Complex atypical hyperplasia of the uterus: characteristics and prediction of underlying carcinoma risk

The objective of the study was to identify additional factors that may improve the ability to predict underlying carcinoma risk in patients with complex atypical hyperplasia (CAH) of the uterus.

All subjects diagnosed with CAH of the uterus on endometrial sampling from March 1994 to May 2008 were identified. CAH was classified as CAH suspicious, CAH polypoid, CAH focal, or CAH not otherwise specified (NOS). Subjects were then exclusively assigned to 1 of 3 categories: CAH suspicious, CAH NOS, or CAH focal and/or polypoid.

We identified 197 cases of CAH diagnosed on preoperative endometrial sampling. Carcinoma was subsequently diagnosed in the hysterectomy specimen in 67 subjects (34%). The risk of underlying carcinoma if assigning subjects as CAH suspicious, CAH NOS, or CAH polypoid and/or focal was 56%, 36%, and 20%, respectively (P < .001).

The risk of underlying carcinoma in patients with CAH on preoperative endometrial sampling is associated with the method of sampling and age and can be significantly modified by the nature of pathologic assessment.