Increasing Utilization of Surgical Nodal Evaluation at Hysterectomy for Endometrial Hyperplasia

Matsuo, Koji; Violette, Caroline; Tavakoli, Amin; Mandelbaum, Rachel S.; Klar, Maximilian; Roman, Lynda D.; Wright, Jason D.

doi:10.1097/aog.0000000000004796

Cited by 2 publications

(5 citation statements)

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“…The utilization rate of lymph node evaluation in this study of ambulatory surgical procedures appears to be similar to what was observed in the inpatient setting where the majority had abdominal hysterectomy during the same study period from 2016 to 2019 (ambulatory versus inpatient setting, 11.0% versus 9.4% for atypia, and 2.5% versus 2.8% for non-atypia) [ 11 ]. The aforementioned U.S. hospital-based study for atypical endometrial hyperplasia also reported similar utilization of lymph node evaluation from 2012 to 2018 (11.2%) [ 10 ].…”

Section: Resultssupporting

confidence: 61%

“…The aforementioned U.S. hospital-based study for atypical endometrial hyperplasia also reported similar utilization of lymph node evaluation from 2012 to 2018 (11.2%) [ 10 ]. All three large-scale analyses suggest increasing trends in lymph node evaluation [ 10 , 11 ]. Collectively, despite the lack of prospective data, U.S. surgeons are gradually adopting this procedure in the surgical management of endometrial hyperplasia.…”

Section: Resultsmentioning

confidence: 99%

“…Lymph node evaluation at the time of minimally invasive hysterectomy for endometrial hyperplasia in the ambulatory surgery setting appears to be gradually increasing in the USA. Investigations have recently begun in the past few years [ 10 , 11 , 25 , 26 ], and more studies are surely warranted to examine the benefits and risks of this surgical procedures. Barring more data to justify this surgical procedure, careful patient selection and balanced counseling are necessary.…”

Section: Discussionmentioning

confidence: 99%

“…A recent analysis of the Premier Perspective Healthcare Database found that utilization of lymph node evaluation at hysterectomy for endometrial hyperplasia with atypia increased from 0.8 in 2012 to 14.0% in 2018 [ 10 ]. Another recent national-level analysis of inpatient hysterectomy for endometrial hyperplasia using the National Inpatient Sample showed increasing utilization of lymph node evaluation for endometrial hyperplasia with atypia (6.3% to 13.4%) and without atypia (1.2% to 4.4%) from 2016 to 2019 [ 11 ].…”

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confidence: 99%

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Lymph node evaluation for endometrial hyperplasia: a nationwide analysis of minimally invasive hysterectomy in the ambulatory setting

Matsuo,

Ciesielski,

Mandelbaum

et al. 2023

Surg Endosc

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Background Given the possibility of occult endometrial cancer where nodal status confers important prognostic and therapeutic data, role of lymph node evaluation at hysterectomy for endometrial hyperplasia is currently under active investigation. The objective of the current study was to examine the characteristics related to lymph node evaluation at the time of minimally invasive hysterectomy when performed for endometrial hyperplasia in an ambulatory surgery setting. Methods The Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample was retrospectively queried to examine 49,698 patients with endometrial hyperplasia who underwent minimally invasive hysterectomy from 1/2016 to 12/2019. A multivariable binary logistic regression model was fitted to assess the characteristics related to lymph node evaluation at hysterectomy and a classification tree model with recursive partitioning analysis was constructed to examine the utilization pattern of lymph node evaluation. Results Lymph node evaluation was performed in 2847 (5.7%) patients. In a multivariable analysis, (i) patient factors with older age, obesity, high census-level household income, and large fringe metropolitan, (ii) surgical factors with total laparoscopic hysterectomy and recent year surgery, (iii) hospital parameters with large bed capacity, urban setting, and Western U.S. region, and (iv) histology factor with presence of atypia were independently associated with increased utilization of lymph node evaluation at hysterectomy (all, P < 0.05). Among those independent factors, presence of atypia exhibited the largest association for lymph node evaluation (adjusted odds ratio 3.75, 95% confidence interval 3.39–4.16). There were 20 unique patterns of lymph node evaluation based on histology, hysterectomy type, patient age, year of surgery, and hospital bed capacity, ranging from 0 to 20.3% (absolute rate difference, 20.3%). Conclusion Lymph node evaluation at the time of minimally invasive hysterectomy for endometrial hyperplasia in the ambulatory surgery setting appears to be evolving with large variability based on histology type, hysterectomy modality, patient factors, and hospital parameters, warranting a consideration of developing clinical practice guidelines.

