Prognostic Markers for Detection of Coexistent Carcinoma in High-risk Endometrial Hyperplasia

Objectives: Reliable predictive uterus-sparing methods are crucial for treatment decisions among women who wish to preserve fertility and for seriously ill patients for whom surgery is hazardous. Thus, prediction of myoinvasive carcinoma by objective histomorphometry (4C-rule) and subjective diagnosis (endometrial intraepithelial neoplasia, EIN) were investigated in high-risk endometrial biopsies. Patients and Methods: A total of 45 patients retrospectively diagnosed with high-risk hyperplasia, of whom ten were found to have concurrent carcinoma, were investigated. The histomorphometric 4C-rule and the EIN classification system were used for outcome prediction. Results: Myoinvasive disease was predicted with a sensitivity of 87% and a specificity of 79% by using 4C-rule assessment. The sensitivity and specificity of the EIN classification to predict coexistent carcinoma or not was 50% and 97%, respectively. Conclusion: Six out of the seven reported cases with myoinvasion were correctly diagnosed with the 4C-rule assessment. In contrast, only three out of the seven myoinvasive cases were diagnosed as cancer using the EIN approach. Reliable methods for uterus-sparing strategies predicting myoinvasive disease after diagnosis of high-risk hyperplasia or early stage of carcinoma have been considered of great importance for patients not suitable for surgical treatment with hysterectomy. Endometrial cancer, developing through preliminary stages of endometrial hyperplasia, is presently the most common gynaecologic malignancy of the Western world and the incidence is constantly rising (1). Hysterectomy represents routine therapy for high-risk endometrial pre- cancer and only hysterectomy provides conclusive evidence of the existence of myoinvasive adenocarcinoma. Different