Incidence of endometrial carcinoma after hysterectomy for atypical hyperplasia or FIGO stage IA carcinoma diagnosed on endometrial biopsy or endometrial resection

摘要

OBJECTIVE: To evaluate the risk of finding an infiltrating endometrial carcinoma when atypical hyperplasia (AH) or FIGO stage IA carcinoma were diagnosed on endometrial biopsy by Novak curette during ambulatory hysteroscopy or on pathological analysis of endometrial ablation product during operatoring hysteroscopy. METHOD: Retrospective unicentric study from 2000 to 2006 including 107 patients. Total hysterectomy with bilateral oophorectomy was performed on 95 of them. All patients had initial diagnosis of AH or FIGO stage IA carcinoma realised either by biopsy with Novak curette performed according to hysteroscopic data (52 cases), or on product of endometrial ablation (43 cases). AH and stage IA carcinoma were voluntarily studied together because of the same surgical treatment and because it is acknowledged that no complementary treatment is necessary if lesion remains intramucous. However, in presence of myometrial infiltration, the risk of lymph node infiltration exists and lymphadenectomy must be discussed. RESULTS: Out of the 95 hysterectomy specimens, 20 infiltrating endometrial carcinoma were diagnosed (21%). The risk of discovering an infiltrating endometrial carcinoma when diagnosis of AH or stage IA carcinoma is done by biopsy with Novak curette is 32.7% (17 out of 52 patients). Let's note that 30% of these ambulatory hysteroscopies (5 out of 17) were non suspect. When diagnosis is done on the products of endometrial ablation, infiltrating carcinoma is observed on the hysterectomy piece in 6.9% of cases (3 out of 43 patients). DISCUSSION AND CONCLUSION: Presence of AH or stage IA endometrial carcinoma on endometrial biopsies or on products of endometrial ablation can be associated with infiltrating endometrial carcinoma. In presence of AH or stage IA carcinoma diagnosed on biopsy with Novak curette, the incidence of infiltrating carcinoma on hysterectomy product is sizeable (32.7%) and check-up of infiltrating endometrial carcinoma should be realised with the view to state the prognostic factorsand the possible indication of lymphadenectomy. Besides, in the case of a patient presenting with post menopausal bleeding with non suspect hysteroscopy, biopsic examination is necessary.