Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage.

Abstract:

OBJECTIVE:To evaluate whether preoperative dilation and curettage (D&C) lowers the risk of unexpected cancer at hysterectomy. METHODS:Women with complex atypical endometrial hyperplasia on sampling from January 2000 to May 2008 who underwent hysterectomy within 6 months were identified using a pathology database. Patient age, sampling procedures, and hysterectomy pathology were recorded. Women were categorized as having either an office biopsy-based evaluation or a curettage-based evaluation. The proportion of women with cancer at surgery was estimated and compared for the two groups. RESULTS:Of 824 women with complex atypical endometrial hyperplasia on initial sampling, 48% were found to have cancer. For 100 women, cancer was diagnosed preoperatively by additional sampling before hysterectomy. For the remaining 724, 298 (41%) had unexpected cancer at hysterectomy. The diagnosis of complex atypical endometrial hyperplasia was biopsy-based for 531 (73%) and curettage-based for 193 (27%). The risk of cancer for women who had a D&C was significantly lower than for those who had biopsy, but still of concern (30% compared with 45%, P<.001), as was the risk of myometrial invasion (18% compared with 25%, P=.05). Age was strongly correlated to risk of cancer, invasive cancer, and deeply invasive or grade 3 disease. CONCLUSION:Dilation and curettage lowered the risk of unexpected cancer compared with biopsy, but 18% of women still had invasive cancer found at hysterectomy. The risk of unexpected cancer is strongly related to age. Dilation and curettage can help detect cancer preoperatively but is not reliable for excluding cancer. LEVEL OF EVIDENCE:II.

journal_name

Obstet Gynecol

authors

Suh-Burgmann E,Hung YY,Armstrong MA

doi

10.1097/AOG.0b013e3181b190d5

subject

Has Abstract

pub_date

2009-09-01 00:00:00

pages

523-529

issue

3

eissn

0029-7844

issn

1873-233X

pii

00006250-200909000-00007

journal_volume

114

pub_type

杂志文章
  • Repair techniques for obstetric anal sphincter injuries: a randomized controlled trial.

    abstract:OBJECTIVE:To compare one-year outcomes of primary overlap versus end-to-end repair of the external anal sphincter after acute obstetric anal sphincter injury. METHODS:Women who sustained third-degree (3b = greater than 50% external anal sphincter thickness, 3c = internal sphincter injury) or fourth-degree (including a...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/01.AOG.0000218693.24144.bd

    authors: Fernando RJ,Sultan AH,Kettle C,Radley S,Jones P,O'Brien PM

    更新日期:2006-06-01 00:00:00

  • Peritoneal cytology of ovarian cancer patients receiving intraperitoneal therapy: quantitation of malignant cells and response.

    abstract::An analysis was performed of malignant and host cells found in peritoneal fluids obtained during intraperitoneal chemotherapy and immunotherapy in patients with ovarian cancer. The concentration of malignant cells and the surgically documented response to the intraperitoneal treatment were correlated. Twenty-three pat...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Sagae S,Berek JS,Fu YS,Chang N,Dauplat J,Hacker NF

    更新日期:1988-11-01 00:00:00

  • Perinatal outcome in growth-restricted fetuses: do hypertensive and normotensive pregnancies differ?

    abstract:OBJECTIVE:To test the hypothesis that fetal growth restriction (FGR) associated with a maternal hypertensive disorder results in worse perinatal outcome than FGR in pregnancies without maternal hypertension. METHODS:All consecutive, singleton, nondiabetic, small for gestational age (SGA) deliveries (birth weight at or...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/0029-7844(96)02169-2

    authors: Piper JM,Langer O,Xenakis EM,McFarland M,Elliott BD,Berkus MD

    更新日期:1996-08-01 00:00:00

  • Dual-Force Vaginoplasty for Treatment of Segmental Vaginal Aplasia.

    abstract:BACKGROUND:Vaginal aplasia occurs in 1 in 5,000-10,000 female live births. In this report, we evaluated a novel dual-force vaginoplasty technique for treatment of 11 patients with segmental vaginal aplasia. TECHNIQUE:The principle of the approach is to thin the atretic part between two counteracting forces. The instru...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000001974

    authors: El Saman AM,Farag MA,Shazly SA,Noor M,Ali MK,Othman ER,Khalifa M,Farghly TA,El Saman DA

    更新日期:2017-05-01 00:00:00

  • Hormone therapy prescribing patterns in the United States.

    abstract:OBJECTIVE:We sought to examine prescribing patterns (prevalence and rates of initiation and discontinuation) for estrogen plus progestin (hormone therapy [HT] and estrogen alone [ET]) in the United States in the 2 years before the published results of Women's Health Initiative's (WHI) HT trial's early termination and f...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/01.AOG.0000143826.38439.af

    authors: Buist DS,Newton KM,Miglioretti DL,Beverly K,Connelly MT,Andrade S,Hartsfield CL,Wei F,Chan KA,Kessler L

