Case Report
Endometrial Cancer After Endometrial Ablation: Systematic Review of Medical Literature

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Abstract

Data are limited regarding the occurrence of endometrial cancer after endometrial ablation (EA). A systematic review of the English-language medical literature was performed of cases of endometrial cancer after EA. This review included the present case report involving a 47-year-old woman with a diagnosis of stage IA, grade 1 endometrial adenocarcinoma 5 years after radiofrequency EA. The systematic literature review identified 22 endometrial cancer cases occurring after EA. Most (76.5%) were stage I at diagnosis. Time to endometrial cancer diagnosis ranged from 2 weeks to 10 years following EA. All but 3 cases involved patients with known endometrial cancer risk factors. To our knowledge, the present case is the first reported occurrence of endometrial cancer after radiofrequency EA. Endometrial cancer has been detected after EA at variable intervals. Occurrence of endometrial cancer after EA is low, yet it continues to be difficult to quantify through retrospective analyses.

Section snippets

Case Report

A 47-year-old woman, gravida 2, para 2, with previous vaginal deliveries and a history remarkable for hypertension and obesity (body mass index [BMI], 36) was evaluated at the Abnormal Uterine Bleeding Clinic in December 2009. The patient had undergone radiofrequency EA to treat menorrhagia in 2004, and had experienced amenorrhea for 5 years. An endometrial biopsy specimen obtained before EA demonstrated secretory endometrium. The uterine cavity was 4 cm long at ablation, and a global treatment

Materials and Methods

A systematic search of MEDLINE, EMBASE, the Cochrane Library, WoS, and SCOPUS from database inception to February 2010 was performed. All publications referring to endometrial ablation and endometrial cancer were searched. Two reviewers (M.M.A. and M.R.H.) independently reviewed titles and identified abstracts. Exclusion criteria included a diagnosis of endometrial cancer made before or at EA and non–English-language publications. Agreement in study selection was evaluated using κ statistics.

Results

The primary search identified 234 abstracts. Of these, 205 reports were excluded on review of titles and abstracts (Fig. 2). Of the other 29 reports, 3 were in a language other than English and 1 was not retrievable. On final review, 8 of 29 reports did not fulfill the study inclusion criteria. Mean (SD) κ agreement was 0.94 (0.04).

Overall, 17 studies in the literature reported endometrial cancer occurring after EA 2, 7, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25. A total of 21

Case Report

Concerns have been proposed about the possibility that symptoms of endometrial cancer may be masked through endometrial destruction with EA [10]. The present patient had a 6-month history of bleeding after a prolonged period of amenorrhea, which prompted evaluation. In addition, she had specific risk factors for endometrial cancer including obesity and hypertension. This presentation is consistent with endometrial cancer after EA in the case reports reviewed, which highlights that patient

Conclusion

The incidence of endometrial cancer after EA continues to be undefined, although it does not seem to be increased [7]. Herein are reported all known endometrial cancer cases after EA: 22 individual endometrial cancer cases after all types of EA including first- and second-generation EA procedures. To our knowledge, the present case report is the first known case in the literature of endometrial cancer after radiofrequency EA. Although the underlying mechanisms of first- and second-generation EA

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    The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

    Dr. Famuyide has a grant/research relationship with Hologic, Inc., in support of research in the area of gynecology.

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