Internet-Based Assessment of Observer Variability for Diagnostically Challenging Endometrial Biopsies
JD Marotti, K Glatz, V Parkash, JL Hecht. Beth Israel Deaconess Medical Center, Boston, MA; University of Basel, Basel, Switzerland; Bridgeport Hospital, Bridgeport, CT
Background: Endometrial Intraepithelial Neoplasia (EIN) is a diagnostic schema for premalignant endometrial lesions that has been developed by histopathologic correlation with clinical outcome, molecular changes, and objective computerized histomorphometry. However, several benign mimics of EIN continue to cause diagnostic confusion. Using an internet-based quiz we assessed observer variability in the diagnosis of EIN to better understand the diagnostic pitfalls.
Design: An online quiz consisting of 18 cases of endometrial biopsies considered difficult was prepared. Each case contained clinical history and at least 3 microscopic images. Answer choices included: 1) EIN, 2) Polyp, 3) Benign endometrium (proliferative, secretory, disordered, tubal metaplasia, lower uterine segment) and 4) Adenocarcinoma. For analysis, polyp and benign answers were combined into a single answer. Online EIN tutorial materials were offered to all participants prior to starting the quiz and the authors' diagnosis and clinical follow-up were provided at the end.
Results: The online quiz was completed by 51 participants with percentage agreement with the authors ranging from 22 to 100% (mean 55%). The mean percentage agreement was highest with benign/polyp cases: tubal metaplasia (86%) polyp (86%), and secretory -change (79%). Participants performed the worst with cases containing morular metaplasia (29%) and EIN arising in a polyp (52%). The mean percentage agreement for EIN without these features was 71%, and those participants who reviewed online tutorial performed better than those who did not (60% vs 49%).
Conclusions: Reproducibility of EIN criteria is good. A subset of biopsies with morular metaplasia and EIN in polyps are problematic and likely require consensus review. Limitations of this study include the limited format of selected case images.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 121, Wednesday Morning