Abstract
<b>Objectives:</b> This study aimed to assess outcomes in a cohort of patients (pts) with a preoperative diagnosis of atypical endometrial hyperplasia undergoing hysterectomy with and without sentinel node evaluation and to assess molecular classification in this cohort. <b>Methods:</b> We included all patients in our prospective database (between 2017 and 2021) diagnosed with premalignant pathology on preoperative endometrial biopsy (including endometrial intraepithelial neoplasia, complex atypical hyperplasia, and hyperplasia bordering on carcinoma) who underwent hysterectomy (HYST) and hysterectomy with sentinel lymph node (SLN) mapping. All biopsies were reviewed by gynecologic pathologists. Clinical, pathologic, surgical, and treatment data and TCGA molecular classification were abstracted, and appropriate statistical tests were utilized. <b>Results:</b> We identified 221 pts; 161 (73%) SLN and 60 (27%) HYST. Median age (56 vs 57 years, p=0.1) and BMI (33 vs 34 kg/m2, p=0.4) were similar. Bilateral SLN mapping was documented for 158 (98%) SLN pts. Of 221 pts, 98 (45%) had FIGO grade 1-2 endometrioid endometrial cancer (EC) on final hysterectomy pathology: 17 (28%) HYST and 81 (50%) SLN pts (p=0.003). Myoinvasion was identified in 15/221 (7%) pts, with 2/15 (13%) being the outer half myoinvasion. Among 98 pts with EC, four (4%) were stage IB or higher, including one pt with stage IIIC and one with stage IIIA. Among 161 patients in the SLN group, one (0.6%) was node-positive and three (2%) pts had isolated tumor cells in an SLN. Ten of 98 (10%) pts received adjuvant treatment, and all were within the SLN group (chemotherapy [<i>n</i>=1], IVRT [<i>n</i>=8], or combination chemotherapy and radiation [<i>n</i>=1]). No pt has recurred in either group, with a median follow-up of 13.8 mos (range: 0.4-52). Eight of 60 HYST (13%) and 15/161 SLN (9%) pts had a postoperative 30-day adverse event (p=0.9). TCGA molecular classification was available for 38 pts: 32 (87%) CN-L, three (8%) MSI-H, two (5%) <i>POLE</i>, and no CN-H pts. <b>Conclusions:</b> Among pts with a preoperative biopsy of premalignant endometrial pathology, 45% were upgraded to endometrial cancer, including 7% with myoinvasion and variable TCGA molecular subtype. SLN mapping did not increase postoperative morbidity and showed a low incidence of occult disease but can help avoid reoperation with full lymphadenectomy for staging. Referral of pts with endometrial hyperplasia to gynecologic oncologists provides an opportunity for shared decision-making to balance the risks and benefits of SLN biopsy.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call