Anatomical Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy.
Gynaecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
Histopathology. 2019 Apr;74(5):676-687. doi: 10.1111/his.13776. Epub 2019 Feb 10.
Endometrial hyperplasia (EH) is classified into benign and precancerous according to two different histomorphological systems: the World Health Organisation (WHO) system (based on the subjective evaluation of cytological atypia) and the endometrial intraepithelial neoplasia (EIN) system (based on a combination of several parameters that are assessable subjectively, or objectively through computerised analysis). The American College of Obstetricians and Gynecologists recommends use of the EIN system. Nonetheless, a higher prognostic value for EIN criteria was demonstrated only with the objective assessment, which is not routinely applicable. The aim of this study was to evaluate which of the subjective classifications of EH (WHO or EIN) has better prognostic value, by assessing the risk of coexistent cancer. Electronic databases were searched for relevant articles from the inception of the databases to July 2018. All studies assessing the presence of cancer on hysterectomy specimens after a preoperative histological diagnosis of EH were included. Odds ratios (ORs), sensitivity and specificity were calculated with 95% confidence intervals (CIs). Sixteen cohort studies and three case-control studies, assessing 2582 EHs, were included. The WHO criteria showed an OR of 11.15 (95% CI 7.65-16.24), a sensitivity of 0.86 (95% CI 0.82-0.90) and a specificity of 0.67 (95% CI 0.64-0.70) for coexistent cancer. The subjective EIN system showed a similar OR (11.85, 95% CI 4.91-28.62; P = 0.90), higher sensitivity (0.98, 95% CI 0.94-0.99), and lower specificity (0.29, 95% CI 0.24-0.34). The WHO system and the subjective EIN system have similar prognostic values. However, the EIN criteria appear to be more sensitive and thus more suitable for selecting women who need to be treated, whereas the WHO criteria, based on cytological atypia, seem to be more specific for lesions at higher risk of cancer. Therefore, integration of the EIN system with cytological atypia should be considered.
子宫内膜增生（EH）根据两种不同的组织形态学系统分为良性和癌前病变：世界卫生组织（WHO）系统（基于细胞学异型性的主观评估）和子宫内膜上皮内瘤变（EIN）系统（基于几个可主观评估或通过计算机分析客观评估的参数）。美国妇产科医师学会推荐使用 EIN 系统。然而，只有通过客观评估才能证明 EIN 标准具有更高的预后价值，而客观评估并不常规适用。本研究旨在通过评估同时存在癌症的风险，评估 EH 的主观分类（WHO 或 EIN）中哪一种具有更好的预后价值。从数据库建立之初到 2018 年 7 月，电子数据库中搜索了相关文章。所有评估术前组织学诊断为 EH 后子宫切除标本中存在癌症的研究均被纳入。计算比值比（ORs）、敏感性和特异性，置信区间（CI）为 95%。纳入了 16 项队列研究和 3 项病例对照研究，共评估了 2582 例 EH。WHO 标准显示同时存在癌症的 OR 为 11.15（95%CI7.65-16.24），敏感性为 0.86（95%CI0.82-0.90），特异性为 0.67（95%CI0.64-0.70）。主观 EIN 系统显示相似的 OR（11.85，95%CI4.91-28.62；P=0.90）、更高的敏感性（0.98，95%CI0.94-0.99）和更低的特异性（0.29，95%CI0.24-0.34）。WHO 系统和主观 EIN 系统具有相似的预后价值。然而，EIN 标准似乎更敏感，因此更适合选择需要治疗的女性，而基于细胞学异型性的 WHO 标准似乎更适合具有更高癌症风险的病变。因此，应考虑将 EIN 系统与细胞学异型性相结合。
