WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

*Dr. Ahmed Abd Alhassan Omran, Dr. Rihab Hameed Abdul-Sahib Almudhafar, Dr. Azhar Naji Alnajim

ABSTRACT

Background: The dilemma of interpreting endometrial biopsies among pathologists is well known. Until, 2008, diagnosing endometrial hyperplasia through endometrial sampling presents significant challenges due to substantial diagnostic discrepancies that are influenced by both the adequacy of the sample and the interpretation of the existing histological characteristics. Aim of the Study: To assess the prevalence, underestimated and overestimated diagnosis of proliferative endometrium, disordered proliferative endometrium and endometrium hyperplasia without atypia among perimenopausal women with abnormal uterine bleeding according to last updatein diagnostic criteria. Materials and methods: In this observationalcross sectional study were 178 formalin fixed paraffin embedded (FFPE) tissue block and hematoxylin and eosin stained slides were retrospectively collected from Iraqi patients with Abnormal uterine bleeding having endometrium hyperplasia without atypia, disordered proliferative endometrium and proliferative endometrium. Results: Original endometrial diagnoses revealed that 40.4% of the cases (72 out of 178) were diagnosed as proliferative endometrium, 3.4% (6 out of 178) as disordered proliferative endometrium, and 56.2% (100 out of 178) as endometrial hyperplasia without atypia, The total number of cases analyzed was 178, representing 100% of the sample. The pathology panel diagnoses over 3 years showed that 39.9% of the cases (71 out of 178) were diagnosed as proliferative endometrium, 24.2% (43 out of 178) as disordered proliferative endometrium with a statistical significance (Sig.) of 0.01, and 36.0% (64 out of 178) as endometrial hyperplasia without atypia, which had statistical significance of 0.03. For Proliferative Endometrium, there is a consistent underestimation of 1.1% over the 3-year period and 2.8 % in 2023 (p=0.01), with no overestimation observed. In contrast, Endometrial Hyperplasia without atypia shows significant overestimation, with 20.2% over the 3-year period, 23.5 % in 2021, 28.5 % in 2022, and 11.2 % in 2023, all with statistical significance (p=0.01). Disordered Proliferative Endometrium shows minimal overestimation (0.6%) in the 3-year analysis and 1.4 % in 2023, with no underestimation observed. The data indicates consistent trends of underestimation in Proliferative Endometrium and overestimation in Endometrial Hyperplasia without atypia, with statistical significance in most cases. Conclusion: Proliferative endometrium is under-diagnosed to a negligible extent; but there is substantial overestimation of endometrial hyperplasia without atypia which may lead unnecessary close follow up and or medical and surgical therapeutic interventions.