Skip to main content

Advertisement

SpringerLink
Log in

Occult endometrial cancer in women undergoing hysterectomy for benign indications: a retrospective cohort study in a tertiary hospital in China

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the feasibility of further reducing the incidence of occult endometrial cancer in women undergoing hysterectomy for benign gynecological indications.

Methods

Patients who underwent hysterectomies for presumed benign gynecologic conditions at Peking Union Medical College Hospital were retrospectively identified. Patients with occult endometrial cancer, which was defined as endometrial cancer diagnosed on postoperative histopathology with no preoperative confirmed malignancy, were selected.

Results

24/7558 (0.32%; 95% CI 0.20–0.47%) patients undergoing hysterectomy for benign indications had occult endometrial cancer. Asymptomatic patients with normal endometrial imaging all tended to have favorable pathology. Heavy menstrual bleeding was the most overlooked AUB pattern in the premenopausal group. In the postmenopausal group, all the patients with serous adenocarcinoma or G3 endometrioid adenocarcinoma histology/stage T1b disease/LVSI space invasion had a history of persistent or recurrent PMB ≥ 6 months and/or an intracavitary lesion > 20 mm in diameter. 3/4 of the samples of the postmenopausal patients did not have adequate endometrium for evaluation.

Conclusion

To further reduce the incidence of occult endometrial cancer, physicians should focus on the patient’s bleeding pattern and actively implement endometrial sampling whenever indicated. Transvaginal ultrasonography is a valuable preoperative evaluation. Hysteroscopy with directed biopsy is the preferred procedure in postmenopausal patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All available data are presented in this paper.

References

  1. American College of, O. and Gynecologists, (2005) ACOG practice bulletin clinical management guidelines for obstetrician gynecologists, number 65, august 2005: management of endometrial cancer. Obstet Gynecol. https://doi.org/10.1097/00006250-200508000-00050

    Article  Google Scholar 

  2. Kimura T et al (2004) Abnormal uterine bleeding and prognosis of endometrial cancer. Int J Gynaecol Obstet 85(2):145–150. https://doi.org/10.1016/j.ijgo.2003.12.001

    Article  CAS  PubMed  Google Scholar 

  3. Seebacher V et al (2009) The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study. BMC Cancer 9:460. https://doi.org/10.1186/1471-2407-9-460

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tsakiridis I, Giouleka S, Koutsouki G, Kostakis N, Kalogiannidis I, Kourtis A, Athanasiadis A, Goulis DG, Dagklis T (2022) Investigation and management of abnormal uterine bleeding in reproductive-aged women: a descriptive review of national and international recommendations. Eur J Contracept Reprod Health Care 27(6):504–517. https://doi.org/10.1080/13625187.2022.2112169

    Article  PubMed  Google Scholar 

  5. Papakonstantinou E, Adonakis G (2022) Management of pre-, peri-, and post-menopausal abnormal uterine bleeding: when to perform endometrial sampling? Int J Gynaecol Obstet 158(2):252–259. https://doi.org/10.1002/ijgo.13988

    Article  PubMed  Google Scholar 

  6. Vitale SG, Buzzaccarini G, Riemma G, Pacheco LA, Di Spiezio SA, Carugno J, Chiantera V, Török P, Noventa M, Haimovich S, De Franciscis P, Perez-Medina T, Angioni S, Laganà AS (2023) Endometrial biopsy: indications, techniques and recommendations. an evidence-based guideline for clinical practice. J Gynecol Obstet Hum Reprod 52(6):102588. https://doi.org/10.1016/j.jogoh.2023.102588

    Article  PubMed  Google Scholar 

  7. Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H (2023) Management of women with abnormal uterine bleeding: clinical practice guidelines of the French National College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 288:90–107. https://doi.org/10.1016/j.ejogrb.2023.07.001

    Article  CAS  PubMed  Google Scholar 

  8. Committee on Practice Bulletins—Gynecology (2012) Practice bulletin no: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol 120:197–206. https://doi.org/10.1097/AOG.0b013e318262e320

    Article  Google Scholar 

  9. National Collaborating Centre for Women’s and Children’s Health (2007) Heavy Menstrual Bleeding. RCOG Press, London

    Google Scholar 

  10. Exceptional Surveillance of Heavy Menstrual Bleeding (2021) assessment and management (NICE guideline NG88) [Internet]. National Institute for Health and Care Excellence (NICE), London

    Google Scholar 

  11. Munro MG, Critchley HOD, Fraser IS, Menstrual Disorders Committee FIGO (2018) The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet 143(3):393–408. https://doi.org/10.1002/ijgo.12666

