Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias

Jan P A Baak, Anne Ørbo, Paul J. Van Diest, Mehdi Jiwa, Peter De Bruin, Marc Broeckaert, Wim Snijders, P. Jan Boodt, Guus Fons, Curt Burger, Renee H M Verheijen, Paul W H Houben, H. Sien The, Peter Kenemans

Research output: Contribution to journalArticle


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 ≤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 ≤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).

Original languageEnglish (US)
Pages (from-to)930-935
Number of pages6
JournalAmerican Journal of Surgical Pathology
Issue number7
StatePublished - 2001
Externally publishedYes



  • Endometrium
  • Hyperplasia
  • Morphometry
  • Progression
  • WHO

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Baak, J. P. A., Ørbo, A., Van Diest, P. J., Jiwa, M., De Bruin, P., Broeckaert, M., Snijders, W., Boodt, P. J., Fons, G., Burger, C., Verheijen, R. H. M., Houben, P. W. H., The, H. S., & Kenemans, P. (2001). Prospective multicenter evaluation of the morphometric D-score for prediction of the outcome of endometrial hyperplasias. American Journal of Surgical Pathology, 25(7), 930-935.