The present review regarding atypical endometrial hyperplasia (AEH) focused on the main debated factors regarding this challenging clinical condition: (i) predictive variables of occult endometrial cancer (EC); (ii) the rate of EC underestimation according to different endometrial sampling methods; and (iii) the appropriateness of lymph node status assessment. When cancer is detected, approximately 90% of cases include low-risk EC, although intermediate/high-risk cases have been found in 10–13% of women with cancer. Older age, diabetes, high BMI, and increased endometrial thickness are the most recurrent factors in women with EC. However, the predictive power of these independent variables measured on internal validation sets showed disappointing results. Relative to endometrial sampling methods, hysteroscopic endometrial resection (Hys-res) provided the lowest EC underestimation, ranging between 6 and 11%. Further studies, including larger sample sizes of women undergoing Hys-res, are needed to confirm these findings. These data are urgently needed, especially for female candidates for conservative treatment. Finally, the evaluation of lymph node status measured on 660 of over 20,000 women showed a lymph node positivity of 2.3%. Although there has been an increase in the use of this procedure in AEH in recent years, the present data cannot recommend this option in AEH based on a cost/risk/benefit ratio.
本综述围绕非典型子宫内膜增生这一具有挑战性的临床状况，聚焦于三个核心争议点：(1) 隐匿性子宫内膜癌的预测变量；(2) 不同子宫内膜取样方法导致的子宫内膜癌漏诊率；(3) 淋巴结状态评估的适用性。当检测出癌症时，约90%的病例属于低危型子宫内膜癌，但仍有10%-13%的癌症患者被诊断为中/高危型。高龄、糖尿病、高体重指数及子宫内膜增厚是子宫内膜癌患者最常见的风险因素，然而这些独立变量在内部验证集中的预测效能表现欠佳。关于子宫内膜取样方法，宫腔镜子宫内膜切除术的子宫内膜癌漏诊率最低（6%-11%），但需通过更大样本量的研究加以验证，这对拟行保守治疗的女性患者尤为重要。最后，通过对20,000余名患者中660例淋巴结状态的分析显示，淋巴结阳性率为2.3%。尽管近年来该检查在非典型子宫内膜增生中的应用有所增加，但基于成本/风险/效益比，现有数据尚不支持将其作为常规推荐方案。
肿瘤(癌症)患者之家