Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery

About 10–66% of patients with atypical endometrial hyperplasia diagnosed before surgery (preoperative-AEH) are found to have concurrent endometrial cancer (EC) at definitive hysterectomy, leading to incomplete primary surgery and delayed adjuvant treatment. This study aims to investigate the potential risk factors of concurrent EC in preoperative-AEH patients in a clinical setting with a gynecological pathology review. All patients diagnosed with AEH by endometrial biopsy or curettage that then underwent definitive hysterectomy from January 2016 to December 2019 in a tertiary hospital were retrospectively analyzed. All diagnoses were reviewed by gynecological pathologists. A total of 624 preoperative-AEH patients were included, 30.4% of whom had concurrent EC. In multivariate analysis, postmenopausal status and CA125 ≥ 35 U/mL significantly correlated with concurrent EC (OR = 3.57; 95% CI = 1.80–7.06; OR = 2.15; 95% CI = 1.15–4.03). This risk was remarkably increased in patients with both postmenopausal status and CA125 ≥ 35 U/mL (OR = 16.20; 95% CI = 1.73–151.44). Notably, concurrent EC seemed to occur more frequently in women with postmenopausal time ≥ 5 years (OR = 4.04, 95% CI = 1.80–5.85). In addition, CA125 ≥ 35 U/mL seemed to be an independent risk factor (OR = 5.74; 95% CI = 1.80–18.27) for concurrent intermediate-high-risk EC. Intermediate-high-risk EC was also more commonly seen in preoperative-AEH women with postmenopausal time ≥ 5 years (OR = 5.52, 95% CI = 1.21–25.19, p = 0.027). In conclusion, preoperative-AEH patients with postmenopausal status or elevated level of CA125 might have a high risk of concurrent EC. Adequate pre-surgical evaluation might be suggested for such patients.

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Comparison of endometrial biopsy and postoperative hysterectomy specimen findings in patients with atypical endometrial hyperplasia and endometrial cancer

Ginekologia Polska ◽

10.5603/gp.2016.0031 ◽

2016 ◽

Vol 87 (7) ◽

pp. 488-492 ◽

Cited By ~ 2

Author(s):

Filip Kisielewski ◽

Małgorzata Ewa Gajewska ◽

Maja Janina Marczewska ◽

Grzegorz Panek ◽

Mirosław Wielgoś ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Endometrial Biopsy ◽

Atypical Endometrial Hyperplasia

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Which surgical procedure for patients with atypical endometrial hyperplasia?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200501000-00019 ◽

2005 ◽

Vol 15 (1) ◽

pp. 127-131 ◽

Cited By ~ 4

Author(s):

B. S. Karamursel ◽

S. Guven ◽

G. Tulunay ◽

T. Kucukali ◽

A. Ayhan

Keyword(s):

Endometrial Carcinoma ◽

Endometrial Hyperplasia ◽

Menopausal Status ◽

Endometrial Biopsy ◽

Surgical Staging ◽

Lymph Node Status ◽

Atypical Endometrial Hyperplasia ◽

Group I ◽

Significant Difference ◽

Group Ii

ObjectiveTo determine the occult coexistence of endometrial carcinoma in patients with atypical endometrial hyperplasia and to compare histological prognostic factors according to lymph node status in occult endometrial carcinoma.Materials and MethodsTwo hundred and four patients from two referral centers (during the period 1990–2003) who were operated on within 1 month of endometrial biopsy for symptomatic endometrial hyperplasia without receiving any medical treatment were included retrospectively. Patients having preoperative endometrial biopsy results of concomitant endometrial hyperplasia and carcinoma were excluded from the study. Fifty-six patients having atypia in preoperative biopsy (group I) were compared with 148 patients without atypia (group II). Chi-square and Mann–Whitney U-tests were used for statistical analyses.ResultsNo significant difference was observed between the two groups according to age or menopausal status. Patients in group II had significantly higher parity than patients in group I. In group I, 62.5% of the patients had endometrial carcinoma, 21.4% had endometrial hyperplasia, and 16.1% had normal endometrium in hysterectomy specimens. In group II, the percentages were 5.4, 38.5, and 56.1%, respectively. Complete surgical staging was performed in 20 patients. Four patients had metastatic lymph nodes. All of them had grade 2 tumors with lymphovascular space involvement. Three of them had nonendometrioid tumors.ConclusionCareful intraoperative and preoperative evaluation of the endometrium must be the sine qua non for patients with atypical endometrial hyperplasia. It is reasonable to do frozen section at the time of hysterectomy for atypical endometrial hyperplasia, and if grade 2/3 of nonendometriod cancer with lymphovascular space involvement is found, complete surgical staging should be performed.

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OP011/#250 Postmenopausal status and elevated serum level of cancer antigen 125 significantly predicted concurrent endometrial cancer in women diagnosed with atypical endometrial hyperplasia before surgery

10.1136/ijgc-2021-igcs.28 ◽

2021 ◽

Author(s):

Y-C Lou ◽

J Guan ◽

X Chen

Keyword(s):

Endometrial Cancer ◽

Serum Level ◽

Endometrial Hyperplasia ◽

Elevated Serum ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Elevated Serum Level ◽

Atypical Endometrial Hyperplasia ◽

Postmenopausal Status

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Menopausal status combined with serum CA125 level significantly predicted concurrent endometrial cancer in women diagnosed with atypical endometrial hyperplasia before surgery

10.3802/jgo.2021.32.s1.om2 ◽

2021 ◽

Author(s):

Yaochen Lou ◽

Jiongbo Liao ◽

Jun Guan

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Menopausal Status ◽

Atypical Endometrial Hyperplasia ◽

Ca125 Level ◽

Serum Ca125 ◽

Serum Ca125 Level

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Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

Diagnostics ◽

10.3390/diagnostics11030442 ◽

2021 ◽

Vol 11 (3) ◽

pp. 442

Author(s):

Norbert Stachowicz ◽

Agata Smoleń ◽

Michał Ciebiera ◽

Tomasz Łoziński ◽

Paweł Poziemski ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Menopausal Status ◽

Power Doppler ◽

Uterine Cavity ◽

Abnormal Uterine Bleeding ◽

Scoring Systems ◽

Diagnostic Challenge

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

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