DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20205235

Clinical study of risk factors and ultrasonographic correlation of endometrial hyperplasia according to the WHO classification 2014

Janu Mangala Kanthi, Sudha Sumathy, Anu Vasudevan, Gokulkumar Kamalanathandurai

Abstract


Background: Type 1 endometrial carcinoma is usually preceded by atypical hyperplasia. Nonatypical hyperplasia should be managed conservatively and atypical hyperplasia have to be managed aggressively. So, the diagnosis is crucial for its management.

Methods: The study population included women diagnosed with endometrial hyperplasia by histopathology as per WHO classification 2014 from the year January 2015 to February 2020.Women with endometrial polyp diagnosed by transvaginal ultrasonography and histopathology were excluded. Primary objective was to compare the endometrial thickness between the two types of hyperplasia. Secondary objective was to analyses the risk factors of the two types.

Results: In multivariate analysis of logistic regression, diabetic women have 1.57 times risk of developing atypia and obese women have 3.12 times risk of developing atypia. Polycystic ovarian disease is having borderline significance for causing atypia. There was significant difference in endometrial thickness between atypical and nonatypical hyperplasia (P=0.040). In premenopausal women, (P=0.069) the thickness difference in atypia is of only borderline significance. Heteroechoic pattern or cystic spaces in the endometrium also didn’t predict atypia.

Conclusions: Mean endometrial thickness is significantly different in atypical hyperplasia. Heteroechoic pattern of endometrium do not predict atypia. We need color doppler sonography to gain knowledge about atypia. Obesity and diabetes mellitus are significant risk factors of atypia.


Keywords


Endometrial hyperplasia, WHO classification, Risk factors, Endometrial thickness

Full Text:

PDF

References


New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Available at: https://europepmc.org/article/pmc/pmc5834925 #free-full-text. Accessed on 30 October 2020.

Giannella L, Cerami LB, Setti T, Bergamini E, Boselli F. Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding. Bio Med Res Int. 2019;2019:8598152.

Malpani A, Singer J, Wolverson MK, Merenda G. Endometrial hyperplasia: value of endometrial thickness in ultrasonographic diagnosis and clinical significance. J Clin Ultrasound. 1990;18(3):173-7.

Cheung AP. Ultrasound and menstrual history in predicting endometrial hyperplasia in polycystic ovary syndrome. Obstet Gynecol. 2001;98(2):325-31.

McCormick BA, Wilburn RD, Thomas MA, Williams DB, Maxwell R, Aubuchon M. Endometrial thickness predicts endometrial hyperplasia in patients with polycystic ovary syndrome. Fertil Steril. 2011;95(8):2625-7.

Kim M-J, Kim J-J, Kim SM. Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci. 2016;59(3):192-200.

El Agwany AS. Sonographic Criteria for Uterine Curettage: Suspecting Endometrial Neoplasia. Ind J Surg Oncol. 2019;10(4):679-84.

Alcázar JL, Bonilla L, Marucco J, Padilla AI, Chacón E, Manzour N, et al. Risk of endometrial cancer and endometrial hyperplasia with atypia in asymptomatic postmenopausal women with endometrial thickness≥11 mm: A systematic review and meta-analysis. J Clin Ultrasound. 2018;46(9):565-70.

Ghoubara A, Emovon E, Sundar S, Ewies A. Thickened endometrium in asymptomatic postmenopausal women - determining an optimum threshold for prediction of atypical hyperplasia and cancer. J Obstet Gynaecol J Inst Obstet Gynaecol. 2018;38(8):1146-9.

Ozelci R, Dilbaz B, Akpınar F, Kınay T, Baser E, Aldemir O, et al. The significance of sonographically thickened endometrium in asymptomatic postmenopausal women. Obstet Gynecol Sci. 2019;62(4):273-9.

Li Z, Li L. Risk of malignancies among asymptomatic postmenopausal women with thickened endometrium: A cohort study. Medicine. 2019;98(6):e14464.

Van den Bosch T, Verbakel JY, Valentin L, Wynants L, De Cock B, Pascual MA, et al. Typical ultrasound features of various endometrial pathology described using the International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2020;2.

Wise MR, Jordan V, Lagas A, Showell M, Wong N, Lensen S, et al. Obesity and endometrial hyperplasia and cancer in premenopausal women: A systematic review. Am J Obstet Gynecol. 2016;214(6):689e1-17.

Rosen MW, Tasset J, Kobernik EK, Smith YR, Johnston C, Quint EH. Risk Factors for Endometrial Cancer or Hyperplasia in Adolescents and Women 25 Years Old or Younger. J Pediatr Adolesc Gynecol. 2019;32(5):546-9.

Ricci E, Moroni S, Parazzini F, Surace M, Benzi G, Salerio B, et al. Risk factors for endometrial hyperplasia: results from a case-control study. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2002;12(3):257-60.

16. Liao C, Zhang D, Mungo C, Tompkins DA, Zeidan AM. Is diabetes mellitus associated with increased incidence and disease-specific mortality in endometrial cancer? A systematic review and meta-analysis of cohort studies. Gynecol Oncol. 2014;135(1):163-71.