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Section: Resultssupporting

confidence: 61%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Lymph node evaluation for endometrial hyperplasia: a nationwide analysis of minimally invasive hysterectomy in the ambulatory setting

Matsuo,

Ciesielski,

Mandelbaum

et al. 2023

Surg Endosc

Self Cite

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“…The study population was patients with a diagnosis of endometrial hyperplasia, both with and without atypia, who underwent endometrial evaluation in the ambulatory surgery setting from January 2016 to December 2019. The diagnosis of endometrial hyperplasia was based on the World Health Organization’s International Classification of Disease 10th revision (ICD-10) code of N85.0 (Supplemental Table S1 ) [ 14 ]. Patients with a diagnosis of gynecologic malignancy (uterine cancer, cervical cancer, and ovarian cancer) were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

Increasing utilization of intrauterine device insertion at hysteroscopic endometrial evaluation for patients with endometrial hyperplasia

Ciesielski,

Mann,

Mandelbaum

et al. 2024

Arch Gynecol Obstet

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Purpose To examine the utilization and characteristics related to the use of hysteroscopy at the time of endometrial evaluation for endometrial hyperplasia in the outpatient surgery setting. Methods This cross-sectional study queried the Healthcare Cost and Utilization Project’s Nationwide Ambulatory Surgery Sample. The study population was 3218 patients with endometrial hyperplasia who underwent endometrial evaluation from January 2016 to December 2019. Performance and clinical characteristics of hysteroscopic endometrial evaluation were assessed with multivariable binary logistic regression models. Results A total of 2654 (82.5%) patients had hysteroscopic endometrial tissue evaluation. Patients with postmenopausal bleeding, heavy menstrual bleeding, and polycystic ovary syndrome were more likely to undergo hysteroscopic endometrial evaluation in multivariable analysis (all, adjusted-P < 0.001). Uterine injury occurred in 4.9 per 1000 hysteroscopic endometrial evaluations; none had uterine injury in the non-hysteroscopy cohort. Among the 2654 patients who had hysteroscopic endometrial evaluation, 106 (4.0%) patients had intrauterine device insertion at surgery, and the utilization increased from 2.9 to 5.8% during the study period (P-trend < 0.001). Younger age, more recent year surgery, and obesity were independently associated with increased utilization of intrauterine device insertion at hysteroscopic endometrial evaluation (all, adjusted-P < 0.05). Among 2023 reproductive-age patients with endometrial hyperplasia, 1666 (82.4%) patients underwent hysteroscopic endometrial evaluation. On multivariable analysis, patients with heavy menstrual bleeding were more likely to have hysteroscopic endometrial evaluation (adjusted-P < 0.05). Intrauterine device insertion increased from 3.7% in 2016 to 8.0% in 2019 (P-trend = 0.007). Conclusion This nationwide analysis suggests that the insertion of intrauterine devices at the time of hysteroscopic endometrial tissue evaluation for endometrial hyperplasia is increasing among reproductive-age population.

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Increasing Utilization of Surgical Nodal Evaluation at Hysterectomy for Endometrial Hyperplasia

Cited by 2 publications

References 5 publications

Lymph node evaluation for endometrial hyperplasia: a nationwide analysis of minimally invasive hysterectomy in the ambulatory setting

Lymph node evaluation for endometrial hyperplasia: a nationwide analysis of minimally invasive hysterectomy in the ambulatory setting

Increasing utilization of intrauterine device insertion at hysteroscopic endometrial evaluation for patients with endometrial hyperplasia

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