Abstract
Background
LS women have a 40–60 % lifetime risk of endometrial cancer (EC). Most international guidelines recommend screening. However, data on efficacy are limited.
Purpose
To assess the performance of OHES for EC screening in LS and compare it with transvaginal ultrasound (TVS) alone.
Methods
A prospective observational cohort study of LS women attending a tertiary high-risk familial gynaecological cancer clinic was conducted. LS women opting for EC screening underwent annual OHES and TVS. Histopathological specimens were processed using a strict protocol. Data of women screened between October 2007 and March 2010 were analysed from a bespoke database. Histology was used as the gold standard. Diagnostic accuracy of OHES was compared with TVS using specificity, and positive (PLR) and negative (NLR) likelihood ratios.
Results
Forty-one LS women underwent 69 screens (41 prevalent, 28 incident). Four (three prevalent, one incident) women were detected to have EC/atypical endometrial hyperplasia (AEH), five had endometrial polyps and two had endometrial hyperplasia (EH) on OHES. TVS detected two of four EC/AEH. OHES had similar specificity of 89.8 % (CI 79.2, 96.2 %), but higher PLR 9.8 (CI 4.6, 21) and lower NLR (zero) compared to TVS: specificity 84.75 %(CI 73, 92.8 %), PLR 3.28 (CI 1.04, 10.35) and NLR 0.59 (CI 0.22, 1.58). No interval cancers occurred over a median follow-up of 22 months. The annual incidence was 3.57 % (CI 0.09, 18.35) for EC, 10.71 % (CI 2.27, 28.23) for polyps and 21.4 % (CI 8.3, 40.1) for any endometrial pathology.
Conclusions
Our findings suggest that in LS, annual OHES is acceptable and has high diagnostic accuracy for EC/AEH screening. Larger international studies are needed for confirmation, given the relatively small numbers of LS women at individual centres. It reinforces the current recommendation that endometrial sampling is crucial when screening these women.
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Acknowledgments
We are particularly grateful to all our patients. We acknowledge the support and help provided by Ms S. Chamberlain (secretary), Ms S. Parker and Ms E. Palmer (nurse hysteroscopists) as well as The Eve Appeal. A large portion of this work was done at UCLH/UCL within the “Women’s Health Theme” of the National Institute for Health Research UCLH/UCL Comprehensive Biomedical Research Centre (CBRC) supported by the Department of Health. This work has not been directly funded by any commercial organisation, charity or other sources.
Conflict of interest
IJ has consultancy arrangements with Becton–Dickinson, who have an interest in tumour markers and ovarian cancer. IJ and UM have a financial interest in Abcodia, Ltd., a company formed to develop academic and commercial development of biomarkers for screening and risk prediction. IJ is a member of the board of Abcodia Ltd and Women’s Health Specialists Ltd. ANR has received honoraria from Fujirebio Diagnostics for giving lectures and attending meetings on the use of biomarkers in ovarian cancer management, but none were directly related to this work. ES received honoraria from Ethicon for provision of training to health-care professionals; this was not related to the work. The other authors declare no conflict of interest.
Ethical standard
The project was referred to the Chair of the Research Ethics Committee (University College London Hospital, Research Deanery). Under the Research Governance Framework, the project was deemed to be a clinical audit, and permission for data analysis and submission for publication was given on 26/04/2010.
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Manchanda, R., Saridogan, E., Abdelraheim, A. et al. Annual outpatient hysteroscopy and endometrial sampling (OHES) in HNPCC/Lynch syndrome (LS). Arch Gynecol Obstet 286, 1555–1562 (2012). https://doi.org/10.1007/s00404-012-2492-2
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DOI: https://doi.org/10.1007/s00404-012-2492-2