Introduction/Background To examine the accuracy of the diagnosis endometrial intraepithelial neoplasia (EIN) in an office endometrium sample (OES).
Methodology Consecutive patients aged ≥40 years with any indication for OES by aspiration curettage (OES-A) or outpatient hysteroscopy (OES-H) were asked for written consent. Pathology was assessed according to the EIN system and the WHO94 classification. The pathology of any further, more extensive, specimen obtained within 12 months of OES, was regarded as the final pathological diagnosis. Statistical analysis was performed with SPSS24. Central study approval was obtained at the ErasmusMC, (MEC 2015-740), the study was registered on www.trialregister.nl (NL7608).
Results From 01-2016 to 02-2019, 343 patients were included, as summarized in table 1. OES-A was the first sampling for 340 patients. Of these, 43 samples were non-diagnostic (12,4%). Benign, EIN or malignancy was the diagnosis in 258 (76,1%), 6 (1,8%) and 33 (9,7%) cases respectively (figure 1). Final pathological diagnosis showed 290 benign cases (85,5%), 3 of EIN (0,9%) and 46 malignancies (13,6%). The accuracy of diagnosing EIN in an OES-A was 85,5%, with sensitivity of 46,2% and specificity of 100%. Subsequently, 66 OES-H samples were obtained, the accuracy of diagnosing EIN in an OES-H was 91,3%. The incidence of EIN in any OES was 2,5%. In eight out of ten patients a malignancy was ultimately diagnosed. Analyses of the EIN cases show that, despite not all five EIN histopathological criteria were met, the diagnosis EIN was set.
Conclusion EIN was diagnosed in specimen obtained through OES, although the diagnosis EIN was made despite not all histological criteria were being met. The EIN and WHO94 systems showed a considerable overlap. Given the low incidence of EIN, our study cohort will be extended to further define the place of the EIN system in an office sampling setting.
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