Molecular Classification of Endometrial Cancer and the 2023 FIGO Staging: Exploring the Challenges and Opportunities for Pathologists

Simple Summary: In this commentary, I delve into the complexities and potential of the recently proposed 2023 FIGO staging system for endometrial cancer, with a focus on the incorporation of molecular classifications. I aim to evaluate the predictive capacity of histology and molecular testing, emphasizing the challenge of utilizing the POLE mutation test in determining prognosis. By addressing challenges like discerning synchronous independent tumors from metastatic ones when both endometrium and ovary are involved, and considering new elements such as lymph node metastasis size, this work may inform future treatment approaches, reinforcing the indispensable role of pathologists in this evolving landscape. This commentary explores the complexities of the FIGO 2023 staging system and the inclusion of The Cancer Genome Atlas's (TCGA) molecular classification in the management of endometrial cancer. It highlights the importance of histology as a prognostic tool, while scrutinizing the merits and demerits of its application to aggressive endometrial cancers. The commentary review sheds light on the recent introductions of lymphovascular space invasion (LVSI) and lymph node metastasis size in cancer staging. It outlines the difficulties in differentiating between synchronous and metastatic endometrial and ovarian cancers, underlining their implications on treatment strategies. Furthermore, the commentary discusses the integration of molecular classifications within the FIGO 2023 framework, emphasizing the pivotal yet challenging implementation of the pathogenic POLE mutation test. The commentary concludes by reaffirming the vital role of pathologists in executing the FIGO 2023 staging system.