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Gama Q, Wang L, Wu P, Liu S, Yang B, Zhang H, Sun L, Wang Y, Luo X, Yu M, Shan W. Effects of levonorgestrel-releasing intrauterine system on recurrence and fertility outcomes during assisted reproduction after complete remission of early endometrioid endometrial cancer and precancerous lesions: A retrospective cohort study. Int J Cancer 2025. [PMID: 40366317 DOI: 10.1002/ijc.35465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 04/10/2025] [Accepted: 04/15/2025] [Indexed: 05/15/2025]
Abstract
To investigate the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) on recurrence and fertility outcomes during controlled ovarian stimulation (COS) in patients with early stage endometrioid endometrial carcinoma (EEC) and endometrial atypical hyperplasia (EAH) following successful fertility-preserving treatment. We reviewed the patients with Grade 1 presumed Stage IA EEC or EAH who underwent in vitro fertilization and embryo transfer after successful fertility-sparing treatment. A total of 176 women were enrolled in this study, undergoing 318 cycles of COS and 290 cycles of embryo transfer (ET). Twenty-one percent (37/176) patients have an LNG-IUS insertion during the initial ovarian stimulation, and the median follow-up time for this cohort was 61.3 months (interquartile range [IQR], 39.0-76.6 months), while it was 60.5 months for the other cohort (IQR, 44.9-80.3 months). Disease recurrence was experienced by 34.7% (61/176) of the patients. Compared to the non-LNG-IUS group, the LNG-IUS group had a lower recurrence rate 1 year after COS (5.4% (2/37) versus 20.9% (29/139), p = .034). The use of LNG-IUS was associated with a reduced recurrence rate 1 year after COS (hazard ratio = 0.203, 95% confidence interval [0.042-0.984], p = .048). The overall clinical pregnancy rate reached as high as 65.3% (115/176), while the cumulative live birth rates were up to 46.6% (85/176). We found that LNG-IUS during COS did not impact oocyte yield, ET, or pregnancy outcomes. The placement of LNG-IUS during COS in EEC/EAH patients is worth considering, as it is likely to reduce the recurrence of endometrial lesions without affecting fertility outcomes.
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Affiliation(s)
- Qujia Gama
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Lulu Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Pengfei Wu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Sijia Liu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Bingyi Yang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Hongwei Zhang
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
- Department of Cervix, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Li Sun
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
- Department of Ultrasound, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yiqin Wang
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xuezhen Luo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Min Yu
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
- Reproductive Medicine Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Weiwei Shan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
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Zhang Y, Tian L. Advances and challenges in the use of liquid biopsy in gynaecological oncology. Heliyon 2024; 10:e39148. [PMID: 39492906 PMCID: PMC11530831 DOI: 10.1016/j.heliyon.2024.e39148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 10/08/2024] [Accepted: 10/08/2024] [Indexed: 11/05/2024] Open
Abstract
Ovarian cancer, endometrial cancer, and cervical cancer are the three primary gynaecological cancers that pose a significant threat to women's health on a global scale. Enhancing global cancer survival rates necessitates advancements in illness detection and monitoring, with the goal of improving early diagnosis and prognostication of disease recurrence. Conventional methods for identifying and tracking malignancies rely primarily on imaging techniques and, when possible, protein biomarkers found in blood, many of which lack specificity. The process of collecting tumour samples necessitates intrusive treatments that are not suitable for specific purposes, such as screening, predicting, or evaluating the effectiveness of treatment, monitoring the presence of remaining illness, and promptly detecting relapse. Advancements in treatment are being made by the detection of genetic abnormalities in tumours, both inherited and acquired. Newly designed therapeutic approaches can specifically address some of these abnormalities. Liquid biopsy is an innovative technique for collecting samples that examine specific cancer components that are discharged into the bloodstream, such as circulating tumour DNA (ctDNA), circulating tumour cells (CTCs), cell-free RNA (cfRNA), tumour-educated platelets (TEPs), and exosomes. Mounting data indicates that liquid biopsy has the potential to improve the clinical management of gynaecological cancers through enhanced early diagnosis, prognosis prediction, recurrence detection, and therapy response monitoring. Understanding the distinct genetic composition of tumours can also inform therapy choices and the identification of suitable targeted treatments. The main benefits of liquid biopsy are its non-invasive characteristics and practicality, enabling the collection of several samples and the continuous monitoring of tumour changes over time. This review aims to provide an overview of the data supporting the therapeutic usefulness of each component of liquid biopsy. Additionally, it will assess the benefits and existing constraints associated with the use of liquid biopsy in the management of gynaecological malignancies. In addition, we emphasise future prospects in light of the existing difficulties and investigate areas where further research is necessary to clarify its rising clinical capabilities.
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Affiliation(s)
- Yingfeng Zhang
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Libi Tian
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
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Kurata M, Tajiri T, Ueda M, Inomoto C, Sugiyama T, Fujita H, Nomura N, Machida T, Iida T, Ooiwa I, Nishijima Y, Kajiwara H, Muramatsu T, Nakamura N. Utility of Pipet Curet Cytology and Biopsy as a Diagnostic Method for Endometrial Endometrioid Carcinoma. Acta Cytol 2024; 68:413-422. [PMID: 39236701 DOI: 10.1159/000541279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
INTRODUCTION We aimed to determine the utility of Pipet Curet cytology (PCC) and Pipet Curet biopsy (PCB) for diagnosing uterine endometrial endometrioid carcinoma (EEC). METHODS We divided 77 patients with EEC into two groups per Federation of Gynecology and Obstetrics (FIGO) grades: G1 (n = 44) and G2/3 (n = 33) and compared the diagnostic sensitivity of PCC, PCB, and PCC and PCB combined, retrospectively. Next, we investigated any diagnostic discordance between PCC-based and PCB-based diagnoses per FIGO grade group. RESULTS The diagnostic sensitivity of PCC, PCB, and the two modalities combined was significantly higher for G2/3 EECs than for G1 EECs (72.7% vs. 45.5%, p = 0.0209; 84.8% vs. 63.6%, p = 0.0434; and 93.9% vs. 65.9%, p = 0.0046, respectively), likely due to more friable cancer cells in higher grade EEC cases. Among our 77 EEC patients, there were 4 patients (5.19%) with PCC-based concordant but PCB-based discordant results against EEC, in the G2/3 group predominantly. Diagnostic sensitivity of all cases increased from 72.7% (56/77) by PCB alone to 77.9% (60/77) by use of both modalities combined. CONCLUSION Cytologic evaluation can reduce the number of false-negative histologic diagnoses. By providing complementary information, the two modalities combined from the Pipet Curet procedure would be valuable as a diagnostic method for EEC.
