Factors Predicting Type II Histology in Endometrial Biopsies Among Postmenopausal Women at a Safety Net Hospital [27H

Abstract

INTRODUCTION: Endometrial cancer (EC) may be categorized into two histologic subtypes, type I and type II. Type II EC are more aggressive, metastasize early, and have worse survival compared to type I. Disparities in Type II EC risk vary by race/ethnicity. Our objective was to evaluate a cohort of women undergoing endometrial biopsy (EMB) at a public safety net hospital (PSNH) to identify factors that predict type II EC. METHODS: A retrospective chart review was performed of postmenopausal women over age 50 who had an EMB at a PSNH between 2010 and 2016. Clinicodemographic data were abstracted. Statistical analysis included chi-square and logistic regression with significance set at P<.05. RESULTS: Of 461 EMB results reviewed, 80 (17.3%) had EC. Median age was 62 years, and the majority were Hispanic (64%). The most common indication for EMB was postmenopausal bleeding. 36 (45%) patients had type II histology. Among those with cancer, type II histology prevalence was 17%; in whites, 41%; in Hispanics, and 61%; in blacks (P=.03). In a univariate analysis, factors associated with type II tumors included older age (OR 1.10 [CI 1.03-1.18], P<.01), black race (OR 8.75 [CI 0.86-88.70], P=.07), number of years since menopause (OR 1.06 [CI 1.01-1.12], P=.027), and BMI >30 (OR 0.39 [0.15-0.98], P=.044). CONCLUSION: Our data from a SNH confirm previous findings that black women are at higher risk for type II EC and suggest menopause duration and obesity as additional risk factors. Clinician recognition of factors associated with high-grade histologies is crucial to prompt expeditious work-up for malignancy.