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- W2024273516 abstract "Objectives: Endometrial histologic assessment has been challenged as a diagnostic tool for fertility evaluation due to inter- and intraobserver variability and the uncertain correlation between histology, molecular markers, and clinical presentation. In this study we evaluated interobserver variability between national commercial laboratories (CL) and a reproductive pathologist (RP). We further utilized cyclin E, which is normally only expressed in follicular phase glands, and p27, which is normally only expressed in the luteal phase glands, as markers of the glandular differentiation state. Design: Histologic dating and frequency of glandular-stromal dyssynchrony were compared between the CL and RP in split endometrial biopsies from patients seeking fertility care. A second set of biopsies from infertility patients were further evaluated for cyclin E and p27 expression by immunohistochemistry. Materials and Methods: Mid-late luteal endometrial biopsies (n=60) collected at a private RE clinic were submitted simultaneously for H&E analysis to one of three national CL and to a RP. Diagnoses from the CL were recorded as reported in their reports. Endometrial dating of the stroma and glands was determined by the RP according to the criteria of Hendrickson and Kempson. 40 additional mid-late luteal biopsies sampled from infertile women evaluated at several centers were H&E and immunohistochemically stained for cyclin E and p27. Results: When comparing endometrial dating, 26/60 biopsies (43%) differed between the CL and RP by ≥2 days, and 9/60 (15%) differed by >4 days. The CL noted 4/60 (6.7%) biopsies with glandular-stromal dyssynchrony, while the RP noted 32/60 (53%) to have ≥50% dyssynchronous glands. The 40 biopsies from the other centers also exhibited a high prevalence of dyssynchrony (19/40 (48%) with ≥50% dyssynchronous glands). Cyclin E immunohistochemistry revealed inappropriate staining in the dyssynchronous glands consistent with the apparent cycle day of the glands independent of the stromal dating while p27 was inappropriately decreased in the same dyssynchronous glands. Conclusions: Endometrial H&E assessment by the CL appears to be insufficient as a diagnostic tool for fertility evaluation. Because cyclin E and p27 expression parallels the differentiation state of the endometrial glands, these cyclins may be useful in improving the accuracy of routine endometrial assessment. Further, the patterns of cyclin E and p27 expression indicates that glandular-stromal dyssynchrony is a true arrest in glandular development. This supports the contention that endometrial glands and stroma develop independently and therefore should be evaluated separately. The prevalence of dyssynchrony in these patients suggests that glandular developmental arrest is a phenomenon clinically relevant to infertility. Prospective, multi-center controlled studies are required to further evaluate this observation." @default.
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- W2024273516 date "2000-09-01" @default.
- W2024273516 modified "2023-09-27" @default.
- W2024273516 title "Endometrial Biopsy and Infertility Evaluation: New Insights from Cyclins" @default.
- W2024273516 doi "https://doi.org/10.1016/s0015-0282(00)01255-3" @default.
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