The incidence rates of endometrial hyperplasia and endometrial cancer: a four-year population-based study

Accuracy of endometrial sampling in the diagnosis of endometrial cancer: a multicenter retrospective analysis of the JAGO-NOGGO

BACKGROUND

Accurate preoperative molecular and histological risk stratification is essential for effective treatment planning in endometrial cancer. However, inconsistencies between pre- and postoperative tumor histology have been reported in previous studies. To address this issue and identify risk factors related to inaccurate histologic diagnosis after preoperative endometrial evaluation, we conducted this retrospective analysis.

METHODS

We conducted a retrospective analysis involving 375 patients treated for primary endometrial cancer in five different gynaecological departments in Germany. Histological assessments of curettage and hysterectomy specimens were collected and evaluated.

RESULTS

Preoperative histologic subtype was confirmed in 89.5% of cases and preoperative tumor grading in 75.2% of cases. Higher rates of histologic subtype variations (36.84%) were observed for non-endometrioid carcinomas. Non-endometrioid (OR 4.41) histology and high-grade (OR 8.37) carcinomas were identified as predictors of diverging histologic subtypes, while intermediate (OR 5.04) and high grading (OR 3.94) predicted diverging tumor grading.

CONCLUSION

When planning therapy for endometrial cancer, the limited accuracy of endometrial sampling, especially in case of non-endometrioid histology or high tumor grading, should be carefully considered.

Does repetitive dilatation and curettage or hysteroscopic biopsy in patients treated with progestins for endometrial hyperplasia or carcinoma affect subsequent fetomaternal outcomes? A population-based study using the National Health Insurance Research Database of Taiwan

OBJECTIVE

To investigate the impact of repeated dilatation and curettage or hysteroscopic biopsy on fetomaternal outcomes in patients receiving progestin treatment for endometrial hyperplasia or early-stage carcinoma.

METHOD

This was a population-based study using the Taiwan National Health Insurance Research Database between 2009 and 2017 of women who gave birth and had a history of endometrial hyperplasia and early-stage carcinoma treated with progestins. Logistic regression analysis was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) reflecting the association between repeated procedures and fetomaternal outcomes.

RESULTS

A total of 6956 women with 8690 deliveries were identified. Compared with those who had two or fewer procedures, women who received more than two procedures had a significantly higher risk for cervical insufficiency (aOR, 5.09 [95 CI, 2.31-11.24]). Furthermore, women who had more than two procedures were prone to have adverse neonatal outcomes, including Apgar score < 7 at 1 min (aOR, 1.97 [95% CI, 1.13-3.43]) and 5 min (aOR, 3.11 [95% CI, 1.33-7.23]) and preterm delivery <32 weeks (aOR, 2.86 [95% CI, 1.50-5.45]).

CONCLUSION

Undergoing more than two procedures was associated with subsequent maternal cervical insufficiency, preterm delivery <32 weeks, and low neonatal Apgar score. Health care providers should be aware of the potential risks and balance the benefits and harms of repeated procedures.

Endometrial cancer risk with menopausal hormone therapy: Health Insurance Database in South Korea-based cohort study

OBJECTIVE

To determine the risk of endometrial cancer according to the types of menopausal hormones used.

METHODS

This retrospective cohort study recruited postmenopausal women older than 40 years from 2003 to 2011, utilizing data from the Korean national health insurance system from 2002 to 2019. The menopausal hormone therapy (MHT) group consisted of women who had been prescribed MHT for greater than 6 months between 2003 and 2011. The non-MHT group consisted of women who had never used menopausal hormones between 2003 and 2011.

RESULTS

A non-MHT group of 1 000 550 women and a MHT group of 353 025 women were chosen. In comparison to never-users, the risk of endometrial cancer was not higher in women who reported last using tibolone (adjusted hazard ratio [aHR] 1.08, 95% confidence interval [CI] 0.96-1.2), combined estrogen plus progestin by the manufacturer (aHR 0.83, 0.72-0.96), combined estrogen plus progestin by the physician (aHR 0.88, 0.7-1.12), and transdermal estrogen (aHR 1.13, 0.36-3.52).

CONCLUSIONS

Tibolone, combined estrogen plus progestin by the physician, and transdermal estrogen do not affect the risk of endometrial cancer. The combination of estrogen plus progestin by the manufacturer decreases the risk of endometrial cancer.

Therapeutic efficacy of gentle endometrial curettage on antibiotic-resistant chronic endometritis in infertile women

Purpose

To identify the efficacy of endometrial curettage on antibiotic-resistant chronic endometritis (CE) in infertile women.

