007, respectively), whereas the grading system of Alkushi et al did not (P = 0.1). In nonendometrioid tumors, the new grading system proved to be the best predictor of survival, reaching near statistical significance (P = 0.06). The new grading system had acceptable intraobserver and interobserver reproducibility assessment (κ = 0.87 and κ = 0.45, respectively).

Conclusion: The 3-tiered FIGO grading system retained its superior prognostic power. However, available binary grading systems remain an attractive option by being highly reproducible and by eliminating the clinical ambiguity of intermediate grades of disease.

  • Endometrial carcinoma
  • Grade
  • FIGO
  • Reproducibility
  • Prognostic power

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The authors declare no conflict of interest. All the authors have read and approved the manuscript.