Page 84 - ESHRE2019

Absence of consensus on the diagnostic criteria for diagnosing CE basing on PCs count
1. at least 1 plasma cell per section (Cicinelli et al. 2005);
2. at least 1 plasma cell per HPF (Johnston‐MacAnnany etl al., 2010);
3. at least 1 plasma cell per ten HPFs (Kitaya & Yasuo, 2010);
4. at least 5 plasma cells per ten HPFs (Bouet et al., 2016);
5. at least 5 plasma cells per 20 HPFs (Kitaya & Yasuo, 2011);
6. the presence of 1 to 5 plasma cells per HPF or discrete clusters of <20 plasma cells (McQueen et al., 2015);
7. an endometrial stromal plasmacyte density index (the sum of the stromal CD138+ cell counts divided by the number of the HPFs evaluated) (Kitaya et al., 2017);
8. number of plasma cells per unit area: to count all CD138+ cells in the entire section, then measure the area of the examined tissue section and express the result as plasma cell count per unit area. In this way, it would overcome the problem of local fluctuation of plasma cell count as well as correcting for the variation in results due to sample size difference (Liu et al., 2018).
1. The number of PCs per whole section:
– PCs are not normally present in the endometrium and the finding of one or more plasma cells is indicative of a diagnosis of CE (Greenwood & Moran, 1981; , Kitaya et al., 2016).
Shortcoming: it does not take into account the size of the specimen. The larger the specimen size, the more likely it is to find plasma cells, and vice versa.
2. The PCs count per a defined number of (e.g., ten) randomly chosen high power fields (HPFs) (concept of plasma cell density):
– To correct for the size of the specimen examined (Bouet et al. 2011; Kitaya et al. 2017; McQueen et al. 2014).
– ToavoidbiasinselectingtheHPFstobeexaminedandtoimproveobjectivity,it is desirable to have randomly chosen fields.
Shortcoming: PCs are usually present in low numbers, so the inclusion of only ten HPFs may not be sufficient to produce a consistently reproducible result.
Criticisms regarding PCs count
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