Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia

Abstract

BACKGROUNDAdenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for approximately 36,000 diagnoses of invasive carcinoma annually. The most common histologic type, endometrioid adenocarcinoma (EC), accounts for 75–80% of patients. The objective of this work was to estimate the prevalence of concurrent carcinoma in women with a biopsy diagnosis of the precursor lesion, atypical endometrial hyperplasia (AEH).METHODSThis prospective cohort study included women who had a community diagnosis of AEH. Diagnostic biopsy specimens were reviewed independently by three gynecologic pathologists who used International Society of Gynecologic Pathologists/World Health Organization criteria. Study participants underwent hysterectomy within 12 weeks of entry onto protocol without interval treatment. The hysterectomy slides also were reviewed by the study pathologists, and their findings were used in the subsequent analyses.RESULTSBetween November 1998 and June 2003, 306 women were enrolled on the study. Of these, 17 women were not included in the analysis: Two patients had unreadable slides because of poor processing or insufficient tissue, 2 patients had only slides that were not endometrial, the slides for 5 patients were not available for review, and 8 of the hysterectomy specimens were excluded because they showed evidence of interval intervention, either progestin effect or ablation. In total, 289 patients were included in the current analysis. The study panel review of the AEH biopsy specimens was interpreted as follows: 74 of 289 specimens (25.6%) were diagnosed as less than AEH, 115 of 289 specimens (39.8%) were diagnosed as AEH, and 84 of 289 specimens (29.1%) were diagnosed as endometrial carcinoma. In 5.5% (16 of 289 specimens), there was no consensus on the biopsy diagnosis. The rate of concurrent endometrial carcinoma for analyzed specimens was 42.6% (123 of 289 specimens). Of these, 30.9% (38 of 123 specimens) were myoinvasive, and 10.6% (13 of 123 specimens) involved the outer 50% of the myometrium. Among the women who had hysterectomy specimens with carcinoma, 14 of 74 women (18.9%) had a study panel biopsy consensus diagnosis of less than AEH, 45 of 115 women (39.1%) had a study panel biopsy consensus diagnosis of AEH, and 54 of 84 women (64.3%) had a study panel diagnosis of carcinoma. Among women who had no consensus in their biopsy diagnosis, 10 of 16 women (62.5%) had carcinoma in their hysterectomy specimens.CONCLUSIONSThe prevalence of endometrial carcinoma in patients who had a community hospital biopsy diagnosis of AEH was high (42.6%). When considering management strategies for women who have a biopsy diagnosis of AEH, clinicians and patients should take into account the considerable rate of concurrent carcinoma. Cancer 2006. © 2006 American Cancer Society.

Presence of endometrial adenocarcinoma in situ in complex atypical endometrial hyperplasia is associated with increased incidence of endometrial carcinoma in subsequent hysterectomy

“…6,7,11,13,14 We found that the presence of AIS in complex atypical endometrial hyperplasia patients was associated with significantly greater likelihood of finding endometrial adenocarcinoma and myoinvasive endometrial adenocarcinoma on subsequent hysterectomy. Approximately two-thirds of patients with AIS in endometrial curettage/biopsy have endometrial adenocarcinoma on subsequent hysterectomy vs about a quarter of those that lack AIS.…”

Significance of Concurrent Endometrial Cancer in Women With a Preoperative Diagnosis of Atypical Endometrial Hyperplasia

“…This statistic was significantly higher than the traditionally accepted rate of 25% 6 and consistent with other more recent reviews. [7][8][9][10] Sixteen percent of our patients with concurrent EC were also found to have significant-risk cancers. We interpreted these results to mean that managing all patients who have a preoperative diagnosis of AEH with routine HBSO may be suboptimal.…”

“…Although it seems widely accepted that 23% to 25% of patients with AEH will progress to cancer, 1,2 the frequency and significance of concurrent EC remains controversial. [3][4][5][6][7][8][9][10] The traditional view has been that concurrent EC is acceptably infrequent and of low importance in patients with preoperative AEH. [3][4][5] In 1993, Janicek et al summarized the results of six studies in which 122 of 463 patients with AEH (26%) were found to have concurrent EC.…”

“…[3][4][5] More recent reviews of patients with a preoperative diagnosis of AEH report both higher rates of concurrent EC and more significant disease postoperatively. [6][7][8][9][10] In the Gynecologic Oncology Group study reported by Trimble et al, 123 of 289 patients (42.6%) with AEH had a postoperative diagnosis of EC. 10 Of those patients with concurrent EC, 10.6% were found to have deep myometrial invasion.…”

“…[6][7][8][9][10] In the Gynecologic Oncology Group study reported by Trimble et al, 123 of 289 patients (42.6%) with AEH had a postoperative diagnosis of EC. 10 Of those patients with concurrent EC, 10.6% were found to have deep myometrial invasion. These findings suggest that a policy of conservative surgery for patients with preoperative AEH could result in a substantial proportion of patients receiving suboptimal surgery.…”