摘要

The aims of this study were: (1) to review the rate of concurrent endometrial cancer in patients with a preoperative diagnosis of atypical endometrial hyperplasia (AEH); and (2) to determine the features of concurrent endometrial carcinoma and their impact on the subsequent management of AEH. We reviewed a retrospective series of 219 AEHs diagnosed locally in routine practice, over 24 years, and followed by a repeat biopsy or hysterectomy. Another series of 65 cases with a malignant diagnosis on preoperative sampling was included as a control group. Clinicopathologic parameters were obtained. In addition, published data on the risk of malignancy and features of malignant tumors after a diagnosis of AEH were collected and analyzed. This study reported on 2571 patients diagnosed in 31 published studies in addition to the current one. This showed a wide variation in the positive predictive value (PPV) of AEH in detecting endometrial cancer (6% to 63%) with an overall PPV of 37%. This variation is not only based on the differences among studies but also on the degree of atypia [mild/moderate (PPV 13%) or severe (PPV 50%)], the type of subsequent intervention (biopsy vs. hysterectomy), and more importantly the time period of diagnosis (around 20% in studies published before 1990s and up to 40% to 48% in recently published cases). Of the benign outcome cases, nearly 40% to 50% showed AEH with a potential risk of progressing to invasive carcinoma in 25% of cases. Malignant tumors after AEH diagnosis are associated with features of good prognosis with endometrioid morphology, lower grade, and early stage. Although the overall PPV of AEH is 37%, a figure of 40% to 48% is expected in the cases currently diagnosed in routine practice. Providing qualifying criteria for AEH will help identify its different associated risks and therefore should be included in routine pathology reports whenever possible. Unless there is a clinical contraindication, hysterectomy should be performed to treat concurrent carcinoma and to reduce the risk of subsequent carcinoma in nonmalignant cases with residual AEH.

译文

这项研究的目的是 :( 1) 回顾术前诊断为不典型子宫内膜增生 (AEH) 的患者并发子宫内膜癌的比率; 和 (2) 确定并发子宫内膜癌的特征及其对 AEH 后续管理的影响。我们回顾了 219 例在 24 年的常规实践中局部诊断的 AEHs 的回顾性系列，随后进行了重复活检或子宫切除术。另纳入 65 例经术前取样诊断为恶性的病例作为对照组。获得临床病理参数。此外，收集并分析了诊断 AEH 后关于恶性肿瘤风险和恶性肿瘤特征的已发表数据。除了目前的研究，这项研究还报道了 31 项已发表研究中诊断的 2571 名患者。这表明在检测子宫内膜癌 (6% 到 63%) 时，AEH 的阳性预测值 (PPV) 有很大差异，总 PPV 为 37%。这种变化不仅基于研究之间的差异，也基于异型性的程度 [轻度/中度 (PPV 13%) 或重度 (PPV 50%)], 后续干预的类型 (活检 vs.子宫切除术)，更重要的是诊断的时间段(在 20世纪90年代之前发表的研究中，约 20%，在最近发表的病例中，高达 40% 至 48%)。在良性结果病例中，近 40% 至 50% 的病例显示 AEH 有发展为浸润性癌的潜在风险，占 25%。AEH 诊断后的恶性肿瘤与预后良好的子宫内膜样形态、低级别和早期相关。尽管 AEH 的总 PPV 为 37%，但目前在常规实践中诊断的病例预计为 40% 至 48%。为 AEH 提供合格标准将有助于确定其不同的相关风险，因此应尽可能纳入常规病理报告。除非有临床禁忌症，否则应进行子宫切除术以治疗并发癌，并降低残留 AEH 的非恶性病例的后续癌的风险。