    更新日期:2004-11-01 00:00:00

  • Umbilical cord serum ionized magnesium level and total pediatric mortality.

    abstract:OBJECTIVE:To estimate whether higher magnesium levels in umbilical cord blood at delivery are associated with increased total pediatric (fetal + neonatal + postneonatal) mortality. METHODS:During the Magnesium and Neurologic Endpoints Trial, in addition to randomizing mothers having preterm labor into arms containing ...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s0029-7844(01)01398-9

    authors: Mittendorf R,Covert R,Elin R,Pryde PG,Khoshnood B,Lee K

    更新日期:2001-07-01 00:00:00

  • Surgeon General's Conference on the Prevention of Preterm Birth.

    abstract::To address the serious and seemingly intractable problem of preterm birth, the Surgeon General's Conference on the Prevention of Preterm Birth convened many of the country's experts from the public and private sectors of research, public health, and health care delivery to discuss preventive strategies. The purpose of...

    journal_title:Obstetrics and gynecology

    pub_type: 共识发展会议,杂志文章

    doi:10.1097/AOG.0b013e31819bdba3

    authors: Ashton DM,Lawrence HC 3rd,Adams NL 3rd,Fleischman AR

    更新日期:2009-04-01 00:00:00

  • Risk of large-for-gestational-age newborns in women with gestational diabetes by race and ethnicity and body mass index categories.

    abstract:OBJECTIVE:To compare the prevalence of large-for-gestational-age (LGA) newborns across categories of body mass index (BMI) in five racial and ethnic groups. METHODS:This cohort study examined 7,468 women with gestational diabetes mellitus (GDM) who delivered a live newborn between 1995 and 2006 at Kaiser Permanente No...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0b013e318291b15c

    authors: Sridhar SB,Ferrara A,Ehrlich SF,Brown SD,Hedderson MM

    更新日期:2013-06-01 00:00:00

  • The Q-tip test and urethrovesical junction mobility.

    abstract:OBJECTIVE:To determine the accuracy of the Q-tip test to measure urethrovesical junction mobility. METHODS:One hundred fourteen women with urinary incontinence or genital prolapse were evaluated with a Q-tip test and perineal ultrasound scanning to measure urethrovesical junction mobility with strain. The sensitivity,...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Caputo RM,Benson JT

    更新日期:1993-12-01 00:00:00

  • Laser therapy of genital condylomata acuminata.

    abstract::The effectiveness of the carbon dioxide laser was evaluated in the treatment of penile, anorectal, and urethral condylomata acuminata in 40 men. All but six cases of urethral condylomata were prior conventional treatment failures. Postlaser follow-up ranged between one and two years, with an average of 16 months. No p...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Ferenczy A

    更新日期:1984-05-01 00:00:00

  • Factors contributing to the accuracy in diagnosing ovarian malignancy by color Doppler ultrasound.

    abstract:OBJECTIVE:To determine whether resistance index values obtained by color Doppler ultrasound contribute to the accuracy in diagnosing ovarian malignancies. METHODS:Four hundred ten patients with ovarian neoplasms referred for color Doppler ultrasound evaluation were enrolled, excluding patients examined during the lute...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Wu CC,Lee CN,Chen TM,Lai JI,Hsieh CY,Hsieh FJ

    更新日期:1994-10-01 00:00:00

  • Changes in Use of Long-Acting Reversible Contraceptive Methods Among U.S. Women, 2009-2012.

    abstract:OBJECTIVE:To examine current levels, current correlates of, and changes in long-acting reversible contraceptive (LARC) use, including intrauterine devices and implants, among females aged 15-44 years using contraception between 2008-2010 and 2011-2013 with specific attention to associations between race, income, and ag...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000001094

    authors: Kavanaugh ML,Jerman J,Finer LB

    更新日期:2015-11-01 00:00:00

  • Venous thromboembolism prophylaxis in gynecologic surgery: a systematic review.

    abstract:OBJECTIVE:To comprehensively review and critically assess the available gynecologic surgery venous thromboembolism prophylaxis literature and provide clinical practice guidelines. DATA SOURCES:MEDLINE and Cochrane databases from inception to July 2010. We included randomized controlled trials in gynecologic surgery po...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审

    doi:10.1097/AOG.0b013e318232a394

    authors: Rahn DD,Mamik MM,Sanses TVD,Matteson KA,Aschkenazi SO,Washington BB,Steinberg AC,Harvie HS,Lukban JC,Uhlig K,Balk EM,Sung VW,Society of Gynecologic Surgeons Systematic Review Group.

    更新日期:2011-11-01 00:00:00

  • Fertility sparing treatment for in situ and early invasive adenocarcinoma of the cervix.

    abstract:OBJECTIVE:To explore the outcome and long-term follow-up of fertility sparing surgery for cervical adenocarcinoma in situ and early invasive adenocarcinoma. METHODS:Between 1985 and 1996, all women with adenocarcinoma in situ (AIS) and stage I adenocarcinoma were identified. Data were abstracted from clinical records ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/s0029-7844(01)01544-7

    authors: McHale MT,Le TD,Burger RA,Gu M,Rutgers JL,Monk BJ

    更新日期:2001-11-01 00:00:00

  • Clinical and laboratory evaluation of patients with primary amenorrhea.

    abstract::Sixty-two patients with primary amenorrhea were retrospectively categorized into 4 groups: 1) breast development absent and uterus present (29 patients), 2) breast development present and uterus absent (9 patients), 3) both breast development and uterus absent (2 patients), and 4) both breast development and uterus pr...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Mashchak CA,Kletzky OA,Davajan V,Mishell DR Jr

    更新日期:1981-06-01 00:00:00

  • Nulliparous Women in the Second Stage of Labor: Changes in Delivery Outcomes Between Two Cohorts From 2000 and 2011.

    abstract:OBJECTIVE:To evaluate changes over the past decade in the mode of delivery and second-stage duration in nulliparous women. METHODS:We conducted a retrospective cohort study at a single institution of nulliparous women reaching complete cervical dilation with singleton gestations 36 weeks or greater from January 1, 201...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/AOG.0000000000000872

    authors: Fitzwater JL,Owen J,Ankumah NA,Campbell SB,Biggio JR,Szychowski JM,Edwards RK

    更新日期:2015-07-01 00:00:00

  • Elevated maternal serum alpha-fetoprotein with normal ultrasound: is amniocentesis always appropriate? A review of 26,069 screened patients.

    abstract::We reviewed our experience with a policy of revising the estimated probability of an open neural tube defect for those cases in which maternal serum alpha-fetoprotein (MSAFP) was elevated and the ultrasound examination was normal. Assuming a sensitivity for the ultrasound diagnosis of neural tube defects of 90%, the r...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Richards DS,Seeds JW,Katz VL,Lingley LH,Albright SG,Cefalo RC

    更新日期:1988-02-01 00:00:00

  • Induction of an LH surge with estradiol benzoate in a patient with incomplete testicular feminization syndrome.

    abstract::A 31-year-old patient with incomplete testicular feminization syndrome characterized by a 46, XY karyotype in a phenotypic female with absent müllerian structures, marked clitoromegaly, testes and wolffian duct structures, partial labioscrotal fold fusion, and male levels of circulating androgens is described. She was...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Hochman J,Ganguly M,Weiss G

    更新日期:1977-01-01 00:00:00

  • Vascular endothelial growth factor serum concentrations in ovarian cancer.

    abstract:OBJECTIVE:To determine whether serum vascular endothelial growth factor is an independent prognostic factor in ovarian cancer patients. METHODS:We measured vascular endothelial growth factor in pretreatment serum samples of 60 women with International Federation of Gynecology and Obstetrics stages I to IV epithelial o...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/s0029-7844(98)00190-2

    authors: Tempfer C,Obermair A,Hefler L,Haeusler G,Gitsch G,Kainz C

    更新日期:1998-09-01 00:00:00

  • Urinary retention secondary to a Gartner's duct cyst.

    abstract::A 22-month-old child with a large cyst of Gartner's duct suffered from recurrent episodes of urinary retention. Excision of such large symptomatic cysts has been recommended in the past. Marsupialization is discussed as an alternative to extensive excision. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Muram D,Jerkins GR

    更新日期:1988-09-01 00:00:00

  • Prenatal ultrasound diagnosis of cerebral arteriovenous fistula.

    abstract:BACKGROUND:We describe a case of arteriovenous fistula of the middle and posterior cerebral arteries detected in a fetus. CASE:Fetal echocardiography revealed a high-output cardiac failure. Color Doppler ultrasound demonstrated an arteriovenous fistula, localized at the middle and posterior cerebral arteries, which dr...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1016/0029-7844(96)00100-7

    authors: Paladini D,Palmieri S,D'Angelo A,Martinelli P

    更新日期:1996-10-01 00:00:00

  • Influence of an "opt-out" test strategy and patient factors on human immunodeficiency virus screening in pregnancy.

