Case ReportEndometrial Cancer After Endometrial Ablation: Systematic Review of Medical Literature
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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Cited by (39)
The incidence of unexpected uterine malignancy in women undergoing hysteroscopic myomectomy or polypectomy: A national population-based study
2018, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Through a large national health insurance database analysis, this study observed that the incidence of UUM diagnosed after hysteroscopic myomectomy was 0.86%. To the best of our knowledge, this study is the first to report the incidence of UUM diagnosed after hysteroscopic myomectomy, although there are several case reports on uterine sarcoma diagnosed after hysteroscopic resection or endometrial cancer [6,10,11]. Therefore, our results are the first large-scale study on this issue and may provide useful information to clinicians who perform hysteroscopic myomectomy or to women who are undergoing this procedure.
Endometrial Ablation
2018, Journal of Minimally Invasive GynecologyCitation Excerpt :On the other hand, office endometrial biopsy is often painful, and because of restricted access to the endometrial cavity, sampling is frequently impossible or inadequate [60]. Despite these limitations, in a systematic review of all cases of endometrial cancer diagnosed after endometrial ablation, endometrial biopsy was feasible and yielded an accurate diagnosis in 89% of cases [9]. Furthermore, approximately 77% of the cases were diagnosed with stage 1 endometrial cancer 6 months to 10 years after initial endometrial ablation; this is comparable with the general nonablation population in whom stage 1 cancers represent 73% of the cases, suggesting ablation may not delay diagnosis [61].
Late-onset endometrial ablation failure
2017, Case Reports in Women's HealthCitation Excerpt :Of the 24 cases available for analysis provided by AlHilli [57] and the author [58,59] abnormal uterine bleeding was present in 19 (79.2%) while pain was described as an important feature in 6 (25%) of the cases. Interestingly, EC can also be entirely asymptomatic as noted in 3 of AlHilli's [57] subjects raising the concern that the earliest signs of EC may be obscured. It is now understood that traditional evaluative tools for EC—transvaginal ultrasound, diagnostic hysteroscopy and endometrial biopsy—are often inadequate in the woman with a previous EA.
Response to Letter to the Editor: Author's Reply
2017, Journal of Minimally Invasive GynecologyManagement of Abnormal Uterine Bleeding with Emphasis on Alternatives to Hysterectomy
2016, Obstetrics and Gynecology Clinics of North AmericaEffects of Endometrial Ablation on Treatment Planning in Women With Endometrial Cancer
2016, Journal of Minimally Invasive GynecologyCitation Excerpt :There is no ultrasound-defined normal endometrial thickness in women with previous ablation, and cancer has been reported in women free of bleeding [11]. In their systematic review on endometrial cancer after endometrial ablation, AlHilli et al described the case of a woman with a thin endometrial stripe (3 mm) on transvaginal ultrasonography who was diagnosed with stage IA, grade 1 endometrial adenocarcinoma [1]. Morelli et al described the outcomes of 63 postmenopausal women who had previously undergone endometrial ablation [11].
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.