Descriptive epidemiology of endometrial hyperplasia in patients with abnormal uterine bleeding

PURPOSE OF INVESTIGATION: To evaluate the prevalence and epidemiologic characteristics of endometrial hyperplasias in women with abnormal uterine bleeding. METHODS: We performed a retrospective analysis on data gained from 294 patients with histologically documented endometrial hyperplasia (with or without atypia), detected among 1,469 women who underwent fractional dilatation and curettage in our department due to abnormal uterine bleeding from 1986 to 1998. Epidemiologic characteristics were abstracted from the patients' medical charts. RESULTS: 294/1469 women were found with endometrial hyperplasia (258 without atypia and 36 atypical hyperplasias). Thirty-six of them were under 40 years of age. Four of the detected endometrial hyperplasias progressed to endometrial carcinoma (one with simple hyperplasia, two with complex and one with atypical hyperplasia). Obesity and hypertension were justified as risk factors in our study population. CONCLUSIONS: The prevalence of endometrial hyperplasia according to our data was 20%. There were statistically significant differences in most epidemiologic parameters between the two types of hyperplasia. The progression of four endometrial hyperplasias to endometrial adenocarcinoma indicates the need for intense follow-up even in cases where patients undergo conservative therapy.     

Prevalence of underlying adenocarcinoma in women with atypical endometrial hyperplasia.

There is controversy regarding the prevalence of underlying endometrial adenocarcinoma among women with a diagnosis of atypical endometrial hyperplasia. This study further defines that risk. At our institution atypical endometrial proliferations non-diagnostic for invasive adenocarcinoma are diagnosed as either atypical endometrial hyperplasia (ATHY) or as an "atypical proliferative lesion of the endometrium, suggestive but not diagnostic of atypical endometrial hyperplasia" (APL). Between 1996 and 2003, these diagnoses were made on either endometrial biopsy or endometrial curettings in 60 women who subsequently received a hysterectomy. Endometrial adenocarcinoma was identified in 48% (29/60) of the hysterectomy specimens. Age and sampling method had no significant impact on the prevalence of adenocarcinoma. Adenocarcinoma was no more likely to be subsequently identified when a woman had a preoperative diagnosis of ATHY (24 of 52, 46%) compared to APL (5 of 8, 63%). In some women with a diagnosis of ATHY a comment was made in the report that "carcinoma cannot be ruled out". These cases had a significantly higher prevalence of underlying adenocarcinoma (16 of 25, 64%) compared to cases of ATHY in which such a comment was not made (8 of 27, 30%) (p = 0.025). In conclusion, there is a high prevalence of underlying endometrial adenocarcinoma among women undergoing hysterectomy for any of atypical endometrial proliferation.     

Immunohistochemical evaluation of PTEN protein in patients with endometrial intraepithelial neoplasia compared to endometrial adenocarcinoma and proliferative phase endometrium

OBJECTIVE: The aim of this study was to reclassify endometrial hyperplasia cases and examine PTEN protein immunoreactivity compared to cases with endometrial adenocarcinoma and proliferative endometrium. DESIGN: Endometrial samples from 37 women with endometrial hyperplasia with atypia were reclassified as endometrial intraepithelial neoplasia (EIN). Eighteen were complex and 19 were simple endometrial hyperplasia. Twenty-our cases of EIN, ten endometrial adenocarcinoma cases and ten proliferative phase endometrium sections were immunostained for PTEN expression. PTEN expression was documented according to the degree of immunoreactivity as complete loss, partial loss and present. RESULTS: Twenty-four of 37 (64%) women with endometrial hyperplasia were reclassified as EIN. Complete loss of PTEN immunoreactivity was found in only one of the 24 EIN patients (4.2%), partial loss in eight of 24 (33.3%) and present in 15 of 24 (62.5%). There were no difference in PTEN immunoreactivity between EIN, endometrial adenocarcinoma and endometrial proliferation (p = 0.342). PTEN immunoreactivity was partially lost in seven and present in three of the patients with endometrial adenocarcinoma. None of the patients expressed complete loss of PTEN immunoreactivity in this group. CONCLUSION: EIN classification may provide a better and more objective assessment of endometrial hyperplasia cases. PTEN expression showed no differences among the cases of EIN, endometrial carcinoma and proliferative phase endometrium.     

