Giannella Luca, Delli Carpini Giovanni, Sopracordevole Francesco, Papiccio Maria, Serri Matteo, Giorda Giorgio, Tsiroglou Dimitrios, Del Fabro Anna, Ciavattini Andrea
Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60121 Ancona, Italy.
Gynecological Oncology Unit, Centro di Riferimento Oncologico-National Cancer Institute, 33081 Aviano, Italy.
Diagnostics (Basel). 2020 Jul 13;10(7):474. doi: 10.3390/diagnostics10070474.
Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC.
Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient's characteristics were compared between the three ESM groups.
D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193-177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002-1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%.
HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.
高达40%的非典型子宫内膜增生（AEH）女性在子宫切除术中可发现子宫内膜癌（EC）。术前子宫内膜取样方法（ESM）和一些独立的癌症预测因素可能会影响这一结果。本研究旨在比较接受刮宫术（D&C）、宫腔镜引导活检（HSC-bio）或宫腔镜子宫内膜切除术（HSC-res）的AEH女性在子宫切除术中的EC发生率。次要结果是比较显示与EC相关的独立变量的女性中ESM的可靠性。
回顾性分析2000年1月至2017年12月期间连续208例接受子宫切除术的AEH女性。基于对EC的术前和术后概率分析，比较了三种ESM：D&C、HSC-bio和HSC-res。进行单因素和多因素分析以评估预测最终组织学癌症的危险因素。最后，比较了三个ESM组之间患者的特征。
D&C组和HSC-bio组每组各有75名女性，而HSC-res组有58名女性。49名女性（23.6%）在子宫切除术中发现癌症（术前概率）。术后概率分析显示，HSC-res对EC低估的百分比最低：HSC-res = 11.6%；HSC-bio = 19.5%；D&C = 35.3%。患者特征在三种ESM之间无显著差异。多因素分析显示，体重指数≥40（比值比（OR）= 19.75；置信区间（CI）2.193 - 177.829）和年龄（标准> 60岁）（OR = 1.055，CI 1.002 - 1.111）与EC显著相关。在有一个或两个危险因素的女性中，术后概率分析显示，与术前概率44.2%相比，HSC-res是子宫切除术中EC发生率较低的唯一方法：HSC-res = 19.96%；HSC-bio = 53.81%；D&C = 63.12%。
HSC-res在AEH中对EC低估的发生率最低，在显示有EC预测因素的女性中也是如此。这些数据可用于更好地进行AEH的诊断和治疗规划。
