To determine whether use of stringent histologic criteria when diagnosing endometrial polyps can increase the predictive value for intracavitary lesions.
A retrospective chart review of 104 patients who underwent office hysteroscopy or sonohysterography after an endometrial biopsy. Histology slides were reviewed by three blinded pathologists to determine whether they met the following criteria for endometrial polyp: 1) thick-walled blood vessels, 2) irregularly shaped and positioned glands, and 3) stroma altered by fibrosis or excessive collagen. Each specimen was reviewed at least twice by each pathologist to determine intraobserver and interobserver reliability. Sensitivity and specificity analyses were performed using the presence of lesions on office imaging as the true positive.
Using standard reported biopsy results, 57 patients had polyps compared with 47 with other benign diagnoses. Thirty-eight patients had lesions on imaging for a positive predictive value (PPV) of 33.3% and a negative predictive value (NPV) of 59.6%. Intraobserver reliability of repeat evaluations by the same pathologist to identify polyps (if two of the three criteria were met) was moderate for each of the three pathologists (Fleiss' Kappa 0.49–0.66), and agreement among the three pathologists using the first evaluation from each pathologist was significant (Kendall's coefficient of concordance=0.74, P<.001). When the consensus among all three pathologists was used, the PPV and NPV improved to 43.7% and 66.7%, respectively.
Use of stringent histologic criteria to diagnose endometrial polyps can improve the PPV and NPV for the presence of intracavitary lesions on office imaging.