Endometrial intraepithelial neoplasia: clinical correlates and outcomes
Luwam G Semere1, Emily Ko, Natasha R Johnson
1From the Departments of Obstetrics and Gynecology and Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
Objective:
To estimate cancer outcome and outcome predictors of women with endometrial intraepithelial neoplasia (EIN).
Methods:
Outcomes of women with first diagnosis of EIN ("index biopsy") were determined by follow-up pathology. Patient characteristics were correlated with EIN regression, EIN persistence, and progression to cancer.
Results:
Fifteen percent (95% confidence interval [CI] 9.8-20.8%, 26 of 177) of index EIN biopsy samples had concurrent cancer. Of the women with cancer-free index EIN biopsy samples and follow-up by hysterectomy or more than 18 months of surveillance, 25% (95% CI 18.4-33.3%, 36 of 142) showed regression, 35% (95% CI 27.4-43.7%, 50 of 142) showed persistence, and 39% (95% CI 31.3-48.0%, 56 of 142) showed progression. Nonwhite ethnicity and progestin treatment reduced cancer outcomes (odds ratio [OR] 0.16, 95% CI 0.03-0.84 and OR 0.24, 95% CI 0.08-0.70, respectively), whereas body mass index greater than 25 increased malignant outcomes (body mass index 25 or higher, OR 3.05, 95% CI 1.10-8.45).
Conclusion:
Endometrial intraepithelial neoplasia confers a high risk of cancer, but individual patient outcomes cannot be predicted. Management should include exclusion of concurrent carcinoma and consideration of hysterectomy.
