Background/Objectives: The diagnosis of atypical endometrial hyperplasia (AEH) is associated with a high rate of concurrent endometrial cancer (EC). This occurrence can be particularly challenging in premenopausal women wishing to become pregnant, as they may be subjected to conservative treatment. The type of endometrial sampling may affect this outcome. Currently, the recommended type of endometrial sampling is under hysteroscopic guidance. There is scant literature regarding the reliability of hysteroscopically guided biopsy (HSC-bio) and hysteroscopic endometrial resection (HSC-res) on this topic. We aimed to assess the underestimation rate of EC in AEH, according to different hysteroscopic sampling methods. The secondary outcome was to evaluate the procedure performance in pre- and postmenopausal women.Methods: We conducted a multi-institutional retrospective study that included 536 women diagnosed with AEH who underwent hysterectomy between 2015 and 2020. Patients were divided into two groups based on the initial diagnostic approach for AEH: HSC-bio and HSC-res. The comparison was performed using univariate and multivariate analyses.Results: 160/536 women (29.9%) showed EC at hysterectomy. Overall, the following rate of EC underestimation was found: HSC-bio = 32.1%, HSC-res = 24.2%,p= 0.07. After adjusting for baseline characteristics using logistic regression analysis, overall, there was no significant association of EC underestimation according to the type of sampling procedure. Interestingly, in premenopausal women, including 161 cases, the rate of EC underestimation in HSC-bio and HSC-res was 28.8% vs. 14.0%, respectively (p= 0.034).Conclusions: There were no significant differences in EC underestimation between the two hysteroscopic procedures in the entire cohort of women with AEH. Limited to the secondary objective, the significant findings in premenopausal women may be of particular clinical interest, as this population may undergo conservative treatment.
背景/目的：非典型子宫内膜增生（AEH）的诊断常伴随较高的并发子宫内膜癌（EC）风险。对于有生育需求的绝经前女性而言，这种情况尤为棘手，因其可能接受保守治疗。子宫内膜取样方式可能影响诊断结果。目前推荐在宫腔镜引导下进行子宫内膜取样，但关于宫腔镜引导活检（HSC-bio）与宫腔镜下子宫内膜切除术（HSC-res）在该领域可靠性的研究尚不充分。本研究旨在评估不同宫腔镜取样方法对AEH中EC的漏诊率，次要目标是评估该方法在绝经前与绝经后女性中的实施效果。 方法：我们开展了一项多机构回顾性研究，纳入2015年至2020年间诊断为AEH并接受子宫切除术的536例女性患者。根据AEH的初始诊断方法将患者分为两组：HSC-bio组与HSC-res组。采用单变量与多变量分析进行比较。 结果：536例患者中160例（29.9%）在子宫切除术中发现EC。总体EC漏诊率如下：HSC-bio组为32.1%，HSC-res组为24.2%（p=0.07）。经逻辑回归分析校正基线特征后，总体上不同取样方式与EC漏诊率无显著相关性。值得注意的是，在包含161例的绝经前女性亚组中，HSC-bio组与HSC-res组的EC漏诊率分别为28.8%和14.0%（p=0.034）。 结论：在整个AEH患者队列中，两种宫腔镜操作方式的EC漏诊率无显著差异。针对次要目标，绝经前女性亚组中的显著发现具有特殊临床意义，因该人群可能接受保守治疗。
肿瘤(癌症)患者之家