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

        Lee Shi Hui,Selina Hui Men Chin,Charissa Goh,Lin Xiao Hui,Manisha Mathur,Timothy Lim Yong Kuei,Felicia Chin Hui Xian 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.3

        ObjectiveTo determine the risk factors for occult endometrial atypia and malignancy in patients diagnosed with non-atypicalendometrial hyperplasia (NEH) on endometrial biopsy. MethodsAll new cases of NEH diagnosed between April 2015 and March 2016 at KK Women’s and Children’s Hospital, whounderwent hysterectomy as first-line treatment, were included in the study. Patients with a history of endometrialhyperplasia 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. ResultsIn total, 262 patients were diagnosed with NEH, of which 18.3% (n=48) underwent hysterectomy as first-linemanagement. 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 thehysterectomy specimen showed 9 (18.8%) patients with atypical hyperplasia and 2 (4.2%) with grade 1, stage 1Aendometrioid 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. ConclusionOccult 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 inpatients with NEH.

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