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Risk of subsequent endometrial carcinoma associated with endometrial intraepithelial neoplasia classification of endometrial biopsies†
Article first published online: 21 AUG 2008
Published 2008 American Cancer Society
Volume 113, Issue 8, pages 2073–2081, 15 October 2008
How to Cite
Lacey, J. V., Mutter, G. L., Nucci, M. R., Ronnett, B. M., Ioffe, O. B., Rush, B. B., Glass, A. G., Richesson, D. A., Chatterjee, N., Langholz, B. and Sherman, M. E. (2008), Risk of subsequent endometrial carcinoma associated with endometrial intraepithelial neoplasia classification of endometrial biopsies. Cancer, 113: 2073–2081. doi: 10.1002/cncr.23808
This article is a US Government work and, as such, is in the public domain in the United States of America.
- Issue published online: 3 OCT 2008
- Article first published online: 21 AUG 2008
- Manuscript Accepted: 21 MAY 2008
- Manuscript Revised: 12 MAY 2008
- Manuscript Received: 12 MAR 2008
- The National Cancer Institute's intramural research program (Division of Cancer Epidemiology and Genetics)
- Intramural Research Program of the NIH
- The Johns Hopkins Medical Institutions
- University of Maryland Medical Center
- Kaiser Foundation Research Institute
- endometrial hyperplasia;
- atypical hyperplasia;
- uterine cancer;
- cancer precursor;
- volume percentage stroma
Histopathologic diagnosis of endometrial biopsies is used to estimate the risk of progression to carcinoma and guide clinical management. Problems with the widely used World Health Organization (WHO) system for classifying endometrial hyperplasia (EH) have prompted the development of an alternative system based on endometrial intraepithelial neoplasia (EIN). The authors estimated progression risk associated with EIN among endometrial biopsies in a nested case-control study of EH progression.
Index biopsies with original community pathology diagnoses of disordered proliferative endometrium (DPEM) or EH that were independently confirmed by a panel of pathologists were independently reviewed and assigned EIN classifications (inadequate, benign, EIN, or cancer) by a second panel of pathologists. Cases (N = 138) progressed to carcinoma at least 1 year (median, 6 years) after their index biopsy. Controls (N = 241) also had EH, did not progress to carcinoma, and were individually matched to cases based on age at EH, date of EH, and length of follow-up. By using conditional logistic regression, the authors estimated relative risks (RRs) with 95% confidence intervals (95% CIs) for progression to carcinoma for EIN versus benign.
In the EIN system, 71 (52.6%) cases and 159 (66.8%) controls were classified as benign and 42 (31.1%) cases and 65 (27.3%) controls were classified as EIN. The RR for EIN versus benign was 7.76 (95% CI, 3.36-17.91). In the WHO system, the RR for atypical hyperplasia (AH) versus DPEM, simple hyperplasia, or complex hyperplasia was 9.19 (95% CI, 3.87-21.83).
Among women observed for at least 1 year after receiving a biopsy-based EH diagnosis, EIN and AH were both found to have similarly increased risks of progression to carcinoma. Cancer 2008. © Published 2008 by American Cancer Society