nach oben

Erschienen in:

06.03.2017 | General Gynecology

One-stop clinical assessment of risk for endometrial hyperplasia (OSCAR-Endo): a fast-track protocol for evaluating endometrial pathologies

verfasst von: Katrin Hefler-Frischmuth, Elisabeth Hirtl-Goergl, Verena Unterrichter, Judith Lafleur, Gudrun Brunnmayr-Petkin, Farid Moinfar, Lukas Hefler

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate a one-stop clinical assessment of risk for assessing endometrial pathologies (OSCAR-Endo), consisting of a fast-track protocol with hysteroscopy, dilation and curettage (D&C) with intraoperative frozen section analysis of the removed tissue in cases of hysteroscopic suspicion of malignancy.

Methods

In this prospective clinical trial, a total of 304 consecutive women with sonographically suspected endometrial hyperplasia and/or postmenopausal bleeding, underwent D&C with intraoperative frozen section analysis between May 2013 and September 2015. Based on the results of the hysteroscopy and/or frozen section, the OSCAR-Endo score was reported: negative, when no frozen section was regarded necessary or the frozen section yielded a negative result; equivocal, when the frozen section reported an equivocal result; positive, when frozen section reported either complex hyperplasia with atypia or cancer.

Results

Frozen sections were required by the surgeons in 59 (19.4%) of cases. When compared with the final histology after D&C, frozen section showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 91.3, 100, 100, 94.1, and 96.3% for predicting malignant disease, respectively. The OSCAR-Endo score showed a sensitivity, specificity, PPV, NPV, and overall test accuracy of 84, 100, 100, 98.6, and 98.7% for predicting malignant disease, respectively.

Conclusion

The OSCAR-Endo protocol is easy to perform in daily clinical practice reaching an excellent test accuracy. It helps in immediate postoperative counseling of affected patients.

Clinical Trial Registration http://www.clinicaltrials.gov; NCT01961102.

National Cancer Institute (2016) Surveillance, epidemiology, and end result program. Cancer Stat Facts: Endometrial Cancer. http://seer.cancer.gov/statfacts/html/corp.html. Accessed 02 Mar 2017

Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403CrossRefPubMed

Moodley M, Roberts C (2004) Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J Obstet Gynaecol 24:736CrossRefPubMed

Yasa C, Dural O, Bastu E, Ugurlucan FG, Nehir A, İyibozkurt AC (2016) Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women. Arch Gynecol Obstet 294(2):311–316CrossRefPubMed

Grimes DA (1982) Diagnostic dilation and curettage: a reappraisal. Am J Obstet Gynecol 142:1–6CrossRefPubMed

Abdelazim IA, Abdelrazak KM, Elbiaa AA, Al-Kadi M, Yehia AH (2015) Accuracy of endometrial sampling compared to conventional dilatation and curettage in women with abnormal uterine bleeding. Arch Gynecol Obstet 291(5):1121–1126CrossRefPubMed

Lipscomb GH, Lopatine SM, Stovall TG, Ling FW (1994) A randomized comparison of the pipelle, accurette, and explora endometrial sampling devices. Am J Obstet Gynecol 170:591–594CrossRefPubMed

Hefler L, Lemach A, Seebacher V, Polterauer S, Tempfer C, Reinthaller A (2009) The intraoperative complication rate of nonobstetric dilation and curettage. Obstet Gynecol 113:1268–1271CrossRefPubMed

Hefler L, Leipold H, Hinterberger S, Concin N, Klotz R, Reinthaller A (2008) Influence of the time interval between hysteroscopy, dilation and curettage, and hysterectomy on survival in patients with endometrial cancer. Obstet Gynecol 112:1098–1101CrossRefPubMed

10.

Turnbull HL, Akrivos N, Simpson P, Duncan TJ, Nieto JJ, Burbos N (2017) Investigating vaginal bleeding in postmenopausal women found to have an endometrial thickness of equal to or greater than 10 mm on ultrasonography. Arch Gynecol Obstet 295:445-450CrossRefPubMed

11.

Elfayomy AK, Habib FA, Elkablawy MA (2012) Role of hysteroscopy in the detection of endometrial pathologies in women presenting with postmenopausal bleeding and thickened endometrium. Arch Gynecol Obstet 285(3):839–843CrossRefPubMed

12.

Brocken P, Prins JB, Dekhuijzen PN, van der Heijden HF (2012) The faster the better?—a systematic review on distress in the diagnostic phase of suspected cancer, and the influence of rapid diagnostic pathways. Psychooncology 21:1–10CrossRefPubMed

13.

Seklehner S, Hladschik-Kermer B, Lusuardi L, Schabauer C, Riedl C, Engelhardt PF (2013) Psychological stress assessment of patients suffering from prostate cancer. Scand. J Urol 47:101–107

14.

Saraçoğlu T, Unsal A, Taşkın F, Sevinçok L, Karaman CZ (2012) The impact of pre-procedural waiting period and anxiety level on pain perception in patients undergoing transrectal ultrasound-guided prostate biopsy. Diagn Interv Radiol 18:195–199PubMed

15.

