Significance of concurrent endometrial cancer in women with a preoperative diagnosis of atypical endometrial hyperplasia.
OBJECTIVE
Our objectives were (1) to review the rate of concurrent endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia (AEH); (2) to determine the proportion of patients with concurrent endometrial cancer who have high-risk disease; and (3) to re-evaluate our surgical management of AEH.


METHODS
We performed a retrospective chart review of all patients who had surgery on the basis of a preoperative diagnosis of atypical endometrial hyperplasia between January 2001 and December 2006. Demographic data, the method of preoperative diagnosis, postoperative grade of tumour, and other postoperative findings were recorded. When applicable, this included cancer stage, lymph node status, and presence of lymphovascular space invasion. In postoperative review, patients were considered to be high risk if they had disease beyond the uterus or a combination of other risk factors.


RESULTS
Of 70 patients, 25 (35.7%) were found to have concurrent endometrial cancer. This was higher than the commonly accepted rate of 25% (P = 0.03). Of the 25 patients upgraded, 4 (16%) had high-risk cancer on final pathologic evaluation.


CONCLUSIONS
Simple hysterectomy in women with AEH may result in inadequate surgical management. Simple methods are required to identify patients with a preoperative diagnosis of AEH who may harbour significant cancers.
Giede
Kurt Christopher
KC
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon SK.
Yen
Tin-Wing
TW
Faculty of Medicine University of Saskatchewan, Saskatoon SK.
Chibbar
Rajni
R
Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon SK.
Pierson
Roger A
RA
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan, Saskatoon SK.
D004714:Endometrial Hyperplasia / Q000175:diagnosis* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies