Risk of occult atypical hyperplasia or cancer in women with non-atypical endometrial hyperplasia

초록

Objective: The aims of this study were to investigate the risk of occult atypical endometrial hyperplasia (AEH) or endometrial cancer (EC) in women who were diagnosed as non-atypical endometrial hyperplasia (NAEH) by endometrial biopsy and to identify subsets with higher risk. Method: We retrospectively reviewed the medical records of 327 women who underwent hysterectomy within 6 months after being diagnosed as NAEH on endometrial biopsy. Data on age, BMI, menopausal status, hormone replacement therapy, tamoxifen use, history of NAEH, previous progestin treatment, endometrial biopsy details (who, where, curettage vs pipelle sampling), interval between endometrial biopsy and hysterectomy, and presence of occult AEH or EC on hysterectomy specimens were collected. Association of variables with occult AEH or EC was analyzed. Results: Among 327 women, 33 (10.1%) and 5 (1.5%) had occult AEH and EC in uterus, respectively. Women with occult AEH or EC were older (51.0 ± 6.8 vs 47.6 ± 0.4 years, P < 0.001) and more menopausal (55% vs 21%, P < 0.001) than those without occult AEH nor EC. BMI, hormone replacement therapy, tamoxifen use, history of NAEH, previous progestin treatment, endometrial biopsy details, and interval between endometrial biopsy and hysterectomy were not associated with occult AEH or EC. In 81 postmenopausal women, 16 (19.8%) and 5 (6.2%) had occult AEH and EC, respectively. In 246 premenopausal women, 17 (6.9%) had occult AEH and none had occult EC. Conclusion: The overall risk of occult AEH or EC in women with NAEH is low. However, the risk in postmenopausal women is high. In postmenopausal women with NAEH, the risk of occult AEH or EC should be informed and hysterectomy can be recommended.