Computerised morphometrical analysis in endometrial hyperplasia for the prediction of cancer development. A long term retrospective study from northern Norway

Aims-To evaluate and compare the long term prognostic value of the WHO clas sification and the computerised multivariate morphometrical D score in endo metrial hyperplasia. To test the reproducibility of the D score in two diff erent centres. Methods-Histopathological WHO classification and computerised morphometrica l analysis using the D score (< 0, high risk; > 1, low risk; 0-1, uncertain ) in a population based study from northern Norway of archival dilatation a nd curettage material from 68 women with 10-20 years of follow up. Results-Of the 68 patients included in the study, 18 developed cancer. The sensitivity and specificity of the D score (< 0 v > 1) were 100% and 78%, r espectively, which was better than the WHO classification (89% and 60%, res pectively). The negative and positive predictive values for the D score wer e 100% and 58% and of the WHO classification 94% and 44%, respectively. Thi s study found a slightly higher specificity for the D score than former ret rospective studies, but otherwise the results were comparable. The D score results were reproducible between the two centres (R = 0.91; slope = 0.98; intercept = 0.3). Conclusions-D score assessment is a reproducible and more accurate predicto r of outcome of endometrial hyperplasia than the WHO classification assesse d by an experienced gynaecological pathologist. Routine application of the D score might reduce over and undertreatment of endometrial hyperplasia.