Endometrial carcinoma in Chinese postmenopausal women with atypical endometrial hyperplasia

Abstract

Objectives: To determine the risk factors and the rate of endometrial carcinoma (EC) among Chinese postmenopausal women with atypical endometrial hyperplasia (AEH).

Methods: We retrospectively reviewed medical records of Chinese postmenopausal women with AEH who underwent endometrial biopsy (using pipelle) or curettage between 1 January 2012 and 31 December 2023 at the Queen Elizabeth Hospital. Postmenopausal women with a final diagnosis of AEH or EC were compared to determine the risk factors for EC.

Result: In total, 45 Chinese postmenopausal women with AEH underwent hysterectomy and bilateral salpingo-oophorectomy. Of these, 15 (33.3%) underwent additional pelvic lymph node dissection with or without para-aortic lymph node dissection or subdiaphragmatic scraping, based on preoperative imaging findings (n=10) or intra-operative findings (n=5). All these 15 patients had a histopathological diagnosis of EC. Of the 45 patients, 11 and 34 had a histopathological diagnosis of AEH and EC, respectively. The final diagnosis of EC was not associated with age, body mass index, parity, hypertension, diabetes, or hyperlipidaemia in postmenopausal women with AEH.

Conclusion: Of 45 Chinese postmenopausal women with AEH, 75.6% had a final diagnosis of EC and 24.4% required lymph node dissection in addition to hysterectomy and bilateral salpingo-oophorectomy. In selected patients, preoperative imaging and referral to a gynaecological oncologist for tumour staging may be necessary for optimal treatment outcomes.