Characteristics of Patients Undergoing Laparoscopic Hysterectomy for Atypical Endometrial Hyperplasia

TL;DR

This study examines the risk of endometrial cancer in patients undergoing laparoscopic surgery for atypical endometrial hyperplasia, finding that older age correlates with cancer diagnosis.

Contribution

The study provides insights into clinicopathological differences between atypical endometrial hyperplasia and endometrial cancer in laparoscopic surgery.

Findings

Endometrial cancer was diagnosed in 6 out of 17 patients preoperatively diagnosed with AEH.

Patients with endometrial cancer were significantly older than those with AEH (median age 59.5 vs. 47.5 years).

All endometrial cancer cases were endometrioid carcinoma Grade 1, with most at an early stage.

Abstract

Objective: This study aimed to investigate the potential risk of a final pathological diagnosis of endometrial cancer in laparoscopic surgery for preoperatively diagnosed atypical endometrial hyperplasia (AEH), considering literature reports indicating a 40% coexistence rate of AEH with endometrial cancer.

Methodology: A retrospective analysis was conducted on 17 patients with preoperative AEH undergoing laparoscopic surgery at our hospital. The median age was 50 (37-74) years, and the median body mass index (BMI) was 25.1 (16.9-44.3) kg/m2. Surgical procedures included total hysterectomy and bilateral adnexectomy, accounting for the possible coexistence of endometrial cancer. Diagnostic methods comprised histological examination, dilatation and curettage, and pelvic MRI. Clinicopathological factors were thoroughly examined.

Results: Postoperative diagnoses were AEH in 10 cases, atypical polypoid adenomyoma (APAM) in one case, and endometrial cancer in six cases. Comparison between the AEH group and the endometrial cancer group showed that the proportion of postmenopausal women was higher in the endometrial cancer group (33.3% vs. 66.7%), as was the presence of endometrial thickening on imaging (20% vs. 66.7%), although these differences were not statistically significant. However, patients in the endometrial cancer group were significantly older than those in the AEH group (median age: 59.5 vs. 47.5 years, P = 0.02). All endometrial cancer cases were endometrioid carcinoma Grade 1, with five cases classified as FIGO (International Federation of Gynecology and Obstetrics) stage IA and one case as stage IB.

Conclusions: Despite nonsignificant differences in factors other than age, our study underscores the critical consideration of endometrial cancer during laparoscopic surgery for AEH, even with comprehensive preoperative examinations. This emphasizes the need for vigilant management strategies and heightened awareness of the surgical approach to AEH cases.