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Original Research

Open Access

Predictive factors of concurrent endometrial carcinoma and the role of frozen section in patients with preoperative diagnosis of atypical endometrial hyperplasia

  • Yin-Juan Chang1,†
  • Yong-Shen Fan2,†
  • Reshmi Hareendra Kariyapperuma3
  • Yong-An Xu4,*,

1Department of Obstetrics and Gynecology, Women’s Hospital School of Medicine Zhejiang University, 310006 Hangzhou, Zhejiang, China

2Department of General Surgery, Zhejiang Hospital, 310006 Hangzhou, Zhejiang, China

3School of Medicine, Zhejiang University, 310058 Hangzhou, Zhejiang, China

4Department of Emergency Medicine, The Second Affiliated Hospital of Medical College, Zhejiang University, 310009 Hangzhou, Zhejiang, China

DOI: 10.22514/ejgo.2024.044 Vol.45,Issue 3,June 2024 pp.16-20

Submitted: 25 July 2023 Accepted: 20 September 2023

Published: 15 June 2024

*Corresponding Author(s): Yong-An Xu E-mail:

† These authors contributed equally.


Type 1 endometrial adenocarcinoma or endometrioid adenocarcinoma had developed from a precursor lesion known as atypical endometrial hyperplasia (AEH). This study aimed to evaluate the rates and risk factors of concurrent endometrial carcinoma in patients with preoperative diagnosis of AEH and assessed the role of intraoperative frozen section examination among these patients. Sixty-six patients undergone hysterectomy after the preoperative diagnosis of AEH via diagnostic curettage or hysteroscopy biopsy, were included in this retrospective cohort study. The major study outcomes were the rates and risk factors of co-existent endometrial cancer and the frozen section efficacy in detecting concurrent invasive disease. 31.81% AEH patients had endometrial cancer diagnosis in hysterectomy specimens. Among these endometrial cancer patients, 18 were of Stage IA, 1 of Stage IB, and 2 of Stage II. Stage III or IV was not detected in any of the patients. Patients preoperatively diagnosed as AEH via hysteroscopy had less probability of co-existent endometrial carcinoma than those diagnosed by endometrial curettage (17.24% vs. 43.24%) (p < 0.05). BMI (Body Mass Index) >28 kg/m2, post-menopausal status, and endometrial thickness were the determinant factors in diagnosing endometrial carcinoma through final histopathology of AEH patients (p < 0.05). Regarding presence or absence of concomitant endometrial carcinoma, the frozen section diagnoses were consistent with the final histopathology in 47.06% patients. Co-existent endometrial cancer with AEH was prevalent and possessed good prognostic features. The predictive factors of harboring concomitant endometrial cancer included older age, overweight, and endometrial thickness. Intraoperative frozen section analysis of AEH might assist in the clinical decision-making during surgery.


Atypical endometrial hyperplasia; Endometrial carcinoma; Intraoperative frozen section; Hysterectomy; Risk factors; Hysteroscopy

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Yin-Juan Chang,Yong-Shen Fan,Reshmi Hareendra Kariyapperuma,Yong-An Xu. Predictive factors of concurrent endometrial carcinoma and the role of frozen section in patients with preoperative diagnosis of atypical endometrial hyperplasia. European Journal of Gynaecological Oncology. 2024. 45(3);16-20.


[1] Hyuna Sung, Jacques Ferlay, Rebecca L Siegel, Mathieu Laversanne, Isabelle Soerjomataram, Ahmedin Jemal, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[2] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[3] Nees LK, Heublein S, Steinmacher S, Juhasz-Böss I, Brucker S, Tempfer CB, et al. Endometrial hyperplasia as a risk factor of endometrial cancer. Archives of Gynecology and Obstetrics. 2022; 306: 407–421.

[4] Barakat A, Ismail A, Chattopadhyay S, Davies Q. Endometrial cancer incidence in patients with atypical endometrial hyperplasia according to mode of management. Cancer Diagnosis & Prognosis. 2022; 2: 564–568.

[5] Ring KL, Mills AM, Modesitt SC. Endometrial hyperplasia. Obstetrics & Gynecology. 2022; 140: 1061–1075.

