Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia

Vetter, Monica Hagan; Smith, B.; Benedict, Jason; Hade, Erinn M.; Bixel, Kristin; Copeland, Larry J.; Cohn, David E.; Fowler, Jeffrey M.; O’Malley, David M.; Salani, Ritu; Backes, Floor J.

doi:10.1016/j.ajog.2019.08.002

Cited by 82 publications

(92 citation statements)

References 28 publications

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“…Our percentage of unexpected cancers at final histology was 23.6%. This result is in line with what is reported in the literature, with percentages ranging from 20% to 40% (3,7,13,14). A recent meta-analysis showed an EC rate of 31% in women with a pre-operative diagnosis of AEH (12).…”

Section: Discussionsupporting

confidence: 91%

“…Matsuo et al showed that "older age, obesity, diabetes mellitus, and complex atypical hyperplasia are predictive of concurrent endometrial carcinoma in endometrial hyperplasia patients" [14]. A recent study showed that "endometrial stripe thickness and age were the strongest predictors of concurrent endometrial cancer at the time of hysterectomy for endometrial intraepithelial neoplasia" [13]. In line with these results, the present study showed an association between elevated BMI, older age, and EC at hysterectomy in women with AEH.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of unexpected cancer in AEH may be affected by some EC predictors, and the endometrial sampling method (ESM) used preoperatively [7][8][9][10][11][12]. Previous studies have shown that some cancer predictors in women with AEH are associated with concurrent EC [13,14]. Less is present in the literature about the diagnostic reliability of ESMs in women with AEH.…”

Section: Introductionmentioning

confidence: 99%

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Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

et al. 2020

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Background: Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC. Methods: Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient’s characteristics were compared between the three ESM groups. Results: D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193–177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002–1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%. Conclusions: HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

et al. 2020

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“…An endometrial thickness of >2 cm on ultrasound is associated with a four times higher probability of invasive carcinoma and twice the risk for high risk features for lymph node metastases. 24 Manuscript. Rossi, Tanner.…”

Section: Sln Biopsy For Endometrial Cancermentioning

confidence: 99%

Controversies in Sentinel Lymph Node Biopsy for Gynecologic Malignancies

Rossi

Tanner

2021

Journal of Minimally Invasive Gynecology

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“…Thus, in many studies, the hypothesis of estrogen-dependent state is preferred, but according to other researches up to 20-30% of endometrial adenocarcinomas are not associated with hormonal response [1,3]. Endometrial hyperplasia сould result in the malignization if untreated with progression to cancer [4][5][6].The prevalence of EHin the general population reaches 30%, and the percentage of transformation into endometrial cancer ranges from 5 to 50% [1,2,7].…”

Section: Introductionmentioning

confidence: 99%

Hif-1α and IGF Expression in Endometrial Hyperplasia

Chumak

Shapoval

Andrievskiy

2020

J Educ Health Sport

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The objective: to assess the effect of insulin resistance and hypoxia on the risk of endometrial hyperplasia development. The research was conducted on the base of Municipal Maternity House №5 (Odessa, Ukraine). The data obtained from the sample of 417 reproductive, perimenopausal, and postmenopausal age women who referred for medical care to the gynecological department, were analyzed. All the women under examination were carried out medical and diagnostic scraping of the uterine cavity. Results. The intensity of hypoxia increases with age and closely correlates (r=0,78) with the level of insulin resistance. IGF demonstrates reverse dynamicsits rates has been diminished with age (r=-0,63). Conclusion. It was demonstrated that insulin resistance and hypoxia play significant role in the pathogenesis of endometrial hyperplasia. Indices of IGF and HIF could be recommended as valuable biomarkers of prognosis in the case of endometrial hyperplasia.

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Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia

Cited by 82 publications

References 28 publications

Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

Controversies in Sentinel Lymph Node Biopsy for Gynecologic Malignancies

Hif-1α and IGF Expression in Endometrial Hyperplasia

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