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Affiliation(s)
- Makiko Kurata
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan,
| | - Takuma Tajiri
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masataka Ueda
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Chie Inomoto
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomoko Sugiyama
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Hirotaka Fujita
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Nozomi Nomura
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomohisa Machida
- Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tetsuji Iida
- Department of Internal Medicine, Tomei Atsugi Hospital, Atsugi, Japan
| | - Ippei Ooiwa
- Department of Gynecology, Tokai University Hachioji Hospital, Tokyo, Japan
| | | | - Hiroshi Kajiwara
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | | | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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Alnemr AA, Harb OA, Atia H. The efficacy of the levonorgestrel intrauterine system versus oral megestrol acetate in treating atypical endometrial hyperplasia: a superior randomized controlled trial. J Gynecol Oncol 2024; 35:e62. [PMID: 38425141 PMCID: PMC11390252 DOI: 10.3802/jgo.2024.35.e62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/18/2023] [Accepted: 02/11/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE To compare the efficacy of the levonorgestrel intrauterine system (LNG-IUS) versus megestrol acetate (MA) in inducing complete regression among women with atypical endometrial hyperplasia (AEH) who declined hysterectomy. METHODS In this single-center, open-label randomized controlled trial, we included 148 women with AEH who declined hysterectomy. We randomized participants to receive either daily oral MA 160 mg (n=74) or apply LNG-IUS (n=74) and scheduled their follow-up by endometrial sampling at 3, 6, 9, 12, 18, and 24 months. The success rate and duration until complete regression were the primary outcomes. RESULTS The mean duration until complete regression was 5.52 months (95% confidence interval [CI]=4.85-6.18) for the LNG-IUS group versus 6.87 months (95% CI=6.09-7.64) for the megestrol group (log-rank test p-value=0.011). The cumulative regression rate after 12 months was 91.9% with the LNG-IUS versus 77% with MA (p=0.026). Weight gain in the MA group vs LNG-IUS group after one year (4.7±4 kg vs. 2.7±2.6 kg, 95% CI=0.89-3.12; p=0.001) and after two years of therapy (7.8±5.1 kg vs. 4.1±2.9 kg, 95% CI=2.29-5.06; p<0.001). CONCLUSION Compared to MA, the LNG-IUS was more efficacious in treating AEH in women who declined hysterectomy, especially those with moderate/severe obesity, with fewer adverse effects and less weight gain. Extending therapy to 12 months for persistent cases would improve regression rates with reasonable safety. Alternate hysteroscopic and office sampling seemed convenient for follow-up. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04385667.
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Affiliation(s)
- Amr A Alnemr
- Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ola A Harb
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hytham Atia
- Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Koh KML, Ng ZY, Chin FHX, Wong WL, Wang J, Lim YK. Comparing Surgical and Oncological Outcomes between Indocyanine Green (ICG) Sentinel Lymph Node Mapping with Routine Lymphadenectomy in the Surgical Staging of Early-Stage Endometrioid Endometrial Cancer. Obstet Gynecol Int 2023; 2023:9949604. [PMID: 37881680 PMCID: PMC10597725 DOI: 10.1155/2023/9949604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023] Open
Abstract
Methods A retrospective single-centre cohort study of patients with early-stage endometrioid endometrial cancer undergoing staging surgery (total hysterectomy, bilateral salpingo-oophorectomy with/without pelvic lymph node, and/or para-aortic lymph node dissection (PLND)) with either SLN mapping or routine lymphadenectomy between July 2017 and December 2018. Results 203 cases with clinical and radiological International Federation of Gynaecology and Obstetrics (FIGO) stage I endometrioid endometrial cancer were included, out of which 109 cases underwent SLN mapping and 94 cases complete lymphadenectomy. Compared to the PLND group, the SLN group had shorter operative time (129 vs. 162 minutes), less blood loss (100 vs. 300 ml), and decreased length of postoperative hospital stay (3 vs. 4 days) (p < 0.001). The lymph node metastases detection rate was 4.6% and 7.4% for the SLN and PLND groups, respectively (p = 0.389). With a median follow-up of 14 months for the SLN and 15 months for the PLND group, the disease-free (DFS) and overall survival (OS) were comparable for both at 13 months (p = 0.538 and p = 0.333, respectively). Conclusion SLN mapping has been shown to be an acceptable alternative to routine lymphadenectomy in the surgical staging of early-stage endometrial cancer in our centre, with a comparable lymph node metastases detection rate, DFS and OS, and reduction in operative morbidity. Our results with SLN mapping reproduce comparable outcomes to those reported in the literature.
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Affiliation(s)
- Krystal Miao Lin Koh
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - Zheng Yuan Ng
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - Felicia Hui Xian Chin
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - Wai Loong Wong
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - Junjie Wang
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
| | - Yong Kuei Lim
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, 100 Bukit Timah Road 229899, Singapore
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Peremiquel-Trillas P, Gómez D, Martínez JM, Fernández-González S, Frias-Gomez J, Paytubi S, Pelegrina B, Pineda M, Brunet J, Ponce J, Matias-Guiu X, Bosch X, de Sanjosé S, Bruni L, Alemany L, Costas L, Díaz M. Cost-effectiveness analysis of molecular testing in minimally invasive samples to detect endometrial cancer in women with postmenopausal bleeding. Br J Cancer 2023; 129:325-334. [PMID: 37165201 PMCID: PMC10338433 DOI: 10.1038/s41416-023-02291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION New approaches are being developed to early detect endometrial cancer using molecular biomarkers. These approaches offer high sensitivities and specificities, representing a promising horizon to develop early detection strategies. OBJECTIVE To evaluate the effectiveness and cost-effectiveness of introducing molecular testing to detect endometrial cancer in women with postmenopausal bleeding compared to the current strategy using the national healthcare service perspective. METHODS A Markov model was developed to assess the two early detection strategies. The model predicts the number of hysterectomies, lifetime expectancy, quality-adjusted life-years, endometrial cancer prevalence and incidence, mortality from endometrial cancer and the lifetime cost of screening, diagnosis, and treatment. Strategies were compared using the incremental cost-effectiveness ratio. RESULTS The molecular strategy reduces 1.9% of the overall number of hysterectomies and the number of undetected cancer cases by 65%. Assuming a molecular test cost of 310€, the molecular strategy has an incremental cost of -32,952€ per QALY gained, being more effective and less expensive than the current strategy. CONCLUSIONS The introduction of molecular testing to diagnose endometrial cancer in women presenting postmenopausal bleeding provides more health benefit at a lower cost, and therefore has the potential to be cost-effective.
