Histological evaluation of hysterectomy specimens after NovaSure® endometrial ablation in patients with atypical endometrial hyperplasia or endometrial carcinoma

Abstract Background Treatment with NovaSure® endometrial ablation is approved for patients with heavy menstrual bleeding (HMB) without evidence of malignant or premalignant lesions. This analysis addresses the rare but clinically relevant situation in which endometrial carcinoma (EC) or atypical hyperplasia (AEH) is identified histologically after endometrial ablation in premenopausal patients. Objective Histological evaluation of hysterectomy specimens with correlation to clinical parameters in patients undergoing hysterectomy after incidental histological diagnosis of AEH or EC following NovaSure® endometrial ablation. Methods A retrospective single-center analysis was conducted on more than 400 patients who underwent NovaSure® endometrial ablation at our center between January 2020 and February 2025. Patients with AEH or EC for whom subsequent hysterectomy specimens were available were included. Histological evaluation was performed and independently reviewed to assess residual endometrium, residual endometrial atypia or carcinoma, and ablation-related histomorphological changes. Results A total of 11 patients (AEH n = 8; EC n = 3) underwent subsequent hysterectomy after NovaSure® endometrial ablation. Six out of eight patients with AEH showed no residual atypia in the hysterectomy specimens (2/8 with focal residual atypia), and no residual invasive carcinoma was detected in any of the three carcinoma cases. Histopathological analysis showed pronounced postablative changes, including necrosis, fibrosis, zonation, and vascular and lymphatic alterations. Conclusion This descriptive study provides a clinicopathological characterization of patients with EC or AEH who underwent hysterectomy after endometrial ablation. In these patients, no preprocedural evidence of endometrial pathology was present, and the diagnosis was established solely through routine histopathological examination of curettage specimens obtained immediately before the ablation procedure. Histological assessment revealed pronounced changes, highlighting specific diagnostic challenges and underscoring the importance of careful patient selection and thorough diagnostic evaluation before NovaSure® ablation. Within the limitations of this study, no evidence was found that prior endometrial ablation compromises oncological outcome.