Diagnosing endometrial hyperplasia - Why is it so difficult to agree?
Diagnosing endometrial hyperplasia - Why is it so difficult to agree?
复制标题
DOI：
10.1097/pas.0b013e318159a2a0
复制
发表时间：
2008-05-01
影响因子：
5.6
通讯作者：
Garcia, Rochelle L.
中科院分区：
文献类型：
--
作者：
Allison, Kimberly H.;Reed, Susan D.;Garcia, Rochelle L.
由于诊断重复性差，目前世界卫生组织对子宫内膜增生的分类存在问题。我们在审查 2601 份子宫内膜标本时试图确定导致诊断不一致的因素。正常子宫内膜、增生和子宫内膜癌的盲法随机标本由 2 名病理学家进行审查，如果存在分歧，则由第三名病理学家进行审查。所有子宫内膜增生或子宫内膜癌病例均根据腺体拥挤程度、结构复杂性和细胞异型性进行评分。还对样本充足性、增生体积、化生或子宫内膜息肉的存在进行评分。总体一致 K 值为 0.71，当排除“无增生”病例时，K 值较低为 0.36。无增生的特异性一致性百分比为 90.3%，单纯性增生为 31.1%，复杂性增生为 51.1%，非典型增生为 49.8%，腺癌为 57.5%。归类为“低体积增生”的病例比“高体积增生”的诊断分歧更大（62% vs. 39%，P = 0.003）。同样，被称为“很少”的病例比“不很少”的病例有更多的诊断分歧（65% vs. 57%，P = 0.013）。与大多数诊断不一致相关的组织学特征是细胞学异型性（P < 0.0001）。结构拥挤、结构复杂性或息肉的存在都与诊断不一致相关（P < 0.0001）。子宫内膜增生症的高度诊断分歧与样本充足性和组织学特征的解释有关。尽管获得额外的组织可能会提高诊断的可重复性，但对细胞学异型性等关键组织学特征的解释差异仍然是导致诊断不一致的主要因素。
Current World Health Organization classification of endometrial hyperplasia is problematic because of poor diagnostic reproducibility. We sought to determine factors that cause diagnostic disagreement in a review of 2601 endometrial specimens. Blinded random specimens of normal endometrium, hyperplasias, and carcinoma were reviewed by 2 pathologists, with review by a third pathologist in cases with disagreement. All cases of endometrial hyperplasia or carcinoma were scored for degree of glandular crowding, architectural complexity, and cytologic atypia. Sample adequacy, hyperplasia volume, presence of metaplasia, or endometrial polyp were also scored. The overall K for agreement was 0.71, with a lower K of 0.36 when cases called "no hyperplasia" were excluded. The percent specific agreement was 90.3% for no hyperplasia, 31.1% for simple hyperplasia, 51.1% for complex hyperplasia, 49.8% for atypical hyperplasia, and 57.5% for adenocarcinoma. Cases categorized as "low volume hyperplasia" had more diagnostic disagreement than "high volume," (62% vs. 39%, P = 0.003). Similarly, cases called "scant" had more diagnostic disagreement than "not scant" (65% vs. 57%, P = 0.013). The histologic feature associated with the most diagnostic disagreement was cytologic atypia (P < 0.0001). Architectural crowding, architectural complexity, or the presence of a polyp were all associated with diagnostic disagreement (P < 0.0001). High diagnostic disagreement in endometrial hyperplasia is related to both sample adequacy and interpretation of histologic features present. Although obtaining additional tissue may increase diagnostic reproducibility, differences in interpretation of key histologic features like cytologic atypia remain major factors contributing to diagnostic disagreement.