PMID- 22865035
OWN - NLM
STAT- MEDLINE
DCOM- 20130513
LR  - 20161125
IS  - 1432-0711 (Electronic)
IS  - 0932-0067 (Linking)
VI  - 286
IP  - 6
DP  - 2012 Dec
TI  - Annual outpatient hysteroscopy and endometrial sampling (OHES) in HNPCC/Lynch 
      syndrome (LS).
PG  - 1555-62
LID - 10.1007/s00404-012-2492-2 [doi]
AB  - BACKGROUND: LS women have a 40-60% lifetime risk of endometrial cancer (EC). Most 
      international guidelines recommend screening. However, data on efficacy are 
      limited. PURPOSE: To assess the performance of OHES for EC screening in LS and 
      compare it with transvaginal ultrasound (TVS) alone. METHODS: A prospective 
      observational cohort study of LS women attending a tertiary high-risk familial 
      gynaecological cancer clinic was conducted. LS women opting for EC screening 
      underwent annual OHES and TVS. Histopathological specimens were processed using a 
      strict protocol. Data of women screened between October 2007 and March 2010 were 
      analysed from a bespoke database. Histology was used as the gold standard. 
      Diagnostic accuracy of OHES was compared with TVS using specificity, and positive 
      (PLR) and negative (NLR) likelihood ratios. RESULTS: Forty-one LS women underwent 
      69 screens (41 prevalent, 28 incident). Four (three prevalent, one incident) 
      women were detected to have EC/atypical endometrial hyperplasia (AEH), five had 
      endometrial polyps and two had endometrial hyperplasia (EH) on OHES. TVS detected 
      two of four EC/AEH. OHES had similar specificity of 89.8% (CI 79.2, 96.2%), but 
      higher PLR 9.8 (CI 4.6, 21) and lower NLR (zero) compared to TVS: specificity 
      84.75%(CI 73, 92.8%), PLR 3.28 (CI 1.04, 10.35) and NLR 0.59 (CI 0.22, 1.58). No 
      interval cancers occurred over a median follow-up of 22 months. The annual 
      incidence was 3.57% (CI 0.09, 18.35) for EC, 10.71% (CI 2.27, 28.23) for polyps 
      and 21.4% (CI 8.3, 40.1) for any endometrial pathology. CONCLUSIONS: Our findings 
      suggest that in LS, annual OHES is acceptable and has high diagnostic accuracy 
      for EC/AEH screening. Larger international studies are needed for confirmation, 
      given the relatively small numbers of LS women at individual centres. It 
      reinforces the current recommendation that endometrial sampling is crucial when 
      screening these women.
FAU - Manchanda, Ranjit
AU  - Manchanda R
AD  - Department of Gynaecological Oncology, EGA Institute for Women's Health, 
      Gynaecological Cancer Research Centre, University College London, and Department 
      of Gynaecology, University College London Hospital, First floor, Maple House, 149 
      Tottenham Court Road, London, W1T 7NF, UK.
FAU - Saridogan, Ertan
AU  - Saridogan E
FAU - Abdelraheim, Ahmed
AU  - Abdelraheim A
FAU - Johnson, Michelle
AU  - Johnson M
FAU - Rosenthal, Adam N
AU  - Rosenthal AN
FAU - Benjamin, Elizabeth
AU  - Benjamin E
FAU - Brunell, Carol
AU  - Brunell C
FAU - Side, Lucy
AU  - Side L
FAU - Gessler, Sue
AU  - Gessler S
FAU - Jacobs, Ian
AU  - Jacobs I
FAU - Menon, Usha
AU  - Menon U
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20120804
PL  - Germany
TA  - Arch Gynecol Obstet
JT  - Archives of gynecology and obstetrics
JID - 8710213
SB  - IM
MH  - Adult
MH  - Biopsy
MH  - Colorectal Neoplasms, Hereditary Nonpolyposis/*complications/genetics
MH  - Early Detection of Cancer
MH  - Endometrial Neoplasms/complications/diagnostic imaging/*pathology
MH  - Endometrium/*pathology
MH  - Endosonography
MH  - False Negative Reactions
MH  - False Positive Reactions
MH  - Female
MH  - Humans
MH  - Hyperplasia/pathology
MH  - *Hysteroscopy
MH  - Kaplan-Meier Estimate
MH  - Likelihood Functions
MH  - Middle Aged
MH  - Polyps/diagnostic imaging/pathology
MH  - Prospective Studies
MH  - Sensitivity and Specificity
MH  - Statistics, Nonparametric
EDAT- 2012/08/07 06:00
MHDA- 2013/05/15 06:00
CRDT- 2012/08/07 06:00
PHST- 2012/01/30 00:00 [received]
PHST- 2012/07/19 00:00 [accepted]
PHST- 2012/08/07 06:00 [entrez]
PHST- 2012/08/07 06:00 [pubmed]
PHST- 2013/05/15 06:00 [medline]
AID - 10.1007/s00404-012-2492-2 [doi]
PST - ppublish
SO  - Arch Gynecol Obstet. 2012 Dec;286(6):1555-62. doi: 10.1007/s00404-012-2492-2. 
      Epub 2012 Aug 4.