ENDOMETRIAL CARCINOMA AFTER ENDOMETRIAL ABLATION - HIGH-RISK FACTORS PREDICTING ITS OCCURRENCE

Our purpose was to review reported cases of endometrial carcinoma afte r endometrial ablation and to evaluate high-risk factors predicting it s occurrence. We present guidelines for the treatment of abnormal uter ine bleeding unresponsive to medical therapy in this high-risk group o f patients. Eight detailed reports on endometrial carcinoma after endo metrial ablation were reviewed. The indications, methods of treatment, followup, and associated high-risk factors for endometrial carcinoma were analyzed. A focused list of high-risk factors for endometrial car cinoma was developed on the basis of the data collected. Guidelines we re established to enable surgeons to minimize the risks of subsequent uterine cancer in women with abnormal uterine bleeding that is unrespo nsive to medical therapy tie, candidates for ablation). Women who had endometrial carcinoma develop after ablation had predictive high-risk factors for subsequent neoplasia, and all eventually underwent a hyste rectomy. Women with abnormal uterine bleeding and high-risk factors fo r endometrial carcinoma who did not respond to medical treatment may s afely undergo endometrial ablation but must have a preablation biopsy indicating normal endometrium. Persistent hyperplasia unresponsive to hormonal therapy should influence the selection of a hysterectomy. Car eful screening of patients before undergoing endometrial destructive p rocedures is prescient because minimally invasive, nonhysteroscopic ab lative techniques are now emerging.