Risk of endometrial carcinoma in patients with atypical endometrial hyperplasia in a population of predominantly racial and ethnic minorities, a single institution study

OBJECTIVE: To identify clinicopathologic predictors of concurrent endometrial carcinoma (EC) and need for lymph node assessment at time of hysterectomy for atypical endometrial hyperplasia (AEH) in a minority-enriched population. METHODS: Retrospective analysis of AEH cases treated definitively via hysterectomy at a single urban center from 2014 to 2022. Demographic and clinicopathologic characteristics were analyzed using univariate and multivariate regression modeling to identify independent risk factors. RESULTS: 123 AEH patients (45% Hispanic, 22% Black, 20% non-Black/non-Hispanic other, 13% undisclosed) were included; 56% with EC at hysterectomy. In the multivariate model, hypertension increased EC odds (OR 5.52, 95% CI 1.56-19.62). Concurrent adenomyosis (OR 0.26, 95% CI 0.07-0.91) and endometrial polyps (OR 0.25, 95% CI 0.08-0.81) were independently associated with reduced EC odds. Of the 62 EC cases evaluable, 24 (39%) met Mayo criteria on final histopathologic review, representing an overall 21% likelihood risk. Lack of antecedent medical care (p = 0.047) increased likelihood of meeting Mayo criteria. In the multivariate model, endometrial echogenicity (EE) ≥2 cm was associated with increased odds of meeting Mayo criteria (OR 13.22, 95% CI, 1.62-108.17), while adenomyosis presence was negatively associated with concurrent cancer meeting Mayo criteria (OR, 0.22, 95% CI, 0.05-0.98). CONCLUSIONS: In an underrepresented urban population, rates of EC and patients at risk for nodal involvement as defined by Mayo criteria are higher than previously reported. Novel investigation of other intrauterine pathologies demonstrated association of adenomyosis with improved prognosis. No racial/ethnic differences were found in this single-center experience. Factors associated with inequity, however, negatively impact cancer probability and risk stratification.