Clinical significance of endometrial abnormalities: an observational study on 1020 women undergoing hysteroscopic surgery

Lodovico Patrizi; Carlo Ticconi; Barbara Borelli; Susanna Finocchiaro; Carlo Chiaramonte; Francesco Sesti; Alessandro Mauriello; Caterina Exacoustos; Luisa Casadei

doi:10.1186/s12905-022-01682-5

Clinical significance of endometrial abnormalities: an observational study on 1020 women undergoing hysteroscopic surgery

BMC Womens Health. 2022 Apr 7;22(1):106. doi: 10.1186/s12905-022-01682-5.

Affiliations

¹ Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy.
² Department of Surgical Sciences, Section of Gynecology and Obstetrics, University of Rome Tor Vergata, Rome, Italy. ticconi@med.uniroma2.it.
³ Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
⁴ Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.

^# Contributed equally.

Abstract

Background: The overall clinical significance of the finding of endometrial abnormalities in predicting premalignant/malignant endometrial lesions is still incompletely determined. For this reason the management, surgical or expectant, of women in which an endometrial abnormality has been detected is debated.

Methods: This retrospective study was carried out on 1020 consecutive women, 403 premenopausal and 617 postmenopausal, who underwent operative hysteroscopy in a University Hospital for suspected endometrial abnormalities, which were detected by transvaginal ultrasound (TVS) and/or office hysteroscopy. In these women, the clinical characteristics and findings at TVS and hysteroscopy were evaluated in relation to the presence/absence of premalignant/malignant endometrial lesions at pathology report.

Results: The clinical characteristics considered were significantly different when the study women were compared according to their menopausal status. Premalignant/malignant lesions were found in 34/1020 (3.33%) women. Complex hyperplasia with atypia and endometrial cancer were detected in 22 (2.15%) and 12 (1.17%) cases, respectively. The postmenopausal women had a significantly higher risk of premalignant/malignant lesions than premenopausal women (O.R. = 5.098 [95% C.I.: 1.782-14.582], P < 0.005). This risk was even higher when abnormal uterine bleeding (AUB) was present (O.R. = 5.20 [95% C.I.: 2.38-11.35], P < 0.0001). The most significant associations with premalignant/malignant endometrial lesions were BMI, AUB in postmenopause, overall polyp size, atypical aspect of endometrial polyps at hysteroscopy, postmenopausal status, diabetes mellitus and patient age.

Conclusions: The results of the present study suggest that the proper, aggressive or expectant, management of endometrial abnormalities should take into account both ultrasonographic and hysteroscopic findings together with the specific clinical characteristics of the patients.

Keywords: AUB; Endometrial atypia and cancer; Endometrial polyps; Hysteroscopy; Menopause; Transvaginal ultrasonography.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Endometrial Neoplasms* / pathology
Endometrial Neoplasms* / surgery
Endometrium / diagnostic imaging
Endometrium / pathology
Female
Humans
Hysteroscopy / methods
Polyps* / diagnostic imaging
Polyps* / surgery
Precancerous Conditions*
Pregnancy
Retrospective Studies
Ultrasonography
Uterine Diseases* / diagnostic imaging
Uterine Diseases* / surgery
Uterine Hemorrhage / etiology
Uterine Neoplasms* / pathology