Survey on Reporting of Endometrial Biopsies From Women on Progestogen Therapy for Endometrial Atypical Hyperplasia/Endometrioid Carcinoma

Abstract

Histologic assessment of response to progestogen therapy is a cornerstone of nonsurgical management of atypical hyperplasia/low-grade endometrioid carcinoma. Pathologists are required to assess whether there is ongoing preneoplastic or neoplastic change in the biopsies (often multiple) taken during therapy. There have been few studies documenting the specific histologic changes induced by therapeutic progestogens and currently there are no guidelines on terminology used in this scenario. Given the need for uniformity in reporting and the lack of guidance in the current literature, we initiated an online survey (including questions, categories of reporting, and scanned slides for assessment) which was sent to all members of British Association of Gynaecological Pathologists (BAGP) and the International Society of Gynecological Pathologists (ISGyP) with the aim to assess the variability among pathologists in reporting these specimens and to come up with a consensus-based terminology for reporting of endometrial biopsies from women on progestogen therapy for endometrial atypical hyperplasia/endometrioid carcinoma. In total, 95 pathologists participated in this survey. This manuscript elaborates on the results of the survey with recommendations aimed at promoting uniform terminology in reporting these biopsies.

Factors associated with interobserver variation amongst pathologists in the diagnosis of endometrial hyperplasia: A systematic review

“…Accurately quantifying the extent of interobserver variation is a difficult process, and it is possible that the high levels of interobserver variability in the included studies could in part be explained by the study protocols. These protocols are not reflective of typical, everyday working practices where prior and additional endometrial biopsies can be reviewed, clinical (including patient age) and radiological information is accessible, and colleagues can be consulted [ 30 , 32 ].…”

“…However, further research is warranted to determine the applicability of this panel in the diagnostic setting for EH. Interestingly, in a recently conducted international survey of pathologist working practices in the diagnosis of post-hormonal therapy EH specimens, 76% of 95 responding pathologists reported that they never undertook immunohistochemical staining [ 32 ]. This is despite significant advancements in the field regarding the immunohistochemical profile of EH, including proposed biomarker panels for the diagnosis of atypical hyperplasia/EIN [ 38 ].…”