Predictive factors of concurrent endometrial carcinoma and the role of frozen section in patients with preoperative diagnosis of atypical endometrial hyperplasia

Type 1 endometrial adenocarcinoma or endometrioid adenocarcinoma had developed from a precursor lesion known as atypical endometrial hyperplasia (AEH). This study aimed to evaluate the rates and risk factors of concurrent endometrial carcinoma in patients with preoperative diagnosis of AEH and assessed the role of intraoperative frozen section examination among these patients. Sixty-six patients undergone hysterectomy after the preoperative diagnosis of AEH via diagnostic curettage or hysteroscopy biopsy, were included in this retrospective cohort study. The major study outcomes were the rates and risk factors of co-existent endometrial cancer and the frozen section efficacy in detecting concurrent invasive disease. 31.81% AEH patients had endometrial cancer diagnosis in hysterectomy specimens. Among these endometrial cancer patients, 18 were of Stage IA, 1 of Stage IB, and 2 of Stage II. Stage III or IV was not detected in any of the patients. Patients preoperatively diagnosed as AEH via hysteroscopy had less probability of co-existent endometrial carcinoma than those diagnosed by endometrial curettage (17.24% vs. 43.24%) (p < 0.05). BMI (Body Mass Index) >28 kg/m2, post-menopausal status, and endometrial thickness were the determinant factors in diagnosing endometrial carcinoma through final histopathology of AEH patients (p < 0.05). Regarding presence or absence of concomitant endometrial carcinoma, the frozen section diagnoses were consistent with the final histopathology in 47.06% patients. Co-existent endometrial cancer with AEH was prevalent and possessed good prognostic features. The predictive factors of harboring concomitant endometrial cancer included older age, overweight, and endometrial thickness. Intraoperative frozen section analysis of AEH might assist in the clinical decision-making during surgery.

Atypical endometrial hyperplasia; Endometrial carcinoma; Intraoperative frozen section; Hysterectomy; Risk factors; Hysteroscopy

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