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Canadian Consensus-based and Evidence-based Guidelines for Benign Endometrial Pathology Reporting in Biopsy Material

Parra-Herran, Carlos, M.D.; Cesari, Matthew, M.D., F.C.R.C.P.; Djordjevic, Bojana, M.D., F.C.R.C.P.; Grondin, Katherine, M.D., F.C.R.C.P.; Kinloch, Mary, M.D., F.C.R.C.P.; Köbel, Martin, M.D., F.C.R.C.P.; Pirzada, Amrah, M.D.; Plotkin, Anna, M.D., F.C.R.C.P.; Gilks, C. Blake, M.D., F.C.R.C.P.

International Journal of Gynecological Pathology: March 2019 - Volume 38 - Issue 2 - p 119–127
doi: 10.1097/PGP.0000000000000481

Standardized terminology has proven benefits in cancer reporting; in contrast, reporting of benign diagnoses in endometrial biopsy currently lacks such standardization. Unification and update on the lexicon can provide the structure and consistency needed for optimal patient care and quality assurance purposes. The Special Interest Group in Gynecologic Pathology of the Canadian Association of Pathologists-Association Canadienne des Pathologistes (CAP-ACP) embarked in an initiative to address the current need for consensus terminology in benign endometrial biopsy pathology reporting. Nine members of the Special Interest Group developed a guideline for structured diagnosis of benign endometrial pathology through critical appraisal of the available peer-reviewed literature and joint discussions. The first version of the document was circulated for feedback to a group of professionals in akin fields, the CAP-ACP Executive Committee and the CAP-ACP general membership. The final 1-page document included 17 diagnostic terms comprising the most common benign endometrial entities, as well as explanatory notes for pathologists. The proposed terminology was implemented in the practice of 5 pathologists from the group, who applied the guideline to all benign endometrial biopsies over a 2-wk period. A total of 212 benign endometrial biopsies were evaluated in this implementation step; the recommended terminology adequately covered the diagnosis in 203 cases (95.8%). A list of terminology for benign endometrial biopsy reporting, based on expert consensus and critical appraisal of the available literature, is presented. On the basis of our results of implementation at multiple centers, the proposed guideline can successfully cover the large majority of diagnostic scenarios. The document has the potential to positively impact patient care, promote quality assurance, and facilitate research initiatives aimed at improving histopathologic assessment of benign endometrium.

Department of Laboratory Medicine and Pathobiology, University of Toronto and Sunnybrook Health Sciences Centre (C.P.-H., M.C., B.D.)

Department of Laboratory Medicine and Pathobiology, University of Toronto and Trillium Health Partners (A.P.), Toronto, ON

Department of Pathology, University Hospital of Quebec (Centre Hospitalier Universitaire de Quebec), Quebec, QC (K.G.)

Department of Pathology and Laboratory Medicine, University of Saskatchewan and Saskatoon City Hospital, Saskatoon, SK (M.K.)

Department of Pathology and Laboratory Medicine, University of Calgary and Arnie Charbonneau Cancer Institute, Calgary, AB (M.K.)

Department of Laboratory Medicine, Memorial University, St John’s, NL (A.P.)

Department of Pathology, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada (C.B.G.)

The authors declare no conflict of interest.

Address correspondence and reprint requests to Carlos Parra-Herran, MD, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room E4-27a, Toronto, ON, Canada M4N 3M5. E-mail:

©2019International Society of Gynecological Pathologists