Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia

A gynecologic oncology group study

Cornelia L. Trimble, James Kauderer, Richard Zaino, Steven Silverberg, Peter C. Lim, James J. Burke, David S Alberts, John Curtin, Denise Mackey

Research output: Contribution to journalArticle

325 Citations (Scopus)

Abstract

BACKGROUND. Adenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for approximately 36,000 diagnoses of invasive carcinoma annually. The most common histologic type, endometrioid adenocarcinoma (EC), accounts for 75-80% of patients. The objective of this work was to estimate the prevalence of concurrent carcinoma in women with a biopsy diagnosis of the precursor lesion, atypical endometrial hyperplasia (AEH). METHODS. This prospective cohort study included women who had a community diagnosis of AEH. Diagnostic biopsy specimens were reviewed independently by three gynecologic pathologists who used International Society of Gynecologic Pathologists/World Health Organization criteria. Study participants underwent hysterectomy within 12 weeks of entry onto protocol without interval treatment. The hysterectomy slides also were reviewed by the study pathologists, and their findings were used in the subsequent analyses. RESULTS. Between November 1998 and June 2003, 306 women were enrolled on the study. Of these, 17 women were not included in the analysis: Two patients had unreadable slides because of poor processing or insufficient tissue, 2 patients had only slides that were not endometrial, the slides for 5 patients were not available for review, and 8 of the hysterectomy specimens were excluded because they showed evidence of interval intervention, either progestin effect or ablation. In total, 289 patients were included in the current analysis. The study panel review of the AEH biopsy specimens was interpreted as follows: 74 of 289 specimens (25.6%) were diagnosed as less than AEH, 115 of 289 specimens (39.8%) were diagnosed as AEH, and 84 of 289 specimens (29.1%) were diagnosed as endometrial carcinoma. In 5.5% (16 of 289 specimens), there was no consensus on the biopsy diagnosis. The rate of concurrent endometrial carcinoma for analyzed specimens was 42.6% (123 of 289 specimens). Of these, 30.9% (38 of 123 specimens) were myoinvasive, and 10.6% (13 of 123 specimens) involved the outer 50% of the myometrium. Among the women who had hysterectomy specimens with carcinoma, 14 of 74 women (18.9%) had a study panel biopsy consensus diagnosis of less than AEH, 45 of 115 women (39.1%) had a study panel biopsy consensus diagnosis of AEH, and 54 of 84 women (64.3%) had a study panel diagnosis of carcinoma. Among women who had no consensus in their biopsy diagnosis, 10 of 16 women (62.5%) had carcinoma in their hysterectomy specimens. CONCLUSIONS. The prevalence of endometrial carcinoma in patients who had a community hospital biopsy diagnosis of AEH was high (42.6%). When considering management strategies for women who have a biopsy diagnosis of AEH, clinicians and patients should take into account the considerable rate of concurrent carcinoma.

Original languageEnglish (US)
Pages (from-to)812-819
Number of pages8
JournalCancer
Volume106
Issue number4
DOIs
StatePublished - Feb 15 2006

Fingerprint

Endometrial Hyperplasia
Endometrial Neoplasms
Biopsy
Hysterectomy
Carcinoma
Endometrioid Carcinoma
Myometrium
Community Hospital
Progestins
Endometrium
Adenocarcinoma
Cohort Studies

Keywords

  • Atypia
  • Biopsy
  • Consensus diagnosis
  • Endometrial hyperplasia
  • Endometrioid adenocarcinoma
  • Hysterectomy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Trimble, C. L., Kauderer, J., Zaino, R., Silverberg, S., Lim, P. C., Burke, J. J., ... Mackey, D. (2006). Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A gynecologic oncology group study. Cancer, 106(4), 812-819. https://doi.org/10.1002/cncr.21650

Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia : A gynecologic oncology group study. / Trimble, Cornelia L.; Kauderer, James; Zaino, Richard; Silverberg, Steven; Lim, Peter C.; Burke, James J.; Alberts, David S; Curtin, John; Mackey, Denise.

In: Cancer, Vol. 106, No. 4, 15.02.2006, p. 812-819.