Incidence of endometrial carcinoma in patients with endometrial hyperplasia

OBJECTIVE: The purpose of this retrospective study was to establish the risk of developing endometrial adenocarcinoma in patients diagnosed with endometrial hyperplasia. MATERIAL AND METHODS: The incidence of endometrial hyperplasia and its relation with endometrial adenocarcinoma was evaluated in 1,139 patients who presented with abnormal bleeding between January 2000 and December 2004; D&C was performed in all cases. There were 591 (51.88%) cases of simple endometrial hyperplasia, out of which 110 (18.61% from 51.88%) cases had atypia, 60 (5.26%) cases of complex hyperplasia, out of which 19 (31.66% from 5.26%) had atypia, and the remaining 488 (42.84%) had different forms of mixed hyperplasia. RESULTS: The incidence of endometrial adenocarcinoma was 3.87% in atypical hyperplasia and 0.81% in other forms, and was related only to cases with atypia in which the incidence was 0.61%. CONCLUSIONS: The most indicated measure to prevent endometrial carcinoma in cases with complex endometria hyperplasia with atypia is hysterectomy, while for other forms of hyperplasia, hormonal treatment is used but only under strict control.     

Normal endometrial cells in Papanicolaou smears: prevalence in women with and without endometrial disease

OBJECTIVE: To determine whether the prevalence of normal endometrial cells in Papanicolaou smears of women with and those without endometrial carcinoma or hyperplasia differs significantly. METHODS: Papanicolaou smears of women with biopsy-proved endometrial hyperplasia or carcinoma diagnosed between 1990 and 1998 were reviewed for the presence of normal endometrial cells. Chi-square and a power analysis were used to compare these smears with results of smears from women older than 35 years of age with tissue diagnoses other than hyperplasia or carcinoma. All Papanicolaou smears obtained within the 5 years before endometrial sampling were reviewed. Each patient had at least one smear done within the previous 12 months. Clinical information was available for all patients. RESULTS: Of the 201 women in whom endometrial hyperplasia (n = 103) or carcinoma (n = 98) was diagnosed, 4 (2%) had normal endometrial cells in otherwise negative Papanicolaou smears. Of the 289 women in the comparison group, 15 (5%) had normal endometrial cells in their Papanicolaou smears. The prevalence of normal endometrial cells did not differ significantly between the two groups (P =.071). The study had 80% power to detect a 5% or greater difference between groups. CONCLUSION: The prevalence of normal endometrial cells in Papanicolaou smears of women with endometrial carcinoma or hyperplasia does not significantly differ from that in women without these conditions. Reporting normal endometrial cells in Papanicolaou smears according to the recommendations of the Bethesda System may lead to unnecessary procedures and patient anxiety.     

Significance of atypical endometrial cells detected by cervical cytology

A retrospective study was conducted to assess the histologic significance of atypical endometrial cells identified on routine cervical cytology. One hundred seventy-seven women had Papanicolaou smears demonstrating atypical endometrial cells. The histology of the endometrium was available from endometrial sampling and/or hysterectomy in 134 of the patients within 12 months of their abnormal cytologic evaluation. Fifty-six women (42%) had endometrial disease, including 14 cases (10%) of endometrial polyp, 15 cases (11%) of endometrial hyperplasia, and 27 cases (20%) of adenocarcinoma. The frequency and nature of the endometrial changes depended on the age of the patient (P less than .001) and the degree of cytologic atypia (P less than .05). In 21 women over 59 years who had atypical endometrial cells suspicious for adenocarcinoma, 12 (57%) had adenocarcinoma. Using this information, we have estimated the risk of adenocarcinoma in various groups of women with atypical endometrial cells.     

Development of metastatic endometrial endometrioid adenocarcinoma while on progestin therapy for endometrial hyperplasia

BACKGROUND: Conservative treatment with progestins is a reasonable treatment option for endometrial complex atypical hyperplasia and, in the experimental setting, for some women with grade 1 endometrial endometrioid adenocarcinoma. The risk of progression to a high-stage endometrial cancer is quite low, with only two previously reported cases in the English literature. CASE: A 40-year-old woman with endometrial complex atypical hyperplasia diagnosed by dilatation and curettage was managed conservatively with progestin therapy (initially, megesterol acetate; then, a combination oral contraceptive). More than 2 years after her original diagnosis, she developed endometrial endometrioid adenocarcinoma, FIGO grade 2, with lymph node metastasis. The tumor was microsatellite instability-high due to methylation of MLH1 and loss of MLH1 protein. CONCLUSION: Currently, there are no good criteria for predicting which patients with complex atypical hyperplasia/grade 1 endometrioid adenocarcinoma will optimally respond to progestin therapy. There is some evidence that endometrial complex hyperplasia demonstrating loss of MLH1 protein by immunohistochemistry is strongly related to subsequent or concurrent endometrial cancer, especially tumors of higher grade and stage. In a woman with a biopsy diagnosis of endometrial hyperplasia, evaluation of MLH1 protein status by immunohistochemistry may provide useful information when medical management is being considered.     