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Affiliation(s)
- Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - David Gómez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Manuel Martínez
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Fernández-González
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Joan Brunet
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Medical Oncology Department. Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital. Av. França-Sant Ponç s/n, 17007, Girona, Spain
| | - Jordi Ponce
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Health Sciences, UOC - Open University of Barcelona, Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Consultant National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laia Bruni
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Mireia Díaz
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain.
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Emons G, Steiner E, Vordermark D, Uleer C, Paradies K, Tempfer C, Aretz S, Cremer W, Hanf V, Mallmann P, Ortmann O, Römer T, Schmutzler RK, Horn LC, Kommoss S, Lax S, Schmoeckel E, Mokry T, Grab D, Reinhardt M, Steinke-Lange V, Brucker SY, Kiesel L, Witteler R, Fleisch MC, Heinrich Prömpeler † 25, Friedrich M, Höcht S, Lichtenegger W, Mueller M, Runnebaum I, Feyer P, Hagen V, Juhasz-Böss I, Letsch A, Niehoff P, Zeimet AG, Battista MJ, Petru E, Widhalm S, van Oorschot B, Panke JE, Weis J, Dauelsberg T, Haase H, Beckmann MW, Jud S, Wight E, Prott FJ, Micke O, Bader W, Reents N, Henscher U, Reina Tholen † 52, Schallenberg M, Rahner N, Mayr D, Kreißl M, Lindel K, Mustea A, Strnad V, Goerling U, Bauerschmitz GJ, Langrehr J, Neulen J, Ulrich UA, Nothacker MJ, Blödt S, Follmann M, Langer T, Wenzel G, Weber S, Erdogan S. Endometrial Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry Number 032/034-OL, September 2022). Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer, Geriatric Assessment and Supply Structures. Geburtshilfe Frauenheilkd 2023; 83:919-962. [PMID: 37588260 PMCID: PMC10427205 DOI: 10.1055/a-2066-2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/22/2023] [Indexed: 08/18/2023] Open
Abstract
Summary The S3-guideline on endometrial cancer, first published in April 2018, was reviewed in its entirety between April 2020 and January 2022 and updated. The review was carried out at the request of German Cancer Aid as part of the Oncology Guidelines Program and the lead coordinators were the German Society for Gynecology and Obstetrics (DGGG), the Gynecology Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Cancer Aid (DKH). The guideline update was based on a systematic search and assessment of the literature published between 2016 and 2020. All statements, recommendations and background texts were reviewed and either confirmed or amended. New statements and recommendations were included where necessary. Aim The use of evidence-based risk-adapted therapies to treat women with endometrial cancer of low risk prevents unnecessarily radical surgery and avoids non-beneficial adjuvant radiation therapy and/or chemotherapy. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimum level of radical surgery and indicates whether chemotherapy and/or adjuvant radiation therapy is necessary. This should improve the survival rates and quality of life of these patients. The S3-guideline on endometrial cancer and the quality indicators based on the guideline aim to provide the basis for the work of certified gynecological cancer centers. Methods The guideline was first compiled in 2018 in accordance with the requirements for S3-level guidelines and was updated in 2022. The update included an adaptation of the source guidelines identified using the German Instrument for Methodological Guideline Appraisal (DELBI). The update also used evidence reviews which were created based on selected literature obtained from systematic searches in selected literature databases using the PICO process. The Clinical Guidelines Service Group was tasked with carrying out a systematic search and assessment of the literature. Their results were used by interdisciplinary working groups as a basis for developing suggestions for recommendations and statements which were then modified during structured online consensus conferences and/or additionally amended online using the DELPHI process to achieve a consensus. Recommendations Part 1 of this short version of the guideline provides recommendations on epidemiology, screening, diagnosis, and hereditary factors. The epidemiology of endometrial cancer and the risk factors for developing endometrial cancer are presented. The options for screening and the methods used to diagnose endometrial cancer are outlined. Recommendations are given for the prevention, diagnosis, and therapy of hereditary forms of endometrial cancer. The use of geriatric assessment is considered and existing structures of care are presented.
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Affiliation(s)
- Günter Emons
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Eric Steiner
- Frauenklinik GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
| | - Dirk Vordermark
- Universität Halle (Saale), Radiotherapie, Halle (Saale), Germany
| | - Christoph Uleer
- Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Germany
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpfleger (KOK), Hamburg, Germany
| | - Clemens Tempfer
- Frauenklinik der Ruhr-Universität Bochum, Bochum/Herne, Germany
| | - Stefan Aretz
- Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Bonn, Germany
| | | | - Volker Hanf
- Frauenklinik Nathanstift – Klinikum Fürth, Fürth, Germany
| | | | - Olaf Ortmann
- Universität Regensburg, Fakultät für Medizin, Klinik für Frauenheilkunde und Geburtshilfe, Regensburg, Germany
| | - Thomas Römer
- Evangelisches Klinikum Köln Weyertal, Gynäkologie Köln, Köln, Germany
| | - Rita K. Schmutzler
- Universitätsklinikum Köln, Zentrum Familiärer Brust- und Eierstockkrebs, Köln, Germany
| | | | - Stefan Kommoss
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Sigurd Lax
- Institut für Pathologie, LKH Graz Süd-West, Graz, Austria
| | | | - Theresa Mokry
- Universitätsklinikum Heidelberg, Diagnostische und Interventionelle Radiologie, Heidelberg, Germany
| | - Dieter Grab
- Universitätsklinikum Ulm, Frauenheilkunde und Geburtshilfe, Ulm, Germany
| | - Michael Reinhardt
- Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Verena Steinke-Lange
- MGZ – Medizinisch Genetisches Zentrum München, München, Germany
- Medizinische Klinik und Poliklinik IV, LMU München, München, Germany
| | - Sara Y. Brucker
- Universitätsklinikum Tübingen, Universitätsfrauenklinik Tübingen, Tübingen, Germany
| | - Ludwig Kiesel
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Ralf Witteler
- Universitätsklinikum Münster, Frauenklinik A Schweitzer Campus 1, Münster, Germany
| | - Markus C. Fleisch
- Helios, Universitätsklinikum Wuppertal, Landesfrauenklinik, Wuppertal, Germany
| | | | - Michael Friedrich
- Helios Klinikum Krefeld, Klinik für Frauenheilkunde und Geburtshilfe, Krefeld, Germany
| | - Stefan Höcht
- XCare, Praxis für Strahlentherapie Saarlouis, Saarlouis, Germany
| | - Werner Lichtenegger
