What we do
About our project
Aim of this project
Several clinical problems can be related to (pre) malignancies of the endometrium. For histopathological analyses, the EIN scheme is applied, differentiating between benign, EIN, and malignant endometrial diseases. One of the major strengths of this system is its correlation to outcome data; a diagnosis of EIN imparts a 45-fold increased risk of progression to carcinoma after the first year.
All knowledge is based on retrospective analyses of tissues obtained by classical dilatation and curettage (D&C) procedures, while currently endometrial samples are obtained in an outpatient setting, retrieving much smaller samples. We study the EIN classification in current daily practice.
Postmenopausal bleeding is one of the main reasons for women to visit a gynaecologist. The Dutch national guideline for women with postmenopausal bleeding - revised in 2016 - recommends that all women should undergo a hysteroscopy after a benign office sample. This recommendation is based on minimal evidence. A hysteroscopy is invasive and uncomfortable, requires a proper setting, is time consuming, and more expensive than a wait-and-see policy. In our project we will investigate the adherence to, and efficiency of the current guideline, as well as the cost effectiveness.
Execution of the project
This is a prospective multicentre study, including all women aged 40 years and older, who visit the outpatient clinic of a participating centre with any indication for endometrial biopsy. Biopsies are examined in the traditional way (hyperplasia / malignancy) and with the EIN system. All data regarding diagnostic tests, outcome and treatment will be collected and analysed.
Impact on patient care
We might find that the current guideline for postmenopausal bleeding does not improve the diagnosis of (pre) malignancies at reasonable costs, and that sub-groups of patients do not benefit from the more extended diagnostics. If so, in the future a patient tailored approach might be offered.
Our research focus
EIN classificationThe diagnosis of EIN can be summarized as a focus of clustered endometrial glands exceeding a gland to stroma ratio of 1:1, which have altered cytology from the background endometrium, and which comprise a sufficient volume of 1 mm. Given that in an office setting only a very small specimen is obtained, it is questionable if EIN could be diagnosed at all. It is also unclear if the diagnosis of EIN in a endometrial sample reflects a pre malignancy or a malignancy. Making this distinction is important for treatment planning. An inter-observer study will give more information on this matter.
Funds & Grants
Collaboration within Erasmus MC
- Departments of Gynaecologic Oncology
- Department of Pathology
Collaboration outside of Erasmus MC
- Albert Schweitzer Hospital, Dordrecht
- Bravis hospital, Bergen op Zoom
- Fransiscus Vlietland group, Rotterdam