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 morphometric D-score to predict endometrial hyperplasia cancer progression. In 132 endometrial hyperplasias WHO classification was performed by two experienced gynecologic pathologists. The D-score was assessed blindly by technicians in a routine diagnostic setting. Development of endometrial carcinoma during a 1-10-year follow-up was used as the end point. Eleven of 132 patients (8%), 10 of 61 (16%) atypical hyperplasias, and 1 of 71 (1%) nonatypical hyperplasias developed cancer. Twenty-six curettings had a D-score < or = 0 ("unfavorable" or endometrial intraepithelial neoplasia) of which 10 (38%) developed cancer. None of the 86 cases with a D-score > 1 ("favorable") and one of the 20 (5%) cases with 0 < D-score < or = 1 ("uncertain") developed cancer. Sensitivity of the D-score was 100%, specificity 82%, the positive and negative predictive values were 38% and 100%, respectively. These values are similar to those in three prior retrospective D-score studies but higher than the WHO values (which are 91%, 58%, 16%, and 99%, respectively). The D-score in endometrial hyperplasias is a more sensitive and specific marker for cancer prediction than the WHO classification, can be assessed in a routine clinical setting on standard hematoxylin and eosin sections (15-30 minutes per case), and is highly reproducible and cost-effective (U.S. $50 per case).

Ki-67 immunoquantitation in cervical intraepithelial neoplasia (CIN): a sensitive marker for grading.

The aim of this study was to assess the value of Ki-67 immunoquantitation with a computerized image analysis system for grading support in cervical intraepithelial neoplasia (CIN). Sixty-five 'blind' consensus biopsies (23 CIN 1, 22 CIN 2, and 20 CIN 3) were used as a learning set. Measurements were done in the carefully selected most severely dysplastic part of the epithelium of each CIN case. The resulting discriminating combination of quantitative features was then prospectively applied on 121 new biopsies (test set) and compared with the classical CIN grade assessed routinely by six different pathologists and with the blind review grades assessed by two experienced pathologists. In the learning set of 65 cases, a jack-knifed stepwise discriminant analysis showed that the 90th percentile of the stratification index and the number of positive nuclei per 100 microm basal membrane are the best discriminating set of features to distinguish the three CIN grades at the same time. With these features, two CIN 1 cases were 'misclassified' as CIN 2 and nine CIN 2 cases as CIN 3. Overall agreement, therefore, was only 83%. However, recut of the paraffin blocks in the two 'misclassified' CIN 1 cases revealed CIN 2 in the first and CIN 3 in the other, while the other CIN 1 cases that were correctly classified with Ki-67 quantitation remained CIN 1. Likewise, nine CIN 2 cases were misclassified as CIN 3, but in two of these nine cases histological follow-up clearly indicated CIN 3. Agreement may thus be higher than the 83% in the learning set suggests. In the subsequent prospective evaluation on 121 routine CIN cases (test set), agreement between routine CIN grades (by six independent different pathologists) and quantitative Ki-67 classification was 78%. However, when compared with the blind review CIN grades of two expert pathologists, agreement was 97% and sensitivity, specificity, and positive and negative predictive value were very high. It is concluded that Ki-67 immunoquantitation is a useful diagnostic adjunct to distinguish different CIN grades and may also be a sensitive biological indicator of progression of seemingly low-grade CIN.

Confirmation of the prognostic value of the ECPI-1 score (myometrial invasion, DNA-ploidy and mean shortest nuclear axis) in FIGO stage I endometrial cancer patients with long follow-up.

In FIGO stage I endometrial cancer patients, histologic type and grade are correlated with prognosis and used for therapeutic decision making. However, assessment of these histologic features is subjective, and the results are not always perfectly reproducible. Contrarily, previous studies have shown that DNA-ploidy and morphometric features are highly reproducible and have a strong prognostic value in these cancers. Multivariate analysis has demonstrated that a combination of mean shortest nuclear axis (MSNA), DNA-ploidy and depth of myometrial invasion (the so-called ECPI-1 score) overshadowed the value of all other features investigated. The present study was set up to evaluate further and compare the prognostic power of the ECPI-1 score in 77 FIGO I patients with long follow-up (10-15 years). Grade (revised), invasion depth, MSNA and ploidy were all highly significant. However, the ECPI-1 score (with exactly the same threshold as in the previous study, 0.87) greatly exceeded the prognostic value of these single features. Only two (3%) of the 64 patients with ECPI-1 0.87 (10 died within 42 months) (P < 0.0001, Mantel-Cox value = 51.1). These results confirm the prognostic strength of the ECPI-1 score in stage I endometrial carcinoma.

Single-dose prophylaxis in hysterectomies. An interim analysis.

The efficacy of single-dose prophylaxis with intravenous cefuroxime 1,500 mg plus 500 mg metronidazole in vaginal or abdominal hysterectomies was investigated in a randomized, double-blind, placebo-controlled study, involving 396 evaluable patients. A significant reduction of the number in urinary tract infections was observed in the groups undergoing abdominal hysterectomy or vaginal hysterectomy with vaginal repair. The incidence of wound infections and the duration of hospitalization were significantly reduced in patients undergoing vaginal hysterectomy with or without vaginal repair. Body temperature normalized faster in all three groups receiving peri-operative antibiotic prophylaxis. It is concluded that a single injection of antimicrobial prophylaxis is sufficient and useful in both abdominal and vaginal hysterectomies.