This gynecological issue is misdiagnosed over 50 percent of the time

As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses are downgraded to a less serious condition or normal variant, and the remaining 25 percent of those cases are upgraded to a more serious condition. Pathologists are particularly likely to overdiagnose endometrial hyperplasia on the low end of the spectrum, which is referred to as simple hyperplasia without atypia. Many cases with this initial diagnosis are reinterpreted by experts as either proliferative or disordered proliferative endometrium, neither of which needs to be treated nor followed. In a 2008 study, this was the situation in 57 percent of cases (documented in the authors’ Table 1). The problem of frequent overdiagnosis is compounded when gynecologists recommend hysterectomy for patients diagnosed with simple hyperplasia without atypia rather than the more standard options of observation with risk factor reduction or hormonal therapy. These gynecologists see the word “hyperplasia” in the diagnosis line of the pathology report, and their knee-jerk reaction is hysterectomy, despite the absence of atypia. This toxic combination of ove...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions OB/GYN Source Type: blogs