{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:01:38Z","timestamp":1784721698846,"version":"3.55.0"},"reference-count":78,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Endometrial hyperplasia (EH) is an estrogen-driven proliferative disorder with a measurable risk of progression to endometrial carcinoma. Although many guidelines have been issued over the years, clinical practice remains heterogeneous. In this paper, we aim to compare and summarize key recommendations and disagreements among major international guidelines for managing endometrial hyperplasia, focusing especially on conservative and fertility-sparing strategies. All guidelines align with some key principles: they all adopt the 2020 WHO classification, strongly prefer hysteroscopy-directed sampling, and recommend progestin therapy as the first-line treatment for non-atypical EH, favoring the levonorgestrel-releasing intrauterine system (LNG-IUS) over oral regimens. They designate total hysterectomy as definitive management for atypical hyperplasia\/intraepithelial endometrial neoplasia (AEH\/EIN) due to the substantial prevalence of concurrent carcinoma. Nevertheless, several key discrepancies appear, mainly concerning how long to continue progestin therapy and when to escalate treatment; and how intensively and for how long to conduct post-treatment surveillance. Variations in diagnostic and therapeutic protocols reflect evidence gaps and differences across healthcare settings. Future research should focus on harmonized outcomes, comparative studies of conservative strategies, and the integration of new pathology tools for personalized management.<\/jats:p>","DOI":"10.3390\/cancers18132048","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:03:56Z","timestamp":1782349436000},"page":"2048","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of Patients Diagnosed with Endometrial Hyperplasia: Comparison of Guidelines"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7848-0329","authenticated-orcid":false,"given":"Stefano","family":"Restaino","sequence":"first","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, \u201cSanta Maria della Misericordia\u201d University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"},{"name":"PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, 07100 Sassari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5416-1925","authenticated-orcid":false,"given":"Chiara","family":"Paglietti","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, \u201cSanta Maria della Misericordia\u201d University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0881-7233","authenticated-orcid":false,"given":"Federico","family":"Paparcura","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, \u201cSanta Maria della Misericordia\u201d University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"},{"name":"Department of Medicine, University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8373-8569","authenticated-orcid":false,"given":"Giorgio","family":"Bogani","sequence":"additional","affiliation":[{"name":"Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4720-5663","authenticated-orcid":false,"given":"Vito Andrea","family":"Capozzi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula","family":"Catena","sequence":"additional","affiliation":[{"name":"Department of Woman, Child and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Raffone","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, and General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9978-8130","authenticated-orcid":false,"given":"Maria","family":"Orsaria","sequence":"additional","affiliation":[{"name":"Institute of Pathology, \u201cSanta Maria della Misericordia\u201d University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9023-282X","authenticated-orcid":false,"given":"Carlo","family":"Ronsini","sequence":"additional","affiliation":[{"name":"Unit of Gynecologic Oncology, National Cancer Institute, IRCCS, Fondazione \u201cG. Pascale\u201d, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Scibilia","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, \u201cGiovanni Paolo II\u201d Hospital, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2971-0079","authenticated-orcid":false,"given":"Tommaso","family":"Simoncini","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3235-4378","authenticated-orcid":false,"given":"Diego","family":"Raimondo","sequence":"additional","affiliation":[{"name":"Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9254-5790","authenticated-orcid":false,"given":"Violante","family":"Di Donato","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed","family":"Elhadi","sequence":"additional","affiliation":[{"name":"College of Medicine (Elhadi), Korea University, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5523-8943","authenticated-orcid":false,"given":"Giampiero","family":"Capobianco","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, 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60123 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0735-6301","authenticated-orcid":false,"given":"Errico","family":"Zupi","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Seracchioli","sequence":"additional","affiliation":[{"name":"Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenza","family":"Driul","sequence":"additional","affiliation":[{"name":"Clinic of Obstetrics and Gynecology, \u201cSanta