Prevalence of Co-existing Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia

Kadiroğullari, Pınar; Atalay, Cemal; Özdemir, Özhan; Sarı, Mustafa

doi:10.7860/jcdr/2015/12484.6618

Cited by 16 publications

(24 citation statements)

References 26 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Endometrial hyperplasia (EH) is classified into benign and precancerous according to two different histomorphological systems: the World Health Organisation (WHO) system (based on the subjective evaluation of cytological atypia) and the endometrial intraepithelial neoplasia (EIN) system (based on a combination of several parameters that are assessable subjectively, or objectively through computerised analysis). The American College of Obstetricians and Gynecologists recommends use of the EIN system. Nonetheless, a higher prognostic value for EIN criteria was demonstrated only with the objective assessment, which is not routinely applicable. The aim of this study was to evaluate which of the subjective classifications of EH (WHO or EIN) has better prognostic value, by assessing the risk of coexistent cancer. Electronic databases were searched for relevant articles from the inception of the databases to July 2018. All studies assessing the presence of cancer on hysterectomy specimens after a preoperative histological diagnosis of EH were included. Odds ratios (ORs), sensitivity and specificity were calculated with 95% confidence intervals (CIs). Sixteen cohort studies and three case–control studies, assessing 2582 EHs, were included. The WHO criteria showed an OR of 11.15 (95% CI 7.65–16.24), a sensitivity of 0.86 (95% CI 0.82–0.90) and a specificity of 0.67 (95% CI 0.64–0.70) for coexistent cancer. The subjective EIN system showed a similar OR (11.85, 95% CI 4.91–28.62; P = 0.90), higher sensitivity (0.98, 95% CI 0.94–0.99), and lower specificity (0.29, 95% CI 0.24–0.34). The WHO system and the subjective EIN system have similar prognostic values. However, the EIN criteria appear to be more sensitive and thus more suitable for selecting women who need to be treated, whereas the WHO criteria, based on cytological atypia, seem to be more specific for lesions at higher risk of cancer. Therefore, integration of the EIN system with cytological atypia should be considered.

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“…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.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…However, it was unclear whether age was a risk factor for occult EC in patients with NAEH in this study because both AEH and NAEH were included in the analysis. 8 A classic retrospective study reported that progression to EC occurred in 1% and 3% of patients with simple and complex NAEH, respectively. 9 A meta-analysis reported that complex NAEH had a higher risk for occult EC than simple NAEH.…”

Section: Discussionmentioning

confidence: 99%

“…Of 118 women with NAEH, only 2 patients were diagnosed with AEH and 2 others diagnosed with EC following hysterectomy. 8 A retrospective study reported the rate of EC was 1.6% at follow-up (1-27 years) after the diagnosis of NAEH. 9 In another study, the cumulative risk of progression to cancer remained below 3% up to 19 years after the diagnosis of NAEH.…”

Section: Introductionmentioning

confidence: 99%

Risk of occult atypical hyperplasia or cancer in women with nonatypical endometrial hyperplasia

Lee

Kim

et al. 2020

J of Obstet and Gynaecol

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Aim: The aim of this study was to identify subsets of patients diagnosed with nonatypical endometrial hyperplasia (NAEH) by endometrial biopsy who had high risk for occult atypical endometrial hyperplasia (AEH) or endometrial cancer (EC). Methods: We retrospectively reviewed the medical records of 281 patients who underwent hysterectomy within 6 months after a diagnosis of NAEH. We collected data on age, body mass index, menopausal status, tamoxifen use, previous history of NAEH, details of endometrial biopsy (location, curettage vs. pipelle sampling), NAEH subtype (simple vs. complex), interval between endometrial biopsy and hysterectomy, indication of hysterectomy and the presence of occult AEH or EC in hysterectomy specimen. Associations between variables and occult AEH or EC were analyzed. Risk of occult AEH or EC in subsets were calculated and visualized using a heatmap. Results: Among 281 patients, 34 (12.1%) and 9 (3.2%) had occult AEH and EC in hysterectomy specimens, respectively. Using univariate analysis, we found age, menopausal status and subtype were associated with occult AEH or EC. Using multivariate analysis, older age (odds ratio = 1.09, P < 0.01) and complex subtype (odds ratio = 3.34, P < 0.01) were independent risk factors. Patients at an age ≥ 51 years with complex NAEH had about 50% risk of occult AEH or EC. Conclusion: Women at an age ≥ 51 years with complex NAEH had high risk for occult AEH or EC and surgical treatment can be considered for these patients.

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“…Endometrial cancer is among the 3 most common malignant tumors in the female reproductive system. Endometrial adenocarcinoma is the most common type, with increased incidence and a trend toward affecting younger women [9,10]. …”

Section: Introductionmentioning

confidence: 99%

P53 and Murine Double Mimute 2 (MDM2) Expression Changes and Significance in Different Types of Endometrial Lesions

Jiang

Dan

et al. 2016

Med Sci Monit

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BackgroundEndometrial lesions are common in obstetrics and gynecology, including endometrial polyps, uterine adenomyosis, and malignant endometrial adenocarcinoma. Endometrial lesions seriously affect women’s health, fertility, quality of life, and life safety. As a pro-apoptosis gene, p53 is considered to be closely related with human tumors. Murine double mimute 2 (MDM2) is an oncogene that can promote tumor occurrence and development. P53 and MDM2 expression and significance in different types of endometrial lesions have not been fully elucidated.Material/MethodsNormal endometrium, endometrial polyps, uterine adenomyosis, and endometrial adenocarcinoma tissue samples were collected. Real-time PCR was used to detect p53 and MDM2 mRNA expression. Immunohistochemical staining and Western blot analysis were applied to test p53 and MDM2 protein expression. Their correlation with clinical staging of endometrial adenocarcinoma was analyzed.ResultsP53 and MDM2 mRNA and protein expression were significantly elevated in the endometrial polyps group and the endometrial adenocarcinoma group compared with the normal control group (P<0.05). Their levels increased more obviously in endometrial adenocarcinoma compared with endometrial polyps (P<0.05). P53 and MDM2 mRNA and protein expression were slightly enhanced in uterine adenomyosis compared with normal controls, but this difference lacked statistical significance (P>0.05). P53 and MDM2 mRNA and protein level showed a positive correlation. Significantly higher expression of p53 or MDM2 was observed in patients with stage III compared to those in patients with stage II. Higher expression was also observed in patients with stage II than in patients with stage I.ConclusionsP53 and MDM2 mRNA and protein were elevated in endometrial polyps and endometrial adenocarcinoma and their expressions were correlated with clinical staging of endometrial adenocarcinoma. They can promote cancer occurrence and development, and can be treated to assist diagnosis and provide a reference for treatment.

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Prevalence of Co-existing Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia

Cited by 16 publications

References 26 publications

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

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

Risk of occult atypical hyperplasia or cancer in women with nonatypical endometrial hyperplasia

P53 and Murine Double Mimute 2 (MDM2) Expression Changes and Significance in Different Types of Endometrial Lesions

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