Risk of subsequent endometrial carcinoma associated with endometrial intraepithelial neoplasia classification of endometrial biopsies

Authors

  • James V. Lacey Jr PhD,

    Corresponding author
    1. Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    • Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, MSC 7234, Rockville, MD 20852-7234
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    • Fax: (301) 402-0916

  • George L. Mutter MD,

    1. Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, Massachusetts
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  • Marisa R. Nucci MD,

    1. Department of Pathology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, Massachusetts
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  • Brigitte M. Ronnett MD,

    1. Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Olga B. Ioffe MD,

    1. Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland
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  • Brenda B. Rush RN,

    1. Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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  • Andrew G. Glass MD,

    1. Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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  • Douglas A. Richesson MPH,

    1. Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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  • Nilanjan Chatterjee PhD,

    1. Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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  • Bryan Langholz PhD,

    1. Division of Biostatistics, Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
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  • Mark E. Sherman MD

    1. Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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  • This article is a US Government work and, as such, is in the public domain in the United States of America.

Abstract

BACKGROUND.

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.

METHODS.

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.

RESULTS.

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).

CONCLUSIONS.

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

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