Error in histologic dating of secretory endometrium: variance component analysis

Area of Science:

• Reproductive endocrinology
• Gynecologic pathology
• Infertility diagnostics

Background:

• Accurate histologic dating of endometrial biopsies is crucial for diagnosing ovulatory and luteal phase defects.
• Previous studies have suggested variability in endometrial dating, but the specific sources and extent remain unclear.

Purpose of the Study:

• To quantify the imprecision in histologic dating of endometrial biopsies.
• To identify the primary sources of variability in endometrial dating.

Main Methods:

• Twenty-five women undergoing infertility evaluation provided duplicate endometrial biopsies.
• Five pathologists independently dated these biopsies on two separate occasions.
• Variance component analysis was used to assess intrauterine, intra-evaluator, and inter-evaluator variability.

Main Results:

• Inter-evaluator disagreement accounted for 65% of the total variability in dating.
• Intra-evaluator inconsistency contributed 27% to the variability.
• Uterine regional differences explained only 8% of the observed variability.

Conclusions:

• Significant variability exists in the histologic dating of endometrial biopsies.
• The substantial inter- and intra-evaluator variability can lead to a high false-positive rate for diagnosing luteal phase defects.
• Standardization of endometrial dating protocols is needed to improve diagnostic accuracy.