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 journalArticlepeer-review


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


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