Does Preoperative Diagnosis of Endometrial Hyperplasia Necessitate Intraoperative Frozen Section Consultation?

Abstract

Background:In women with endometrial hyperplasia, there is a risk for co-existent endometrial cancer when patients are subjected to immediate surgical treatment. Aims: The aim of this study was to investigate the frequency of endometrial cancer and the accuracy of frozen section analysis at the time of hysterectomy among patients with endometrial hyperplasia, to reveal whether or not a preoperative diagnosis of endometrial hyperplasia necessitates frozen section consultation. Study Design: Retrospective cross-sectional study. Methods: A department database review was performed to identify patients who were subjected to hysterectomy with a preoperative diagnosis of endometrial hyperplasia, during the period from 2007 to 2014. Results: The study group included 189 cases. The final pathological examination revealed endometrial cancer in 16 women (8.4%). The risk of cancer in patients with endometrial hyperplasia was 1 of 125 (0.8%) in simple hyperplasia without atypia, 1 of 21 (4.8%) in complex hyperplasia without atypia and 14 of 43 (32.5%) in atypical hyperplasia. Of women with cancer, 2 of 16 (12.5%) had high-risk features. Frozen section analysis was requested in 46 cases. Frozen sections helped to identify six out of 11 cases of endometrial cancer (54.5%). The sensitivity, specificity and positive and negative predictive values of frozen section analysis for the detection of endometrial cancer among women with endometrial hyperplasia were 54.4%, 97.2%, 85.7% and 87.5%, respectively. Conclusion: Although a significant proportion of patients with atypical endometrial hyperplasia are diagnosed with endometrial cancer following hysterectomy, most of these cases have low-risk features and do not require surgical staging. Additionally, intraoperative frozen section analysis if not helpful for diagnosing concurrent endometrial cancer in patients with endometrial hyperplasia. Therefore, it seems that patients with endometrial hyperplasia can be operated upon in settings with no available method for obtaining frozen sections intraoperatively. Keywords: Endometrial hyperplasia, endometrial cancer, frozen sections

Endometrial hyperplasia and the risk of coexistent cancer: WHO versus EIN criteria

“…Eighteen studies with a total of 2527 EHs were included in the systematic review . Fourteen studies used the WHO criteria, two used the EIN criteria, and two used both systems.…”

“…For the ‘patient selection’ domain, the risk of bias was high for one study (case–control design) and unclear for two studies (selection criteria not specified); the remaining studies were considered to be at low risk. Concerns about applicability were high for four studies (study population composed of women with EH at higher risk of progression).…”

“…For the 'index test' domain, one study was considered to be at high risk (simple EH without atypia grouped together with simple atypical EH 28 ), four studies were considered to be at low risk (blinding to reference standard), and the remaining studies were considered to be at unclear risk (blinding not reported). For the 'reference test' domain, one study was at low risk (blinding to index test) and the remaining studies were at unclear risk (blinding not reported).…”

“…6,10 Several authors have assessed the prognostic value of one or both classification systems by considering the rate of coexistent cancer on hysterectomy specimens after a preoperative diagnosis of EH. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] This allows data from different studies to be compared, eliminating the confounding due to the varying durations of follow-up.…”

Estimation of candidate genes in the development of a combination of endometrial hyperplasia and uterine fi broids

“…Введение В структуре гинекологических заболеваний ги-перпластические процессы эндометрия занима-ют лидирующее место и составляют 10-50% [1]. Гиперплазия эндометрия -патологический процесс, за-трагивающий эпителиальный и стромальный компоненты эндометрия и проявляющийся увеличением общего числа желез [2].…”