Hui Lee Shi, Chin Selina Hui Men, Goh Charissa, Hui Lin Xiao, Mathur Manisha, Kuei Timothy Lim Yong, Xian Felicia Chin Hui
Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore.
Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore.
Obstet Gynecol Sci. 2021 May;64(3):300-308. doi: 10.5468/ogs.20294. Epub 2021 Feb 25.
To determine the risk factors for occult endometrial atypia and malignancy in patients diagnosed with non-atypical endometrial hyperplasia (NEH) on endometrial biopsy.
All new cases of NEH diagnosed between April 2015 and March 2016 at KK Women's and Children's Hospital, who underwent hysterectomy as first-line treatment, were included in the study. Patients with a history of endometrial hyperplasia or malignancy were excluded from the study. Patient demographics (e.g., age, parity, body mass index [BMI]), medical history, and clinical presentation were obtained for analysis.
In total, 262 patients were diagnosed with NEH, of which 18.3% (n=48) underwent hysterectomy as first-line management. The average time to surgery was 77.0±35.7 days. All cases were diagnosed by dilation and curettage, and hysteroscopy. The mean age was 51 years, and the mean BMI was 26.9±5.8 kg/m2. Histology from the hysterectomy specimen showed 9 (18.8%) patients with atypical hyperplasia and 2 (4.2%) with grade 1, stage 1A endometrioid adenocarcinoma. Patients with higher grade final pathology had significantly lower median parity (1 vs. 2, P=0.039), higher mean BMI (30.1±6.5 vs. 25.9±5.3 kg/m2, P=0.033), and BMI ≥30 kg/m2 (54.5% vs. 13.5%, P=0.008, odds ratio 7.68), compared to patients whose final histology showed NEH or no residual hyperplasia.
Occult endometrial atypia and malignancy were found in 18.8% and 4.2% of patients with an initial diagnosis of NEH, respectively. High BMI and low parity were identified as significant risk factors for high-grade endometrial lesions in patients with NEH.
确定经子宫内膜活检诊断为非典型子宫内膜增生（NEH）的患者发生隐匿性子宫内膜不典型增生及恶性病变的危险因素。
纳入2015年4月至2016年3月期间在KK妇女儿童医院诊断为NEH且接受子宫切除术作为一线治疗的所有新病例。有子宫内膜增生或恶性肿瘤病史的患者被排除在研究之外。收集患者的人口统计学资料（如年龄、产次、体重指数[BMI]）、病史和临床表现进行分析。
共有262例患者被诊断为NEH，其中18.3%（n = 48）接受子宫切除术作为一线治疗。手术平均时间为77.0±35.7天。所有病例均通过刮宫术和宫腔镜检查确诊。平均年龄为51岁，平均BMI为26.9±5.8kg/m²。子宫切除标本的组织学检查显示，9例（18.8%）患者为非典型增生，2例（4.2%）为1级1A期子宫内膜样腺癌。与最终组织学显示为NEH或无残留增生的患者相比，最终病理分级较高的患者中位产次显著较低（1对2，P = 0.039），平均BMI较高（30.1±6.5对25.9±5.3kg/m²，P = 0.033），BMI≥30kg/m²的比例更高（54.5%对13.5%，P = 0.008，比值比7.68）。
初诊为NEH的患者中，隐匿性子宫内膜不典型增生和恶性病变的发生率分别为18.8%和4.2%。高BMI和低产次被确定为NEH患者发生高级别子宫内膜病变的重要危险因素。
