Acta Obstet Gynecol Scand. 2016 Sep 16. doi: 10.1111/aogs.13022

Author
Visser NC¹, Sparidaens EM², van den Brink JW³, Breijer MC⁴, Boss EA⁵, Veersema S⁶, Siebers AG⁷, Bulten J⁷, Pijnenborg JM⁸, Bekkers RL².

Author information
¹Department of Pathology, Radboud University Medical Center, Nijmegen. nicole.visser@radboudumc.nl.
²Department of Obstetrics and Gynecology, Radboud university medical center, Nijmegen.
³Department of Obstetrics and Gynecology, Canisius-Wilhemina Hospital, Nijmegen.
⁴Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam.
⁵Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven and Eindhoven.
⁶Department of Obstetrics and Gynecology, St. Antonius Hospital, Nieuwegein.
⁷Department of Pathology, Radboud University Medical Center, Nijmegen.
⁸Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.

Abstract

INTRODUCTION:

Women with postmenopausal bleeding and endometrial thickness >4 mm undergo endometrial sampling to exclude endometrial cancer. The aim of this study is to investigate the relative risk of developing endometrial cancer in a prospective cohort after initial work-up for postmenopausal bleeding showing reassuring histology or insufficient sampling.

MATERIAL AND METHODS:

All women presenting with postmenopausal bleeding were prospectively included from January 2009 to April 2011. Follow-up data were collected from patient charts and PALGA (Dutch Pathology Registry). Hazard ratios for endometrial cancer were determined by calculating standardized incidence ratios.

RESULTS:

A total of 668 women were included and 568 women were available for follow-up (median follow-up time 47 (range 7-63) months). Women who presented with postmenopausal bleeding, endometrial thickness >4 mm and hyperplasia without atypia on biopsy at the first presentation showed a significantly increased risk (standardized incidence ratio 17.15, 95% CI; 1.96-61.93) of being diagnosed with endometrial cancer during the first four years of follow-up compared to the age-specific population. All women that developed endometrial cancer after initial reassuring histology presented with recurrent postmenopausal bleeding. None of the women with endometrial thickness >4 mm and no or insufficient sample for histology at the first presentation developed endometrial cancer during the follow-up.

CONCLUSIONS:

Although in general, women with endometrial hyperplasia without atypia are considered to have a low risk for cancer, we observed a significant long-term risk of endometrial cancer after postmenopausal bleeding. Whether additional diagnostics or a more stringent follow-up regimen would be cost-effective, needs to be studied. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS:

Endometrial cancer; endometrial hyperplasia without atypia; endometrial sampling; long term incidence; postmenopausal bleeding