Arends, Mark

Critchley, Hilary

Esnal-Zufiaurre, Arantza

Sanderson, Peter

Saunders, PTK

Williams, Alistair

English

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     Edinburgh Research Explorer                                      A Diagnosis of Endometrial Hyperplasia: Where are we now?Citation for published version:Sanderson, P, Esnal-Zufiaurre, A, Critchley, H, Saunders, PTK, Arends, M & Williams, A 2017, 'A Diagnosisof Endometrial Hyperplasia: Where are we now?', PathSoc Winter Meeting 2017, London, United Kingdom,19/01/17 - 20/02/17.Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordGeneral rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 03. Dec. 2020Title: A Diagnosis of Endometrial Hyperplasia: Where are we now? Authors: Sanderson PA1, Esnal-Zufiaurre A1, Critchley HOD2, Saunders PTK1, Arends MJ3,4, Williams ARW3 1 MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK 2MRC Centre for Reproductive Heath, University of Edinburgh, Edinburgh, UK 3Division of Pathology, University of Edinburgh, Edinburgh, UK 4Centre for Comparative Pathology, University of Edinburgh, Edinburgh, UK  Purpose:  Endometrial hyperplasia (EH) is an 'umbrella-term' depicting a heterogeneous collection of morphologically abnormal endometrial lesions. When cytological atypia is present there is substantial risk of endometrioid endometrial cancer development. In 2014, the WHO endorsed the Endometrial Intraepithelial Neoplasia (EIN) system of EH classification. Although predominantly a morphological classification, it recognises the importance of unopposed oestrogen stimulation in EH development, distinguishing it from a mutationally activated premalignant clone (EIN) developing in an oestrogen stimulated background. Utilising EIN criteria has been shown to increase diagnostic reproducibility and aligns well with clinical treatments, more so than the preceding WHO94 classification.  Methods:  Pathology reports coded as EH using WHO94 diagnostic criteria within NHS Lothian were retrospectively evaluated from 2004-2009. The index diagnostic sections (n=127) underwent blinded expert gynae-path review to: 1) verify WHO94 diagnosis and 2) reclassify using EIN criteria. FFPE sections were obtained from the cohort (LREC:15/ES/0094) and immunohistochemistry performed (PTEN, PAX2, ARID1A, HAND2, p53) for characterisation of molecular features.  Results:  Agreement between initial WHO94 diagnosis and expert review WHO94 diagnosis was 52% (n=66). The largest inconsistency was within the WHO94 complex EH category, where only 38.5% (10/26) of review diagnoses agreed with the original. The cohort contained 44 EIN and 83 non-EIN cases. Of note, PTEN-null gland expression was found in 56.8% (25/44) of EIN cases, including 38.6% (17/44) where the entire EIN lesion was PTEN-null.  Conclusions:  Our study highlights problematic interobserver differences encountered using WHO94, which remains a familiar system in gynaecological practice, thus creating potential for under/overtreatment of EH. Work continues to fully elucidate the molecular features of EH/EIN and unravel underlying neoplastic mechanisms. 

A Diagnosis of Endometrial Hyperplasia: Where are we now?

https://www.research.ed.ac.uk/portal/files/31547324/A_Diagnosis_of_Endometrial_Hyperplasia_Where_are_we_now.pdf

A Diagnosis of Endometrial Hyperplasia: Where are we now?

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