Conservatively treated endometrial intraepithelial neoplasia/cancer: Risk of intrauterine synechiae - 15/04/21

Doi : 10.1016/j.jogoh.2020.101930

Christina N. Cordeiro Mitchell ^a,^⁎ , Kiley F. Hunkler ^a , Jacqueline Y. Maher ^a,^b , Rebecca A. Garbose ^a , Megan E. Gornet ^a , Lillian J. Whiting-Collins ^c , Mindy S. Christianson ^a
^a Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology & Infertility, Johns Hopkins Medicine, 10751 Falls Rd, Suite 280, Lutherville, MD 21093, USA
^b Divisions of Pediatric and Adolescent Gynecology and Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 10 Central Drive, Building 10 Rm I-3340, Bethesda, MD 20892, USA
^c Johns Hopkins University School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA

^⁎Corresponding author at: 10751 Falls Rd, Suite 280, Lutherville, MD 21093, USA.10751 Falls RdSuite 280LuthervilleMD21093USA

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Highlights

•	Among 54 women conservatively treated for endometrial intraepithelial neoplasia/cancer, 19 % had intrauterine synechiae.
•	Patients who underwent more dilation and curettage procedures had a higher odds of developing intrauterine synechiae.
•	Exposure to a levonorgestrel intrauterine device was associated with a nonsignificant lower odds of intrauterine synechiae.
•	We observed a 41 % livebirth rate among 22 women attempting pregnancy after endometrial intraepithelial neoplasia/cancer.
•	Number of dilation and curettage procedures and progestin treatment type were not associated with pregnancy.

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Abstract

Introduction

To determine whether progestin type or number of dilation and curettage procedures (D&Cs) were associated with intrauterine synechiae (IS) or pregnancy outcomes in patients conservatively treated for endometrial intraepithelial neoplasia (EIN) or endometrial cancer (EC).

Materials and methods

We evaluated patients conservatively treated for EIN or EC from 2000 to 2017 at an academic center. IS were identified hysteroscopically. We calculated proportions for categorical variables and tested associations between D&C number, progestin, and pregnancy outcomes using Pearson chi-squared and Fisher’s exact tests. A post-hoc power analysis indicated sufficient power to detect livebirth.

Results

We analyzed 54 patients, 15 with EIN (28 %) and 39 with EC (72 %), with a mean age of 34 ± 1.2 years. Progestin treatment types included megestrol acetate (MA) (n = 24), MA with levonorgestrel intrauterine device (LngIUD) (n = 10), MA followed by LngIUD (n = 3), and LngIUD alone (n = 6). Mean number of D&Cs was 3.9 ± 0.9. Overall, 53 subjects underwent hysteroscopy; 10 (19 %) had IS. When D&Cs were grouped into 0−2, 3−4 and ≥5, each increase in D&C group had a 2.9 higher odds of IS (OR: 2.91, p = 0.04, CI: 1.05–10.02). LngIUD was associated with a nonsignificant 46 % decrease in the odds of IS (OR: 0.54, p = 0.66, CI: 0.08–2.87). Twenty-two women attempted pregnancy; 14 women achieved a total of 20 pregnancies and 9 women had total of 15 livebirths (41 % livebirth rate). The number of D&Cs and progestin treatment type were not associated with pregnancy outcomes.

Discussion

Among 54 patients conservatively treated for EC/EIN, nearly 20 % developed IS. However, hysteroscopic and/or fertility treatments may improve pregnancy outcomes.

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Keywords : Fertility preservation, Endometrial cancer, Endometrial intraepithelial neoplasia, Intrauterine synechiae, Levonorgestrel intrauterine device, Dilation and curettage procedure