G蛋白偶联雌激素受体在子宫内膜腺癌组织表达及其意义

目的探讨G蛋白偶联雌激素受体(GPER)在子宫内膜腺癌组织中发生发展的作用。方法选取2005年3月至2008年4月郑州大学第一附属医院病理科手术及活检标本的存档蜡块,采用免疫组织化学SP法检测55例子宫内膜腺癌、49例子宫内膜增殖症及10例正常增生期子宫内膜组织中GPER蛋白的表达,分析其与子宫内膜腺癌患者临床病理特征的关系。结果正常增生期子宫内膜组织、子宫内膜增殖症组织和子宫内膜腺癌组织中GPER蛋白的阳性表达率分别为20.0%、67.3%和81.8%,差异具有统计学意义(χ2=15.778,P<0.001)。子宫内膜增殖症中,简单型增生、复杂型增生及不典型增生内膜组织中GPER蛋白的阳性表达率分别为30.0%、70.0%和84.2%,差异具有统计学意义(χ2=8.864,P=0.012)。绝经后和未绝经子宫内膜腺癌组织中GPER的阳性表达率分别为89.7%和62.5%,差异具有统计学意义(χ2=3.977,P=0.046)。高分化和中、低分化子宫内膜腺癌组织中GPER的阳性表达率分别为71.4%和100%,差异具有统计学意义(χ2=5.196,P=0.023)。临床分期Ⅰ期和(Ⅱ+Ⅲ)期子宫内膜腺癌组织中GPER的阳性表达率分别为73.0%和100%,差异具有统计学意义(χ2=4.268,P=0.039)。有淋巴结转移和无淋巴结转移的子宫内膜腺癌组织中GPER的阳性表达率分别为66.7%和83.7%,差异无统计学意义(χ2=0.210,P=0.646)。在肌层浸润深度<1/2和≥1/2的子宫内膜腺癌组织中GPER的阳性表达率分别为75%和100%,差异无统计学意义(χ2=3.057,P=0.080)。结论 GPER与子宫内膜腺癌的发生、发展可能具有相关性。     

The prevalence of endometrial hyperplasia and endometrial cancer in women with polycystic ovary syndrome or hyperandrogenism

Objective. Polycystic ovary syndrome may be associated with an increased risk of endometrial hyperplasia and endometrial cancer, but substantial evidence for this remains to be established. We investigated the prevalence of endometrial hyperplasia and endometrial cancer in a well characterized group of women with polycystic ovary syndrome and/or clinical/biochemical hyperandrogenism. Design. Retrospective observational trans-sectional study. Setting. Out-patient clinic at the Departments of Endocrinology and Gynecology, Odense University Hospital, Denmark. Population. In all, 963 premenopausal women consecutively referred with the diagnoses polycystic ovary syndrome and/or hirsutism during 1997-2008. Methods. All women underwent a standardized evaluation program. In 2011, The Danish Data Bank of Pathology was used to identify women with endometrial histology diagnoses (year range of diagnosis 1982-2011). Main outcome measures. Histology diagnoses, demographic variables. Results. Endometrial hyperplasia was diagnosed in 10 (1.0%) women and endometrial cancer in one (0.1%) woman. The median body mass index of these women was 30.6 kg/m(2) compared with 26.8 kg/m(2) in the total cohort. There were no differences between the cases and total cohort in terms of individual Rotterdam Criteria. In Denmark, 70 cases of endometrial cancer are diagnosed yearly in women 40-55 years, a prevalence of 0.4% in the corresponding period. Conclusion. The results of the present study do not suggest a higher prevalence of endometrial cancer in women with polycystic ovary syndrome and/or clinical/biochemical hyperandrogenism than in the general population.     

Heparanase expression increases throughout the endometrial hyperplasia-cancer sequence.

