title: Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia.
abstract: OBJECTIVE
  Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting adenocarcinoma, and approximately 20% to 52% of atypical hyperplasias, if untreated, progress to cancer. The objective of this study was to estimate the incidence of atypical endometrial hyperplasia encountered during routine resectoscopic surgery in women with AUB and to evaluate the role of resectoscopic surgery in the management of women with AUB and atypical endometrial hyperplasia who refused and/or were at high risk for hysterectomy.
  
  
  METHODS
  Prospective cohort study (Canadian Task Force classification II-3).
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  From January 1990 through December 2005, the senior author (GAV) performed primary resectoscopic surgery in 3401 women with AUB. Among these, there were 22 women with atypical (17 complex, 5 simple) endometrial hyperplasia.
  
  
  METHODS
  All women underwent hysteroscopic evaluation and partial (n = 3) or complete (n = 19) endometrial electrocoagulation and/or resection. Subsequently, 6 women had hysterectomy and bilateral salpingo-oophorectomy (BSO).
  
  
  RESULTS
  The median (range) for age, parity, and body mass index were 55 years (24-78 years), 2 (0-4), and 30.1 kg/m2 (22.5-52.2 kg/m2), respectively. Among the 3401 women, there were 22 cases of atypical endometrial hyperplasia, 12 of which were incidentally diagnosed at the time of hysteroscopy (complex 10, simple 2, incidence 0.35%). After hysteroscopic diagnosis or confirmation of diagnosis, 6 women underwent hysterectomy and BSO. Of the remaining 16 women, followed for a median of 5 years (range 1.5-12 years), 1 was lost to follow-up, 1 had only a biopsy to preserve fertility, 1 died from lung cancer after 4 years, and 1 died from colon cancer after 5 years. One patient developed endometrial cancer after 10.5 years with postmenopausal bleeding. She remains alive and well 3.5 years after hysterectomy and BSO. The remaining 11 patients are amenorrheic at a median follow-up of 6 years (range 1.5-12 years).
  
  
  CONCLUSIONS
  Resectoscopic surgery in 3391 women with AUB detected 12 incidental cases of atypical endometrial hyperplasia (incidence 0.35%). Skillful resectoscopic surgery may be an alternative to hysterectomy in women with AUB and atypical endometrial hyperplasia, who refuse or are at high-risk for hysterectomy and who are compliant with regular and long-term follow-up.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Edris
authors.forename: George A
authors.initials: GA
authors.lastname: Vilos
authors.forename: Awatif
authors.initials: A
authors.lastname: Al-Mubarak
authors.forename: Helen C
authors.initials: HC
authors.lastname: Ettler
authors.forename: Jackie
authors.initials: J
authors.lastname: Hollett-Caines
authors.forename: Basim
authors.initials: B
authors.lastname: Abu-Rafea
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D004564:Electrocoagulation / Q000009:adverse effects*; D004714:Endometrial Hyperplasia / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D008796:Metrorrhagia / Q000209:etiology / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome