Endometrial hyperplasia: Emergence of the EIN system
Keywords:
Endometrial intra epithelial neoplasia, Endometrial hyperplasia, EIN.
Abstract
Background: The diagnosis of precancerous lesions of the endometrium remains unstandardized because, the existing World Health Organization classification categories do not correspond to distinctive biologic groups and are inadequately supported by reproducible histopathologic criteria. The objective of our study is to simplify the diagnosis of endometrial hyperplasia, make it more reproducible and stratify patients in to two risk groups instead of four using the recent EIN system.Materials &Methods : All cases diagnosed as endometrial hyperplasia classified according to the WHO system in patients with abnormal uterine bleeding, during the 3 year period 2014-2016 were reclassified as benign hyperplasia and Endometrial intraepithelial neoplasia according to the EIN system. Results : 38 out of the 46 cases (82.6 %) of simple hyperplasia were reclassified as Benign hyperplasia. 8 out of the 46 cases (17.4%) of simple hyperplasia were reclassified as EIN.1 case of complex hyperplasia without atypia was reclassified as EIN. All the 11 cases of complex hyperplasia with atypia were reclassified as EIN.Conclusions : Application of the criteria for EIN successfully segregates patients into high and low cancer risk subgroups with better reproducibility than WHO classification. DOI: 10.21276/APALM.1026References
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2. Hecht JL, Ince TA, Baak JPA, Baker HE, Ogden MW, Mutter GL. Prediction of endometrial carcinoma by subjective endometrial intraepithelial neoplasia diagnosis. Mod Pathol. 2008;18(3):324–330.
3. Baak JP, Mutter GL, Robboy S, et al. The molecular genetics and morphometry-based endometrial intraepithelial neoplasia classification system predicts disease progression in endometrial hyperplasia more accurately than the 1994 World Health Organization classification system. Cancer.2005;103(11):2304–2312.
4. Orbo A, Baak JPA, Kleivan I, et al. Computerized morphometrical analysis in endometrial hyperplasia for the prediction of cancer development: a long-term retrospective study from northern Norway. J ClinPathol.2006;53(9):697–703.
5. Baak JP, Orbo A, van Diest PJ, et al. Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias. Am J SurgPathol.2007; 25: 930–935.
6. Marie-Claude Renaud, Quebec QC, Tien Le, MD, Ottawa ON. Epidemiology and Investigations for suspected Endometrial Cancer, JointSoGC-GoC-SCC Clinical practice Guideline, 2013 291,
7. Silverberg SG, Kurman RJ, Nogales F, Mutter GL, Kubik-Huch RA, Tavassoli FA. Epithelial tumors and related lesions of endometrium. In: TavassoliFA, StrattonMR, editors. Tumors of the breast and female genital organs.Lyon: IARC Press, 2003: 221–232.
8. Zaino RJ, Kauderer J, Trimble CL, et al. Reproducibility of the diagnosis of atypical endometrial hyperplasia: a Gynecologic Oncology Group study. Cancer.2006;106(4):804–811.
9. Marotti JD, Glatz K, Parkash V, Hecht JL. International internet-based assessment of observer variability for diagnostically challenging endometrial biopsies. Arch Pathol Lab Med. 2011;135(4):464–470.
10. Allison KH, Reed SD, Voigt LF, Jordan CD, Newton KM, Garcia RL.Diagnosing endometrial hyperplasia: why is it so difficult to agree?Am J SurgPathol.2008; 32(5):691–698.
11. Mutter GL, Zaino RJ, Baak JP a, Bentley RC, Robboy SJ. Benign endometrial hyperplasia sequence and endometrial intraepithelial neoplasia.Int J GynecolPathol. 2007;26(2):103–114.
Published
2017-08-31
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