FCO-52 Navigating Challenges: COVID-19's impact on the surveillance of atypical endometrial hyperplasia – an observational study

Introduction

Atypical endometrial hyperplasia (AEH) is associated with risk of coexistence of undiagnosed endometrial cancer or progression to cancer. Women who decline hysterectomy should be offered Levonorgestrel IUS or high dose oral progesterone with timely endometrial biopsy surveillance based on RCOG’s recommendations. 

Objective and Methods

This a retrospective study conducted to explore how COVID-19 pandemic affected the endometrial biopsy surveillance in women with AEH who opted for conservative management. Data was collected from hospital electronic records of patients diagnosed with AEH on histology, using a standardised proforma. 

Results

We identified 279 patients with histology diagnosis of AEH, gathered from 01/01/2020 to 31/10/2022, excluding 5 deceased patients secondary to other medical causes. 

Out of 108 patients who chose conservative management, only 37% (n=40) had endometrial biopsy in 3-6 months as surveillance. 11% of patients (n=12) did not attend their scheduled appointments. 46% (n=50) had delayed endometrial biopsy surveillance, due to administrative issues, pandemic related disruption of clinical activity and inadequate patient tracking across different Gynaecological subspecialties.

Out of 26 patients who achieved the defined disease regression for AEH, only 42% (n=11) had 6-12 monthly endometrial biopsy surveillance as follow-up. 

Conclusion

Significant delay in endometrial biopsy surveillance in women with AEH was demonstrated during COVID pandemic. Despite the delays, there was no disease progression, affirming the safety and efficacy of conservative management with Levonorgestrel IUS or high dose oral progesterone in AEH. A Benign Gynaecology MDT was established to coordinate the follow-up for patients with AEH and facilitate the discussions of complex cases.