The use and disuse of morphometry in the diagnosis of endometrial hyperplasia and carcinoma

Endometrial adenomatous hyperplasia, and the different grades of endometrial carcinoma form a continuous spectrum of morphologic deviations. The reproducibility and consistency of the assessment of these microscopical patterns is a historical problem ("nicht Karzinom - aber besser hinaus"). Lack of objective criteria is the major cause of this. Computer-aided morphometric analysis has revealed the diagnostic significance of several quantitative microscopical features. Using these in a multivariate combination, a highly reproducible and objective classifier has been developed. Selection of the significant areas by skilled gynaecopathologists is essential for the useful application of this algorythm. Especially in cases of doubt, this classification rule can be of decisive importance. Routine application in diagnostic gynaecopathology of this selective type of morphometry over a period of four years has regularly corrected the original subjective histopathological grade. In a case of a young patient with an unsuspected sexcord tumor of the ovary with annular tubules, the erroneous diagnosis of endometrial carcinoma was corrected by the application of morphometry into adenomatous hyperplasia. An excision of the ovarian tumor was performed, and slowly the morphologic pattern of the subsequent microcurettings revealed a more and more normal microscopical pattern, with eventually signs of secretion. Other studies have shown, that morphometrical analysis of adenomatous hyperplasias can predict the majority of those patients, who will develop frank carcinoma in their later course. Finally, objective histopathological grading of carcinomas reveals the superior quality of morphometry above subjective qualitative methods. Prevention of under- or overtreatment with radiotherapy can therefore be the result of routine diagnostic morphometry.(ABSTRACT TRUNCATED AT 250 WORDS)