- Universitätsmedizin Berlin, Frauenklinik Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Michael Mueller
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Petra Feyer
- Vivantes Klinikum Neukölln, Klinik für Strahlentherapie und Radioonkologie, Berlin, Germany
| | - Volker Hagen
- Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | | | - Anne Letsch
- Universitätsklinikum Schleswig Holstein, Campus Kiel, Innere Medizin, Kiel, Germany
| | - Peter Niehoff
- Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
| | - Alain Gustave Zeimet
- Medizinische Universität Innsbruck, Universitätsklinik für Gynäkologie und Geburtshilfe, Innsbruck, Austria
| | | | - Edgar Petru
- Med. Univ. Graz, Frauenheilkunde, Graz, Austria
| | | | - Birgitt van Oorschot
- Universitätsklinikum Würzburg, Interdisziplinäres Zentrum Palliativmedizin, Würzburg, Germany
| | - Joan Elisabeth Panke
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V. Essen, Essen, Germany
| | - Joachim Weis
- Albert-Ludwigs-Universität Freiburg, Medizinische Fakultät, Tumorzentrum Freiburg – CCCF, Freiburg, Germany
| | - Timm Dauelsberg
- Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
| | | | | | | | - Edward Wight
- Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
| | - Franz-Josef Prott
- Facharzt für Radiologie und Strahlentherapie, Wiesbaden, Wiesbaden, Germany
| | - Oliver Micke
- Franziskus Hospital Bielefeld, Klinik für Strahlentherapie und Radioonkologie, Bielefeld, Germany
| | - Werner Bader
- Klinikum Bielefeld Mitte, Zentrum für Frauenheilkunde, Bielefeld, Germany
| | | | | | | | | | | | - Doris Mayr
- LMU München, Pathologisches Institut, München, Germany
| | - Michael Kreißl
- Universität Magdeburg, Medizinische Fakultät, Universitätsklinik für Radiologie und Nuklearmedizin, Germany
| | - Katja Lindel
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Alexander Mustea
- Universitätsklinikum Bonn, Zentrum Gynäkologie und gynäkologische Onkologie, Bonn, Germany
| | - Vratislav Strnad
- Universitätsklinikum Erlangen, Brustzentrum Franken, Erlangen, Germany
| | - Ute Goerling
- Universitätsmedizin Berlin, Campus Charité Mitte, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Gerd J. Bauerschmitz
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Jan Langrehr
- Martin-Luther-Krankenhaus, Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Berlin, Germany
| | - Joseph Neulen
- Uniklinik RWTH Aachen, Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Aachen, Germany
| | - Uwe Andreas Ulrich
- Martin-Luther-Krankenhaus, Johannesstift Diakonie, Gynäkologie, Berlin, Germany
| | | | | | - Markus Follmann
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Thomas Langer
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Gregor Wenzel
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Sylvia Weber
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
| | - Saskia Erdogan
- Universitätsmedizin Göttingen, Klinik für Gynäkologie und Geburtshilfe, Göttingen, Germany
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Vitale SG, Buzzaccarini G, Riemma G, Pacheco LA, Sardo ADS, Carugno J, Chiantera V, Török P, Noventa M, Haimovich S, De Franciscis P, Perez-Medina T, Angioni S, Laganà AS. Endometrial Biopsy: Indications, Techniques and Recommendations. An Evidence-Based Guideline for Clinical Practice. J Gynecol Obstet Hum Reprod 2023; 52:102588. [PMID: 37061093 DOI: 10.1016/j.jogoh.2023.102588] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/04/2022] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
This practice guideline provides updated evidence for the gynecologist who performs endometrial biopsy (EB) in gynecologic clinical practice. An international committee of gynecology experts developed the recommendations according to AGREE Reporting Guideline. An adequate tissue sampling is mandatory when performing an EB. Blind methods should not be first choice in patients with suspected endometrial malignancy. Hysteroscopy is the targeted-biopsy method with highest diagnostic accuracy and cost-effectiveness. Blind suction techniques are not reliable for the diagnosis of endometrial polyps. In low resources settings, and in absence of the capacity to perform office hysteroscopy, blind techniques could be used for EB. Hysteroscopic punch biopsy allows to collect only limited amount of endometrial tissue. grasp biopsy technique should be considered first choice in reproductive aged women, bipolar electrode chip biopsy should be preferred with hypotrophic or atrophic endometrium. EB is required for the final diagnosis of chronic endometritis. There is no consensus regarding which endometrial thickness cut-off should be used for recommending EB in asymptomatic postmenopausal women. EB should be offered to young women with abnormal uterine bleeding and risk factors for endometrial carcinoma. Endometrial pathology should be excluded with EB in nonobese women with unopposed hyperestrogenism. Hysteroscopy with EB is useful in patients with abnormal bleeding even without sonographic evidence of pathology. EB has high sensitivity for detecting intrauterine pathologies. In postmenopausal women with uterine bleeding, EB is recommended. Women with sonographic endometrial thickness > 4mm using tamoxifen should undergo hysteroscopic EB.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giovanni Buzzaccarini
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Luis Alonso Pacheco
- Unidad de Endoscopia Ginecológica, Centro Gutenberg, Hospital Xanit Internacional, Málaga, Spain
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Jose Carugno
- Obstetrics and Gynecology Department, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Peter Török
- University of Debrecen, Faculty of Medicine, Department of Obstetrics and Gynecology
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Laniado University Hospital, Netanya, Israel and Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Tirso Perez-Medina
- Department of Obstetrics and Gynecology, University Hospital Puerta de Hierro Majadahonda, Autonoma University of Madrid, Madrid, Spain
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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9
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Otsuka I. Therapeutic Benefit of Systematic Lymphadenectomy in Node-Negative Uterine-Confined Endometrioid Endometrial Carcinoma: Omission of Adjuvant Therapy. Cancers (Basel) 2022; 14:cancers14184516. [PMID: 36139675 PMCID: PMC9497184 DOI: 10.3390/cancers14184516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Endometrial cancer is the most common gynecological tract malignancy in developed countries. Extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors. Abstract Endometrial cancer is the most common gynecological tract malignancy in developed countries, and its incidence has been increasing globally with rising obesity rates and longer life expectancy. In endometrial cancer, extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors. In this review, I discuss the characteristics of lymph node metastasis, the methods of lymph node assessment, and the therapeutic benefits of systematic lymphadenectomy in patients with intermediate- and high-risk endometrioid endometrial carcinoma.
