title: Treatment results of endometrial hyperplasia after prospective D-score classification: a follow-up study comparing effect of LNG-IUD and oral progestins versus observation only.
abstract: OBJECTIVE
  Three different treatment options for endometrial hyperplasia were evaluated in a prospective long-time follow-up study, comparing effects of intrauterine levonorgestrel impregnated device (LNG-IUD), low oral dose of medroxyprogesterone acetate (MPA) and no treatment (observation only). To select patients with high probability for co-existing or future carcinoma we used the objective morphometric algorithm, D-score, stratifying patients into three different risk groups. As far as we know, this is the first prospective long-time follow-up study in which treatment recommendation and outcome is based on the D-score assessment.
  
  
  METHODS
  From a total of 370 patients initially diagnosed with endometrial hyperplasia from eight different hospitals in North Norway, 258 were available for long-time follow-up. After D-score classification, one of three different treatment options was chosen: LNG-IUD, low oral dose of MPA or observation only. Follow-up controls were performed and biopsies taken in the local hospitals.
  
  
  RESULTS
  Among the 370 investigated cases with endometrial hyperplasia, only ten endometrial cancers were detected at the entrance of the study, all belonging to the high risk group (D-score <0). No further cancers were detected during follow-up, irrespective of risk group. After 6 months treatment with LNG-IUD proved significantly superior to oral treatment (p=0.001 for D-score >1 and p=0.003 for D-score 0-1 groups) and observation only (p=0.001 for D-score >1 and p=0.001 for D-score 0-1 groups). After 56 to 108 months the LNG-IUD proved significantly superior to oral treatment and to the observation group. Comparison of oral therapy to observation only showed no significant differences, neither after 6 months nor after long-time observation.
  
  
  CONCLUSIONS
  LNG-IUD is the optimal treatment for endometrial hyperplasia. Outcome after oral low-dose MPA regimen is comparable to expectation.
authors.affiliation: Department of Pathology, University Hospital of Tromsø, N-9038 Tromsø, Norway. anne.orbo@fagmed.uit.no
authors.forename: Anne
authors.initials: A
authors.lastname: Ørbo
authors.forename: Marit
authors.initials: M
authors.lastname: Arnes
authors.forename: Christine
authors.initials: C
authors.lastname: Hancke
authors.forename: Anne Beate
authors.initials: AB
authors.lastname: Vereide
authors.forename: Inger
authors.initials: I
authors.lastname: Pettersen
authors.forename: Kurt
authors.initials: K
authors.lastname: Larsen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D008875:Middle Aged; D019370:Observation; D012307:Risk Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate