Prognostic markers for detection of coexistent carcinoma in high-risk endometrial hyperplasia.
OBJECTIVE
Reliable predictive uterus-sparing methods are crucial for treatment decisions among women who wish to preserve fertility and for seriously ill patients for whom surgery is hazardous. Thus, prediction of myoinvasive carcinoma by objective histomorphometry (4C-rule) and subjective diagnosis (endometrial intraepithelial neoplasia, EIN) were investigated in high-risk endometrial biopsies.


METHODS
A total of 45 patients retrospectively diagnosed with high-risk hyperplasia, of whom ten were found to have concurrent carcinoma, were investigated. The histomorphometric 4C-rule and the EIN classification system were used for outcome prediction.


RESULTS
Myoinvasive disease was predicted with a sensitivity of 87% and a specificity of 79% by using 4C-rule assessment. The sensitivity and specificity of the EIN classification to predict coexistent carcinoma or not was 50% and 97%, respectively.


CONCLUSIONS
Six out of the seven reported cases with myoinvasion were correctly diagnosed with the 4C-rule assessment. In contrast, only three out of the seven myoinvasive cases were diagnosed as cancer using the EIN approach.
Research Group of Gynaecological Cancer, Faculty of Medicine, Institute of Medical Biology, University of Tromsø, N-9037 Tromsø, Norway. anne.orbo@fagmed.uit.no
A
A
Ørbo
B T
BT
Moe
M
M
Arnes
I
I
Pettersen
K
K
Larsen
T
T
Eggen
K
K
Myrmel
K
K
Hanssen
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000601:surgery; D004714:Endometrial Hyperplasia / Q000175:diagnosis* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010052:Ovariectomy; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate
D014408:Biomarkers, Tumor