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Affiliation(s)
- Isao Otsuka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa 296-8602, Chiba, Japan
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10
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A comparison of malignant histopathological diagnoses on uterine curettings and hysterectomy specimens. SOUTH AFRICAN JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2022. [DOI: 10.7196/sajog.2022.v28i1.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Endometrial carcinoma (EC) is a common gynaecological malignancy in postmenopausal females. Diagnosis is made onendometrial biopsy, where histological subtype and tumour grade are used to predict disease progression and to plan surgical management.Objectives. To determine the accuracy of preoperative biopsies compared with the final diagnosis on hysterectomy specimens.Methods. This was a retrospective, cross-sectional study in which 126 biopsies and corresponding hysterectomy specimens, collected over a 3-year period, were reviewed. Patient demographics and histological features were recorded and statistically analysed.Results. The most prevalent tumours were endometrioid endometrial carcinoma (EEC) (48.5%), serous carcinomas (25.4%) and carcinosarcomas (16.7%). The majority (66.7%) of tumours were high-grade tumours on biopsy and hysterectomy specimens (58.7%). EECs had a poor sensitivity level (65.1%) compared with other subtypes but had a high specificity rate (90%). There was moderateagreement between biopsy and excision specimen diagnoses. High-grade tumours had a high sensitivity level (94.3%).Conclusions. Our study showed moderate agreement between histopathological diagnoses on biopsy and excision specimens. There was a high sensitivity level for biopsies of high-grade tumours, concordant with other studies. Accurate preoperative tumour subtyping and grading are needed to guide surgical management. It is envisaged that use of a combined histological and molecular tumour classificationwill better guide patient treatment and allow for reproducible results.
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11
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Qin R, Liao M, Qin W, Wang J, Zheng F, Ma N, Zhao Y, Qin A. The Diagnostic value of Serum YKL-40 in Endometrial Cancer: a meta-analysis. Biomarkers 2022; 27:215-221. [PMID: 34974784 DOI: 10.1080/1354750x.2021.2024603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Serum YKL-40 is a promising noninvasive biomarker for the early diagnosis of endometrial cancer (EC), but its value is disputed. OBJECTIVE To investigate the serum YKL-40 in the early diagnostic value of EC. METHODS Databases were systematically searched again before April 2021 and 14 studies were finally included in this meta-analysis. Pooled sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve analyses were assessed. This meta-analysis investigated the source of heterogeneity using sensitivity analysis, subgroup analysis, and meta-regression. RESULTS Databases were systematically searched again before April 2021 and 14 studies were finally included in this meta-analysis. First, the SROC curve presented an area under the curve (AUC) of 0.853 (SE =0.0213) for YKL-40 alone and an AUC of 0.946 (SE =0.0268) for YKL-40 combined with other biomarkers. Second, diagnostic types might be related to the diagnostic accuracy and is a significant source of heterogeneity (P = 0.035). CONCLUSION Serum YKL-40 helped diagnose EC, and its combination with other biomarkers was better than itself alone.
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Affiliation(s)
- Rongyan Qin
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ming Liao
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weili Qin
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiawei Wang
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fengque Zheng
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Nana Ma
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yunxiao Zhao
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Aiping Qin
- Reproductive Medical Center, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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12
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Kamii M, Nagayoshi Y, Ueda K, Saito M, Takano H, Okamoto A. Laparoscopic surgery for atypical endometrial hyperplasia with awareness regarding the possibility of endometrial cancer. Gynecol Minim Invasive Ther 2022; 12:32-37. [PMID: 37025442 PMCID: PMC10071869 DOI: 10.4103/gmit.gmit_44_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/01/2022] [Accepted: 08/10/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives Although atypical endometrial hyperplasia (AEH) is considered a precancerous disease, the frequency with which AEH and endometrial cancer (EC) coexist is not low. Broadly, total laparoscopic hysterectomy (TLH) is performed for treating AEH; however, it is unclear what perioperative precautions need to be taken. This study aimed to clarify the points to be considered when performing TLH for AEH. Materials and Methods We retrospectively identified 57 patients who underwent TLH for AEH in our hospitals. We extracted data on clinical characteristics, preoperative examinations (endometrial sampling and diagnostic imaging), surgical procedures, and final pathological diagnoses. Then, we statistically analyzed the difference in clinicopathological features and preoperative examinations between patients postoperatively diagnosed with EC and those diagnosed with AEH. Results Twenty patients (35%) who underwent TLH for AEH were diagnosed with EC postoperatively (16 [28%] with stage IA EC and four [7.0%] with stage IB EC). We found no significant differences in clinical characteristics and preoperative evaluations between patients postoperatively diagnosed with EC and those diagnosed with AEH. The group with stage IB EC had a significantly higher median age and a significantly higher proportion of postmenopausal patients and patients with adenomyosis. Conclusion It is important to recognize the risk of coexisting EC when performing TLH for AEH. High-precision endometrial sampling and contrast-enhanced magnetic resonance imaging are recommended for diagnosing AEH. In addition, surgical procedures for AEH are required to prevent cancer spillage in consideration of its coexistence, such as tubal sealing before manipulator insertion or avoiding using manipulator.
