Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia?

Erdem, Baki; Aşıcıoğlu, Osman; Seyhan, Niyazi Alper; Peker, Nuri; Ülker, Volkan; Akbayır, Özgür

doi:10.1016/j.ijsu.2018.04.019

Cited by 18 publications

(30 citation statements)

References 22 publications

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“…In our case, the higher percentage of women undergoing HSC-res increased the diagnostic accuracy of AEH by decreasing EC instances. Recently, Erdem et al also showed an EC rate of 25.1% in 227 women with AEH confirming our results [20].…”

Section: Discussionsupporting

confidence: 92%

Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

et al. 2020

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Background: Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC. Methods: Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient’s characteristics were compared between the three ESM groups. Results: D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193–177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002–1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%. Conclusions: HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.

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Section: Discussionsupporting

confidence: 92%

Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

et al. 2020

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“…This ratio has seen 10-59% in the literature [4,6,7]. Although this ratio is very wide, our rate is consistent with many studies in the literature [14][15][16][17]. However, the rate of our study is less than the results of some studies.…”

Section: Discussionsupporting

confidence: 89%

“…These tumors are often high-grade, have a poor prognosis, and not obviously associated with estrogen stimulation and the precursor lesion [11][12][13]. In many studies,The existence of atypia in endometrial hyperplasia has been shown as an independent risk factor for concurrent EC [13,4,[14][15][16][17]. It should be kept in mind that while most studies focus on atypical hyperplasia and other risk factors, there may be simultaneous endometrial canser with non-atypical endometrial hiperplasias.…”

Section: Evaluation Of Concurrent Endometrial Cancer In Patients Withmentioning

confidence: 99%

Evaluation of Concurrent Endometri̇al Cancser i̇n Pati̇ents Wi̇th Endometrial Hyperplasia; 10 Years Experience as a Terti̇ary Center

Çakmak

Öge²,

Uslu³

et al. 2019

Zeynep Kamil Tıp Bülteni

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Objective: We aimed to determine the incidence of simultaneous endometrial cancer in patients with endometrial hyperplasia who underwent surgical treatment. Material and Methods: Our study was designed retrospectively. The medical data of patients who was diagnosed endometrial hyperplasia (EH) by the endometrial biopsy and accepted surgical treatment were examined and collected between 2007-2017 at the gynecologic oncology depertmant of Eskişehir Osmangazi University (ESOGÜ). The data of 522 patients with endometrial hyperplasia as a result of endometrial sampling were evaluated. Due to 187 patients received medical treatment, 35 patients lacked medical data and 15 patients suspected endometrial CA were excluded from the study. A total of 285 patients with endometrial hyperplasia were included in the study. Results: Of the 285 patients included in the study, 64 (22.4%) were simple hyperplasia, 31 (10.8%) were simple atypia hyperplasia, 72 (25.2%) were complex hyperplasia and 118 (41.4%) were complex atypia hyperplasia. Endometrial hyperplasia could not be detected in 84 (29.4%) patients after a final pathology. We found endometrial cancer in 36 (12.6%) patients and endometrial hyperplasia in 165 (57.8%) patients. We found 1 (1.5%) patient EC in simple hyperplasia. EC was detected in 1 (3.2%) patient in SAH. 6 patients (8.3%) had EC in CH. 28 (23.7%) EC's were detected in patients with CAH. According to the 2014 WHO classification system, Concurrent endometrial cancer rates were determined as AEH 19.4% and EH without atypia was 5.1%. Conclusion: Concurrent EC ratio in simple hyperplasia was 5.1% this rate was found to be 8.3% in CH. Management of patients with endometrial hyperplasia without atypia If medical treatment is to be chosen, these rates should be considered and it is recommended to consider all risk factors for EC.

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“…Therefore, this study recommended preparing frozen sections of specimens from preoperative sampling for all patients operated for atypical hyperplasia. Moreover, Erdem et al15 found that 25.1% of cases diagnosed as atypical hyperplasia using biopsies actually had coexisting Ca following excision, and 3% of them were high-risk cancers that had been overlooked during the examination of both biopsies and frozen sections.…”

Section: Discussionmentioning

confidence: 99%

The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding

Nemer

Bayat

Qahtani

2019

SMJ

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Objectives: Abnormal uterine bleeding (AUB) is a leading cause of hysterectomies, the cause of which is usually diagnosed with preoperative endometrial sampling. We planned this study to assess the accuracy of diagnosing the histologic patterns of endometrium in the preoperative sample in reference to the final histologic diagnosis in hysterectomy. Methods: We retrospectively reviewed medical charts between January 2011 and December 2015 at a tertiary hospital in Saudi Arabia and identified 43 cases of AUB with complete documentation. The histologic diagnoses were classified into normal and benign pathology group (N/B), or carcinoma and hyperplasia category (Ca/H). Measures of validity were used to compare endometrial sampling histological diagnoses to diagnoses following hysterectomy and Cohen’s kappa to assess for agreement between the 2 modalities. Results: The median age of all patients was 49 years. Preoperative histologic examination showed 53.8% sensitivity, 90% specificity, 70% positive predictive values and 81.8% negative predictive values, 30.1% false positive rates and 18.2% false negative rates. The agreement between preoperative and postoperative histologic diagnoses was moderate (79.1%, k=0.469). Conclusion: The accuracy of preoperative histologic examination was moderate. Our findings recommend cautious clinical decision making and limiting hysterectomy to women who do not respond to other therapeutic measures.

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Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia?

Abstract: High-risk endometrial cancer can coexist with AEH. It should be remembered that despite preoperative and FS examinations, these high-risk tumors can be overlooked until final pathology.

Cited by 18 publications

References 22 publications

Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

Evaluation of Concurrent Endometri̇al Cancser i̇n Pati̇ents Wi̇th Endometrial Hyperplasia; 10 Years Experience as a Terti̇ary Center

The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding

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