Methods

Of 1580 women with CE, 87 with antibiotic-resistant CE after two to five cycles of antibiotic treatment were recruited between 2019 and 2021. The women who underwent endometrial curettage without applying any force and, in the subsequent menstrual cycle, endometrial sampling for CD138 immunostaining without antibiotic use. Pregnancy outcomes after in vitro fertilization treatment were analyzed in women who did not desire endometrial curettage and in those with cured and persistent CE after endometrial curettage.

Results

In 64 women who underwent endometrial curettage, the number of CD138-positive cells decreased from 28.0 ± 35.3 to 7.7 ± 14.0 (p < 0.0001), and CE in 41 women (64.1%) was cured (<5 CD138-positive cells). The pathological findings detected 3.1% of endometrial hyperplasia and 1.6% of endometrial cancer. The ongoing pregnancy rates in women aged ≤42 without endometrial curettage were significantly lower than those of women with cured and persistent CE (26.7%, 67.6%, and 57.1%, respectively, p = 0.03).

Conclusions

Gentle endometrial curettage for antibiotic-resistant CE significantly decreased the number of CD138-positive cells, resulting in improved pregnancy outcomes regardless of remaining CE. Endometrial curettage is also important as a screening for endometrial malignancy.

Expression of CD117, CD34, and VEGF proteins in progression from endometrial hyperplasia to endometrioid carcinoma

BACKGROUND

The risk of endometrial hyperplasia progressing into endometrioid carcinoma ranges from 1% for benign hyperplasia to 46.2% for endometrial intra-epithelial neoplasia. Differentiation between both types of hyperplasia is thus crucial for optimal management. The present study investigates the expression of the following immune-histochemical markers, for their potential roles in differentiating between both types of endometrial hyperplasia; as well as their expression in endometrial carcinoma: VEGF, CD34 and CD117.

METHODS

Tissue samples were obtained, fixed, processed, stained by hematoxylin and eosin for diagnosis, and then imunohistochemically stained using anti CD117, CD34, and VEGF antibodies.

RESULTS

In benign endometrial hyperplasia, the cells show weak expression to VEGF and CD34, and absent CD117. In endometrial intra-epithelial neoplasia, the cells show strong expression of VEGF and weak expression of CD34 and CD117. In case of endometrioid carcinoma, all cases showed strong reaction for VEGF and CD34, and moderate expression to CD117.

CONCLUSION

Our data suggests a role for CD117, CD34, and VEGF in progression from hyperplasia to carcinoma.

Endometrial hyperplasia in infertile women undergoing IVF/ICSI: A retrospective cross-sectional study

OBJECTIVE

To describe the frequency and risk factors of endometrial hyperplasia (EH) in infertile women undergoing their first IVF/ICSI treatment.

METHODS

A total of 3198 infertile women undergoing their first IVF/ICSI cycle were recruited retrospectively from a fertility treatment center. Endometrial scratching and biopsy were conducted before IVF/ICSI treatment. The relationship between EH and clinical characteristics were analyzed.

RESULTS

EH without atypia, atypical hyperplasia, and endometrial cancer (EC) were diagnosed in 94 (2.94%), three (0.093%), and two (0.063%) women, respectively. The frequencies of EH were higher in patients with abnormal uterine bleeding (i.e. menstrual cycle irregularity in terms of frequency, volume, or length; 6.8% vs. 1.6%, P < 0.001, OR = 4.42), obesity (4.1% vs. 2.7%, P = 0.044, OR = 1.55), and elevated fasting glucose (4.6% vs. 2.5%, P = 0.017, OR = 1.85). In the multivariate analyses, all the three factors (abnormal uterine bleeding, obesity, elevated fasting glucose) were independently associated with risk of EH. In the subgroup analysis, among women with abnormal uterine bleeding, the frequency of EH in the elevated fasting glucose group was 10.7%, which was higher than that of the normal fasting glucose group (5.6%), even after adjustment for BMI (P = 0.014, OR = 1.53).

CONCLUSION

The frequency of EH in infertile women undergoing their first IVF/ICSI treatment was approximately 3%. Elevated fasting glucose was an independent risk factor for EH in infertile women undergoing IVF/ICSI.

The value of MRI in management of endometrial hyperplasia with atypia

Background

The value of the magnetic resonance imaging (MRI) in the assessment of women with endometrial hyperplasia and its role in diagnosis of myometrial invasion or coexistence of cancer is not known. This study aimed to evaluate the accuracy and usefulness of MRI in the management of patients diagnosed on endometrial biopsy with complex endometrial hyperplasia with atypia (CEHA).

