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Original Research

Open Access

Hysteroscopic-view of endometrial atypical hyperplasia. A helpful diagnostic tool in the care and treatment process?

  • Giancarlo Garuti1,*,
  • Paola Francesca Sagrada2
  • Maurizio Mirra3
  • Ottavia Fornaciari1
  • Giovanna Centinaio1
  • Andrea Finco1
  • Marco Soligo1

1Gynecology and Obstetrics Unit, Public Hospital of Lodi, 26900 Lodi, Italy

2Medical Oncology Unit, Public Hospital of Lodi, 26900 Lodi, Italy

3Pathology Unit, Public Hospital of Lodi, 26900 Lodi, Italy

DOI: 10.22514/ejgo.2024.022 Vol.45,Issue 2,April 2024 pp.8-15

Submitted: 11 June 2023 Accepted: 12 July 2023

Published: 15 April 2024

*Corresponding Author(s): Giancarlo Garuti E-mail:


This present study was conducted over a 10-year period to investigate the hysteroscopic-view features of Endometrial Atypical Hyperplasia (EAH) and evaluate the accuracy of hysteroscopy imaging in detecting concurrent Endometrial Carcinoma (EC). A total of 69 patients diagnosed with EAH via hysteroscopy-guided biopsy and subsequently undergoing hysterectomy were eligible for analysis, and the uterine specimen histology was used as a reference for comparison. Of the included patients, EAH was confirmed in 40 women based on the hysterectomy specimens, while EC was identified in 29 cases (42.0% underestimation). Among the 40 patients with EAH, hysteroscopic-view reports of 37 cases (92.5%) indicated benign conditions, mostly diagnosed as polyps or hyperplasia. In the group of 29 women with underestimated EC, hysteroscopic-view agreed with the definitive diagnosis in 20 cases (68.9%), while in 9 patients, non-neoplastic patterns were observed. Overall, hysteroscopic imaging reported a benign endometrial overgrowth in 46 patients, and among them, EAH was identified in 37 cases based on the hysterectomy specimen (80.4%). Hysteroscopic-view demonstrated a sensitivity, specificity, negative predictive value, and positive predictive value of 76.3%, 93.0%, 81.6% and 90.6%, respectively, in predicting EC among patients who underwent hysteroscopic biopsy and received a diagnosis of EAH. However, no specific hysteroscopic features were associated with EAH diagnosis. Overall, despite hysteroscopic-view showing suboptimal sensitivity in detecting a concurrent EC, it can still exclude the presence of underlying EC in approximately 80% of patients when hysteroscopic imaging indicates a non-neoplastic growth.


Atypical endometrial hyperplasia; Endometrial cancer; Endometrial biopsy; Hysteroscopy

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Giancarlo Garuti,Paola Francesca Sagrada,Maurizio Mirra,Ottavia Fornaciari,Giovanna Centinaio,Andrea Finco,Marco Soligo. Hysteroscopic-view of endometrial atypical hyperplasia. A helpful diagnostic tool in the care and treatment process?. European Journal of Gynaecological Oncology. 2024. 45(2);8-15.


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