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Arch Gynecol Obstet. 2017 Apr;295(4):959-964. doi: 10.1007/s00404-017-4326-8. Epub 2017 Mar 6.

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

Author information

1
Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria. katrin.hefler-frischmuth@ordensklinikum.at.
2
Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria. katrin.hefler-frischmuth@ordensklinikum.at.
3
Department of Obstetrics and Gynecology, Gynecological Cancer Center, Ordensklinikum Linz, Seilerstaette 2-4, 4010, Linz, Austria.
4
Karl Landsteiner Institute of Gynecological Surgery and Oncology, Linz, Austria.
5
Department of Pathology, Ordensklinikum Linz, Linz, Austria.
6
Department of Pathology, Medical University of Graz, Graz, Austria.

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 Registration http://www.clinicaltrials.gov ; NCT01961102.

KEYWORDS:

D&C; Endometrial cancer; Endometrial pathology; Frozen section; Hysteroscopy

PMID:
28265757
DOI:
10.1007/s00404-017-4326-8
[Indexed for MEDLINE]

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