One-stop clinical assessment of risk for endometrial hyperplasia (OSCAR-Endo): a fast-track protocol for evaluating endometrial pathologies
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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.
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.
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.
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.
KeywordsHysteroscopy Frozen section Endometrial cancer Endometrial pathology D&C
- 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
- 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
- 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
- 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
- 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
- 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