Diagnosis Of Neoplasia In Endometrial Biopsies PDF Download

ObjectiveTo examine the accuracy of the diagnosis endometrial intraepithelial neoplasia (EIN) in an office endometrium sample (OES) and the correlation between the EIN system and the World Health Organisation 1994 hyperplasia classification (WHO94) in OES.MethodsConsecutive patients aged 40 years and older with any indication for OES trough aspiration curettage (OES-A) or outpatient hysteroscopy (OES-H) were asked for written consent. The pathologists performed assessment in accordance with the EIN system and the WHO94 classification. Diagnoses by OES were compared with the final diagnoses, including all pathology obtained within 12 months after the first OES. Central study approval was obtained at the ErasmusMC (MEC-2015-740), the study was registered on www.trialregister.nl (NL7608). Statistical analysis was generated using IBM SPSS statistics version 24. ResultsFrom 02-01-2016 to 01-02-2019, 343 patients were included. The mean age was 59,5 years (u00b1 10,6 SD) and 70,8% patients were postmenopausal. In total 340 OES-A samples were obtained. First sampling for 340 patients was aspiration curettage which did not result in a diagnose in 42 (12,4%), and in benign, EIN or malignancy in 258 (76,1%), 6 (1,8%) and 33 (9,7%) respectively. At final diagnosis these numbers were O, 290 (85,5%), 3 (0,9%) and 46 (13,6%) respectively. The accuracy of diagnosing EIN in an OES-A was 85,5%, with a sensitivity of 46,2% and a specificity of 100%. In total 69 OES-H samples were obtained, the accuracy of diagnosing EIN in an OES-H was 91,3%, with a sensitivity of 100% and a specificity of 100%. The incidence of EIN in any OES was 2,5%. All 10 EIN positive cases were postmenopausal women with blood loss. In eight out of ten patients finally a malignancy was diagnosed. Analyses of the histological criteria for EIN showed that in most EIN diagnoses not all five criteria were met.ConclusionThe accuracy of the diagnosis EIN in an aspiration curettage was low, although the specificity was high. The diagnosis EIN was made despite not all histological criteria were met. The EIN and WHO94 systems showed a considerable overlap. Given the low incidence of EIN / WHO hyperplasia, our study cohort will be extended to define the place of the EIN system in an office sampling setting.