title: Annual outpatient hysteroscopy and endometrial sampling (OHES) in HNPCC/Lynch syndrome (LS).
abstract: BACKGROUND
  LS women have a 40-60% lifetime risk of endometrial cancer (EC). Most international guidelines recommend screening. However, data on efficacy are limited.
  
  
  OBJECTIVE
  To assess the performance of OHES for EC screening in LS and compare it with transvaginal ultrasound (TVS) alone.
  
  
  METHODS
  A prospective observational cohort study of LS women attending a tertiary high-risk familial gynaecological cancer clinic was conducted. LS women opting for EC screening underwent annual OHES and TVS. Histopathological specimens were processed using a strict protocol. Data of women screened between October 2007 and March 2010 were analysed from a bespoke database. Histology was used as the gold standard. Diagnostic accuracy of OHES was compared with TVS using specificity, and positive (PLR) and negative (NLR) likelihood ratios.
  
  
  RESULTS
  Forty-one LS women underwent 69 screens (41 prevalent, 28 incident). Four (three prevalent, one incident) women were detected to have EC/atypical endometrial hyperplasia (AEH), five had endometrial polyps and two had endometrial hyperplasia (EH) on OHES. TVS detected two of four EC/AEH. OHES had similar specificity of 89.8% (CI 79.2, 96.2%), but higher PLR 9.8 (CI 4.6, 21) and lower NLR (zero) compared to TVS: specificity 84.75%(CI 73, 92.8%), PLR 3.28 (CI 1.04, 10.35) and NLR 0.59 (CI 0.22, 1.58). No interval cancers occurred over a median follow-up of 22 months. The annual incidence was 3.57% (CI 0.09, 18.35) for EC, 10.71% (CI 2.27, 28.23) for polyps and 21.4% (CI 8.3, 40.1) for any endometrial pathology.
  
  
  CONCLUSIONS
  Our findings suggest that in LS, annual OHES is acceptable and has high diagnostic accuracy for EC/AEH screening. Larger international studies are needed for confirmation, given the relatively small numbers of LS women at individual centres. It reinforces the current recommendation that endometrial sampling is crucial when screening these women.
authors.affiliation: Department of Gynaecological Oncology, EGA Institute for Women's Health, Gynaecological Cancer Research Centre, University College London, and Department of Gynaecology, University College London Hospital, First floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Manchanda
authors.forename: Ertan
authors.initials: E
authors.lastname: Saridogan
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelraheim
authors.forename: Michelle
authors.initials: M
authors.lastname: Johnson
authors.forename: Adam N
authors.initials: AN
authors.lastname: Rosenthal
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.forename: Carol
authors.initials: C
authors.lastname: Brunell
authors.forename: Lucy
authors.initials: L
authors.lastname: Side
authors.forename: Sue
authors.initials: S
authors.lastname: Gessler
authors.forename: Ian
authors.initials: I
authors.lastname: Jacobs
authors.forename: Usha
authors.initials: U
authors.lastname: Menon
mesh_terms: D000328:Adult; D001706:Biopsy; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000150:complications* / Q000235:genetics; D055088:Early Detection of Cancer; D016889:Endometrial Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D004717:Endometrium / Q000473:pathology*; D019160:Endosonography; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D015907:Hysteroscopy; D053208:Kaplan-Meier Estimate; D016013:Likelihood Functions; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric