title: One-stop clinical assessment of risk for endometrial hyperplasia (OSCAR-Endo): a fast-track protocol for evaluating endometrial pathologies.
abstract: OBJECTIVE
  To evaluate a one-stop clinical assessment of risk for assessing endometrial pathologies (OSCAR-Endo), consisting of a fast-track protocol with hysteroscopy, dilation and curettage (D&C) with intraoperative frozen section analysis of the removed tissue in cases of hysteroscopic suspicion of malignancy.
  
  
  METHODS
  In this prospective clinical trial, a total of 304 consecutive women with sonographically suspected endometrial hyperplasia and/or postmenopausal bleeding, underwent D&C with intraoperative frozen section analysis between May 2013 and September 2015. Based on the results of the hysteroscopy and/or frozen section, the OSCAR-Endo score was reported: negative, when no frozen section was regarded necessary or the frozen section yielded a negative result; equivocal, when the frozen section reported an equivocal result; positive, when frozen section reported either complex hyperplasia with atypia or cancer.
  
  
  RESULTS
  Frozen sections were required by the surgeons in 59 (19.4%) of cases. When compared with the final histology after D&C, frozen section showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 91.3, 100, 100, 94.1, and 96.3% for predicting malignant disease, respectively. The OSCAR-Endo score showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 84, 100, 100, 98.6, and 98.7% for predicting malignant disease, respectively.
  
  
  CONCLUSIONS
  The OSCAR-Endo protocol is easy to perform in daily clinical practice reaching an excellent test accuracy. It helps in immediate postoperative counseling of affected patients. Clinical Trial Registration http://www.clinicaltrials.gov ; NCT01961102.
authors.affiliation: Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria. katrin.hefler-frischmuth@ordensklinikum.at.|Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria. katrin.hefler-frischmuth@ordensklinikum.at.
authors.forename: Katrin
authors.identifier: http://orcid.org/0000-0001-6166-9312
authors.initials: K
authors.lastname: Hefler-Frischmuth
authors.affiliation: Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.|Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hirtl-Goergl
authors.affiliation: Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.|Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
authors.forename: Verena
authors.initials: V
authors.lastname: Unterrichter
authors.affiliation: Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.|Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Lafleur
authors.affiliation: Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.|Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Brunnmayr-Petkin
authors.affiliation: Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.|Department of Pathology, Ordensklinikum Linz, Linz, Austria.|Department of Pathology, Medical University of Graz, Graz, Austria.
authors.forename: Farid
authors.initials: F
authors.lastname: Moinfar
authors.affiliation: Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.|Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Hefler
mesh_terms: D000328:Adult; D000368:Aged; D004107:Dilatation and Curettage; D004714:Endometrial Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: D&C; Endometrial cancer; Endometrial pathology; Frozen section; Hysteroscopy