Evaluation of Concordance between Examination under Anesthesia and Histopathology in Early Carcinoma Cervix—A Single Institutional Experience

Article Type: Original Article
Authors: Subbiah Shanmugam, Arun Victor Jebasingh, S. Aravind


Evaluation of Concordance between Examination under Anesthesia and Histopathology in Early Carcinoma Cervix—A Single Institutional Experience Introduction: Clinical staging in carcinoma cervix is highly inaccurate, with error rates between 26 and 66%. Hence, for proper assessment of the size and the extent of the tumor, examination under anesthesia (EUA) is required. The aim of this study is to analyze the correlation in staging between EUA and histopathology in early carcinoma cervix treated with upfront radical hysterectomy. Materials and Methods: A retrospective analysis of patients with early carcinoma cervix who were treated from January 2014 to December 2022 was done in our institution. Inclusion criteria consisted of carcinoma cervix of stages IB1, IB2, and IIA1 on clinical examination (FIGO 2018), who were treated with upfront radical hysterectomy. Exclusion criteria consisted of carcinoma cervix stages IB3, IIA2 and above. The postoperative stage of the disease as determined by histopathological examination was then compared with the EUA. Results: A total of 40 patients with carcinoma cervix with the above-mentioned inclusion criteria were analyzed. Twenty-six patients had a similar stage in both EUA and histopathology. Five patients got their disease downstaged in the final histopathology. Amongst the stage distribution, the highest discordance was seen in IB2 and IIA1 stages. The reason for discordance was vaginal involvement in two patients, tumor size in three patients, and pelvic nodal involvement in two patients. The concordance rates in our study were 88% for stage IB1, 66% for stage IB2 and 76% for stage IIA1. In our study, EUA was associated with overestimation of staging. Conclusion: Though EUA is still a valuable part of the staging and treatment planning in carcinoma cervix, it has limitations. Interobserver variability and the inconclusiveness regarding the pelvic nodes are a few of the foremost reasons leading to discrepancies between clinical examination and histopathology.

Keywords: Examination under anesthesia, Concordance, Discordance, Overestimation.
Issue Number: Issue - 3   September - December 2022
Pages: 97 - 138
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