    Article  PubMed  Google Scholar 

  12. Farquhar CM, Lethaby A, Sowter M, Verry J, Baranyai J (1999) An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding. Am J Obstet Gynecol 181(3):525–529. https://doi.org/10.1016/s0002-9378(99)70487-4

    Article  CAS  PubMed  Google Scholar 

  13. Ash SJ, Farrell SA, Flowerdew G (1996) Endometrial biopsy in DUB. J Reprod Med 41(12):892–896

    CAS  PubMed  Google Scholar 

  14. Farquhar CM (1999) An evidence-based guideline for the management of heavy menstrual bleeding. N Z Med J 112:174–177

    Google Scholar 

  15. MacGregor R, Jain V, Hillman S, Lumsden MA (2022) Investigating abnormal uterine bleeding in reproductive aged women. BMJ 16(378):e070906. https://doi.org/10.1136/bmj-2022-070906

    Article  Google Scholar 

  16. Smith-Bindman R et al (1998) Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280(17):1510–1517. https://doi.org/10.1001/jama.280.17.1510

    Article  CAS  PubMed  Google Scholar 

  17. Trimble CL et al (2006) Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: a gynecologic oncology group study. Cancer 106(4):812–819. https://doi.org/10.1002/cncr.21650

    Article  PubMed  Google Scholar 

  18. Theben JU et al (2013) Unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH): an analysis of 1584 LASH cases. Arch Gynecol Obstet 287(3):455–462. https://doi.org/10.1007/s00404-012-2559-0

    Article  PubMed  Google Scholar 

  19. Mahnert N et al (2015) Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications. Obstet Gynecol 125(2):397–405. https://doi.org/10.1097/AOG.0000000000000642

    Article  PubMed  Google Scholar 

  20. Takamizawa S et al (1999) Risk of complications and uterine malignancies in women undergoing hysterectomy for presumed benign leiomyomas. Gynecol Obstet Invest 48(3):193–196. https://doi.org/10.1159/000010172

    Article  CAS  PubMed  Google Scholar 

  21. Frick AC et al (2010) Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol 202:507. https://doi.org/10.1016/j.ajog.2010.01.077

    Article  Google Scholar 

  22. Ramm O et al (2012) Utility of preoperative endometrial assessment in asymptomatic women undergoing hysterectomy for pelvic floor dysfunction. Int Urogynecol J 23(7):913–917. https://doi.org/10.1007/s00192-012-1694-2

    Article  PubMed  Google Scholar 

  23. Soliman PT, Oh JC, Schmeler KM, Sun CC, Slomovitz BM, Gershenson DM, Burke TW, Lu KH (2005) Risk factors for young premenopausal women with endometrial cancer. Obstet Gynecol 105(3):575–580. https://doi.org/10.1097/01.AOG.0000154151.14516.f7

    Article  PubMed  Google Scholar 

  24. Pennant ME, Mehta R, Moody P, Hackett G, Prentice A, Sharp SJ, Lakshman R (2017) Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG 124(3):404–411. https://doi.org/10.1111/1471-0528.14385

    Article  CAS  PubMed  Google Scholar 

  25. Parsons LHP, Pedersen R, Richardson DL, Kho KA (2018) The prevalence of occult endometrial cancer in women undergoing hysterectomy for benign indications. Eur J Obstet Gynecol Reprod Biol 223:108–112. https://doi.org/10.1016/j.ejogrb.2018.02.017

    Article  PubMed  Google Scholar 

  26. Wagner P, Kommoss FKF, Kommoss S, Hartkopf AD, Pasternak I, Oberlechner E, Greif K, Wallwiener M, Neis F, Abele H, Krämer B, Reisenauer C, Staebler A, Wallwiener D, Brucker SY, Taran FA (2019) Unexpected malignant uterine pathology: Incidence, characteristics and outcome in a large single-center series of hysterectomies for presumed benign uterine disease. Gynecol Oncol 153(1):49–54. https://doi.org/10.1016/j.ygyno.2018.12.026

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by a grant from National High Level Hospital Clinical Research Funding (2022-PUMCH-C-031).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric and Gynecologic Disease, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People’s Republic of China

    Yang Cao, Honghui Shi & Xiuping Zhuo

Authors
  1. Yang Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Honghui Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiuping Zhuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HHS and YC contributed to the study conception and design. Material preparation, data collection and analysis were performed by YC and XPZ. The first draft of the manuscript was written by YC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Honghui Shi.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Peking Union Medical College Hospital (reference no: I-22PJ848).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cao, Y., Shi, H. & Zhuo, X. Occult endometrial cancer in women undergoing hysterectomy for benign indications: a retrospective cohort study in a tertiary hospital in China. Arch Gynecol Obstet (2024). https://doi.org/10.1007/s00404-024-07532-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00404-024-07532-z

Keywords

Search

Navigation