AIM: To compare the risk of developing endometrial carcinoma (EC) in young women with atypical endometrial hyperplasia (AEH) undergoing fertility-sparing management compared to women treated by primary hysterectomy. PATIENTS AND METHODS: In this multicentric retrospective study, 111 patients with a diagnosis of AEH by endometrial biopsy were included. EC incidence was compared in two groups: 32 patients treated with fertility-sparing management and 79 older patients treated with primary hysterectomy. RESULTS: The rates of EC diagnosed by pathology of hysterectomy specimens were comparable between the groups. The probability of developing EC at 12, 24 and 36 months were 14%, 21% and 26%, respectively, in patients managed conservatively, and 29%, 37% and 37%, respectively, in patients treated with primary hysterectomy. CONCLUSION: Fertility-sparing management of AEH does not increase the risk of diagnosing EC from the hysterectomy specimen.
Endometrial Hyperplasia/therapy , Endometrial Neoplasms/prevention & control , Fertility Preservation/methods , Hysterectomy/methods , Adult , Disease Progression , Endometrial Hyperplasia/diagnosis , Endometrial Neoplasms/pathology , Female , Humans , Incidence , Middle Aged , Retrospective Studies , Risk Factors , Young Adult
AIM: To identify predictive factors of endometrial cancer in patients with atypical endometrial hyperplasia (AEH). PATIENTS AND METHODS: This was a retrospective cohort study of 79 patients diagnosed with AEH. Clinicopathological characteristics of patients and final histology on hysterectomy were reviewed and univariate and multivariate analyses were performed. RESULTS: Nineteen cases of endometrial cancer (24%) were diagnosed at final histology. Most patients had IA (n=15, 79%) grade 1 (n=15, 79%) cancer, but two had FIGO stage IIIC (10.5%). The predictive factors of endometrial cancer on final histology in univariate analysis were: hysteroscopic sampling, older age, post-menopausal status, suspicion of cancer on hysteroscopy and suspicion of cancer at histology. In multivariable analysis, the only predictive factors of endometrial cancer were older age and the suspicion of cancer on hysteroscopy. CONCLUSION: In patients with AEH on biopsy, our results showed that hysteroscopy could be performed both to assess macroscopic features of malignancy and to orient biopsy.
Endometrial Hyperplasia/complications , Endometrial Hyperplasia/pathology , Endometrial Neoplasms/epidemiology , Endometrial Neoplasms/etiology , Aged , Biopsy , Endometrial Neoplasms/diagnosis , Endometrium/pathology , Female , Humans , Incidence , Menopause , Middle Aged , Neoplasm Grading , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Factors