Dickerson SS, Alqaissi N, Underhill M, Lally RM (2011) Surviving the wait: defining support while awaiting breast cancer surgery. J Adv Nurs 67:1468–1479CrossRefPubMed

16.

Rochester M, Scurrell S, Parry JR (2008) Prospective evaluation of a novel one-stop testicular clinic. Ann R Coll Surg Engl 90:565–570CrossRefPubMedPubMedCentral

17.

Bekkers RL, van der Donck M, Klaver FM, van Minnen A, Massuger LF (2002) Variables influencing anxiety of patients with abnormal cervical smears referred for colposcopy. J Psychosom Obstet Gynaecol 23:257–261CrossRefPubMed

18.

Naik R, Abang-Mohammed K, Tjalma WA, Nordin A, de Barros Lopes A, Cross PA et al (2001) The feasibility of a one-stop colposcopy clinic in the management of women with low grade smear abnormalities: a prospective study. Eur J Obstet Gynecol Reprod Biol 98:205–208CrossRefPubMed

19.

Bindra R, Heath V, Liao A, Spencer K, Nicolaides KH (2002) One-stop clinic for assessment of risk for trisomy 21 at 11–14 weeks: a prospective study of 15 030 pregnancies. Ultrasound Obstet Gynecol 20:219–225CrossRefPubMed

20.

Scrimin F, Wiesenfeld U, Galati EF, Monasta L, Ricci G (2016) Hysteroscopic chasing for endometrial cancer in a low-risk population: risks of overinvestigation. Arch Gynecol Obstet 293(4):851–856CrossRefPubMed

21.

Seebacher V, Schmid M, Polterauer S, Hefler-Frischmuth K, Leipold H, Concin N, Reinthaller A, Hefler L (2009) The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study. BMC Cancer 9:460CrossRefPubMedPubMedCentral

22.

Smith-Bindman R, Weiss E, Feldstein V (2004) How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol 24:558–565CrossRefPubMed

23.

Jacobs I, Gentry-Maharaj A, Burnell M, Manchanda R, Singh N, Sharma A et al (2011) Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort. Lancet Oncol 12:38–48CrossRefPubMed

24.

Clark TJ, Voit D, Gupta JK, Hyde C, Song F, Khan KS (2002) Accuracy of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia: a systematic quantitative review. JAMA 288:1610–1621CrossRefPubMed

25.

Nagele F, O’Connor H, Davies A, Badawy A, Mohamed H, Magos A (1996) 2500 outpatient diagnostic hysteroscopies. Obstet Gynecol 88:87–92CrossRefPubMed

26.

Bourdel N, Modaffari P, Tognazza E, Pertile R, Chauvet P, Botchorishivili R, Savary D, Pouly JL, Rabischong B, Canis M (2016) Does experience in hysteroscopy improve accuracy and inter-observer agreement in the management of abnormal uterine bleeding? Surg Endosc 30:5558–5564CrossRefPubMed

27.

Barber EL, Harris B, Gehrig PA (2016) Trainee participation and perioperative complications in benign hysterectomy: the effect of route of surgery. Am J Obstet Gynecol 215:215.e1-7CrossRefPubMed

28.

Wright JD, Lewin SN, Deutsch I, Burke WM, Sun X, Herzog TJ (2011) Effect of surgical volume on morbidity and mortality of abdominal hysterectomy for endometrial cancer. Obstet Gynecol 117:1051–1059CrossRefPubMed

29.

Bristow RE, Palis BE, Chi DS, Cliby WA (2010) The National Cancer Database report on advanced-stage epithelial ovarian cancer: impact of hospital surgical case volume on overall survival and surgical treatment paradigm. Gynecol Oncol 118:262–267CrossRefPubMed

30.

Drukker L, Hants Y, Farkash R, Grisaru-Granovsky S, Shen O, Samueloff A, Sela HY (2016) Impact of surgeon annual volume on short-term maternal outcome in cesarean delivery. Am J Obstet Gynecol 215:85.e1-8CrossRefPubMed

31.

Alcazar JL, Dominguez-Piriz J, Juez L, Caparros M, Jurado M (2016) Intraoperative gross examination and intraoperative frozen section in patients with endometrial cancer for detecting deep myometrial invasion: a systematic review and meta-analysis. Int J Gynecol Cancer 26:407–415CrossRefPubMed

Titel: One-stop clinical assessment of risk for endometrial hyperplasia (OSCAR-Endo): a fast-track protocol for evaluating endometrial pathologies
verfasst von: Katrin Hefler-Frischmuth
Elisabeth Hirtl-Goergl
Verena Unterrichter
Judith Lafleur
Gudrun Brunnmayr-Petkin
Farid Moinfar
Lukas Hefler
Publikationsdatum: 06.03.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 4/2017
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4326-8

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

One-stop clinical assessment of risk for endometrial hyperplasia (OSCAR-Endo): a fast-track protocol for evaluating endometrial pathologies