Thongsang Waraphon, Kuljarusnont Sompop, Hanamornroongruang Suchanan, Ruengkhachorn Irene
Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
World J Surg Oncol. 2025 Jan 25;23(1):24. doi: 10.1186/s12957-025-03677-6.
To determine the prevalence of occult endometrial carcinoma in patients with endometrial intraepithelial neoplasia (EIN) post-hysterectomy and identify pre-hysterectomy risk factors predictive of occult carcinoma.
This retrospective study included patients diagnosed with EIN between 2007 and 2021 who underwent hysterectomy as primary treatment. An expert gynecologic pathologist reviewed pathological slides. Data collected from medical records included demographic and gynecologic information, sonographic findings, and surgical and pathological outcomes. The prevalence of occult endometrial carcinoma was calculated. Descriptive statistics evaluated carcinoma incidence, and logistic regression analysis identified independent risk factors.
A total of 113 patients were evaluated. The median time to hysterectomy was 9.1 weeks (range 5.8-12.8 weeks). Post-hysterectomy, 36 patients (31.8%) were diagnosed with endometrial carcinoma, all endometrioid type. Of these, 88.9% were stage I per the International Federation of Gynecology and Obstetrics classification system, and 11.1% were at high risk for nodal metastasis. Predictive factors for occult carcinoma included the intraoperative gross lesion size (2 cm or larger and less than 2 cm) and endometrial aspiration. Adjusted odds ratios were 6.723 (95% CI 2.338 to 19.333) for lesions 2 cm or larger, 3.381 (95% CI 1.128 to 10.132) for lesions less than 2 cm, and 2.752 (95% CI 1.092 to 6.936) for endometrial aspiration.
Occult endometrial carcinoma was identified in 31.8% of patients with a pre-hysterectomy EIN diagnosis. The significant predictors were endometrial aspiration and the presence of a gross lesion during surgery.
确定子宫切除术后子宫内膜上皮内瘤变（EIN）患者隐匿性子宫内膜癌的患病率，并识别子宫切除术前预测隐匿性癌的危险因素。
这项回顾性研究纳入了2007年至2021年间被诊断为EIN并接受子宫切除术作为主要治疗方法的患者。一位专业的妇科病理学家对病理切片进行了复查。从医疗记录中收集的数据包括人口统计学和妇科信息、超声检查结果以及手术和病理结果。计算隐匿性子宫内膜癌的患病率。描述性统计评估癌症发病率，逻辑回归分析确定独立危险因素。
共评估了113例患者。子宫切除的中位时间为9.1周（范围5.8 - 12.8周）。子宫切除术后，36例患者（31.8%）被诊断为子宫内膜癌，均为子宫内膜样类型。根据国际妇产科联合会分类系统，其中88.9%为Ⅰ期，11.1%有淋巴结转移高风险。隐匿性癌的预测因素包括术中大体病变大小（2 cm或更大与小于2 cm）和子宫内膜抽吸。病变2 cm或更大时调整后的优势比为6.723（95%置信区间2.338至19.333），病变小于2 cm时为3.381（95%置信区间1.128至10.132），子宫内膜抽吸时为2.752（95%置信区间1.092至6.936）。
在术前诊断为EIN的患者中，31.8%被发现有隐匿性子宫内膜癌。重要的预测因素是子宫内膜抽吸和手术中存在大体病变。
