The accuracy and interobserver reproducibility of endometrial dating

Although controversial, diagnosis of luteal phase defect (LPD) includes the morphological assessment of endometrial development. This study was conduc ted to determine if refresher training in the histological criteria could i mprove the accuracy and interobserver reproducibility of endometrial dating . Seventy-eight endometrial biopsies were dated by a reference panel of two pathologists and then reviewed twice by a study panel of four pathologists . In the first review, usual practice was applied. Prior to the second revi ew, they studied a standard document of histological criteria. Samples were dated: as proliferative, secretory (post-ovulatory day, POD), menstrual, a nd undatable. Accuracy levels based on the reference dating and agreement l evels using kappa values were calculated per review and compared. The kappa for overall dating was 0.683 in the first review and 0.696 in the second. The respective first and second review kappa values were 0.736 and 0.771 fo r proliferative, and 0.794 and 0.764 for secretory. Amongst those dated as secretory in the first and second reviews, respectively, 31 and 28% were as signed the same POD by any two panellists, 68 and 63% were dated to within 1 day, and 77 and 71% were dated to within 2 days. Accuracy levels per pane llist for overall dating were very high in both reviews but were low for in dividual PODs. Accuracy and interobserver reproducibility were unaffected b y refresher training, suggesting the limits of histological dating have bee n reached.