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Computerised morphometrical analysis in endometrial hyperplasia for the prediction of cancer development. A long term retrospective study from northern Norway
  1. Anne Ørbo1,
  2. Jan P A Baak2,
  3. Inger Kleivan1,
  4. Sigrun Lysne1,
  5. Per S Prytz1,
  6. Marc A M Broeckaert2,
  7. André Slappendel3,
  8. Hans J Tichelaar3
  1. 1Institute of Medical Biology, University of Tromsø, N-9037 Tromsø, Norway
  2. 2Department of Pathology, Academic Hospital, Free University, de Bokelaan 1117, 108 1HV Amsterdam, The Netherlands
  3. 3Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
  1. Professor Ørbo email: patano{at}
  2. jbaak{at}


Aims—To evaluate and compare the long term prognostic value of the WHO classification and the computerised multivariate morphometrical D score in endometrial hyperplasia. To test the reproducibility of the D score in two different centres.

Methods—Histopathological WHO classification and computerised morphometrical analysis using the D score (< 0, high risk; > 1, low risk; 0–1, uncertain) in a population based study from northern Norway of archival dilatation and curettage material from 68 women with 10–20 years of follow up.

Results—Of the 68 patients included in the study, 18 developed cancer. The sensitivity and specificity of the D score (< 0 v > 1) were 100% and 78%, respectively, which was better than the WHO classification (89% and 60%, respectively). The negative and positive predictive values for the D score were 100% and 58% and of the WHO classification 94% and 44%, respectively. This study found a slightly higher specificity for the D score than former retrospective studies, but otherwise the results were comparable. The D score results were reproducible between the two centres (R = 0.91; slope = 0.98; intercept = 0.3).

Conclusions—D score assessment is a reproducible and more accurate predictor of outcome of endometrial hyperplasia than the WHO classification assessed by an experienced gynaecological pathologist. Routine application of the D score might reduce over and undertreatment of endometrial hyperplasia.

  • endometrial hyperplasia
  • cancer
  • image analysis
  • prognostic classification rule

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