title: Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage.
abstract: OBJECTIVE
  To evaluate whether preoperative dilation and curettage (D&C) lowers the risk of unexpected cancer at hysterectomy.
  
  
  METHODS
  Women with complex atypical endometrial hyperplasia on sampling from January 2000 to May 2008 who underwent hysterectomy within 6 months were identified using a pathology database. Patient age, sampling procedures, and hysterectomy pathology were recorded. Women were categorized as having either an office biopsy-based evaluation or a curettage-based evaluation. The proportion of women with cancer at surgery was estimated and compared for the two groups.
  
  
  RESULTS
  Of 824 women with complex atypical endometrial hyperplasia on initial sampling, 48% were found to have cancer. For 100 women, cancer was diagnosed preoperatively by additional sampling before hysterectomy. For the remaining 724, 298 (41%) had unexpected cancer at hysterectomy. The diagnosis of complex atypical endometrial hyperplasia was biopsy-based for 531 (73%) and curettage-based for 193 (27%). The risk of cancer for women who had a D&C was significantly lower than for those who had biopsy, but still of concern (30% compared with 45%, P<.001), as was the risk of myometrial invasion (18% compared with 25%, P=.05). Age was strongly correlated to risk of cancer, invasive cancer, and deeply invasive or grade 3 disease.
  
  
  CONCLUSIONS
  Dilation and curettage lowered the risk of unexpected cancer compared with biopsy, but 18% of women still had invasive cancer found at hysterectomy. The risk of unexpected cancer is strongly related to age. Dilation and curettage can help detect cancer preoperatively but is not reliable for excluding cancer.
  
  
  METHODS
  II.
authors.affiliation: From the Division of Gynecologic Oncology, The Permanente Medical Group, Walnut Creek, California; and Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Suh-Burgmann
authors.forename: Yun-Yi
authors.initials: YY
authors.lastname: Hung
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Armstrong
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004107:Dilatation and Curettage; D004714:Endometrial Hyperplasia / Q000473:pathology* / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
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