OBJECTIVE: To assess the expression of heparanase in the different stages leading to endometrial cancer. METHODS: The 38 examined specimens included adenocarcinoma, hyperplasia, and normal endometrium specimens. Heparanase, estrogen, and progesterone receptor expressions were analyzed immunohistochemically and the intensity was scored. RESULTS: Secretory normal endometrium and simple hyperplasia specimens expressed the lowest mean values of expression (1.00 and 0.63, respectively); the complex hyperplasia specimens and G2 endometrioid adenocarcinoma showed the highest values of expression (2.33 and 2.71, respectively). A linear trend (P=0.005) of heparanase expression was observed when comparing the normal endometrium and simple hyperplasia group with the complex hyperplasia+G1 carcinoma group and the G2+G3 carcinoma group. Evaluation of atrophic and inactive endometrium compared with papillary serous carcinomas yielded no significant differences. We found no significant correlation between heparanase expression and estrogen receptor or progesterone receptor expression. CONCLUSION: Heparanase expression was tightly regulated in endometrial tumorigenesis.     

Preliminary stages of endometrial cancer

Our present knowledge of the precursors of endometrial cancer is reviewed. The endometrial cystic gland hyperplasia, atypical adenomatous hyperplasia and adenocarcinoma in situ are discussed in relation to the development of endometrial cancer.     

子宫内膜增生过长和子宫内膜样腺癌中VEGF 和TSP-1表达与血管新生研究

目的探讨子宫内膜增生过长及子宫内膜样腺癌中血管内皮生长因子(VEGF)和血小板反应素1(TSP-1)表达与血管新生的关系以及对子宫内膜样腺癌的发生、发展中的作用.方法采用免疫组织化学方法分别检测子宫内膜正常(12例)、增生过长(13例)、不典型增生(18例)及子宫内膜样腺癌(50例)中微血管密度(MVD)、VEGF及TSP-1表达情况.结果子宫内膜不典型增生和内膜样腺癌中MVD明显大于内膜正常及增生过长者(P＜0.05),子宫内膜样腺癌IA期与不典型增生二者的MVD差异无显著性(P＞0.05),而与正常内膜和增生过长者差异有显著性(P＜0.05);VEGF表达与上述不同内膜病变中MVD呈正相关(r=0.843,P=0.000 1),而TSP-1表达仅在子宫内膜样腺癌中分别与MVD和VEGF呈负相关趋势(r=-0.233,P=0.1041;r=-0.235,P=0.100 3);在子宫内膜样腺癌中TSP-1间质高表达且具有异质性.结论子宫内膜不典型增生和子宫内膜样腺癌中VEGF对血管新生起正向调节作用;TSP-1在部分腺癌患者中表达增强,但其负向调节作用较弱,可能会使血管新生开关平衡失调,与子宫内膜样腺癌发生及发展有关.     

Atypical endometrial hyperplasia: grounds for possible misdiagnosis of endometrial adenocarcinoma

OBJECTIVE: The diagnoses of atypical hyperplasia and well-differentiated adenocarcinoma imply totally different approaches because of clinical and patient-oriented ramifications, especially when morphological differences are not entirely conclusive. The purpose of this study was to examine the relationship between the diagnosis of atypical hyperplasia during curettage or endometrial biopsy and the definitive histological findings from hysterectomy material. STUDY DESIGN: 23 patients were found fit for the current study and subsequently their clinical histories were reviewed for relevant clinical data, histopathological profiling and type of therapeutic interventions. RESULTS: Adenocarcinoma was observed in 12 (52.17%) of 23 hysterectomy cases. The hyperplasia was found in 10 (43.47%) cases, although 4 of them lacked atypia and 1 case proved to be hyperplasia-free. CONCLUSION: Hysterectomy was prescribed as the next step in the diagnosis of atypical endometrial hyperplasia. Other wait-and-see approaches could have easily forfeited the chances of providing an adequate treatment for an operable and curable cancer in approximately half of the studied cases.     

PTEN和P27在子宫内膜腺癌中的表达

目的　探讨与张力蛋白同源的第 1 0染色体丢失的磷酸酶基因 (PTEN)与细胞周期调控因子P2 7在子宫内膜腺癌发生发展中的作用 ,并通过对PTEN与P2 7关系的研究 ,分析PTEN功能异常参与癌发生的分子机制。方法　应用免疫组织化学SP法 ,检测了 1 2例增生期子宫内膜 ,4 2例子宫内膜增殖症包括 1 5例单纯型增生 (SH) ,1 9例复合型增生 (CH)和 8例非典型增生 (AH) ,4 5例子宫内膜腺癌组织中PTEN和P2 7的表达情况。结果　在增生期子宫内膜、子宫内膜增殖症和子宫内膜腺癌中PTEN阳性表达率呈下降趋势 ,分别为 91 7%(1 1 / 1 2 )、 4 2 9% (1 8/ 4 2 )和 37 8% (1 7/ 4 5 ) ,增生子宫内膜PTEN阳性表达率显著高于子宫内膜增殖症和子宫内膜腺癌 (P <0 0 0 1 ) ,PTEN在SH中的阳性表达率为 73 3% (1 1 / 1 5 ) ,高于在CH和AH的阳性表达率 ,分别为2 6 3% (5 / 1 9)和 2 5 0 % (2 / 8) (P <0 0 0 5 )。P2 7在增生子宫内膜、子宫内膜增殖症和子宫内膜腺癌中的阳性表达率分别为 1 0 0 0 % (1 2 / 1 2 )、 6 4 3% (2 7/ 4 2 )和 4 2 2 % (1 9/ 4 5 ) ,三者比较 ,差异有显著性 (P <0 0 5 )。P2 7在SH ,CH和AH中的阳性表达率分别为 80 0 % (1 2 / 1 5 ) ,6 8 4 % (1 3/ 1 9)和 2 5 0 % (2 / 8)。SH和CH中P2 7的阳性     

Cytologic diagnosis of endometrial adenocarcinoma using the Endo-pap sampler

Six hundred ambulatory women were screened with the Endo-pap cytology sampler in two medical centers. None of the women developed complications from the use of the instrument. Their smears were routinely processed together with cervical cytology smears. One hundred fifty-three of these women had a tissue diagnosis by endometrial biopsy, dilatation and curettage, or hysterectomy. Adequate cytology specimens were obtained in 93% of these patients. In these 153 patients, 32 (18%) had a tissue diagnosis of endometrial adenocarcinoma, and 31 patients had a tissue diagnosis of endometrial hyperplasia. The cytology samples obtained with this device were diagnostic of endometrial adenocarcinoma in 30 (94%) of these 32 patients and ten (32%) of the patients with endometrial hyperplasia. Two patients (1.6%) were diagnosed falsely positive. The Endo-pap cytology sampler is considered a safe and effective screening tool for endometrial adenocarcinoma. Its value in diagnosing endometrial hyperplasia remains to be determined.     

Endometrial hyperplasia and carcinoma in endometrial polyps: clinicopathologic and follow-up findings.

The objectives of this study were: 1) to evaluate findings in follow-up hysterectomy specimens after a diagnosis of complex atypical hyperplasia or carcinoma in endometrial polyps (EMPs) for possible significance in management strategies; and 2)to identify features in these polyps, that are predictive of the presence of endometrial hyperplasia or carcinoma in subsequent hysterectomy. Records of all cases of EMPs with endometrial hyperplasia were retrieved from the files of New York University Medical Center from 1993 to 2005. Those cases with follow-up hysterectomy were selected for the study. Of the 29 patients with complex atypical hyperplasia within the polyp, 19 out of 29 (66%) patients had hyperplasia of the non-polyp endometrium, and adenocarcinoma was observed in 9 out of 29 (31%) patients on follow-up hysterectomy. The percentage of polyp area involved by the hyperplasia was predictive of finding endometrial disorder in subsequent hysterectomy (P = 0.005). Of the 8 patients with adenocarcinoma in situ (AIS) within the polyp 3 (38%) had myoinvasive adenocarcinoma. In contrast, in cases without AIS, 4 out of 21 (19%) had myoinvasive adenocarcinoma in follow-up hysterectomy. Eight of the nine cases with carcinoma in endometrial polyp had endometrial pathology on hysterectomy. Approximately two thirds of the patients with hyperplasia and 90% of patients with adenocarcinoma in endometrial polyps show endometrial pathology on subsequent hysterectomy. The above findings reinforce the need for hysterectomy especially in postmenopausal women with atypical complex hyperplasia or carcinoma in endometrial polyps even if these changes appear confined to the polyp in initial sampling.     

Diagnostic and prognostic significance of the mitotic index in endometrial adenocarcinoma.

The aim of current study was to evaluate the diagnostic as well as the prognostic significance of the mitotic index (MI) in endometrial adenocarcinoma. We compared the MI in normal endometrium, endometrial hyperplasia, and endometrial adenocarcinoma. The mean MI in normal proliferative endometrium (4.35 +/- 3.4) was not significantly different from those in glandular hyperplasia (4.19 +/- 6.0) and well-differentiated adenocarcinoma (4.01 +/- 4.2). A significantly higher MI (10.7 +/- 8.2) was found only in poorly differentiated adenocarcinoma (P less than 0.05). Results of our work indicate that the MI cannot be used as a discriminating factor in the differential diagnosis of borderline cases of endometrial hyperplasia and endometrial adenocarcinoma. We examined the usefulness of the MI, grade of differentiation, and depth of invasion as the prognostic factors in endometrial adenocarcinoma. The significantly higher 5-year mortality rate was associated with an MI greater than 5, grade III of differentiation, and neoplastic invasion penetrating to the outer third of the myometrium. All of the patients with MI greater than 5 had tumors with the highest grade of differentiation and/or invasion involving the mid and outer third of myometrium. This suggests that the higher mortality of patients with an MI greater than 5 reflects the presence of anaplastic and/or highly invasive tumor.     

The role of prolactin in endometrial lesions]

The Authors examine serum levels of HPRL in basal conditions and after TRH and sulpiride test in 15 patients with endometrial lesions (hyperplasia) and in 15 patients with endometrial adenocarcinoma included in a age range between 44 and 62 years, in which 7 patients present obesity, 10 patients present hypertension and 2 patients are hyperglycemic. The same examination is carried out in a control group of 30 healthy patients. Then the 15 patients with adenocarcinoma and 3 patients with adenomatosa hyperplasia are subjected to surgery and they estimate HPRL levels in endometrium. The results prove that there is no correlation between HPRL plasma levels and endometrium lesions and between endometrium HPRL. The Authors conclude that HPRL does not play a significant role in the pathogenesis of endometrial lesions; use of HPRL plasma levels as a marker of endometrial lesions is not possible.     

Expression of the inhibin-alpha subunit in normal, hyperplastic and malignant endometrial tissue: an immunohistochemical analysis

OBJECTIVES: Determination of the frequency and tissue distribution of inhibin-alpha (INH-alpha) in normal, hyperplastic and malignant endometrium. MATERIALS AND METHODS: Endometrial tissue was obtained from normal, hyperplastic (glandular-cystic hyperplasia), adenomatous hyperplasia (AH grade I to III) and endometroid adenocarcinoma and immunohistochemically characterized with INH-alpha antibody. RESULTS: INH-alpha was expressed in normal, hyperplastic and malignant endometrium. Highest expression was observed during secretory phase and glandular-cystic hyperplasia compared to all groups. A continuous decline was noted from AH grade I to III with a significance between AH I and II. DISCUSSION: A menstrual cycle associated expression of INH-alpha in glandular endometrial epithelium was observed. Since AH grade II and III can be considered as a precursor of endometrial cancer, INH-alpha could be a marker of cell transformation and an endometrial tumor-suppressor agent.     

Evaluación morfológica endometrial histeroscópica

Objective

To determine the prevalence of endometrial hyperplasia and adenocarcinoma in distinct groups of endometrial morphology defined by hysteroscopy, and to study the validity of hysteroscopic diagnosis in identifying endometrial tumors.

Materials and methods

We performed a prospective study of 830 hysteroscopies carried out between June 1, 2004 and December 31, 2005 in the Gynecology Outpatient Clinic of Hospital Donostia in San Sebastian, northern Spain. Hysteroscopy was used to classify endometria into atrophic, hypotrophic, active, hypertrophic, suspicious for adenocarcinoma and adenocarcinoma, according to a series of morphological criteria. The findings were later correlated with the histopathological diagnoses obtained through endometrial biopsy.

Results

The sensitivity, specificity and negative predictive value (NPV) of hysteroscopic evaluation of endometrial morphology in diagnosing malignant and premalignant disease were extremely high. Sensitivity was 87.5% (95% CI 0.753-0.941), specificity was 94.8% (95% CI 0.925-0.965) and NPV was 98.7% (95% CI 0.971-0.994). The specificity of morphological diagnosis of adenocarcinoma was 99.9%, sensitivity was 74.3%, and the likelihood ratio for a positive result was 625,486. When the groups of adenocarcinoma and suspicious for adenocarcinoma were combined, sensitivity was 100% and specificity was 96.3%.

Conclusions

The prevalence of premalignant disease is very low in the hysteroscopic morphological groups of atrophic, hypotrophic and active endometria. Premalignant disease is slightly more prevalent in hypertrophic endometria and is significantly more prevalent in cases in which the hysteroscopic diagnosis is of suspicious adenocarcinoma and adenocarcinoma. In these cases, the prevalence of adenocarcinoma is very high. Hysteroscopic evaluation of endometrial morphology alone, without biopsy, is a valid tool to exclude or confirm endometrial disease in some groups.