Work

Predicting concurrent endometrial carcinoma in women with endometrial intraepithelial neoplasia without preoperative suspicion of malignancy

Year: 2026

Type: article

Abstract: Objective: Endometrial intraepithelial neoplasia (EIN) is a premalignant lesion with variable risk of concurrent endometrial carcinoma. Identifying predictors of endometrial carcinoma in women with EIN without pathological suspicion of carcinoma may improve surgical planning. Methods: A retrospective cohort study of patients with EIN who underwent hysterectomy between 2014 and 2024. Preoperative clinical and diagnostic variables were evaluated as predictors of concurrent endometrial carcinoma and incorporated into a multivariable logistic regression model to construct a nomogram. Model discrimination was assessed using the area under the receiver operating characteristic curve. Ridge and Firth penalized regression were performed as sensitivity analyses. Results: The final cohort included 124 women, of whom 18 (14.5%) had concurrent endometrial carcinoma. Type 2 diabetes mellitus was associated with increased odds of concurrent carcinoma (adjusted OR 4.18, 95% CI 1.11-15.69). Hysteroscopy-guided sampling or dilation and curettage was associated with lower odds compared with pipelle biopsy (adjusted OR 0.11, 95% CI 0.02-0.50). A nomogram incorporating age, body mass index, type 2 diabetes mellitus, and diagnostic modality demonstrated an AUC of 0.828 (95% CI 0.725-0.931) and an optimism-corrected AUC of 0.784. Penalized sensitivity analyses yielded consistent findings. Conclusion: A simple preoperative nomogram based on routinely available clinical variables showed promising discrimination for concurrent endometrial carcinoma in women with EIN. Prospective and external validation in independent cohorts is required before clinical implementation.

Source: Gynecologic Oncology Reports

DOI: 10.1016/j.gore.2026.102236