Research output: Contribution to journalArticle

Trimble, CL, Kauderer, J, Zaino, R, Silverberg, S, Lim, PC, Burke, JJ, Alberts, DS, Curtin, J & Mackey, D 2006, 'Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A gynecologic oncology group study', Cancer, vol. 106, no. 4, pp. 812-819. https://doi.org/10.1002/cncr.21650
Trimble, Cornelia L. ; Kauderer, James ; Zaino, Richard ; Silverberg, Steven ; Lim, Peter C. ; Burke, James J. ; Alberts, David S ; Curtin, John ; Mackey, Denise. / Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia : A gynecologic oncology group study. In: Cancer. 2006 ; Vol. 106, No. 4. pp. 812-819.
@article{ddd4d4debb894741acd565b802fde5e7,
title = "Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A gynecologic oncology group study",
abstract = "BACKGROUND. Adenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for approximately 36,000 diagnoses of invasive carcinoma annually. The most common histologic type, endometrioid adenocarcinoma (EC), accounts for 75-80{\%} of patients. The objective of this work was to estimate the prevalence of concurrent carcinoma in women with a biopsy diagnosis of the precursor lesion, atypical endometrial hyperplasia (AEH). METHODS. This prospective cohort study included women who had a community diagnosis of AEH. Diagnostic biopsy specimens were reviewed independently by three gynecologic pathologists who used International Society of Gynecologic Pathologists/World Health Organization criteria. Study participants underwent hysterectomy within 12 weeks of entry onto protocol without interval treatment. The hysterectomy slides also were reviewed by the study pathologists, and their findings were used in the subsequent analyses. RESULTS. Between November 1998 and June 2003, 306 women were enrolled on the study. Of these, 17 women were not included in the analysis: Two patients had unreadable slides because of poor processing or insufficient tissue, 2 patients had only slides that were not endometrial, the slides for 5 patients were not available for review, and 8 of the hysterectomy specimens were excluded because they showed evidence of interval intervention, either progestin effect or ablation. In total, 289 patients were included in the current analysis. The study panel review of the AEH biopsy specimens was interpreted as follows: 74 of 289 specimens (25.6{\%}) were diagnosed as less than AEH, 115 of 289 specimens (39.8{\%}) were diagnosed as AEH, and 84 of 289 specimens (29.1{\%}) were diagnosed as endometrial carcinoma. In 5.5{\%} (16 of 289 specimens), there was no consensus on the biopsy diagnosis. The rate of concurrent endometrial carcinoma for analyzed specimens was 42.6{\%} (123 of 289 specimens). Of these, 30.9{\%} (38 of 123 specimens) were myoinvasive, and 10.6{\%} (13 of 123 specimens) involved the outer 50{\%} of the myometrium. Among the women who had hysterectomy specimens with carcinoma, 14 of 74 women (18.9{\%}) had a study panel biopsy consensus diagnosis of less than AEH, 45 of 115 women (39.1{\%}) had a study panel biopsy consensus diagnosis of AEH, and 54 of 84 women (64.3{\%}) had a study panel diagnosis of carcinoma. Among women who had no consensus in their biopsy diagnosis, 10 of 16 women (62.5{\%}) had carcinoma in their hysterectomy specimens. CONCLUSIONS. The prevalence of endometrial carcinoma in patients who had a community hospital biopsy diagnosis of AEH was high (42.6{\%}). When considering management strategies for women who have a biopsy diagnosis of AEH, clinicians and patients should take into account the considerable rate of concurrent carcinoma.",
keywords = "Atypia, Biopsy, Consensus diagnosis, Endometrial hyperplasia, Endometrioid adenocarcinoma, Hysterectomy",
author = "Trimble, {Cornelia L.} and James Kauderer and Richard Zaino and Steven Silverberg and Lim, {Peter C.} and Burke, {James J.} and Alberts, {David S} and John Curtin and Denise Mackey",
year = "2006",
month = "2",
day = "15",
doi = "10.1002/cncr.21650",
language = "English (US)",
volume = "106",
pages = "812--819",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "4",

}

TY - JOUR

T1 - Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia

T2 - A gynecologic oncology group study

AU - Trimble, Cornelia L.

AU - Kauderer, James

AU - Zaino, Richard

AU - Silverberg, Steven

AU - Lim, Peter C.

AU - Burke, James J.

