EIN Flashcards
1
Q
what are histologic criteria for endometrial intraepithelial neoplasia?
A
- old schema simple and complex hyperplasia with ATYPIA.
- glandular component more prominent than typical. stroma less than/equal to 55%
- atypia
- maximum linear dimension > 1 mm
- cytology differs between focal area and background
2
Q
what is the recommended way to work-up EIN?
A
hysteroscopy with D&C is most sensitive. D&C lightly better detection rates of EIN than EMB. Both can leave over 50% of cavity unsampled.
3
Q
endometrial thickness to perform bx?
A
- EMS > 4 mm in postmenopasual with bleeding
4
Q
risk of concurrent EMCA with EIN?
A
40%. risk of progression ~ 10%
5
Q
risk of concurrent high risk EMCA (i.e. requiring further surgical staging)
A
10%.
6
Q
if pt does not want surgery/bad candidate, what medical regimens are options?
A
- MPA 10-20 mg continuous or cycled 12-14d/mo*
- dMPA 150 mg q3 mo
- micronized vaginal progesterone 100-200 mcg continuous or cycled 12-14 d/mo
- megestrol acetate 20-400 mg daily*
- LNG IUD*
7
Q
what is surveillance plan for medically managed pts?
A
- EMB/exam q3-6 mo
- continue for 12 mo or until progression
8
Q
what are definite DON’Ts in surgical management?
A
- supracervical hyst
- morcellation
- endometrial ablation
