Atypical hyperplasia and early endometrial cancer: controversial aspects of terminology, classification, diagnosis and treatment. A review

Natalia M. Podzolkova; Подзолкова Наталья Михайловна; Alexey A. Karpov; Карпов Алексей Андреевич; Sergey S. Lebedev; Лебедев Сергей Сергеевич; Roman E. Kuznetsov; Кузнецов Роман Эдуардович; Yulia V. Denisova; Денисова Юлия Вадимовна; Vladimir A. Alimov; Алимов Владимир Александрович; Andrey M. Danilov; Данилов Андрей Михайлович; Nikita P. Chizhikov; Чижиков Никита Павлович; Evgenij I. Zakurdaev; Закурдаев Евгений Иванович; Larisa G. Sozaeva; Созаева Лариса Габицовна; Olga L. Glazkova; Глазкова Ольга Леонидовна; Asel E. Karpova; Карпова Асель Ерсаиновна; Irina P. Shabalova; Шабалова Ирина Петровна; Karine T. Kasoyan; Касоян Карине Тимуровна

doi:10.26442/20795696.2025.4.203511

Atypical hyperplasia and early endometrial cancer: controversial aspects of terminology, classification, diagnosis and treatment. A review

Authors: Podzolkova N.M.¹^,2, Karpov A.A.¹^,2, Lebedev S.S.¹^,2, Kuznetsov R.E.¹^,2, Denisova Y.V.¹^,2, Alimov V.A.¹^,2, Danilov A.M.¹, Chizhikov N.P.¹, Zakurdaev E.I.¹, Sozaeva L.G.², Glazkova O.L.², Karpova A.E.², Shabalova I.P.², Kasoyan K.T.²
Affiliations:
1. Botkin City Clinical Hospital
2. Russian Medical Academy of Continuous Professional Education
Issue: Vol 27, No 4 (2025)
Pages: 272-280
Section: REVIEW
URL: https://journals.rcsi.science/2079-5831/article/view/373724
DOI: https://doi.org/10.26442/20795696.2025.4.203511
ID: 373724

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Abstract

The incidence of endometrial atypical hyperplasia (EAH) and cancer (EC) shows a steady increase every year, which is associated with an increase in the prevalence of their risk factors, primarily the “nonsteroidal triad”: obesity, diabetes mellitus, and metabolic syndrome. In the context of the demographic crisis and the postponement of reproductive plans for the sake of self-realization, the issue of fertility preservation with a favorable prognosis in young patients with EAH and early stages of EC of the low-risk group becomes especially relevant. Significant advancements in classification approaches, with the isolation of EC molecular subtypes that determine prognosis, and in diagnostics, with the development of a new method of liquid-based cytology combined with ultrasound examination, help clearly stratify patients at the outpatient stage into a cohort suitable for organ-preserving therapy. A review of the results of systematic reviews and meta-analyses proves that to date, oral progestins or gonadotropin-releasing hormone agonists, the installation of a levonorgestrel-containing intrauterine system alone or in various combinations are justified alternatives to radical surgical treatment in patients with precancer and EC with minimal invasion of the myometrium according to expert-level ultrasound or magnetic resonance imaging, provided that complete drug pathomorphosis of foci is achieved with the prompt implementation of reproductive plans with the thorough monitoring by an obstetrician-gynecologist and a reproductive specialist.