Uterus Resected for Complex Atypical Hyperplasia of the Endometrium and Coexisting Endometrial Cancer: Ten-year Experience in a Regional Hospital

Abstract

Objective: To investigate the probability, the diagnostic accuracy of endometrial biopsy and curettage and the value of pathologists’ comments in predicting co-existing endometrial cancer for uterus resected for complex atypical hyperplasia of the endometrium.
Methods: This was a retrospective analysis using data from the operative database of Queen Elizabeth Hospital from 1 July 1998 to 30 June 2008. Sixty-two patients who underwent hysterectomy for complex atypical hyperplasia were recruited for analysis. Patients with prolonged time interval from diagnosis of complex atypical hyperplasia to hysterectomy and those with indeterminate final histology were excluded.
Results: Final histopathological evaluation of hysterectomy specimens revealed endometrial cancer in 28 (45%) of 62 patients. Advanced age and being menopausal were significantly associated with cancer (p=0.027 and 0.002, respectively). A preoperative diagnosis of complex atypical hyperplasia was established by endometrial biopsy in 31 patients and curettage in 31 others. Among them, 16 (52%) and 12 (39%) respectively had endometrial cancer. The diagnostic accuracy of endometrial biopsies and curettage was similar (p=0.307). The chance of co-existing endometrial cancer was significantly associated with the severity of complex atypical hyperplasia revealed by microscopy (p<0.001). When the complex atypical hyperplasia was focal and / or there was mild nuclear atypia, the chance of co-existing cancer was low (1/13, 8%). For specimens reported as ‘cancer could not be excluded’, the chance of such a cancer was 70% (21/30). For specimens with complex atypical hyperplasia for which there was no further comment, the chance of co-existing cancer was 32% (6/19).
Conclusion: A relatively high incidence of co-existing endometrial cancer was found (45%). Older age and being menopausal increased the likelihood of co-existing endometrial cancer. The diagnostic accuracy of endometrial biopsy and curettage was comparable. Pathologists’ comment on the microscopic appearance of specimens was an important predictor in co-existing endometrial cancer.