Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia?

Abstract

BackgroundThis study investigated the frequency of high-risk cancer types in hysterectomy material obtained from patients who were diagnosed with atypical endometrial hyperplasia (AEH) by endometrial sampling. Materials and methodsA total of 227 patients with AEH were retrospectively included in the study. Hysterectomy material was examined as both perioperative frozen section (FS) and paraffin-embedded permanent section (PS). Grade III tumors, grade II tumors larger than 2 cm, over 50% myometrial invasion, cervical involvement, and serous or clear cell histology were considered high-risk. ResultsIn final pathology, 57 (25.1%) patients had endometrial cancer and 7 (3%) patients had high-risk cancer. Overall analysis of FS/PS agreement yielded a Cohen's Kappa (K) coefficient of 0.420 (moderate agreement). There was moderate (K = 0.526) agreement between FS and PS in detecting tumor grade, and good agreement (K = 0.653) in evaluation of myometrial invasion. ConclusionHigh-risk endometrial cancer can coexist with AEH. It should be remembered that despite preoperative and FS examinations, these high-risk tumors can be overlooked until final pathology.