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Endometrial cancer after endometrial ablation: a systematic review
  1. Tamara J Oderkerk1,2,
  2. Mileen R D van de Kar1,
  3. Karlijn M C Cornel3,
  4. Marlies Y Bongers1,2 and
  5. Peggy M A J Geomini1
  1. 1Department of Obstetrics and Gynecology, Máxima Medical Centre Location Veldhoven, Veldhoven, The Netherlands
  2. 2School for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Limburg, The Netherlands
  3. 3Department of Obstetrics and Gynecology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
  1. Correspondence to Tamara J Oderkerk, Department of Obstetrics and Gynecology, Maxima Medical Centre, Veldhoven 5500 MB, The Netherlands; tamara.oderkerk{at}mmc.nl

Abstract

Objective To investigate whether a previously performed endometrial ablation is associated with the development and diagnosis of endometrial cancer.

Methods First, a systematic review was performed of the articles reporting the incidence of endometrial cancer in patients treated with endometrial ablation. Second, a systematic review was performed to identify all individual cases of endometrial cancer after ablation to evaluate presenting symptoms, diagnostic work-up, potential risk factors, and the type and stage of the endometrial cancer. A systematic search was performed, using Medline, EMBASE, and the Cochrane Library databases, from inception through February 24, 2022.

Results Based on 11 included studies, the incidence of endometrial cancer in a population of 29 102 patients with a prior endometrial ablation ranged from 0.0% to 1.6%.

A total of 38 cases of endometrial cancer after ablation were identified. In 71% of cases (17 of 24 cases), vaginal bleeding was the first presenting symptom. With transvaginal ultrasound it was possible to identify and measure the endometrial thickness in eight cases. Endometrium sampling was successful in 16 of 18 described cases (89%). In 18 of 20 cases (90%) pathologic examination showed early-stage endometrioid adenocarcinoma (International Federation of Gynecology and Obstetrics stage I).

Conclusion Previous endometrial ablation is not associated with the development of endometrial cancer. Diagnostic work-up is not impeded by previous endometrial ablation. In addition, endometrial cancers after endometrial ablation are not detected at an advanced stage.

  • Endometrial Neoplasms
  • Endometrium
  • Surgical Procedures, Operative

Data availability statement

Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors TJO, MRDK, KMCC, PMG, and MYB were involved in conception and design of the study. TJO and MRDK drafted the first manuscript. All authors edited the manuscript and read and approved the submitted version. TJO is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MYB reports financial relationships with Gynesonics (device reduction in clinical trials), outside the submitted work. MYB is a member of the advisory board of Hologic. The remaining authors declare no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.