Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias

Prospective multicenter evaluation of the WHO classification and the morpho metric D-score to predict endometrial hyperplasia cancer progression. In 13 2 endometrial hyperplasias WHO classification was performed by two experien ced gynecologic pathologists. The D-score was assessed blindly by technicia ns in a routine diagnostic setting. Development of endometrial carcinoma du ring a 1-10-year follow-up was used as the end point. Eleven of 132 patient s (8%), 10 of 61 (16%) atypical hyperplasias, and 1 of 71 (1%) nonatypical hyperplasias developed cancer. Twenty-six curettings had a D-score less tha n or equal to0 ("unfavorable" or endometrial intraepitherial neoplasia) of which 10 (38%) developed cancer. None of the 86 cases with a D-score >1 ("f avorable") and one of the 20 (5%) cases with 0 < D-score less than or equal to1 ("uncertain") developed cancer. Sensitivity of the D-score was 100%, s pecificity 82%, the positive and negative predictive values were 38% and 10 0%, respectively. These values are similar to those in three prior retrospe ctive D-score studies but higher than the WHO values (which are 91%, 58%, 1 6%, and 99%, respectively). The D-score in endometrial hyperplasias is a mo re sensitive and specific marker for cancer prediction than the WHO classif ication, can be assessed in a routine clinical setting on standard hematoxy lin and eosin sections (1.5-30 minutes per case), and is highly reproducibl e and cost-effective (U.S. $50 per case).