AU - Alberts, David S

AU - Curtin, John

AU - Mackey, Denise

PY - 2006/2/15

Y1 - 2006/2/15

N2 - BACKGROUND. Adenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for approximately 36,000 diagnoses of invasive carcinoma annually. The most common histologic type, endometrioid adenocarcinoma (EC), accounts for 75-80% of patients. The objective of this work was to estimate the prevalence of concurrent carcinoma in women with a biopsy diagnosis of the precursor lesion, atypical endometrial hyperplasia (AEH). METHODS. This prospective cohort study included women who had a community diagnosis of AEH. Diagnostic biopsy specimens were reviewed independently by three gynecologic pathologists who used International Society of Gynecologic Pathologists/World Health Organization criteria. Study participants underwent hysterectomy within 12 weeks of entry onto protocol without interval treatment. The hysterectomy slides also were reviewed by the study pathologists, and their findings were used in the subsequent analyses. RESULTS. Between November 1998 and June 2003, 306 women were enrolled on the study. Of these, 17 women were not included in the analysis: Two patients had unreadable slides because of poor processing or insufficient tissue, 2 patients had only slides that were not endometrial, the slides for 5 patients were not available for review, and 8 of the hysterectomy specimens were excluded because they showed evidence of interval intervention, either progestin effect or ablation. In total, 289 patients were included in the current analysis. The study panel review of the AEH biopsy specimens was interpreted as follows: 74 of 289 specimens (25.6%) were diagnosed as less than AEH, 115 of 289 specimens (39.8%) were diagnosed as AEH, and 84 of 289 specimens (29.1%) were diagnosed as endometrial carcinoma. In 5.5% (16 of 289 specimens), there was no consensus on the biopsy diagnosis. The rate of concurrent endometrial carcinoma for analyzed specimens was 42.6% (123 of 289 specimens). Of these, 30.9% (38 of 123 specimens) were myoinvasive, and 10.6% (13 of 123 specimens) involved the outer 50% of the myometrium. Among the women who had hysterectomy specimens with carcinoma, 14 of 74 women (18.9%) had a study panel biopsy consensus diagnosis of less than AEH, 45 of 115 women (39.1%) had a study panel biopsy consensus diagnosis of AEH, and 54 of 84 women (64.3%) had a study panel diagnosis of carcinoma. Among women who had no consensus in their biopsy diagnosis, 10 of 16 women (62.5%) had carcinoma in their hysterectomy specimens. CONCLUSIONS. The prevalence of endometrial carcinoma in patients who had a community hospital biopsy diagnosis of AEH was high (42.6%). When considering management strategies for women who have a biopsy diagnosis of AEH, clinicians and patients should take into account the considerable rate of concurrent carcinoma.

AB - BACKGROUND. Adenocarcinoma of the endometrium is the most common gynecologic malignancy in the United States, accounting for approximately 36,000 diagnoses of invasive carcinoma annually. The most common histologic type, endometrioid adenocarcinoma (EC), accounts for 75-80% of patients. The objective of this work was to estimate the prevalence of concurrent carcinoma in women with a biopsy diagnosis of the precursor lesion, atypical endometrial hyperplasia (AEH). METHODS. This prospective cohort study included women who had a community diagnosis of AEH. Diagnostic biopsy specimens were reviewed independently by three gynecologic pathologists who used International Society of Gynecologic Pathologists/World Health Organization criteria. Study participants underwent hysterectomy within 12 weeks of entry onto protocol without interval treatment. The hysterectomy slides also were reviewed by the study pathologists, and their findings were used in the subsequent analyses. RESULTS. Between November 1998 and June 2003, 306 women were enrolled on the study. Of these, 17 women were not included in the analysis: Two patients had unreadable slides because of poor processing or insufficient tissue, 2 patients had only slides that were not endometrial, the slides for 5 patients were not available for review, and 8 of the hysterectomy specimens were excluded because they showed evidence of interval intervention, either progestin effect or ablation. In total, 289 patients were included in the current analysis. The study panel review of the AEH biopsy specimens was interpreted as follows: 74 of 289 specimens (25.6%) were diagnosed as less than AEH, 115 of 289 specimens (39.8%) were diagnosed as AEH, and 84 of 289 specimens (29.1%) were diagnosed as endometrial carcinoma. In 5.5% (16 of 289 specimens), there was no consensus on the biopsy diagnosis. The rate of concurrent endometrial carcinoma for analyzed specimens was 42.6% (123 of 289 specimens). Of these, 30.9% (38 of 123 specimens) were myoinvasive, and 10.6% (13 of 123 specimens) involved the outer 50% of the myometrium. Among the women who had hysterectomy specimens with carcinoma, 14 of 74 women (18.9%) had a study panel biopsy consensus diagnosis of less than AEH, 45 of 115 women (39.1%) had a study panel biopsy consensus diagnosis of AEH, and 54 of 84 women (64.3%) had a study panel diagnosis of carcinoma. Among women who had no consensus in their biopsy diagnosis, 10 of 16 women (62.5%) had carcinoma in their hysterectomy specimens. CONCLUSIONS. The prevalence of endometrial carcinoma in patients who had a community hospital biopsy diagnosis of AEH was high (42.6%). When considering management strategies for women who have a biopsy diagnosis of AEH, clinicians and patients should take into account the considerable rate of concurrent carcinoma.

KW - Atypia

KW - Biopsy

KW - Consensus diagnosis

KW - Endometrial hyperplasia

KW - Endometrioid adenocarcinoma

KW - Hysterectomy

UR - http://www.scopus.com/inward/record.url?scp=32544432714&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=32544432714&partnerID=8YFLogxK

U2 - 10.1002/cncr.21650

DO - 10.1002/cncr.21650

M3 - Article

VL - 106

SP - 812

EP - 819

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 4

ER -