The clinical approach for endometrial biopsies with atypical endometrial hyperplasia for further management

Hahn, Ho Suap; Yoon, Seok Geun; Kim, Woo Chul; Choi, Hong Jun; Lee, In Ho; Kwon, Yong Soon; Kim, Tae Jin; Lim, Kyung Taek; Lee, Ki Heon; Shim, Jae Uk; Mok, Jung Eun

Abstract

OBJECTIVE
To evaluate the proper approach in women diagnosed with atypical endometrial hyperplasia (AEH) by endometrial biopsy.
METHODS
We retrospectively analyzed the medical records of 108 patients who underwent hysterectomies for AEH diagnosed by endometrial biopsy from 2000 to 2007. The results of the endometrial biopsies were graded on an ordinal scale and were compared with pathologic features obtained at the hysterectomy.
RESULTS
AEH was initially diagnosed by dilatation and curettage (87 cases) or endometrial biopsy with a Z-sampler (17 cases). The remaining four cases were diagnosed by hysteroscopic polypectomy. In patients preoperatively diagnosed with AEH by biopsy, hysterectomy specimens revealed a rate of simple or complex endometrial hyperplasia without atypia of 33.3% with AEH and normal endometrium found in 52.8 and 3.7% of specimens, respectively. The incidence of endometrial carcinoma was considerably high (11/108, 10.2%). All cases were confined to the endometrium and two of those were located at the adenomyosis without myometrial invasion. All patients with endometrial carcinoma displayed coexisting atypical complex hyperplasia following hysterectomy.
CONCLUSION
Biopsy specimens showing AEH, particularly atypical complex hyperplasia, are associated with an increased risk of coexisting endometrial carcinoma. When considering management strategies for women with a biopsy diagnosis of AEH, clinicians should take into account the considerable rate of concurrent endometrial cancer and the discrepancy with pathologic diagnosis.