Risk stratification for endometrial hyperplasia and malignancy in women age ≤45 with abnormal uterine bleeding (390)

Abstract

<b>Objectives:</b> Quality improvement initiative to identify risk factors for endometrial hyperplasia and carcinoma in a South Texas Hispanic patient population aged ≤45 years. <b>Methods:</b> An IRB-approved retrospective case-control study was conducted among women aged <45 with abnormal uterine bleeding (AUB) at a single academic institution. The study included all women aged <45 years who had endometrial sampling performed between 2010 and 2020. Exclusion criteria included age >45 or <18 at the time of initial biopsy, known cancer diagnosis, or known cancer-related syndrome. Several covariates, including demographics, BMI, parity, menstrual history, endometrial stripe thickness, smoking status, medical comorbid conditions, previous and current treatment were analyzed to identify trends in patients with endometrial hyperplasia and malignancy. <b>Results:</b> There were 1,618 women included in the study. Of these 26 (1.6%) had endometrial malignancy, 114 (7%) had EIN, 114 (7%) had benign endometrial hyperplasia, and 1,364 (84.3%) had normal endometrium. The demographic distribution of our study population included 50% Hispanic, 38% Caucasian, 8% African American, 4% unspecified, and <1% Asian. The average age was 37 years with normal endometrium, 38 with benign hyperplasia, 36 with EIN, and 35 years with malignancy. The median BMI for the entire population was 48. Median BMI for women with normal endometrium, benign hyperplasia, EIN, and malignancy was 35, 33, 39, and 43, respectively. Among the 114 women with EIN, 55% were Hispanic, and 41% were Caucasian, and of the 26 women with malignancy, 65% were Hispanic, and 31% were Caucasian. Women with EIN and malignancy had an average endometrial stripe (ES) of 14.5mm and 20mm. Women with normal biopsies had an average ES of 12mm. Heavy menstrual bleeding (63%) followed by oligomenorrhea (24%) were the most common patterns of AUB across all pathologies. The most common comorbid conditions in women with EIN and malignancy were hypertension (31% and 42%, respectively) and diabetes (30% and 46%, respectively). Prior to diagnosis, 49% of women with EIN and 54% of women with malignancy had failed previous medical management of AUB. <b>Conclusions:</b> In a South Texas patient population, women aged <45 years with AUB are at risk of EIN and malignancy. The characteristics most associated with malignancy and hyperplasia were Hispanic ethnicity, increased BMI, thickened ES, heavy menstrual bleeding pattern, and previous treatment failure. A risk stratification tool may be beneficial to help further clarify which patients are at the highest risk and need endometrial sampling versus those patients in whom inappropriate sampling can be avoided.