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13
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Zhang Z, Gao P, Bao Z, Zeng L, Yao J, Chai D, Li T. Clear Cell Carcinoma of the Endometrium: Evaluation of Prognostic Parameters in 27 Cases. Front Oncol 2021; 11:732782. [PMID: 34926250 PMCID: PMC8674560 DOI: 10.3389/fonc.2021.732782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Clear cell carcinoma (CCC) of the endometrium is an uncommon yet aggressive tumor. Few cohort studies are reporting the overall survival time of CCC patients. This study aimed to retrospectively analyze the clinicopathologic features, molecular characteristics and survival data of 27 endometrial CCC patients to improve the understanding of CCC. METHODS The clinicopathologic features, molecular characteristics and survival data total of 27 CCC patients admitted to the BBMU affiliated hospital (Anhui, China) between January 2005 and December 2018 were retrospectively analyzed. Kaplan-Meier method was used to analyze the prognosis-related factors. RESULTS The median age of the patients was 60 years (range; 39 to 81 years). The average tumor size was 3.8 cm (range; 0.8 to 13.0cm). Myometrial infiltration greater than 50% was reported in 55.6% of the patients, while the Ki-67 index greater than 50% was reported in 70.4% of the patients. The patients' FIGO (2009) surgical stages were as follows: 18 I, 3 II, 4 III, and 2 IV. Besides, 7 (25.6%) patients had lymphovascular invasion, 3 (11.1%) patients with distant metastasis, including 1 patient with bone metastasis, and 2 with liver metastasis. Adjuvant treatment included 7 with chemotherapy alone, 9 with radiotherapy alone, and 9 with both radiotherapy and chemotherapy. The median overall survival time from the time of CCC diagnosis was 56 months. ER and PR showed negative expression and P16 showed patchy immunostaining. 18 (63%) cases showed Napsin A positive expression. Loss of MSH2, MSH6 and PTEN were seen in 5, 4 and 7 cases respectively. All cases showed HER-2/nue negative expression. CONCLUSION CCC is a rare and invasive tumor. Age of diagnosis, FIGO stage, tumor size, myometrial infiltration, lymphovascular invasion, distant metastasis, Ki-67 index and P53 expression are important indicators to evaluate patient's prognosis (P = 0.048, P < 0.001, P = 0.016, P = 0.043, P = 0.001, P < 0.001, P = 0.026, and P = 0.007, respectively). CCC has a worse prognosis than endometrioid carcinoma (P = 0.002), and there is no significant difference when compared with uterine papillary serous carcinoma (P = 0.155).
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Affiliation(s)
- Zhiyang Zhang
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Penglian Gao
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Zhengqi Bao
- Department of Orthopedics, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Linggong Zeng
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Junyi Yao
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Damin Chai
- Department of Pathology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi’an, China
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14
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Gupta S, Vargas A, Saulnier G, Newell J, Faaborg-Andersen C, Kelley RS. Uterine bioimpedance combined with artificial intelligence as a means of cancer detection. J Med Eng Technol 2021; 45:606-613. [PMID: 34225554 DOI: 10.1080/03091902.2021.1936674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study hypothesised that benign and tumour-bearing uterine tissue could be differentiated by their unique electrical bioimpedance patterns, with the aid of artificial intelligence. Twenty whole, ex-vivo uterine specimens were obtained at the time of hysterectomy. A total of 11 benign and 9 malignant specimens were studied. A uterine bioimpedance probe was designed to measure the tissue between the endometrial and serosal layers of the uterus. The impedance data was then analysed with multiple instance learning and principal component analysis, forms of artificial intelligence. Final pathology results for the specimens included uterine sarcoma, adenocarcinoma, carcinosarcoma, and high-grade serous carcinoma. The analysis correctly identified 78% (7/9) of the malignant specimens and 82% (9/11) of the benign specimens. The overall accuracy of our analysis was 80%. Our results demonstrate distinction between electrical impedance properties of malignant and benign uterine specimens. Bioimpedance and artificial intelligence may have potential implications in risk assessment of patients and may subsequently guide surgical decision-making regarding route of organ removal.
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Affiliation(s)
- Shabnam Gupta
- Department of Gynaecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Andres Vargas
- Department of Mathematics, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Gary Saulnier
- College of Engineering and Applied Sciences, University at Albany - SUNY, Albany, NY, USA
| | - Jonathan Newell
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | | | - Robert S Kelley
- Department of Gynaecology and Obstetrics, Female Pelvic Medicine and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA, USA
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15
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Daix M, Angeles MA, Migliorelli F, Kakkos A, Martinez Gomez C, Delbecque K, Mery E, Tock S, Gabiache E, Decuypere M, Goffin F, Martinez A, Ferron G, Kridelka F. Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology in early-stage endometrial cancer. J Gynecol Oncol 2021; 32:e48. [PMID: 33908709 PMCID: PMC8192240 DOI: 10.3802/jgo.2021.32.e48] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/22/2021] [Accepted: 02/06/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To evaluate the concordance between preoperative European Society for Medical Oncology (ESMO)-European Society of Gynaecological Oncology (ESGO)-European SocieTy for Radiotherapy and Oncology (ESTRO) risk classification in early-stage endometrial cancer (EC) assessed by biopsy and magnetic resonance imaging (MRI) with this classification based on histology of surgical specimen. Methods This bicentric retrospective study included women diagnosed with early-stage EC (≤stage II) who had a complete preoperative assessment and underwent a surgical management from January 2011 to December 2018. Patients were preoperatively classified into 3 degrees of risk of lymph node (LN) involvement based on biopsy and MRI. Based on final histological report, patients were re-classified using the preoperative classification. Concordance between the preoperative assessment and definitive histology was calculated with weighted Cohen's kappa coefficient. Results A total of 333 women were included and kappa coefficient of preoperative risk classification was 0.49. The risk was underestimated and overestimated in 37% and 10% of cases, respectively. Twenty-nine percent of patients had an incomplete LN staging according to the degree of risk of re-classification. The observed discordance in the risk classification was attributed to MRI in 75% of cases, to biopsy in 18% and in 7% to both (p<0.001). Kappa coefficient for concordance was 0.25 for MRI and 0.73 for biopsy. Conclusion Concordance between preoperative ESMO-ESGO-ESTRO risk classification and final histology is weak. Given that the risk was underestimated in the majority of patients wrongly classified, sentinel LN procedure instead of no LN dissection could be an option offered to preoperative low-risk patients to decrease the indication of second surgery for re-staging and/or to avoid toxicity of adjuvant radiotherapy.
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Affiliation(s)
- Manon Daix
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium.,Department of Gynecology, Centre Hospitalier Chrétien - Mont Légia, Liège, Belgium.
