European Journal of Obstetrics & Gynecology and Reproductive Biology
Concurrent endometrial carcinoma following hysterectomy for atypical endometrial hyperplasia☆
Introduction
Endometrial hyperplasia is classified into four categories according to the World Health Organization (WHO) system, including simple hyperplasia, complex hyperplasia, simple hyperplasia with atypia, and complex hyperplasia with atypia [1]. While the Endometrial Collaborative Group has proposed a new term, endometrial intraepithelial neoplasia (EIN), for superior reproducibility, this classification has not yet undergone the necessary prospective evaluation or assessment of reproducibility [2]. Miller et al. classified endometrial hyperplasia based on the WHO classification system with additional qualifying comments that could potentially identify patients at high risk for endometrial cancer. The intent was to better predict increased risk for coexistent carcinomas that may require surgical staging. However, several limitations, including the retrospective nature and the absence of expert pathologic review, compromise its utility [3]. Atypical endometrial hyperplasia (AEH) has a well-known role in the progression to endometrial carcinoma, providing the link from proliferative endometrium to well-differentiated adenocarcinoma. Although they fall along the same spectrum, the diagnosis of AEH versus endometrial carcinoma carries different significance, as endometrial carcinoma requires a different clinical approach compared with its predecessor. Despite the significance of the differentiation between AEH and carcinoma, a pathologic review by the Gynecologic Oncology Group (GOG) in 2006 failed to demonstrate diagnostic consistency [4]. In the study, the diagnosis agreement between the referral and the study groups was only 39%, suggesting that morphological differences may be nearly indistinguishable.
Many previous studies have reported that approximately 17–52% of cases of AEH may be associated with coexistent endometrial carcinoma [4], [5], [6], [7], [8], [9], [10], [11]. Moreover, the rate of concurrent endometrial carcinoma following hysterectomy is increasing, and therefore, in recent studies the rates are even higher, reaching 40–50% [4], [11]. In order to ensure appropriate management and patient safety, it is essential to have a better understanding of the rate of concurrent endometrial carcinoma among women with AEH as diagnosed by endometrial biopsy. The purpose of this study was to examine the relationship between the diagnoses of AEH by endometrial sampling and endometrial carcinoma with the postoperative pathology reports from hysterectomy specimens serving as the definitive results.
Section snippets
Materials and methods
We retrospectively analyzed the medical records of 712 patients with endometrial hyperplasia who were diagnosed at Cheil General Hospital and Women's Healthcare Center from January 1999 to December 2008 through pathologic databases based on endometrial preoperative sampling. Among patients with endometrial hyperplasia, 141 patients with AEH were included for the present study. This group was further divided into two sub-groups, one with surgical treatment (hysterectomy) and the other without.
Results
Of the 126 patients who underwent hysterectomy for preoperatively diagnosed AEH, 24 patients (19.0%) were diagnosed with simple AEH by pathologic review and the remaining 102 patients (81.0%) with complex AEH (Fig. 1).
The mean patient age was 45.44 ± 6.62 years with a range of 25–65 years (Table 1). Ninety-eight patients (77.8%) were diagnosed by D&C, 24 patients (19.0%) by EMB and four cases (3.2%) were diagnosed by hysteroscopic polypectomy. Mean body mass index was 24.9 ± 3.6 kg/m2 and mean
Comment
The present study was designed to evaluate the prevalence of concurrent endometrial carcinoma in women who were diagnosed with AEH by endometrial biopsy. The increasing rate of concurrent endometrial carcinoma following hysterectomy seems to be partially due to increasing rates of patients with endometrial carcinoma. Endometrial carcinoma is the most common gynecological malignancy in Western countries [12], [13], and the incidence of endometrial cancer in Korean women has also increased by
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Cited by (32)
Preoperative Factors of Endometrial Carcinoma in Patients Undergoing Hysterectomy for Atypical Endometrial Hyperplasia
2021, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :A diagnosis of AEH is typically made by Pipelle endometrial biopsy or dilation and curettage (D&C). The concurrence of EC in patients diagnosed with AEH is well recognized, although studies report a wide range of 6.2% to 65.8%.4–26 In the largest prospective cohort study to date, the Gynecologic Oncology Group found the prevalence of concurrent EC on final hysterectomy in patients diagnosed with AEH to be 42.6%.27
Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia?
2018, International Journal of SurgeryRisk of coexisting endometrial carcinoma in case of atypical endometrial hyperplasia diagnosed on total hysteroscopic resection
2016, European Journal of Obstetrics and Gynecology and Reproductive BiologySampling in Atypical Endometrial Hyperplasia: Which Method Results in the Lowest Underestimation of Endometrial Cancer? A Systematic Review and Meta-analysis
2016, Journal of Minimally Invasive GynecologyCitation Excerpt :Most of the studies included pre- and postmenopausal subjects. Two studies had a postmenopausal population only [12,39], and 5 articles did not specify menopausal status [38,42,47,51,54]. Fifteen studies included patients given hysterectomy based exclusively on a previous diagnosis of atypical hyperplasia [35,38,41–43,45,48,50–57].
Atypical endometrial hyperplasia in a preoperative biopsy and final pathological result of hysterectomy
2012, Clinica e Investigacion en Ginecologia y ObstetriciaEndometrial Cancer
2012, Obstetrics and Gynecology Clinics of North America
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This study was presented at the 24th Annual Congress of The Korean Society of Gynecologic Oncology and Colposcopy at the Daegu Inter-Burgo Hotel (Korea) on April 17, 2009.