Ultrasound Obstet Gynecol 2019 Aug 7. Epub 2019 Aug 7.
Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Canter, Bronx, New York, USA.
Objective: To assess the long-term outcome of post-menopausal women diagnosed with non-atypical endometrial hyperplasia (NEH).
Methods: It is a retrospective study of women aged 55 and older who underwent endometrial sampling in our large academic medical center between 1997 and 2008. Women diagnosed with NEH were included in the study group and were compared to women diagnosed with atrophic endometrium on endometrial sampling. Outcome data was obtained through February 2018. The main outcomes were the risk of progression to endometrial carcinoma and the risk of persistent endometrial hyperplasia (EH). Logistic regression was used to identify covariates that remained significant risk factors for cancer progression.
Results: 1808 women aged 55 and older underwent endometrial sampling during the study period. The median surveillance time was 10.0 years. 73 women were found to have NEH and they were compared to 742 women with atrophic endometrium (AE). When compared to women with AE, women with NEH had a significantly higher BMI (33.9 vs. 30.6, p=0.01), a higher rate of progression to type 1 endometrial cancer and persistent endometrial hyperplasia (8.2% vs. 0.8%, p<0.0001 and 21.9% vs 0.7% respectively, p<0.0001). They also had a higher rate of progression to all types of uterine cancer or persistent hyperplasia (32.9% vs 3.4%, p<0.0001). Women with NEH also had significantly higher rate of future surgical intervention (50.7% vs 15.4%, p<0.0001) and future hysterectomy (34.3% vs. 9.6%, p<0.0001). On logistic regression analysis, NEH, BMI>35, thick endometrium on ultrasound and diabetes remained significant risk factors for progression to cancer.
Conclusions: Postmenopausal women with NEH are at significant risk for persistent endometrial hyperplasia (EH) and progression to uterine cancer, at higher rates than rates previously reported. Guidelines for the appropriate management of postmenopausal women with NEH are needed to decrease the rate of persistent disease or progression to cancer. This article is protected by copyright. All rights reserved.