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Original research
Concurrent endometrial cancer in atypical endometrial hyperplasia and the role of sentinel lymph nodes: clinical insights from a multicenter experience
  1. Andrea Rosati1,2,
  2. Virginia Vargiu1,
  3. Vito Andrea Capozzi3,
  4. Diana Giannarelli4,
  5. Emilia Palmieri2,
  6. Alessandro Baroni2,
  7. Emanuele Perrone1,
  8. Roberto Berretta3,
  9. Francesco Cosentino5,
  10. Giovanni Scambia1,2 and
  11. Francesco Fanfani1,2
    1. 1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
    2. 2Università Cattolica del Sacro Cuore, Rome, Italy
    3. 3Department of Medicine and Surgery, University of Parma, Parma, Italy
    4. 4Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
    5. 5Department of Medicine and Health Sciences "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Molise, Italy
    1. Correspondence to Dr Andrea Rosati, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; dott.andrearosati89{at}gmail.com

    Abstract

    Objective This study aimed to evaluate the prevalence of concurrent endometrial cancer in patients pre-operatively diagnosed with atypical endometrial hyperplasia undergoing hysterectomy. Additionally, we assessed the occurrence of high to intermediate-risk and high-risk tumors according to the ESGO-ESTRO-ESP classification. The study also compared surgical outcomes and complications between patients undergoing simple hysterectomy and those undergoing hysterectomy with sentinel lymph node biopsy.

    Methods In this multicenter retrospective study, patients with a pre-operative diagnosis of atypical endometrial hyperplasia were identified and divided into two groups: Group 1, which included patients treated with total hysterectomy with or without bilateral salpingo-oophorectomy, and Group 2, where sentinel lymph node biopsy was incorporated into the standard surgical treatment.

    Results Among 460 patients with atypical endometrial hyperplasia, 192 received standard surgical management (Group 1) and 268 underwent sentinel lymph node biopsy (Group 2). A total of 47.2% (95% CI 42.6% to 51.7%) of patients were upgraded to endometrial cancer on final histopathological examination. High to intermediate-risk and high-risk tumors constituted 12.3% and 9.2% in Group 2 and 7.4% and 3.7% in Group 1. Lymph node metastases were identified in 7.6% of patients with concurrent endometrial cancer who underwent nodal assessment with at least unilateral mapping. Of the 12 sentinel lymph node metastases, 75.0% were micrometastases, 16.7% macrometastases, and 8.3% isolated tumor cells. No significant differences were found in estimated blood loss, operative time, and intra-operative and post-operative complications between the two groups. The rate of patients undergoing sentinel lymph node biopsy doubled every 2 years (OR 2.010, p<0.001), reaching 79.1% in the last 2 years.

    Conclusion This study found a prevalence of concurrent endometrial cancer of 47.2%, and sentinel lymph node biopsy provided prognostic and therapeutic information in 60.8% of cases. It also allowed for the adjustment of adjuvant therapy in 12.3% of high to intermediate-risk patients without increasing operative time or complication rates.

    • Endometrial Hyperplasia
    • Endometrial Neoplasms
    • Sentinel Lymph Node

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2023-005202

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • Contributors AR is the guarantor of the study. AR: conceptualization, data curation, formal analysis, methodology, writing - original draft. VV: data curation, formal analysis, methodology, writing - original draft. VAC: data curation, methodology. DG: formal analysis. EP: data curation. AB: data curation. EP: data curation. RB: writing - review and editing, supervision. FC: writing - review and editing, supervision, validation. GS: project administration, supervision, validation. FF: project administration, writing - review and editing, supervision, validation. All authors discussed the results and contributed to the final manuscript.

      • 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 None declared.

      • 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.