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | - Federico Migliorelli
- Department of Gynecology, Centre Hospitalier Intercommunal des Vallées de l'Ariège, Saint Jean de Verges, France
| | - Athanasios Kakkos
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Carlos Martinez Gomez
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Katty Delbecque
- Department of Pathology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Eliane Mery
- Department of Pathology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | - Stéphanie Tock
- Department of Gynecology, Centre Hospitalier Chrétien - Mont Légia, Liège, Belgium
| | - Erwan Gabiache
- Department of Medical Imaging, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France
| | | | - Frédéric Goffin
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Institut Claudius Regaud, Oncopole, Toulouse, France.,Inserm CRCT, Toulouse, France
| | - Frédéric Kridelka
- Department of Gynecology, Centre Hospitalier Universitaire, Liège, Belgium
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Lim YK, Ho WY, Wong WL, Aggarwal I, Yam KL. A Pilot Study on the Use of Indocyanine Green Near-Infrared Technique for Sentinel Lymph Node Biopsy in Early Endometrial Cancers in Singapore. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Yong Kuei Lim
- Department of Gynecologic Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Weng Yan Ho
- Department of Gynecologic Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wai Loong Wong
- Department of Gynecologic Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ieera Aggarwal
- Department of Gynecologic Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kwai Lam Yam
- Department of Gynecologic Oncology, KK Women's and Children's Hospital, Singapore, Singapore
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17
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Uterine serous carcinoma: Molecular features, clinical management, and new and future therapies. Gynecol Oncol 2020; 160:322-332. [PMID: 33160694 DOI: 10.1016/j.ygyno.2020.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/14/2020] [Indexed: 12/14/2022]
Abstract
Uterine serous carcinoma (USC) is an aggressive subtype of endometrial cancer. Multimodality treatment with surgery, radiotherapy, and chemotherapy is commonly used, given its propensity for extrauterine spread, distant recurrences, and poor prognosis. However, the use of molecularly-based therapy is expanding. Here, we review key molecular features of USC, discuss current management, and assess the landscape of novel therapies and combinations.
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TOKALIOGLU A, DİLBAZ B, ÖZELÇİ R, TOKALIOGLU E, ÇOŞKUN B. Asemptomatik postmenopozal kadınlardaki endometrial patolojilerin değerlendirilmesinde sonohisterobiopsinin yeri var mı? CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.690986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Evaluating the diagnostic performance of preoperative endometrial biopsies in patients diagnosed with high grade endometrial cancer: A study of the Society of Gynecologic Oncology (GOC) Community of Practice (CoP). Gynecol Oncol 2020; 159:52-57. [PMID: 32694064 DOI: 10.1016/j.ygyno.2020.06.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/30/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND High grade cancers account for a disproportionate number of recurrences in patients with endometrial cancer. Accurately identifying these cases on endometrial biopsies allows for better surgical planning. This study evaluates the diagnostic accuracy of general pathologists (GP) compared to gynecological pathologists (GYNP) in interpreting preoperative biopsies. METHODS A retrospective cohort study was conducted of patients diagnosed with high grade endometrial cancer (HGEC) between 2012 and 2016 at eight Canadian cancer centres. Data was collected from medical records. Pre-operative biopsies were categorized into groups; biopsies read by GP, GYNP and GP reviewed by GYNP. Rates of HGEC on pre-operative biopsy were calculated. Fisher exact test was used to compare differences between the groups. Univariate logistic regression analysis was conducted for HGEC prediction. RESULTS Of 1237 patients diagnosed with HGEC, 245 (19.8%) did not have a preoperative diagnosis of high-grade disease. Discordancy was identified in 91/287 (31.71%) of biopsies reported by GP, and in 114/910 (12.53%) of biopsies reported by a GYNP (p < 0.0001). Compared to GP, GYNP were 3.24 (CI 2.36-4.45) times more likely to identify high grade disease on preoperative biopsy. Patients whose biopsy was reported by a GYNP were more likely to have a comprehensive staging procedure (OR 1.77 CI 1.33-2.38) and less likely to receive adjuvant therapy (OR 0.71 CI 0.52-0.96). CONCLUSION GYNP are more likely to identify HGEC on pre-operative biopsies. Due to high rates of overall discordancy, it is possible that surgical staging procedures should not be based solely on preoperative biopsy. Further strategies to improve pre-operative biopsies' accuracy are needed.
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Najjar O, Erickson BK, Nickles-Fader AN. Diagnosis and management of uterine serous carcinoma: current strategies and clinical challenges. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1784723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Omar Najjar
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Britt K. Erickson
- Division of Gynecologic Oncology, Department of Obstetrics Gynecology and Women’s Health, University of Minnesota, Minneapolis, MN, USA
| | - Amanda N. Nickles-Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Capozzi VA, Sozzi G, Uccella S, Ceni V, Cianciolo A, Gambino G, Armano G, Pugliese M, Scambia G, Chiantera V, Berretta R. Novel preoperative predictive score to evaluate lymphovascular space involvement in endometrial cancer: an aid to the sentinel lymph node algorithm. Int J Gynecol Cancer 2020; 30:806-812. [PMID: 32284322 DOI: 10.1136/ijgc-2019-001016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Sentinel lymph node (SLN) dissection has been recognized as a valid tool for staging in patients with endometrial cancer. Several factors are predictors of recurrence and survival in endometrial cancer, including positive lymphovascular space invasion. The aim of this study is to formulate a pre-operative score that, in the event of no-SLN identification, may give an estimate of the true probability of lymphovascular space invasion and guide management. METHODOLOGY This was a multi-institutional retrospective study conducted from January 2007 to December 2017. We included all patients with any grade endometrial tumor with a complete pathological description of the surgical specimen and with a minimum follow-up of 12 months. All patients underwent a class A hysterectomy according to Querleu and Morrow and bilateral salpingo-oophorectomy. Lymphadenectomy was performed based on patient risk of node metastases. In order to verify the predictive capacity of the parameters associated with lymphovascular space invasion status, grading, abnormal CA125 (>35 units/ml), myometrial invasion, and tumor size, a synthetic score was calculated. The score was introduced in the receiver operating characteristic curve model in which the binary classifier was represented by the lymphovascular space invasion status. The ideal cut-off was calculated with the determination of the Youden index. Sensitivity and negative predictive value of lymphovascular space invasion score was calculated in patients with lymph node metastasis. RESULTS Six hundred and fourteen patients were included in the study. The average age and BMI of patients were 64.8 (range 33-88) years and 30.1 (range 17-64) respectively. Of the 284 patients who underwent lymphadenectomy, 231 (81.3%) patients had no lymph node metastases, 33 (11.6%) patients had metastatic pelvic lymph nodes, 12 (4.2%) patients had metastatic aortic lymph nodes, and eight (2.8%) patients had both pelvic and aortic metastatic lymph nodes. Lymphovascular space invasion was associated with deep myometrial infiltration (P<0.001), G3 grading (P<0.001), tumor size ≥25 mm (P=0.012), abnormal CA125 (P<0.001), recurrence (P<0.001), overall survival (P<0.001), and disease-free survival (P<0.01). Of all patients with lymphovascular space invasion, 79% had an lymphovascular space invasion score ≥5. The score ranged from a minimum score of 1 to a maximum of 7. The score shows 78.9% sensitivity (95% CI 0.6971 to 0.8594), 65.3% specificity (95% CI 0.611 to 0.693), 29.4% positive predictive value (95% CI 0.241 to 0.353), and 94.4% negative predictive value (95% CI 0.916 to 0.964). CONCLUSION We found that when lymphovascular space invasion score ≤4, there is a very low possibility of finding lymph nodal involvement. The preoperative lymphovascular space invasion score could complement the SLN algorithm to avoid unnecessary lymphadenectomies.