[6] Sullivan MW, Philp L, Kanbergs AN, Safdar N, Oliva E, Bregar A, et al. Lymph node assessment at the time of hysterectomy has limited clinical utility for patients with pre-cancerous endometrial lesions. Gynecologic Oncology. 2021; 162: 613–618.

[7] Morotti M, Menada MV, Moioli M, Sala P, Maffeo I, Abete L, et al. Frozen section pathology at time of hysterectomy accurately predicts endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Gynecologic Oncology. 2012; 125: 536–540.

[8] Widra EA, Dunton CJ, McHugh M, Palazzo JP. Endometrial hyperplasia and the risk of carcinoma. International Journal of Gynecological Cancer. 1995; 5: 233–235.

[9] Trimble CL, Kauderer J, Zaino R, Silverberg S, Lim PC, Burke JJ, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia. Cancer. 2006; 106: 812–819.

[10] Giede KC, Yen T, Chibbar R, Pierson RA. Significance of concurrent endometrial cancer in women with a preoperative diagnosis of atypical endometrial hyperplasia. Journal of Obstetrics and Gynaecology Canada. 2008; 30: 896–901.

[11] Erdem B, Aşıcıoğlu O, Seyhan NA, Peker N, Ülker V, Akbayır Ö. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? International Journal of Surgery. 2018; 53: 350–353.

[12] Gao Y, Zhao M, Dai X, Tong M, Wei J, Chen Q. The prevalence of endometrial cancer in pre- and postmenopausal Chinese women. Menopause. 2016; 23: 884–887.

[13] Kimura T, Kamiura S, Komoto T, Seino H, Tenma K, Ohta Y, et al. Clinical over- and under-estimation in patients who underwent hysterectomy for atypical endometrial hyperplasia diagnosed by endometrial biopsy: the predictive value of clinical parameters and diagnostic imaging. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2003; 108: 213–216.

[14] Rakha E, Wong SC, Soomro I, Chaudry Z, Sharma A, Deen S, et al. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. American Journal of Surgical Pathology. 2012; 36: 1683–1690.

[15] Matsuo K, Ramzan AA, Gualtieri MR, Mhawech-Fauceglia P, Machida H, Moeini A, et al. Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasia. Gynecologic Oncology. 2015; 139: 261–267.

[16] Pu H, Wen X, Luo D, Guo Z. Regulation of progesterone receptor expression in endometriosis, endometrial cancer, and breast cancer by estrogen, polymorphisms, transcription factors, epigenetic alterations, and ubiquitin-proteasome system. The Journal of Steroid Biochemistry and Molecular Biology. 2023; 227: 106199.

[17] Capozzi VA, Rosati A, Rumolo V, Ferrari F, Gullo G, Karaman E, et al. Novelties of ultrasound imaging for endometrial cancer preoperative workup. Minerva Medica. 2021; 112: 3–11.

[18] Indermaur MD, Shoup B, Tebes S, Lancaster JM. The accuracy of frozen pathology at time of hysterectomy in patients with complex atypical hyperplasia on preoperative biopsy. American Journal of Obstetrics and Gynecology. 2007; 196: e40–e42.

[19] Ben-Yehuda OM, Kim YB, Leuchter RS. Does hysteroscopy improve upon the sensitivity of dilatation and curettage in the diagnosis of endometrial hyperplasia or carcinoma? Gynecologic Oncology. 1998; 68: 4–7.

[20] Bedner R, Rzepka-Górska I. Hysteroscopy with directed biopsy versus dilatation and curettage for the diagnosis of endometrial hyperplasia and cancer in perimenopausal women. European Journal of Gynaecological Oncology. 2007; 28: 400–402.

[21] De Rocco S, Buca D, Oronzii L, Petrillo M, Fanfani F, Nappi L, et al. Reproductive and pregnancy outcomes of fertility-sparing treatments for early-stage endometrial cancer or atypical hyperplasia: a systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2022; 273: 90–97.

[22] Vitale SG, Riemma G, Carugno J, Chiofalo B, Vilos GA, Cianci S, et al. Hysteroscopy in the management of endometrial hyperplasia and cancer in reproductive aged women: new developments and current perspectives. Translational Cancer Research. 2020; 9: 7767–7777.

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