How precise is histologic dating of endometrium using the standard dating criteria?

Tin-Chiu Li; Peter Dockery; Andrew W. Rogers; Ian D. Cooke

doi:10.1016/s0015-0282(16)60662-3

Diagnostics Endometrial Assessment

How precise is histologic dating of endometrium using the standard dating criteria?

Li TC, Dockery P, Rogers AW, Cooke ID

Published May 1989 Fertility and Sterility, 51(5), 759-763

DOI 10.1016/s0015-0282(16)60662-3 PMID 2651164

RRM Academy Synopsis

Endometrial biopsy dating is less precise late in the luteal phase

A 1989 Sheffield reliability study in infertile women found endometrial biopsy dating less precise late in the luteal phase. The same observer repeated the exact date in 24 out of 100 biopsies. Between two cycles in one woman, dates differed by more than 2 days in 41 out of 100 pairs, against 10 out of 100 for repeat readings.

Key Findings

The same observer dated 63 endometrial biopsies twice. Exact agreement occurred in 15 (24%), and disagreement of more than 2 days occurred in 6 (10%).
Exact agreement was 32% for biopsies from the first half of the luteal phase (n = 41) and 9% for the second half (n = 22) (P < 0.05).
Disagreement of more than 2 days occurred in 2 of 41 first-half biopsies (5%) and 4 of 22 second-half biopsies (18%), a difference without statistical significance.
In 27 women biopsied in two cycles, exact agreement between cycles was 4% and disagreement of more than 2 days was 41%. Both differed significantly from same-observer variation (P < 0.01).
Correlation between the two readings of the 63 biopsies was r = 0.91 (P < 0.00001).

Interpretation

This reliability study tested how consistent a laboratory method is. One observer read 63 coded biopsy slides twice, 6 weeks to 1 year apart. A separate group of 27 women had biopsies in two cycles. All were infertile women with regular cycles and evidence of ovulation. The authors state that the findings do not invalidate the concept of luteal phase defect. The findings support larger studies of cycle-to-cycle variation in luteal phase timing.

RRM Context

Restorative reproductive medicine evaluates the whole ovulatory cycle. Ovulation is the main event, and the luteal phase is the days after it. Differences between cycles in one woman fit the restorative habit of reading patterns across several cycles. Cycle charting records those days every month and builds a record from the woman's own cycles.

Our editorial summary of this paper, not the article's abstract.

Abstract

Sixty-three endometrial biopsies were dated histologically by using the standard criteria on two separate occasions by the same observer. Overall, it was found that exact agreement occurred in 15 (24%), but disagreement of more than 2 days occurred in 6 (10%). The proportion of exact agreement in the first half of the luteal phase (32%) was found to be significantly higher (P less than 0.05) than that in the second half of the luteal phase (9%). In a separate part of the study, 27 women had two endometrial biopsies, each performed in a separate cycle. The within-subject between-cycle variation of the results of endometrial dating (exact agreement: 4%, disagreement of more than 2 days: 41%) was found to be significantly different from intraobserver variation (P less than 0.01 for both). The amount of intraobserver variation suggests that the traditional dating criteria are not precise enough to quantify corpus luteum function in the second half of the luteal phase, whereas the amount of within-subject between-cycle variation implies that the result of endometrial dating in one cycle cannot be used reliably to predict that of another cycle.

Topics

Diagnostics › Endometrial Assessment › Luteal Phase Biopsy · Research Methods › Measurement and Statistics › Research Tooling and Reproducibility · Menstrual Cycle › Cycle Biomarkers › Hormonal Markers

Tin-Chiu Li, Peter Dockery, Andrew W. Rogers, Ian D. Cooke

T Li, Pete Dockery, P Dockery, Andy Rogers, Drew Rogers, A Rogers, I Cooke

PMID 2651164 2651164 DOI 10.1016/s0015-0282(16)60662-3 10.1016/s0015-0282(16)60662-3 Li et al. 1989, Li 1989

Keywords

Adult, Biopsy, Endometrium/pathology/physiology, False Positive Reactions, Female, Histological Techniques, Humans, Luteal Phase, Menstrual Cycle, Time Factors

How precise is histologic dating of endometrium using the standard dating criteria?

Endometrial biopsy dating is less precise late in the luteal phase

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords