234 Addressing variation in preoperative workup of high-grade endometrial carcinoma

Introduction Patients with high-grade endometrial carcinoma (HGEC) are more likely to present with metastatic disease and require multimodal treatment. Appropriate workup of patients preoperatively can direct optimal order of treatment. International guidelines to guide care are non-proscriptive and inconsistent. We were interested in addressing practice variation and consequences. Methods Retrospective cohort study of HGEC patients referred to a single tertiary cancer centre from 2017–2018. We evaluated CA125, imaging, treatment, pathological and outcomes data. Results 129 HGEC cases were reviewed; 57% serous, 26% Gr3 endometrioid, 17% ‘other’ (clear cell, carcinosarcoma, undifferentiated). Preoperative CA125 was obtained for 76% of patients, and this was elevated in 32%. Of patients with an elevated CA125, 90% had stage III/IV disease. Of patients with no CA125, 52% were upstaged to stage III/IV disease after surgery or imaging. Only 50% of women with HGEC had imaging; 44% with preoperative CT and 6% with PET or MRI. Imaging detected extra-uterine disease in 46% of HGEC, and treatment plan changed based on imaging in 38%; 9 patients received neoadjuvant chemotherapy with delayed surgery, 14 received chemotherapy only, and 2 patients chemo-radiation only. Of patients without imaging, 40% were upstaged to stage III/IV disease and 12.5% of patients had primary surgery with suboptimal debulking. Conclusion We found inconsistent practice of ordering preoperative CA125 and imaging in patients with HGEC. Elevated CA125 was associated with advanced stage disease, and imaging altered treatment in over 1/3 of patients. Routine imaging and CA125 should be performed for all HGECs to help guide appropriate treatment.