Maria della Misericordia\u201d University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"},{"name":"Department of Medicine, University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6275-7488","authenticated-orcid":false,"given":"Paolo","family":"Scollo","sequence":"additional","affiliation":[{"name":"Maternal and Child Department, Obstetrics and Gynecology, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Perrone","sequence":"additional","affiliation":[{"name":"Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8841-6531","authenticated-orcid":false,"given":"Pierandrea","family":"Iaco","sequence":"additional","affiliation":[{"name":"Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, 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Endometrial Hyperplasia, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560693\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1055\/s-0034-1396256","article-title":"Uterus commission of the Gynecological Oncology Working Group. New WHO classification of endometrial hyperplasias","volume":"75","author":"Emons","year":"2015","journal-title":"Geburtsh. Frauenheilk."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101929","DOI":"10.1016\/j.gore.2025.101929","article-title":"Obesity management in the setting of endometrial cancer and hyperplasia: A narrative review","volume":"61","author":"Moshayedi","year":"2025","journal-title":"Gynecol. Oncol. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.xfre.2025.06.007","article-title":"Prevalence of endometrial hyperplasia and carcinoma in women with polycystic ovarian syndrome","volume":"6","author":"Agarwal","year":"2025","journal-title":"F&S Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2243951","DOI":"10.1001\/jamanetworkopen.2022.43951","article-title":"Risk of Endometrial Polyps, Hyperplasia, Carcinoma, and Uterine Cancer After Tamoxifen Treatment in Premenopausal Women With Breast Cancer","volume":"5","author":"Ryu","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"110764","DOI":"10.1016\/j.biopha.2020.110764","article-title":"Type 2 diabetes mellitus facilitates endometrial hyperplasia progression by activating the proliferative function of mucin O-glycosylating enzyme GALNT2","volume":"131","author":"Zhou","year":"2020","journal-title":"BioMed. Pharmacother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"106.e1","DOI":"10.1016\/j.ajog.2025.01.015","article-title":"Ovarian sex cord-stromal cell tumors and the risk of sex hormone-sensitive cancers","volume":"233","author":"Karstensen","year":"2025","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e185946","DOI":"10.1172\/jci.insight.185946","article-title":"Mitochondrial defects and metabolic vulnerabilities in Lynch syndrome-associated MSH2-deficient endometrial cancer","volume":"10","author":"Bowen","year":"2025","journal-title":"JCI Insight"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/ijc.33763","article-title":"Endometrial cancer in Lynch syndrome","volume":"150","author":"Zhao","year":"2022","journal-title":"Int. J. Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ygyno.2018.04.566","article-title":"Converging endometrial and ovarian tumorigenesis in Lynch syndrome: Shared origin of synchronous carcinomas","volume":"150","author":"Niskakoski","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_11","unstructured":"Kurman, R.J., Carcangiu, M.L., Herrington, C.S., and Young, R.H. (2014). WHO Classification of Tumours of Female Reproductive Organs, IARC. [4th ed.]."},{"key":"ref_12","unstructured":"Herrington, C.S. (2020). WHO Classification of Tumours Female Genital Tumours, International Agency for Research on Cancer. [5th ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1002\/(SICI)1096-9896(200003)190:4<462::AID-PATH590>3.0.CO;2-D","article-title":"Endometrial precancer diagnosis by histopathology, clonal analysis, and computerized morphometry","volume":"190","author":"Mutter","year":"2000","journal-title":"J. Pathol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2023). Management of Endometrial Intraepithelial Neoplasia or Atypical Endometrial Hyperplasia: ACOG Clinical Consensus No. 5. Obstet. Gynecol., 142, 735\u2013744.","DOI":"10.1097\/AOG.0000000000005297"},{"key":"ref_15","unstructured":"Royal College of Obstetricians and Gynaecologists, and British Society for Gynaecological Endoscopy (2016). Management of endometrial hyperplasia. RCOG BSGE Jt. Guidel., 67, 125\u2013129."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/j.jogc.2019.03.025","article-title":"Guideline No. 390-Classification and Management of Endometrial Hyperplasia","volume":"41","author":"Auclair","year":"2019","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"108391","DOI":"10.1016\/j.ejso.2024.108391","article-title":"Group for Chinese Guidelines on the Management of Endometrial Hyperplasia. Chinese guidelines on the management of endometrial hyperplasia","volume":"50","author":"Li","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_18","unstructured":"SIGO, AGUI, AOGOI, and AGITE in Collaborazione con SIOG (2026, May 22). Terapia Conservativa in Caso di Tumore Endometrio Stadio IA di Tipo Endometrioide o Iperplasia Endometriale. Available online: https:\/\/www.aogoi.it\/linee-guida\/altre-raccomandazioni\/terapia-conservativa-tumore-endometrio\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"hoac057","DOI":"10.1093\/hropen\/hoac057","article-title":"ESGO\/ESHRE\/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma","volume":"2023","author":"Rodolakis","year":"2023","journal-title":"Hum. Reprod. Open"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"(2015). Committee on Gynecologic Practice, Society of Gynecologic Oncology. The American College of Obstetricians and Gynecologists Committee Opinion no. 631. Endometrial intraepithelial neoplasia. Obstet. Gynecol., 125, 1272.","DOI":"10.1097\/01.AOG.0000465189.50026.20"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/his.13776","article-title":"Endometrial hyperplasia and the risk of coexistent cancer: WHO versus EIN criteria","volume":"74","author":"Travaglino","year":"2019","journal-title":"Histopathology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102588","DOI":"10.1016\/j.jogoh.2023.102588","article-title":"Endometrial biopsy: Indications, techniques and recommendations. An evidence-based guideline for clinical practice","volume":"52","author":"Vitale","year":"2023","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhang, L., Guo, Y., Qian, G., Su, T., and Xu, H. (2022). Value of endometrial thickness for the detection of endometrial cancer and atypical hyperplasia in asymptomatic postmenopausal women. BMC Womens Health, 22.","DOI":"10.1186\/s12905-022-02089-y"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s13224-020-01415-4","article-title":"Thickened Endometrium: When to Intervene? A Clinical Conundrum","volume":"71","author":"Giri","year":"2021","journal-title":"J. Obstet. Gynaecol. India"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.ejogrb.2024.08.016","article-title":"When is it necessary to perform biopsy in asymptomatic postmenopausal women with incidental finding of thickened endometrium?","volume":"302","author":"Wang","year":"2024","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_26","first-page":"199","article-title":"Tamoxifen treatment in breast cancer: Diagnostic methods for endometrial changes","volume":"24","author":"Piecak","year":"2025","journal-title":"Prz. Menopauzalny"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1471-0528.2002.01088.x","article-title":"Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: A systematic quantitative review","volume":"109","author":"Clark","year":"2002","journal-title":"BJOG"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1034\/j.1600-0412.2001.080009784.x","article-title":"Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial hyperplasia","volume":"80","author":"Clark","year":"2001","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1002\/1097-0142(20001015)89:8<1765::AID-CNCR17>3.0.CO;2-F","article-title":"The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia","volume":"89","author":"Dijkhuizen","year":"2000","journal-title":"Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/1097-0142(19850715)56:2<403::AID-CNCR2820560233>3.0.CO;2-X","article-title":"The behavior of endometrial hyperplasia. A long-term study of \u201cuntreated\u201d hyperplasia in 170 patients","volume":"56","author":"Kurman","year":"1985","journal-title":"Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1200\/JCO.2009.24.1315","article-title":"Absolute risk of endometrial carcinoma during 20-year follow-up among women with endometrial hyperplasia","volume":"28","author":"Lacey","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s00404-021-06380-5","article-title":"Endometrial hyperplasia as a risk factor of endometrial cancer","volume":"306","author":"Nees","year":"2022","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Prip, C.M., Stentebjerg, M., Bennetsen, M.H., Petersen, L.K., and Bor, P. (2022). Risk of atypical hyperplasia and endometrial carcinoma after initial diagnosis of non-atypical endometrial hyperplasia: A long-term follow-up study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0266339"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/1471-0528.12100","article-title":"Bariatric surgery and endometrial pathology in asymptomatic morbidly obese women: A prospective, pilot study","volume":"120","author":"Argenta","year":"2013","journal-title":"BJOG"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.ygyno.2015.05.015","article-title":"Women at extreme risk for obesity-related carcinogenesis: Baseline endometrial pathology and impact of bariatric surgery on weight, metabolic profiles and quality of life","volume":"138","author":"Modesitt","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_36","first-page":"1117","article-title":"Phytoestrogen consumption and endometrial cancer risk: A population-based case\u2013control study in New Jersey","volume":"20","author":"Bandera","year":"2009","journal-title":"Cancer Causes Control"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1200\/JCO.2003.10.019","article-title":"Granulosa cell tumor of the ovary","volume":"21","author":"Schumer","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"547.e1","DOI":"10.1016\/j.ajog.2010.07.037","article-title":"Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: A systematic review and metaanalysis","volume":"203","author":"Gallos","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1111\/j.1365-2265.1982.tb01625.x","article-title":"Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD","volume":"17","author":"Nilsson","year":"1982","journal-title":"Clin. Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.ajog.2015.03.037","article-title":"Levonorgestrel-releasing intrauterine system vs oral progestins for non-atypical endometrial hyperplasia: A systematic review and metaanalysis of randomized trials","volume":"213","author":"Ghayaty","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1159\/000321390","article-title":"Comparison of the efficacy of three progestins in the treatment of simple endometrial hyperplasia without atypia","volume":"72","author":"Ozdegirmenci","year":"2011","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1447-0756.2005.00253.x","article-title":"Clinical and pathological responses of progestin therapy for non-atypical endometrial hyperplasia: A prospective study","volume":"31","author":"Rattanachaiyanont","year":"2005","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1177\/1933719115623643","article-title":"Depo-Provera versus norethisterone acetate in management of endometrial hyperplasia without atypia","volume":"23","author":"Nooh","year":"2016","journal-title":"Reprod. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s12325-017-0509-8","article-title":"Comparing the administration of letrozole and megestrol acetate in the treatment of women with simple endometrial hyperplasia without atypia: A randomized clinical trial","volume":"34","author":"Moradan","year":"2017","journal-title":"Adv. Ther."},{"key":"ref_45","first-page":"122","article-title":"The efficacy of intrauterine versus oral progestin for the treatment of endometrial hyperplasia. A prospective randomized comparative study","volume":"40","author":"Dolapcioglu","year":"2013","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/01.AOG.0000167394.38215.56","article-title":"Ovarian conservation at the time of hysterectomy for benign disease","volume":"106","author":"Parker","year":"2005","journal-title":"Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jmig.2009.12.016","article-title":"Bilateral oophorectomy versus ovarian conservation: Effects on long-term women\u2019s health","volume":"17","author":"Parker","year":"2010","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1097\/PAS.0b013e31825dd4ff","article-title":"Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: Institutional experience and review of literature","volume":"36","author":"Rakha","year":"2012","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ygyno.2015.07.108","article-title":"Prediction of concurrent endometrial carcinoma in women with endometrial hyperplasia","volume":"139","author":"Matsuo","year":"2015","journal-title":"Gynecol. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/AOG.0b013e3181e93330","article-title":"Complex hyperplasia with and without atypia: Clinical outcomes and implications of progestin therapy","volume":"116","author":"Reed","year":"2010","journal-title":"Obstet. Gynecol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Chou, A.J., Bing, R.S., and Ding, D.C. (2024). Endometrial Atypical Hyperplasia and Risk of Endometrial Cancer. Diagnostics, 14.","DOI":"10.3390\/diagnostics14222471"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Doherty, M.T., Sanni, O.B., Coleman, H.G., Cardwell, C.R., McCluggage, W.G., Quinn, D., Wylie, J., and McMenamin, \u00da.C. (2020). Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0232231"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/path.5566","article-title":"Genome-Wide Mutation Analysis in Precancerous Lesions of Endometrial Carcinoma","volume":"253","author":"Li","year":"2021","journal-title":"J. Pathol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Sanderson, P.A., Esnal-Zufiaurre, A., Arends, M.J., Herrington, C.S., Collins, F., Williams, A.R.W., and Saunders, P.T.K. (2022). Improving the Diagnosis of Endometrial Hyperplasia Using Computerized Analysis and Immunohistochemical Biomarkers. Front. Reprod. Health, 4.","DOI":"10.3389\/frph.2022.896170"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"657","DOI":"10.5152\/balkanmedj.2016.151232","article-title":"Does preoperative diagnosis of endometrial hyperplasia necessitate intraoperative frozen section consultation?","volume":"33","author":"Boyraz","year":"2016","journal-title":"Balk. Med. J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.ygyno.2014.03.569","article-title":"Intra-operative frozen section results reliably predict final pathology in endometrial cancer","volume":"133","author":"Stephan","year":"2014","journal-title":"Gynecol. Oncol."},{"key":"ref_57","first-page":"435","article-title":"Accuracy of frozen section diagnosis at surgery in pre- malignant and malignant lesions of the endometrium","volume":"29","author":"Montalto","year":"2008","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"6053","DOI":"10.7314\/APJCP.2014.15.15.6053","article-title":"Utility of frozen section pathology with endometrial pre-malignant lesions","volume":"15","author":"Oz","year":"2014","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_59","first-page":"66","article-title":"Sentinel lymph node assessment in patients with atypical endometrial hyperplasia: A systematic review and meta-analysis","volume":"34","author":"Peralta","year":"2023","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"110168","DOI":"10.1016\/j.ejso.2025.110168","article-title":"Is there a role for the sentinel lymph node in endometrial atypical hyperplasia? Insights from an ESGO-accredited