Prediction of endometrial carcinoma by subjective EIN diagnosis
Endometrial intraepithelial neoplasia (EIN) is a precursor to endometrioid endometrial adenocarcinoma characterized by monoclonal growth of mutated cells, a distinctive histopathologic appearance, and 45-fold elevated cancer risk. We have applied EIN diagnostic criteria to 97 successive endometrial...
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Published in | Modern pathology Vol. 18; no. 3; pp. 324 - 330 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
01.03.2005
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Online Access | Get full text |
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Summary: | Endometrial intraepithelial neoplasia (EIN) is a precursor to endometrioid endometrial adenocarcinoma characterized by monoclonal growth of mutated cells, a distinctive histopathologic appearance, and 45-fold elevated cancer risk. We have applied EIN diagnostic criteria to 97 successive endometrial biopsies classified as hyperplastic according to WHO criteria and correlated results with computer assisted morphometry (D-score) and clinical cancer outcomes. Three pathologists separately reviewed all cases using EIN criteria (gland area>stromal area, cytologic change in focus of altered architecture, lesion size >1mm, and exclusion of cancer and mimics) to classify cases as EIN or non-EIN. Discordant cases were resolved by a consensus review at a multiheaded scope. Clinical outcomes were obtained in 84 patients from patient visit and pathology records. Diagnoses using EIN criteria were unanimous amongst all 3 pathologists in 75% of cases, and intraobserver-reproducibility was excellent (kappa 0.73-0.90). EIN cases encompassed hyperplasias previously diagnosed as atypical (n=18) or non-atypical (8 complex, 2 simple). Eight follow-up cancers were scattered between hyperplasia types (5/21 atypical, 3/63 non-atypical), but all classified as EIN (8/25) and D-Score ≤1 (8/38). Subjective application of EIN criteria correlates well with objective morphometry and successfully segregates patients into high and low cancer risk subgroups with high reproducibility. |
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Bibliography: | To Whom Correspondence and Reprint Requests should be directed: George L. Mutter, MD, Div. of Women’s and Perinatal Pathology, Department of Pathology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, (617) 732-6096 Phone, (617) 738-6996 FAX, e-mail: gmutter@rics.bwh.harvard.edu |
ISSN: | 0893-3952 1530-0285 |
DOI: | 10.1038/modpathol.3800328 |