Archives of Gynecology and Obstetrics

, Volume 295, Issue 4, pp 959–964 | Cite as

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

  • Katrin Hefler-Frischmuth
  • Elisabeth Hirtl-Goergl
  • Verena Unterrichter
  • Judith Lafleur
  • Gudrun Brunnmayr-Petkin
  • Farid Moinfar
  • Lukas Hefler
General Gynecology
  • 162 Downloads

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 Registrationhttp://www.clinicaltrials.gov; NCT01961102.

Keywords

Hysteroscopy Frozen section Endometrial cancer Endometrial pathology D&C 

References

  1. 1.
    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
  2. 2.
    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 49:1374–1403CrossRefPubMedGoogle Scholar
  3. 3.
    Moodley M, Roberts C (2004) Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J Obstet Gynaecol 24:736CrossRefPubMedGoogle Scholar
  4. 4.
    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):311–316CrossRefPubMedGoogle Scholar
  5. 5.
    Grimes DA (1982) Diagnostic dilation and curettage: a reappraisal. Am J Obstet Gynecol 142:1–6CrossRefPubMedGoogle Scholar
  6. 6.
    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):1121–1126CrossRefPubMedGoogle Scholar
  7. 7.
    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 170:591–594CrossRefPubMedGoogle Scholar
  8. 8.
    Hefler L, Lemach A, Seebacher V, Polterauer S, Tempfer C, Reinthaller A (2009) The intraoperative complication rate of nonobstetric dilation and curettage. Obstet Gynecol 113:1268–1271CrossRefPubMedGoogle Scholar
  9. 9.
    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 112:1098–1101CrossRefPubMedGoogle Scholar
  10. 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 295:445-450CrossRefPubMedGoogle Scholar
  11. 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):839–843CrossRefPubMedGoogle Scholar
  12. 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 21:1–10CrossRefPubMedGoogle Scholar
  13. 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 47:101–107Google Scholar
  14. 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 18:195–199PubMedGoogle Scholar
  15. 15.
    Dickerson SS, Alqaissi N, Underhill M, Lally RM (2011) Surviving the wait: defining support while awaiting breast cancer surgery. J Adv Nurs 67:1468–1479CrossRefPubMedGoogle Scholar
  16. 16.
    Rochester M, Scurrell S, Parry JR (2008) Prospective evaluation of a novel one-stop testicular clinic. Ann R Coll Surg Engl 90:565–570CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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 23:257–261CrossRefPubMedGoogle Scholar
  18. 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 98:205–208CrossRefPubMedGoogle Scholar
  19. 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 20:219–225CrossRefPubMedGoogle Scholar
  20. 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):851–856CrossRefPubMedGoogle Scholar
  21. 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 9:460CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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 24:558–565CrossRefPubMedGoogle Scholar
  23. 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 12:38–48CrossRefPubMedGoogle Scholar
  24. 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 288:1610–1621CrossRefPubMedGoogle Scholar
  25. 25.
    Nagele F, O’Connor H, Davies A, Badawy A, Mohamed H, Magos A (1996) 2500 outpatient diagnostic hysteroscopies. Obstet Gynecol 88:87–92CrossRefPubMedGoogle Scholar
  26. 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 30:5558–5564CrossRefPubMedGoogle Scholar
  27. 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.e1-7CrossRefPubMedGoogle Scholar
  28. 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 117:1051–1059CrossRefPubMedGoogle Scholar
  29. 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 118:262–267CrossRefPubMedGoogle Scholar
  30. 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.e1-8CrossRefPubMedGoogle Scholar
  31. 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 26:407–415CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyGynecological Cancer Center, Ordensklinikum LinzLinzAustria
  2. 2.Karl Landsteiner Institute of Gynecological Surgery and OncologyLinzAustria
  3. 3.Department of PathologyOrdensklinikum LinzLinzAustria
  4. 4.Department of PathologyMedical University of GrazGrazAustria

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