Nodal Assessment in Endometrial Atypical Hyperplasia

Abstract

<b><i>Objective:</i></b> Atypical endometrial hyperplasia (AH) is the neoplastic precursor more often associated with endometrial cancer (EC). Nowadays, 25–50% of patients subjected to hysterectomy for preoperative AH are diagnosed with EC at the final pathological analysis. Furthermore, there is no consensus on which preoperative AH patients would benefit from sentinel lymph node mapping. This study aimed to evaluate nodal assessment and preoperative cancer risk factors in preoperative AH patients undergoing nodal surgical staging. <b><i>Methods:</i></b> Patients undergoing surgical treatment for AH were retrospectively included in the analysis. Patients were divided into two groups (AH and EC groups) based on the final surgical pathology. The ESGO/ESTRO/ESP risk classification was used for EC cases. <b><i>Design:</i></b> This was a retrospective study. <b><i>Results:</i></b> Of the 207 AH patients treated, 152 cases met the inclusion criteria. Among preoperative AH patients with final EC diagnosis, 39 patients were in the low-risk group (25.7%), 8 in the intermediate-risk group (5.3%), 4 in high-intermediate (2.6%), and 3 patients were allocated in the high-risk group (2.0%). Fifty-four total patients underwent nodal surgical staging. Only one nodal micrometastasis (0.7%) was found at ultrastaging. Multivariate analysis showed abnormal uterine bleeding (AUB) (<i>p</i> = 0.01), hypertension (<i>p</i> < 0.01), and endometrial thickness ≥20 mm (<i>p</i> = 0.02) statistically more represented in patients with EC at final surgical analysis. EC risk was 2.9 (95% CI: 1.29–6.48) in AUB, 2.7 (95% CI: 1.06–6.92) in hypertension, and 3.1 (95% CI: 1.19–7.97) in endometrial thickness ≥20 mm cases. <b><i>Limitations:</i></b> The present study has limitations inherent in its retrospective nature. <b><i>Conclusion:</i></b> The overall risk of nodal metastases in preoperative AH patients was low. Conversely, 9.9% of the preoperative AH patients belonged to the intermediate or high-risk group for EC at the final histological examination. Preoperative cancer risk factors would identify AH patients for whom nodal staging could be suggested.

Utilization and Surgical Outcomes of Sentinel Lymph Node Biopsy for Endometrial Intraepithelial Neoplasia

“…21,22 The literature regarding the performance of SLN biopsy in EIN is limited to retrospective descriptions of relatively small cohorts. 8,10,23 Traditional statistics and machine learning analyses were unable to identify which patients with EIN will have endometrial carcinoma on final pathology, although some retrospective data suggest that endometrial thickness and age are associated with higher risk of endometrial carcinoma. [24][25][26] Although there are recent studies on the uptake and outcomes of SLN biopsy in endometrial carcinoma, 27 these are underreported in EIN.…”

“…Of patients with a preoperative diagnosis of EIN and postoperative pathology of endometrial carcinoma, approximately 10% will have high-risk endometrial carcinoma, in which evaluation of the lymph nodes may support the recommendations regarding adjuvant therapy. [8][9][10] It is common for general gynecologists to perform surgery for patients with EIN. A large study identified that 33.2% of hysterectomies with a final diagnosis of EIN were not performed by a gynecologic oncologist.…”

“…Of patients with a preoperative diagnosis of EIN and postoperative pathology of endometrial carcinoma, approximately 10% will have high-risk endometrial carcinoma, in which evaluation of the lymph nodes may support the recommendations regarding adjuvant therapy. 8–10…”

Atypical Endometrial Hyperplasia and Concurrent Cancer: A Comprehensive Overview on a Challenging Clinical Condition

“…Capozzi et al registered a lymph node positivity of 0.7% (1/54). At the same time, 9.9% (15/152) of patients with AEH received a final diagnosis of endometrial carcinoma at intermediate or higher risk, confirming the elevated number of patients who could obtain information from nodal assessment [ 63 ].…”

“…As shown in Table 6 , the selected articles were all retrospective studies and considered a total of 22,201 women [ 3 , 4 , 43 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. The rate of occult endometrial carcinoma in patients with a preoperative diagnosis of AHE ranged from 27.2 to 53.3%, consistent with the previous literature [ 1 , 2 ].…”