A Novel Preoperative Scoring System for Predicting Endometrial Cancer in Patients with Complex Atypical Endometrial Hyperplasia and Accuracy of Frozen Section Pathological Examination in This Context: A Multicenter Study

Abstract

Objective: To estimate the accuracy of frozen pathological analysis in patients preoperatively diagnosed with endometrial atypical complex hyperplasia (ACH) and to develop a model predicting the probability of the presence of endometrial carcinoma in ACH. Methods: Patients (n = 128) who underwent total hysterectomies because of diagnoses of ACH were evaluated at four tertiary centers. Results: Diagnoses made using frozen sections and permanent sections were in good agreement (ĸ = 0.61, p < 0.0001). A useful scoring system combining weighted risk factors derived from a regression model is as follows: (2 × age ≥50 years) + (3 × BMI ≥30) + (2 × menopausal status) + (2 × diabetes comorbidity) + (3 × endometrial thickness >12 mm). The AUC of this score was 0.793, and the score afforded 80.9% sensitivity, 70.3% specificity, a 75.3% positive predictive value, and a 76.4% negative predictive value, when a score of 5 was used as a cutoff. Conclusions: Patients with ACH should be evaluated by gynecological oncologists and intraoperative frozen section analysis should be performed by pathologists specializing in the evaluation of gynecological malignancies, because ACH is closely associated with endometrial cancer (EC). Our novel preoperative scoring system may aid in the detection of patients at increased risk of EC and thus guide general gynecologists.

Predictors of endometrial carcinoma in patients with atypical endometrial hyperplasia at a tertiary gynaecological cancer centre in Western Australia

“…Furthermore 94% of the patients with concurrent EAC had presumed stage 1A or 1B disease. The low rates of high‐risk EAC in our study are similar to previously published literature 20,31 . However, it is important to note that the morbidity of lymph node assessment is much lower with the introduction of sentinel node biopsy 32 .…”

“…AEH and EAC share risk factors and are strongly associated with obesity and diabetes due to higher circulating unopposed oestrogen 13,14 . Previous studies have reported obesity (BMI >30 kg/m 2 ) to be an independent risk factor for concurrent carcinoma 9,20 so it is notable that BMI and diabetes mellitus were not associated with a final diagnosis of cancer in our study. This may be because our study was underpowered to detect such differences, as three‐quarters of patients were obese and two‐thirds of patients did not have diabetes; however, effect sizes inferred no effect.…”

The Accuracy of an Intraoperative Frozen Section for Premalignant Endometrial Pathology

“…However, the present shows that frozen section is needed in particular for insufficient preoperative biopsy or ultrasonographically suspicious of malignancy but preoperatively benign biopsy patients. The procedure was also found as a reliable method to detect endometrial malignancy by other studies (20,23) especially in patients with premalignant preoperative biopsy results (8,24).…”

Lymph Node Dissection in Atypical Endometrial Hyperplasia

“…Another study showed only 48% concordance between intraoperative frozen section and postoperative pathology in AEH, and the sensitivity for the diagnosis of endometrial carcinoma was reported as 33% ( 3 ). A model for predicting endometrial cancer based on age, body mass index, endometrial thickness, and postmenopausal status was proposed with 80% sensitivity and 70% specificity ( 22 ).…”