Costales Anthony B, Schmeler Kathleen M, Broaddus Russell, Soliman Pamela T, Westin Shannon N, Ramirez Pedro T, Frumovitz Michael
Department of Obstetrics and Gynecology, The University of Texas Medical School at Houston, Houston, Texas.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Gynecol Oncol. 2014 Dec;135(3):451-4. doi: 10.1016/j.ygyno.2014.10.008. Epub 2014 Oct 12.
Because of the frequent detection of carcinoma in surgical specimens after hysterectomy for endometrial complex atypical hyperplasia (CAH), it has been suggested that patients with a preoperative diagnosis of CAH be referred to gynecologic oncology for potential lymphadenectomy. However, the risk of lymph node metastasis in such patients is unknown. We sought to determine the risk of endometrial cancer and to estimate the risk of lymphatic spread in women with a preoperative diagnosis of CAH.
We retrospectively reviewed the medical records of 150 consecutive patients with a preoperative diagnosis of CAH who subsequently underwent hysterectomy. Clinical characteristics and pathologic information were abstracted. Risk of lymphatic spread was modeled using previously published criteria and nomograms.
Fifty-five of the 150 patients (36.7%) had an incidental endometrial carcinoma at the time of hysterectomy. Among patients with a preoperative office biopsy compared to dilation and curettage, the rate of an incidental finding of cancer was 43.5% and 28.1%, respectively (p=0.054). Of patients with cancer, 1 (1.8%) had a grade 3 endometrial carcinoma, 4 (7.3%) had lymphovascular space involvement, and 6 (10.9%) had deep (>50%) myometrial invasion. For the 10 patients who underwent lymphadenectomy, one (10%) had lymph node metastases. Based on multiple models, the estimated risk of lymph node spread was 1.6%-2.1% for all women with a preoperative diagnosis of CAH and 4.4%-6.8% for the 55 women with endometrial cancer.
Given the high rates of underlying endometrial cancer and the potential need for lymphadenectomy, care for patients with a preoperative diagnosis of CAH desiring definitive management with hysterectomy should be referred to a gynecologic oncologist.
由于在子宫内膜复杂性非典型增生（CAH）子宫切除术后的手术标本中经常检测到癌，有人建议将术前诊断为CAH的患者转诊至妇科肿瘤学进行潜在的淋巴结切除术。然而，此类患者的淋巴结转移风险尚不清楚。我们试图确定子宫内膜癌的风险，并估计术前诊断为CAH的女性发生淋巴转移的风险。
我们回顾性分析了150例术前诊断为CAH且随后接受子宫切除术的连续患者的病历。提取了临床特征和病理信息。使用先前发表的标准和列线图对淋巴转移风险进行建模。
150例患者中有55例（36.7%）在子宫切除时意外发现子宫内膜癌。与术前门诊活检相比，刮宫术时意外发现癌症的发生率分别为43.5%和28.1%（p = 0.054）。在患有癌症的患者中，1例（1.8%）为3级子宫内膜癌，4例（7.3%）有淋巴管间隙受累，6例（10.9%）有深肌层浸润（>50%）。对于接受淋巴结切除术的10例患者，1例（10%）有淋巴结转移。基于多种模型，术前诊断为CAH的所有女性的淋巴结转移估计风险为1.6%-2.1%，55例患有子宫内膜癌的女性为4.4%-6.8%。
鉴于潜在子宫内膜癌的高发生率以及潜在的淋巴结切除需求，对于希望通过子宫切除术进行确定性治疗的术前诊断为CAH的患者，应转诊至妇科肿瘤学家处。
