Validation of Diagnostic Criteria for Endometrial Adenocarcinoma.
Andy Lo, Seema Khutti, Khush Mittal. New York University School of Medicine, NY
Background: We previously identified morphologic criteria for endometrial biopsies which showed increased sensitivity and specificity for distinguishing endometrial adenocarcinoma (EA) from complex atypical hyperplasia (CAH). In the current study we evaluated the application of these criteria to endometrial biopsies received at our institution between 2007 and 2010.
Design: We searched the pathology database at NYULMC for all endometrial biopsies with subsequent hysterectomy received between January 2007 and August 2010 which were diagnosed as either CAH or EA, FIGO grade I. Slides for each identified case were retrieved, and were reassessed for the presence or absence of adenocarcinoma without the knowledge of hysterectomy findings. A diagnosis of EA was made if the biopsy possessed either 1)areas of >95% glandular crowding that were 3 mm or larger in aggregate diameter or 2) any cribiform architecture. We compared our diagnosis with that of the resection.
Results: We identified 95 patients that fulfilled all of the criteria for inclusion. On assessment of the slides using the previously discussed criteria, we diagnosed 50 of these cases as EA. On resection, 42 of these patients had EA (42/50, 84%); the remainder had CAH or contained no residual atypical lesion. In 45 cases we diagnosed CAH; 36 of these cases had CAH on resection. The remaining 10 cases were diagnosed as adenocarcinoma and adenocarcinoma in situ on resection (7/45, 15.5% and 3/45,6.6% respectively). These figures produced a sensitivity of 84% and a specificity of 80% for the diagnosis of endometrial adenocarcinoma (p<.0001).
Conclusions: The findings of this study validated previously derived criteria for diagnosing endometrial adenocarcinoma. The criteria used in this study had a higher sensitivity and specificity for predicting endometrial adenocarcinoma in hysterectomy specimens than any of the previously published criteria. The probability of finding endometrial adenocarcinoma in cases diagnosed as CAH was lower than that reported in other published series. Use of these criteria should lead to more accurate classification of cases in the spectrum of complex atypical endometrial hyperplasia to well differentiated endometrial adenocarcinoma.
Category: Gynecologic & Obstetrics
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 149, Wednesday Afternoon