Institution","volume":"51","author":"Restaino","year":"2025","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1136\/ijgc-2023-005202","article-title":"Concurrent endometrial cancer in atypical endometrial hyperplasia and the role of sentinel lymph nodes: Clinical insights from a multicenter experience","volume":"34","author":"Rosati","year":"2024","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Billone, V., De Paola, L., Conti, E., Borsellino, L., Kozinszky, Z., Giampaolino, P., Suranyi, A., Della Corte, L., Andrisani, A., and Cucinella, G. (2025). Sentinel Lymph Node in Endometrial Hyperplasia: State of the Art and Future Perspectives. Cancers, 17.","DOI":"10.3390\/cancers17050776"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"266.e1","DOI":"10.1016\/j.ajog.2012.08.011","article-title":"Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: A systematic review and metaanalysis","volume":"207","author":"Gallos","year":"2012","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_64","first-page":"5412","article-title":"LNG-IUS combined with progesterone ameliorates endometrial thickness and pregnancy outcomes of patients with early-stage endometrial cancer or atypical hyperplasia","volume":"13","author":"Fang","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.jmig.2018.07.001","article-title":"Hysteroscopic endometrial focal resection followed by levonorgestrel intrauterine device insertion as a fertility-sparing treatment of atypical endometrial hyperplasia and early endometrial cancer: A retrospective study","volume":"26","author":"Giampaolino","year":"2019","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.ygyno.2011.11.004","article-title":"Predictors of resolution of complex atypical hyperplasia or grade 1 endometrial adenocarcinoma in premenopausal women treated with progestin therapy","volume":"124","author":"Penner","year":"2012","journal-title":"Gynecol. Oncol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/IGC.0b013e31827c18a1","article-title":"The influence of infertility treatment on the prognosis of endometrial cancer and atypical complex endometrial hyperplasia","volume":"23","author":"Ichinose","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.jmig.2006.08.007","article-title":"Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia","volume":"14","author":"Edris","year":"2007","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1136\/bmj.325.7358.239","article-title":"Effect on endometrium of long term treatment with continuous combined estrogen-progestogen replacement therapy: Follow up study","volume":"325","author":"Wells","year":"2002","journal-title":"BMJ"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1111\/j.1471-0528.2000.tb11654.x","article-title":"The endometrial response to sequential and continuous combined estrogen-progestogen replacement therapy","volume":"107","author":"Sturdee","year":"2000","journal-title":"BJOG"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1093\/jnci\/dji372","article-title":"Tamoxifen for the prevention of breast cancer: Current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study","volume":"97","author":"Fisher","year":"2005","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Chin, J., Konje, J.C., and Hickey, M. (2009). Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen. Cochrane Database Syst. Rev., CD007245.","DOI":"10.1002\/14651858.CD007245.pub2"},{"key":"ref_73","first-page":"492","article-title":"The role of levonorgestrel-releasing intrauterine system for endometrial protection in women with breast cancer taking tamoxifen","volume":"35","author":"Shi","year":"2014","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1097\/AOG.0b013e31828bf80c","article-title":"Prophylactic use of levonorgestrel-releasing intrauterine system in women with breast cancer treated with tamoxifen: A randomized controlled trial","volume":"121","author":"Wong","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1111\/j.1471-0528.2007.01391.x","article-title":"Endometrial hyperplasia involving endometrial polyps: Report of a series and discussion of the significance in an endometrial biopsy specimen","volume":"114","author":"Kelly","year":"2007","journal-title":"BJOG"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1097\/AOG.0000000000001566","article-title":"Atypical endometrial polyps and concurrent endometrial cancer: A systematic review","volume":"128","author":"Steenbergen","year":"2016","journal-title":"Obstet. Gynecol."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Joshua, A., Allen, K.E., and Orsi, N.M. (2025). An Overview of Artificial Intelligence in Gynaecological Pathology Diagnostics. Cancers, 17.","DOI":"10.3390\/cancers17081343"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"100116","DOI":"10.1016\/j.modpat.2023.100116","article-title":"Automated Prognostic Assessment of Endometrial Hyperplasia for Progression Risk Evaluation Using Artificial Intelligence","volume":"36","author":"Rewcastle","year":"2023","journal-title":"Mod. Pathol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2048\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:07:04Z","timestamp":1784718424000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/13\/2048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":78,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["cancers18132048"],"URL":"https:\/\/doi.org\/10.3390\/cancers18132048","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}