Methods

A retrospective study of 86 cases diagnosed with endometrial hyperplasia with atypia on the initial endometrial biopsy in a tertiary university teaching hospital between 2010 and 2015 was carried out. The MRI accuracy in predicting malignant changes and influence the clinical management was compared among women who had either pelvic MRI, transvaginal ultrasound (TVUS), or no additional imagistic studies.

Results

MRI was performed in 24 (28%) and TVUS in 11 (13%)cases, while 51 (59%) women had no additional imagistic studies. In the group of women with no imaging studies, 26/51 (51%) were surgically treated and 8/26 (31%) were diagnosed with endometrial cancer (EEC) stage 1a. In the group of women who had TVUS, 5/11 (45%) were surgically treated and none was diagnosed with EEC. In the group of women who underwent an MRI examination, 20/24 (83%) were surgically treated. Among these, 11/20 (55%) were diagnosed with EEC, 7 had EEC stage 1a, and 4 had EEC stage 1b. Although MRI was able to identify malignant changes with a good sensitivity (91.7%), it had a low specificity in characterisation of malignant transformation (8%). MRI correctly identified 31% of the stage 1a and 33% of the stage 1b endometrial cancer.

Conclusion

In this study, we found a potential diagnostic value of MRI for identifying malignant transformation in patients with CEHA. However, pelvic MRI has a rather weak predictive value of myometrial invasion in women with CEHA and concurrent EEC. The diagnostic and therapeutic benefits of MRI assessment in patients with CEHA need further validation.

Trends in incidence of uterine cancer in Songkhla, Southern Thailand

Objective

To define the present incidence of uterine cancer and the trends of incidence in the future. Additional, subgroup analysis in religion and socio-demographic factors will be analyzed.

Methods

The data of uterine cancer from The Songkhla Cancer Registry between; 1989 and 2016, was extracted. The population denominators of Songkhla Province were referred from the information of the population censuses surveyed by the National Statistical Office. The incidence was estimate by; the age specific rate, and analyzed in trend incidence using Jointpoint and Age-period-cohort; APC regression models and trend projection in 2017–2030 using by Jointpoint, the NordPred and APC model. The comparison of incidence according to habitat and religion were unpaired t-test.

Results

The incidence of uterine cancer in Songkhla Province increased from 1.5, to 5.3 per 100,000 women-years in 2016, and 8 per 100,000 women-years in 2030. The incidence was more in urban areas and in Buddhists.

Conclusion

The incidence of uterine cancer is increasing. The policy, which promotes protective factors and control risk factors, would decrease incidence of endometrial cancer, and other estrogen dependent cancers additional to chronic diseases from the cardiovascular system.

Levonorgestrel-Releasing Intrauterine Systems Versus Oral Cyclic Medroxyprogesterone Acetate in Endometrial Hyperplasia Therapy: A Meta-Analysis

BACKGROUND

This study aimed to compare the levonorgestrel-releasing intrauterine system (LNG-IUS) with oral cyclic medroxyprogesterone acetate (MPA) in endometrial hyperplasia therapy using randomized controlled trials (RCTs).

METHODS

The study searched MEDLINE, EMBASE, CENTRAL, and other databases. All regression outcomes were calculated for dichotomous outcomes in terms of relative risk (RR) and 95% confidence intervals (CIs) using a Mantel-Haenszel random effects model.

RESULTS

The search found 543 articles but selected 342 articles after the removal of duplicates. A meta-analysis found five RCTs (377 patients). The study did not analyze RR for total outcome because of high heterogeneity (I ² = 87%). In a subgroup analysis of studies with non-obese women, the LNG-IUS treatment appeared to have a higher regression rate than oral MPA (RR 1.41; 95% CI 1.23-1.62; 4 trials, 265 patients; I ² = 0%). In a subgroup analysis of studies with obese women, LNG-IUS appeared to have a regression rate similar to that of oral MPA (RR 1.03; 95% CI 0.94-1.13; 1 trial, 60 patients). In a subgroup analysis according to histology in the non-obese group, the LNG-IUS treatment appeared to have a higher regression rate than oral cyclic MPA in a meta-analysis of women with non-atypical endometrial hyperplasia (RR 1.36; 95% CI 1.07-1.73; 2 trials, 92 patients; I ² = 6%) and mixed endometrial hyperplasia (atypical and non-atypical) (RR 1.44; 95% CI 1.21-1.71; 2 trials, 173 patients; I ² = 0%).

CONCLUSIONS

The LNG-IUS treatment has a higher regression rate than cyclic MPA in non-atypical endometrial hyperplasia and mixed endometrial hyperplasia therapy for non-obese women but has a similar regression rate, albeit limited, for obese women.