Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;64(3):300-308.
doi: 10.5468/ogs.20294. Epub 2021 Feb 25.

Non-atypical endometrial hyperplasia: risk factors for occult endometrial atypia and malignancy in patients managed with hysterectomy

Lee Shi Hui  1 , Selina Hui Men Chin  1 , Charissa Goh  1 , Lin Xiao Hui  2 , Manisha Mathur  1 , Timothy Lim Yong Kuei  2 , Felicia Chin Hui Xian  2
Affiliations

Non-atypical endometrial hyperplasia: risk factors for occult endometrial atypia and malignancy in patients managed with hysterectomy

Lee Shi Hui et al. Obstet Gynecol Sci. 2021 May.

Abstract

Objective: To determine the risk factors for occult endometrial atypia and malignancy in patients diagnosed with non-atypical endometrial hyperplasia (NEH) on endometrial biopsy.

Methods: All new cases of NEH diagnosed between April 2015 and March 2016 at KK Women's and Children's Hospital, who underwent hysterectomy as first-line treatment, were included in the study. Patients with a history of endometrial hyperplasia or malignancy were excluded from the study. Patient demographics (e.g., age, parity, body mass index [BMI]), medical history, and clinical presentation were obtained for analysis.

Results: In total, 262 patients were diagnosed with NEH, of which 18.3% (n=48) underwent hysterectomy as first-line management. The average time to surgery was 77.0±35.7 days. All cases were diagnosed by dilation and curettage, and hysteroscopy. The mean age was 51 years, and the mean BMI was 26.9±5.8 kg/m2. Histology from the hysterectomy specimen showed 9 (18.8%) patients with atypical hyperplasia and 2 (4.2%) with grade 1, stage 1A endometrioid adenocarcinoma. Patients with higher grade final pathology had significantly lower median parity (1 vs. 2, P=0.039), higher mean BMI (30.1±6.5 vs. 25.9±5.3 kg/m2, P=0.033), and BMI ≥30 kg/m2 (54.5% vs. 13.5%, P=0.008, odds ratio 7.68), compared to patients whose final histology showed NEH or no residual hyperplasia.

Conclusion: Occult endometrial atypia and malignancy were found in 18.8% and 4.2% of patients with an initial diagnosis of NEH, respectively. High BMI and low parity were identified as significant risk factors for high-grade endometrial lesions in patients with NEH.

Keywords: Dilation and curettage; Endometrial hyperplasia; Endometrial neoplasms.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

References

    1. Emons G, Beckmann MW, Schmidt D, Mallmann P Uterus commission of the Gynecological Oncology Working Group (AGO) New WHO classification of endometrial hyperplasias. Geburtshilfe Frauenheilkd. 2015;75:135–6. - PMC - PubMed
    1. Vereide AB, Arnes M, Strame B, Maltau JM, Ørbo A. Nuclear morphometric changes and therapy monitoring inpatients with endometrial hyperplasia: a study comparing effects of intrauterine levonorgestrel and systemic medroxyprogesterone. Gynecol Oncol. 2003;91:526–33. - PubMed
    1. Ozdegirmenci O, Kayikcioglu F, Bozkurt U, Akgul MA, Haberal A. Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia. Gynecol Obstet Invest. 2011;72:10–4. - PubMed
    1. Kurman RJ, Kaminski PF, Norris HJ. The behavior of endometrial hyperplasia. A long-term study of “untreated” hyperplasia in 170 patients. Cancer. 1985;56:403–12. - PubMed
    1. Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. Int J Gynecol Obstet. 2018;143(Suppl 2):37–50. - PubMed