Risk Factors Analysis Of Endometrioid Adenocarcinoma In Hysterectomy Specimens For Preoperative Diagnosis Of Atypical Endometrial Hyperplasia

Objective: To explore the risk factors of endometrioid adenocarcinoma(ADCA)associated with atypical endometrial hyperplasia(AEH)by retrospective analysis of the clinical and pathological data of patients with AEH diagnosed by curettage or hysteroscopy biopsy and subsequent hysterectomy.Methods:Collecting the cases diagnosed as AEH before operation and then hysterectomy in our hospital from January 2007 to October 2018.Including the cases diagnosed as AEH after re-reading.According to the pathological results of paraffin wax after hysterectomy,the patients were divided into non-cancer group and cancer group.The clinical and pathological data of the two groups were analyzed and compared,and the risk factors of AEH combined with ADCA were explored.Results:1.67 cases of AEH were diagnosed before operation,40 cases were diagnosed as AEH after re-reading,the diagnostic coincidence rate was 59.7%(40/67);40 cases were eventually included,25 cases were non-cancer group,15 cases were cancer group,and the risk of AEH combined with ADCA was 37.5%(15/40).2.In endometrioid adenocarcinoma group,The depth of infiltration:Limited to endometrium 46.7%(7/15),superficial myometrial infiltration 46.7%(7/15),deep myometrial infiltration 6.7%(1/15).FIGO staging:86.7%(13/15)in stage I A,6.7%(1/15)in stage I B and 6.7%(1/15)in stage IIIA.Differentiation:Highly differentiated 73.3%(11/15),moderately differentiated 20.0%(3/15)and poorly differentiated 6.7%(1/15).3.Age,menarche age,menopausal status,number of endometrial paraffin blocks,AEH score and AEH lesion range were risk factors for AEH with ADCA(P < 0.05).Sampling method,body mass index(BMI),marriage age,ultrasound endometrial thickness,fertility,number of uterine operations,complications,cancer history of immediate relatives,time interval between the first diagnosis of AEH and hysterectomy,initial symptoms,intraoperative caesarean endometrium,number of preoperative endometrial biopsies,AEH with endometrial polyps,AEH with metaplasia,AEH with neutrophil/cell debris/necrosis,no complications It was the risk factor of AEH combined with ADCA(P < 0.05).Conclusions:1.Preoperative diagnosis of AEH in hysterectomy specimens is associated with a higher risk of ADCA(37.5%),most of which are highly differentiated,limited to endometrial or superficial myometrial infiltration,stage I A;2.The diagnostic consistency rate of AEH was unsatisfactory(59.7%).3.Patients over 50 years old,menopausal,late menarche,non-focal lesions and severe AEH are more likely to have ADCA after hysterectomy.4.ADCA can be easily detected in more than 6 AEH paraffin samples of endometrium after operation,which should be paid attention to in clinical and pathological practice.