OBJECTIVES: Three different treatment options for endometrial hyperplasia were evaluated in a prospective long-time follow-up study, comparing effects of intrauterine levonorgestrel impregnated device (LNG-IUD), low oral dose of medroxyprogesterone acetate (MPA) and no treatment (observation only). To select patients with high probability for co-existing or future carcinoma we used the objective morphometric algorithm, D-score, stratifying patients into three different risk groups. As far as we know, this is the first prospective long-time follow-up study in which treatment recommendation and outcome is based on the D-score assessment. METHODS: From a total of 370 patients initially diagnosed with endometrial hyperplasia from eight different hospitals in North Norway, 258 were available for long-time follow-up. After D-score classification, one of three different treatment options was chosen: LNG-IUD, low oral dose of MPA or observation only. Follow-up controls were performed and biopsies taken in the local hospitals. RESULTS: Among the 370 investigated cases with endometrial hyperplasia, only ten endometrial cancers were detected at the entrance of the study, all belonging to the high risk group (D-score <0). No further cancers were detected during follow-up, irrespective of risk group. After 6 months treatment with LNG-IUD proved significantly superior to oral treatment (p=0.001 for D-score >1 and p=0.003 for D-score 0-1 groups) and observation only (p=0.001 for D-score >1 and p=0.001 for D-score 0-1 groups). After 56 to 108 months the LNG-IUD proved significantly superior to oral treatment and to the observation group. Comparison of oral therapy to observation only showed no significant differences, neither after 6 months nor after long-time observation. CONCLUSIONS: LNG-IUD is the optimal treatment for endometrial hyperplasia. Outcome after oral low-dose MPA regimen is comparable to expectation.
OBJECTIVES: Three different treatment options for endometrial hyperplasia were evaluated in a prospective long-time follow-up study, comparing effects of intrauterinelevonorgestrel impregnated device (LNG-IUD), low oral dose of medroxyprogesterone acetate (MPA) and no treatment (observation only). To select patients with high probability for co-existing or future carcinoma we used the objective morphometric algorithm, D-score, stratifying patients into three different risk groups. As far as we know, this is the first prospective long-time follow-up study in which treatment recommendation and outcome is based on the D-score assessment. METHODS: From a total of 370 patients initially diagnosed with endometrial hyperplasia from eight different hospitals in North Norway, 258 were available for long-time follow-up. After D-score classification, one of three different treatment options was chosen: LNG-IUD, low oral dose of MPA or observation only. Follow-up controls were performed and biopsies taken in the local hospitals. RESULTS: Among the 370 investigated cases with endometrial hyperplasia, only ten endometrial cancers were detected at the entrance of the study, all belonging to the high risk group (D-score <0). No further cancers were detected during follow-up, irrespective of risk group. After 6 months treatment with LNG-IUD proved significantly superior to oral treatment (p=0.001 for D-score >1 and p=0.003 for D-score 0-1 groups) and observation only (p=0.001 for D-score >1 and p=0.001 for D-score 0-1 groups). After 56 to 108 months the LNG-IUD proved significantly superior to oral treatment and to the observation group. Comparison of oral therapy to observation only showed no significant differences, neither after 6 months nor after long-time observation. CONCLUSIONS: LNG-IUD is the optimal treatment for endometrial hyperplasia. Outcome after oral low-dose MPA regimen is comparable to expectation.
Authors: Seo Yeong Lee; Mi Kyoung Kim; Hyun Park; Bo Sung Yoon; Seok Ju Seong; Jin Hee Kang; Hye Sun Jun; Chong Taik Park Journal: J Gynecol Oncol Date: 2010-06-30 Impact factor: 4.401
Authors: Susan D Reed; Katherine M Newton; Rochelle L Garcia; Kimberly H Allison; Lynda F Voigt; C Diana Jordan; Meira Epplein; Elizabeth Swisher; Kristen Upson; Kelly J Ehrlich; Noel S Weiss Journal: Obstet Gynecol Date: 2010-08 Impact factor: 7.661
Authors: Cornelia L Trimble; Michael Method; Mario Leitao; Karen Lu; Olga Ioffe; Moss Hampton; Robert Higgins; Richard Zaino; George L Mutter Journal: Obstet Gynecol Date: 2012-11 Impact factor: 7.661
Authors: Rachel S Mandelbaum; Marcia A Ciccone; David J Nusbaum; Mahdi Khoshchehreh; Heena Purswani; Elise B Morocco; Meghan B Smith; Shinya Matsuzaki; Christina E Dancz; Begum Ozel; Lynda D Roman; Richard J Paulson; Koji Matsuo Journal: Am J Obstet Gynecol Date: 2020-01-21 Impact factor: 8.661