Predictors of Concurrent Endometrial Carcinoma in Minority Populations with Atypical Hyperplasia: A Synthesis of Clinical, Molecular, and Social Evidence

Highlights

• Concurrent endometrial carcinoma (EC) rates in minority-enriched populations with atypical endometrial hyperplasia (AEH) reach 56%, significantly higher than historical averages.
• Hypertension and endometrial echogenicity (EE) ≥2 cm are potent independent predictors of malignancy and nodal risk, while concurrent adenomyosis surprisingly appears to offer a lower risk of occult cancer.
• Hysteroscopic-directed sampling significantly outperforms blind biopsy in reducing the rate of missed or underestimated cancer diagnoses.
• The integration of GLP-1 receptor agonists with progestin therapy is emerging as a transformative metabolic intervention, reducing the risk of EC progression and subsequent hysterectomy.

Background