Study Objective: To report on the management and outcomes of atypical endometrial hyperplasia (AEH), including the risk of concurrent endometrial cancer to determine if bilateral oophorectomy should be performed at time of hysterectomy. Also to report on the use of progesterone therapy for AEH to make recommendations for duration of therapy and surveillance.
Design: Retrospective audit/case series
Setting: The Mercy Hospital for Women, a tertiary level women’s hospital in Melbourne, Australia
Patients: All women diagnosed with atypical endometrial hyperplasia on endometrial sample from 1st January 2005 – 31st December 2014 inclusive
Interventions: We analysed characteristics and risk factors in those who ever versus never went on to receive a diagnosis of endometrial cancer.
Measurements and Main Results: 15% (18/117) received a diagnosis of endometrial cancer during the study period. 12% (14/117) patients had a concurrent endometrial cancer diagnosed. Those at higher risk of malignancy were those being investigated for postmenopausal bleeding and those for whom the initial pathology report of endometrial biopsy was suspicious for but not diagnostic of malignancy. Of the 69 hysterectomies with removal of ovaries 15/69 (21.7%) had cancer diagnosed in the hysterectomy specimen and 54/69 (78.3%) did not. 28/47 (59.6%) of patients who ever received progesterone therapy had regression of disease to a normal endometrial sample, median time to regression was 151 days (5 months). Of those who normalised on progesterone 2/28 (7.1%) recurred as hyperplasia and 1/28 (3.6%) progressed to malignancy.
Conclusion: Ovarian conservation at hysterectomy for AEH should be practiced in the absence of significant individualised risks. When progesterone therapy is used for AEH, we recommend 6 months duration of treatment followed by resampling. In cases where progesterone has been ceased following normalisation of the endometrium, resampling is recommended.