Endometrial cancer after endometrial ablation: a systematic review

Abstract

ObjectiveTo investigate whether a previously performed endometrial ablation is associated with the development and diagnosis of endometrial cancer.MethodsFirst, a systematic review was performed of the articles reporting the incidence of endometrial cancer in patients treated with endometrial ablation. Second, a systematic review was performed to identify all individual cases of endometrial cancer after ablation to evaluate presenting symptoms, diagnostic work-up, potential risk factors, and the type and stage of the endometrial cancer. A systematic search was performed, using Medline, EMBASE, and the Cochrane Library databases, from inception through February 24, 2022.ResultsBased on 11 included studies, the incidence of endometrial cancer in a population of 29 102 patients with a prior endometrial ablation ranged from 0.0% to 1.6%.A total of 38 cases of endometrial cancer after ablation were identified. In 71% of cases (17 of 24 cases), vaginal bleeding was the first presenting symptom. With transvaginal ultrasound it was possible to identify and measure the endometrial thickness in eight cases. Endometrium sampling was successful in 16 of 18 described cases (89%). In 18 of 20 cases (90%) pathologic examination showed early-stage endometrioid adenocarcinoma (International Federation of Gynecology and Obstetrics stage I).ConclusionPrevious endometrial ablation is not associated with the development of endometrial cancer. Diagnostic work-up is not impeded by previous endometrial ablation. In addition, endometrial cancers after endometrial ablation are not detected at an advanced stage.

Risk of Hysterectomy After Endometrial Ablation

“…9 A protocol of this systematic review and meta-analysis is registered in PROSPERO, an international prospective register of systematic reviews (registration number CRD42020156281). 10 We searched for articles with original research reporting hysterectomy data after nonresectoscopic endometrial ablation for the treatment of HMB with a follow-up period of at least 12 months. The articles were included on the condition that incidence of hysterectomy was described in a specific period after ablation.…”

“…9 A protocol of this systematic review and meta-analysis is registered in PROSPERO, an international prospective register of systematic reviews (registration number CRD42020156281). 10…”

2023 Update on abnormal uterine bleeding

“…One study was a 20-year population database review from Sweden, 4 and the other was a systematic review of 11 cohort studies. 5…”

“…In the systematic review, out of 890 publications from the authors' database search, 11 articles were eventually included for review. 5 A total of 29,102 patients with endometrial ablation were followed for a period of up to 25 years, and the incidence of endometrial cancer after endometrial ablation varied from 0.0% to 1.6%. A total of 38 cases of endometrial cancer after endometrial ablation have been described in the literature.…”

In Reply:

“…The question of whether it is still feasible to enter the uterus for diagnostic purposes after endometrial ablation is addressed in our systematic review regarding endometrial carcinoma after endometrial ablation. 3 According to this review, endometrial sampling still appears to be a useful diagnostic tool after endometrial ablation; 89% of the cases of endometrial cancer were diagnosed by biopsy using pipelle or hysteroscopic methods. In two cases, diagnostic hysterectomy was required to exclude endometrial cancer.…”