The incidence of endometrial carcinoma in patients with atypical endometrial hyperplasia versus atypical endometrial polyp (438)

Abstract

Objectives: The objective of the present study was to compare the incidence of endometrial carcinoma following hysterectomy in patients with presurgical diagnoses of atypical endometrial hyperplasia (non-polypoid) versus atypical endometrial hyperplasia confined to an endometrial polyp. Methods: Medical records of women who underwent staging surgery, including hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node dissection, for atypical endometrial hyperplasia or atypical endometrial polyp between 2016 and 2020 were reviewed. Results: Seventy-nine women who underwent surgery were included. Of those, 46 women were diagnosed with an atypical endometrial polyp that was resected via hysteroscopy (endometrial polyp group), and 33 women had non-polypoid atypical endometrial hyperplasia following endometrial tissue sampling (non-polypoid group). The mean age at diagnosis was 60.2 ± 9.9 years in the endometrial polyp group compared to 61.7 ± 12 years in the non-polypoid group (p=0.5). Most women (81.8%) in the non-polypoid group presented with post-menopausal bleeding, whereas 41.3% of the women in the endometrial polyp group were asymptomatic (p=0.001). Pathology results from the hysterectomy specimens revealed concurrent endometrial carcinoma in 23.9% of women in the endometrial polyp group compared to 51.5% of women in the non-polypoid group (p=0.001). Ninety-one percent of cancers were grade 1 in the endometrial polyp group compared to 53% of cancers in the non-polypoid group. Grade 2 was found in 9% of cancers in the endometrial polyp group compared to 35% of women in the non-polypoid group (p=0.04). Most women were diagnosed at stage IA, 91% in the endometrial polyp group compared to 82% in the non-polypoid group (p=0.6). In both groups, none of the sentinel lymph nodes harvested during surgery were involved by cancer. Conclusions: Concurrent cancer is less frequent with atypical endometrial polyp as compared to atypical endometrial hyperplasia. Still, the high incidence of endometrial carcinoma in both groups supports the current advice to perform a hysterectomy and bilateral salpingo- oophorectomy for peri and post-menopausal women. Our data do not support performing sentinel lymph node dissection for atypical endometrial hyperplasia. Objectives: The objective of the present study was to compare the incidence of endometrial carcinoma following hysterectomy in patients with presurgical diagnoses of atypical endometrial hyperplasia (non-polypoid) versus atypical endometrial hyperplasia confined to an endometrial polyp. Methods: Medical records of women who underwent staging surgery, including hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node dissection, for atypical endometrial hyperplasia or atypical endometrial polyp between 2016 and 2020 were reviewed. Results: Seventy-nine women who underwent surgery were included. Of those, 46 women were diagnosed with an atypical endometrial polyp that was resected via hysteroscopy (endometrial polyp group), and 33 women had non-polypoid atypical endometrial hyperplasia following endometrial tissue sampling (non-polypoid group). The mean age at diagnosis was 60.2 ± 9.9 years in the endometrial polyp group compared to 61.7 ± 12 years in the non-polypoid group (p=0.5). Most women (81.8%) in the non-polypoid group presented with post-menopausal bleeding, whereas 41.3% of the women in the endometrial polyp group were asymptomatic (p=0.001). Pathology results from the hysterectomy specimens revealed concurrent endometrial carcinoma in 23.9% of women in the endometrial polyp group compared to 51.5% of women in the non-polypoid group (p=0.001). Ninety-one percent of cancers were grade 1 in the endometrial polyp group compared to 53% of cancers in the non-polypoid group. Grade 2 was found in 9% of cancers in the endometrial polyp group compared to 35% of women in the non-polypoid group (p=0.04). Most women were diagnosed at stage IA, 91% in the endometrial polyp group compared to 82% in the non-polypoid group (p=0.6). In both groups, none of the sentinel lymph nodes harvested during surgery were involved by cancer. Conclusions: Concurrent cancer is less frequent with atypical endometrial polyp as compared to atypical endometrial hyperplasia. Still, the high incidence of endometrial carcinoma in both groups supports the current advice to perform a hysterectomy and bilateral salpingo- oophorectomy for peri and post-menopausal women. Our data do not support performing sentinel lymph node dissection for atypical endometrial hyperplasia.