Ease of Application of Diagnostic Criteria for Premalignant Endometrial Lesions
Jennifer Kaley, Aleksandra Melnyk, Josh Bornhorst, Chien Chen, Charles Quick. UAMS, Little Rock, AR
Background: Two classification systems are currently used to evaluate premalignant endometrial lesions: the World Health Organization (WHO) criteria and the endometrial intraepithelial neoplasia system (EIN). The WHO system is more widely used, but the EIN system has made recent gains in acceptance. The goal of this study was to determine the ease of use and reproducibility of the 2 systems among naive users.
Design: Twenty-two 3rd and 4th year medical school students, with no prior training in either system, reviewed an online, 20 minute, educational module on both systems' key histologic components and were assigned to take a quiz (48 questions) testing diagnostic criteria including: percent glands; percent stroma; gland to stroma ratio; presence of gland crowding; atypia; cytologic demarcation; and WHO or EIN diagnosis. The answers of both groups were compared with the consensus diagnosis of two gynecologic pathology trained pathologists.
Results: The results are listed in Table 1.
|Gland Crowding (EIN)||85% concordance|
|Gland : Stroma >1 (WHO)||68% concordance|
|Cytologic Demarcation (EIN)||68% concordance|
|Atypia (WHO)||52% concordance|
|EIN Diagnosis||85% concordance|
|WHO Diagnosis||36% concordance|
|Percent Glands||Mean standard deviation = 0.128|
|Percent Stroma||Mean standard deviation = 0.107|