    abstract:OBJECTIVE:To estimate both human immunodeficiency virus (HIV) testing acceptance rates in pregnancy using an opt-out policy and patient characteristics influencing acceptance. METHODS:At the first prenatal visit, HIV testing was offered using an opt-out approach. Reasons for refusing testing were explored. Demographic...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:10.1097/01.AOG.0000267497.39041.06

    authors: Yudin MH,Moravac C,Shah RR

    更新日期:2007-07-01 00:00:00

  • Cystic ovarian enlargement resulting from autoimmune oophoritis.

    abstract::Autoimmune oophoritis is a rare cause of premature ovarian failure. Previous studies of autoimmune oophoritis have detailed the clinical, immunologic, and histologic findings. The gross pathologic features of the involved ovaries have detailed the clinical, immunologic, and histologic findings. The gross pathologic fe...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Biscotti CV,Hart WR,Lucas JG

    更新日期:1989-09-01 00:00:00

  • Transvaginal color Doppler sonography of the ureteral jets: a method to detect ureteral patency.

    abstract:OBJECTIVE:To evaluate the feasibility of the detection of ureteral jets into the bladder in obstetric-gynecologic patients using transvaginal color Doppler ultrasound. METHODS:Fifty-two women were recruited and categorized into four groups: 1) 20 normal nonsurgical, 2) 17 post-cesarean delivery, 3) 12 post-total abdom...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章

    doi:10.1016/s0029-7844(96)00373-0

    authors: Timor-Tritsch IE,Haratz-Rubinstein N,Monteagudo A,Lerner JP,Murphy KE

    更新日期:1997-01-01 00:00:00

  • Sexual function in women with urinary incontinence and pelvic organ prolapse.

    abstract:OBJECTIVE:To compare sexual function in women with urinary incontinence and pelvic organ prolapse and to determine the effects of therapy on sexual function. METHODS:343 community-dwelling women older than 45 years with urinary incontinence or advanced prolapse were recruited into a multi-armed clinical trial. Women w...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s0029-7844(01)01727-6

    authors: Barber MD,Visco AG,Wyman JF,Fantl JA,Bump RC,Continence Program for Women Research Group.

    更新日期:2002-02-01 00:00:00

  • A normal ultrasound does not obviate the need for amniocentesis in patients with elevated serum alpha-fetoprotein.

    abstract::Elevated levels of maternal serum alpha-fetoprotein (MSAFP) will identify a population at increased risk for specific congenital malformations, which are accurately diagnosed by amniotic fluid AFP and acetylcholinesterase. The risk for spontaneous abortion related to amniocentesis, combined with increasing confidence ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Drugan A,Zador IE,Syner FN,Sokol RJ,Sacks AJ,Evans MI

    更新日期:1988-10-01 00:00:00

  • Potential for bias in studies of the influence of human immunodeficiency virus infection on the recognition, incidence, clinical course, and microbiology of pelvic inflammatory disease.

    abstract::As the human immunodeficiency virus (HIV) epidemic affects more women, clinicians are increasingly observing pelvic inflammatory disease (PID) in HIV-infected women. The extent to which PID is a factor in the recognition of HIV or HIV is a factor in the recognition of PID is unknown. Even less is known about how HIV i...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Irwin KL,Rice RJ,Sperling RS,O'Sullivan MJ,Brodman M

    更新日期:1994-09-01 00:00:00

  • Amniotic fluid embolism with survival.

    abstract::Well-documented amniotic fluid embolism with survival is an uncommon occurrence. A case is reported with characteristic clinical findings in addition to electrocardiographic evidence of acute right heart strain, disseminated intravascular coagulation, and amniotic fluid debris in central venous blood. The impact of th...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Resnik R,Swartz WH,Plumer MH,Benirschke K,Stratthaus ME

    更新日期:1976-03-01 00:00:00

  • Ethical analysis of the intrapartum management of pregnancy complicated by fetal hydrocephalus with macrocephaly.

    abstract::The intrapartum management of pregnancy complicated by fetal hydrocephalus with macrocephaly often confronts the physician with a complex array of moral obligations to both mother and fetus that may sometimes come into direct conflict. The authors analyze the component beneficence-based and autonomy-based obligations ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Chervenak FA,McCullough LB

    更新日期:1986-11-01 00:00:00

  • Maternal cerebral hemodynamics in the supine hypotensive syndrome.

    abstract::Cerebral hemodynamics were studied in eight nonpregnant women and 24 women in late pregnancy by internal carotid artery velocimetry with a 3.5-MHz continuous-wave Doppler system. Criteria for supine hypotensive syndrome were a mean blood pressure decrease of 15 mmHg and a 2-minute sustained increase in pulse of 20 bea...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章

    doi:

    authors: Ikeda T,Ohbuchi H,Ikenoue T,Mori N

    更新日期:1992-01-01 00:00:00