Gregg Rebecca W, Kim Ji Won, Lundeberg Kathleen R, Tian Chunqiao, Song Jini, Belgam Daniel, Choe Nicholas, Teschan Nathan J, Riggs McKayla, Darcy Kathleen M, Hope Erica R, Winkler Stuart S
Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX 78234, United States.
Department of Gynecologic Surgery and Obstetrics, Wright Patterson Medical Center, Wright Patterson Air Force Base, OH 45433, United States.
Mil Med. 2025 Sep 1;190(9-10):e1979-e1985. doi: 10.1093/milmed/usaf124.
Endometrial intraepithelial neoplasia (EIN), also known as atypical endometrial hyperplasia (AEH), is a precursor lesion of endometrial carcinoma (EC). In endometrial cancer patients, lymph node assessment with biopsy during hysterectomy is part of surgical staging. However, routine lymph node assessment for EIN is inconsistently utilized. This study aims to investigate the surgical management of EIN in the military to inform best-practice guidelines tailored for the Military Health System to avoid delays in care, manage cost, ensure military readiness and optimize clinical outcome.
We performed a retrospective chart review of patients with EIN treated at 2 military treatment facilities over a 10-year period between July 1, 2013 and July 1, 2023. Pathology reports were queried to identify patients with a preoperative diagnosis of EIN. Patients not surgically managed were excluded. Statistical analysis was performed using chi-squared test and Wilcoxon rank-sum test. Independent associations were investigated using logistic regression modeling.
There were 95 evaluable patients with an EIN diagnosis, including 43 (45.3%) patients upstaged to EC based on final pathology (95% CI: 35.0-55.8). Older patients diagnosed with EIN ≥65 years old and those with endometrial thickness ≥15 mm exhibited the highest risk for upstaging EIN to an EC diagnosis. Of the 50 patients who underwent lymph node assessment, none had positive lymph nodes. Patients diagnosed with EIN via hysteroscopy vs. an endometrial biopsy had the lowest risk of being upstaged to EC.
Upstaging from EIN to EC occurred in 45.3% of the 95 patients emphasizing the value of performing surgicopathologic staging in this setting. In contrast, none of the 50 EIN patients who underwent lymph node resection had positive lymph nodes indicating morbidity risk with low likelihood of clinical benefit. We identified risk factors for upstaging to EC, including age ≥65 years and endometrial thickness ≥15 mm, and confirmed the diagnostic superiority of hysteroscopy. These findings have informed clinical practice guideline recommendations for the surgical management of EIN in the Military Health System.
子宫内膜上皮内瘤变（EIN），也称为非典型子宫内膜增生（AEH），是子宫内膜癌（EC）的前驱病变。在子宫内膜癌患者中，子宫切除术中通过活检进行淋巴结评估是手术分期的一部分。然而，EIN的常规淋巴结评估应用并不一致。本研究旨在调查军队中EIN的手术管理情况，为军事卫生系统量身定制最佳实践指南，以避免治疗延误、控制成本、确保军事准备状态并优化临床结果。
我们对2013年7月1日至2023年7月1日这10年间在2个军事治疗机构接受治疗的EIN患者进行了回顾性病历审查。查询病理报告以确定术前诊断为EIN的患者。未接受手术治疗的患者被排除。使用卡方检验和Wilcoxon秩和检验进行统计分析。使用逻辑回归模型研究独立关联。
有95例可评估的EIN诊断患者，其中43例（45.3%）根据最终病理结果被升级诊断为EC（95%置信区间：35.0 - 55.8）。诊断为EIN的年龄≥65岁的老年患者以及子宫内膜厚度≥15mm的患者将EIN升级为EC诊断的风险最高。在接受淋巴结评估的50例患者中，无一例淋巴结阳性。通过宫腔镜检查诊断为EIN的患者与通过子宫内膜活检诊断的患者相比，升级为EC的风险最低。
95例患者中有45.3%的患者从EIN升级为EC，这强调了在这种情况下进行外科病理分期的价值。相比之下，接受淋巴结切除的50例EIN患者中无一例淋巴结阳性，这表明发病风险高而临床获益可能性低。我们确定了升级为EC的风险因素，包括年龄≥65岁和子宫内膜厚度≥15mm，并证实了宫腔镜检查的诊断优势。这些发现为军事卫生系统中EIN手术管理的临床实践指南建议提供了依据。
