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Background: It remains unclear if there is an endometrial thickness (ET) threshold below which malignancy can be excluded. Guidance on whether endometrial biopsy is needed based on ET varies among regions in New Zealand and there is a desire to standardise guidance nationwide. This study evaluates the potential impact of limiting endometrial biopsy in pre-menopausal persons with abnormal uterine bleeding (AUB) to those with an ET of less than 12 mm., Aims: To determine the number of pre-menopausal patients with AUB with an ET of less than 12 mm undergoing endometrial sampling annually and assess the prevalence of pathology among these patients., Materials and Methods: Endometrial samples from patients aged 18-50 years processed at a tertiary hospital between 15/06/2022 and 13/06/2023 were identified via a pathology lab search. Clinical, radiologic, and pathological data were obtained by case note review for those with AUB whose ET was less than 12 mm., Results: Of 1271 endometrial samples, 355 patients met the eligibility criteria, and 2.2% of these were cancerous (three cases) or pre-malignant (five cases)., Conclusions: If sampling thresholds would change to not perform biopsies in those with an ET of less than 12 mm, eight cases of treatable disease would be missed in pre-menopausal people. This represents 13.6% of all endometrial cancers diagnosed in pre-menopausal people in the same time period. There is no ET cut-off to reliably exclude high-risk pathology and endometrial sampling should be performed in all cases of AUB with risk factors., (© 2024 Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Aim: Endometrial cancer (EC) is increasing in incidence in women across Aotearoa New Zealand as risk factors such as obesity and diabetes become more prevalent. In 2022, a Rapid Access Clinic (RAC) for hysteroscopy was implemented at Te Whatu Ora Counties Manukau District to increase early detection of EC., Method: Plan-Do-Study-Act (PDSA) cycles were used to test and implement RAC supported by a nurse pre-procedural phone consultation. Quantitative data was collected alongside patient experiences of the pre-procedural telephone call., Results: A total of 207 women successfully completed RAC, which enabled one less visit to clinic per patient, subsequent travel cost savings (NZ$35,959) and a decrease in CO2 emissions (1,782kg). Lead time from first specialist appointment (FSA) to outpatient (OP) hysteroscopy, previously 25 days (SD: 21 days), was eliminated. Wait time from referral to provisional diagnosis increased from 26 days to 31 days; however, standard variation reduced from 30 days to 15 days. Clinician productivity increased by 25% per hysteroscopy session. Twenty-six out of 30 patients reported positive experiences of their pre-procedural RAC phone consultation. Twenty-seven out of 207 women were diagnosed with endometrial cancer from RAC., Conclusion: RAC are patient-centric and have demonstrated valuable benefits for both clinicians and women with a high suspicion of EC., Competing Interests: Nil., (© PMA.)

Background: Atypical endometrial hyperplasia (AEH) is the precursor lesion in endometrial carcinoma, the most common gynaecological malignancy in New Zealand, with inequities in disease burden and outcome for Māori and Pacific women., Aims: In women diagnosed with AEH at two hospitals, to audit five standards of care for surgical management and time-to-treatment, and identify variation in care by ethnicity and other factors., Materials and Methods: Demographic, referral, diagnostic and treatment characteristics were collected for women with a new AEH diagnosis between 1/1/2019 and 31/12/2020. Surgical management and time-to-treatment were audited against Royal College of Obstetricians and Gynaecologists and New Zealand Ministry of Health Faster Cancer Treatment recommendations., Results: Of 124 participants, 60% were Pacific, 86% premenopausal, and 80% had obesity. For 55 women managed surgically, surgical standards of care were met. There were delays between referral, diagnosis and treatment - only 18% and 56% of women met the 62-day (referral to treatment) and 31-day (decision-to-treat to treatment) targets, respectively. Wait times were prolonged for women who had dilation and curettage (vs pipelle), magnetic resonance imaging (MRI) (vs no MRI), and surgery (vs medical management). Ethnic disparities were not identified for any standard., Discussion: Delays to treatment were found throughout women's journeys. Hospital services can streamline their clinical pathways for women referred for abnormal uterine bleeding, flagging obesity as a high suspicion for cancer indicator, increasing access to endometrial sampling in primary care and establishing 'one-stop-shop' outpatient assessment with empiric initiation of intrauterine progestogen., (© 2022 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Purpose: Intrauterine levonorgestrel (LNG-IUD) is used to treat patients with endometrial adenocarcinoma (EAC) and endometrial hyperplasia with atypia (EHA) but limited evidence is available on its effectiveness. The study determined the extent to which LNG-IUD with or without metformin (M) or weight loss (WL) achieves a pathological complete response (pCR) in patients with EAC or EHA., Patients and Methods: This phase II randomized controlled clinical trial enrolled patients with histologically confirmed, clinically stage 1 FIGO grade 1 EAC or EHA; a body mass index > 30 kg/m2; a depth of myometrial invasion of less than 50% on MRI; a serum CA125 ≤ 30 U/mL. All patients received LNG-IUD and were randomized to observation (OBS), M (500 mg orally twice daily), or WL (pooled analysis). The primary outcome measure was the proportion of patients developing a pCR (defined as absence of any evidence of EAC or EHA) after 6 months., Results: From December 2012 to October 2019, 165 patients were enrolled and 154 completed the 6-months follow up. Women had a mean age of 53 years, and a mean BMI of 48 kg/m 2 . Ninety-six patients were diagnosed with EAC (58%) and 69 patients with EHA (42%). Thirty-five participants were randomized to OBS, 36 to WL and 47 to M (10 patients were withdrawn). After 6 months the rate of pCR was 61% (95% CI 42% to 77%) for OBS, 67% (95% CI 48% to 82%) for WL and 57% (95% CI 41% to 72%) for M. Across the three treatment groups, the pCR was 82% and 43% for EHA and EAC, respectively., Conclusion: Complete response rates at 6 months were encouraging for patients with EAC and EHA across the three groups., Trial Registration: U.S. National Library of Medicine, NCT01686126., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)