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Assessing the Reliability of Hysteroscopic Sampling Methods for Diagnosing Atypical Endometrial Hyperplasia.
Luca Giannella1, Francesco Piva2, Giovanni Delli Carpini1
1Gynecologic Section, Woman's Health Sciences Department, Polytechnic University of Marche, 60123 Ancona, Italy.
Cancers
|September 27, 2025
Summary
Atypical endometrial hyperplasia (AEH) diagnosis may hide endometrial cancer (EC). Hysteroscopic endometrial resection showed a lower EC underestimation rate than hysteroscopic biopsy in premenopausal women, suggesting method choice is crucial for fertility-sparing management.
Area of Science:
- Gynecology
- Oncology
- Surgical Pathology
Background:
- Atypical endometrial hyperplasia (AEH) diagnosis carries a significant risk of concurrent endometrial cancer (EC).
- Accurate diagnosis is critical, especially for premenopausal women desiring fertility preservation, who may receive conservative management.
- The diagnostic accuracy of hysteroscopic sampling methods for AEH requires further investigation.
Purpose of the Study:
- To compare the underestimation rate of endometrial cancer (EC) in patients diagnosed with atypical endometrial hyperplasia (AEH) using hysteroscopic biopsy (HSC-bio) versus hysteroscopic resection (HSC-res).
- To evaluate the performance of these hysteroscopic sampling methods in premenopausal and postmenopausal women.
Main Methods:
- A multi-institutional retrospective study included 536 women diagnosed with AEH who subsequently underwent hysterectomy.
- Patients were stratified into two groups based on the initial hysteroscopic sampling method: HSC-bio or HSC-res.
- Univariate and multivariate analyses were employed to compare EC underestimation rates and evaluate procedure performance.
Main Results:
- Overall, 29.9% of women with AEH were found to have EC upon hysterectomy.
- The EC underestimation rate was 32.1% for HSC-bio and 24.2% for HSC-res (p=0.07) in the overall cohort.
- In premenopausal women (n=161), EC underestimation was significantly higher with HSC-bio (28.8%) compared to HSC-res (14.0%) (p=0.034).
Conclusions:
- No significant difference in endometrial cancer underestimation was observed between hysteroscopic biopsy and resection in the overall cohort of women with AEH.
- Hysteroscopic resection demonstrated a potentially lower rate of EC underestimation in premenopausal women, a finding of clinical significance for fertility-sparing management.
- The choice of hysteroscopic sampling method may impact diagnostic accuracy, particularly in premenopausal women with AEH.