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Affiliation(s)
| | - Giulio Sozzi
- ARNAS Civico Di Cristina Benfratelli, Department of Gynecologic Oncology Palermo, Sicilia, IT, Palermo, Italy
| | - Stefano Uccella
- Obstetrics and Gynecology Department, Nuovo Ospedale degli Infermi, Biella, Italy
| | - Valentina Ceni
- Department of Obstetrics and Gynecology of Parma, Parma, Italy
| | | | - Giulia Gambino
- Department of Obstetrics and Gynecology of Parma, Parma, Italy
| | - Giulia Armano
- Department of Obstetrics and Gynecology of Parma, Parma, Italy
| | | | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Sicilia, Italy
- Department of Gynecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
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Mhlongo SE, Naidoo TD, Makhathini BS. Discrepancy between preoperative endometrial sampling and hysterectomy diagnosis in endometrial cancer. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2020. [DOI: 10.1080/20742835.2020.1754659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Sanele E Mhlongo
- Grey’s Hospital, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Thinagrin D Naidoo
- Grey’s Hospital, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Bongumusa S Makhathini
- Grey’s Hospital, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
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Hysteroscopic resectoscope-directed biopsies and outpatient endometrial sampling for assessment of tumor histology in women with endometrial cancer or atypical hyperplasia. Eur J Obstet Gynecol Reprod Biol 2020; 251:173-179. [PMID: 32505790 DOI: 10.1016/j.ejogrb.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate and compare the diagnostic efficiency of outpatient endometrial sampling (OES) and hysteroscopic resectoscope-directed biopsies (HYbiopsy) to distinguish between endometrial cancer (EC) and atypical hyperplasia (AH) and to assess tumor type and grade (histotype) in women with EC. DESIGN Patients with AH or EC (n = 266) among 1013 patients consecutively referred because of postmenopausal bleeding were included. Identification of EC versus AH, and unfavorable tumor types (endometrioid grade 3 or non-endometrioid tumors) using OES and HYbiopsy was compared to final histopathology at hysterectomy. AH or EC were identified by OES in 184 patients and by HYbiopsy in212. RESULTS OES had only sufficient tissue samples in 72.7% of intended samples. Even when OES did provide sufficient material, addition of HYbiopsy was a better technique than OES alone to distinguish between EC and AH, with an AUC of 95.9% and 79.8%; sensitivity of 97.4% and 64.6% and a specificity of 94.4% and 95.0%, respectively (p = 0.008). AH was falsely diagnosed with OES in 58 (35.4%) of 164 women with a final diagnose of EC. A final diagnosis of stage 1b or more was seen in 22 of these 58 women, while 5 of 194 patients with EC all stage 1a grade 1 had AH by HYbiopsy. HYbiopsy had higher correlation in assessment of tumor type and grade than OES, but OES and HYbiopsy had comparable AUC of 90.3% and 92.4% for identification of unfavorable tumors when tumor histotype was successfully identified. Regarding identification of unfavorable tumors (n = 57), a successfully assessment of histotype by OES combined with HYbiopsy in women without successfully diagnosed histotype by OES alone had AUC of 91.3%. CONCLUSION Addition of HYbiopsy may improve diagnosis when preoperative OES identifies AH or is insufficient for explicit diagnosis of tumor type and grade. However, there is limited benefit of the addition of HYbiopsy in the presence of definite diagnosis of grade 1-2 endometrioid tumors by OES.
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Ghosh A, Singh T, Singla V, Bagga R, Srinivasan R, Khandelwal N. DTI histogram parameters correlate with the extent of myoinvasion and tumor type in endometrial carcinoma: a preliminary analysis. Acta Radiol 2020; 61:675-684. [PMID: 31533436 DOI: 10.1177/0284185119875019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Myoinvasion and tumor-type determines surgical planning in endometrial carcinoma. Purpose To evaluate whole tumor diffusion tensor imaging histogram texture parameters in evaluating myoinvasion and tumor type in endometrial carcinoma. Material and Methods Twenty-seven patients with endometrial carcinoma underwent diffusion tensor imaging on a 1.5-T MRI system using echo-planar imaging sequence with 0 and 700 s/mm2 b values. Whole tumor histogram parameters were obtained from fractional anisotropy, mean diffusivity maps. Mann–Whitney U test and receiver operating characteristic curve analyses were used Results The mean fractional anisotropy of tumors with no myoinvasion was significantly higher than tumors which underwent myoinvasion, suggesting higher anisotropy in tumors which did not invade the myometrium. Voxel-wise heterogeneity in distribution of fractional anisotropy and mean diffusivity was seen in the form of higher uniformity and lower entropy of tumors with superficial <50% myoinvasion versus >50% myoinvasion. Uniformity, entropy, and energy of voxel-wise fractional anisotropy distribution gave an area under the curve of 0.827, 0.821, and 0.796, respectively, in predicting the presence of deep myometrial invasion while energy, entropy, and uniformity of mean diffusivity distribution in tumor gave an area under the curve of 0.84, 0.815, and 0.809 respectively. Tumor type was predicted with an area under the curve of 0.747, 0.759, and 0.765 for the uniformity, energy, and entropy of voxel-wise fractional anisotropy distribution. A logistic regression combining all the important histogram parameters obtained 94% and 88% sensitivity and 88% and 80% specificity in predicting deep myoinvasion and tumor type, respectively. Conclusion Diffusion tensor histogram analysis can better characterize endometrial carcinomas and can be used as a quantitative marker of tumor behavior.
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Affiliation(s)
- Adarsh Ghosh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Veenu Singla
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rashmi Bagga
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sattanakho P, Kleebkaow P, Sangkomkumhang U, Booranabunyat S, Buppasiri P. Rate of Significant Endometrial Pathology in Women at Low Risk for Endometrial Hyperplasia or Cancer Presenting with Abnormal Uterine Bleeding. Pragmat Obs Res 2020; 11:13-18. [PMID: 32104134 PMCID: PMC7023899 DOI: 10.2147/por.s240930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives To determine the rate of significant endometrial abnormalities in premenopausal women at low risk for endometrial hyperplasia and cancer presenting with abnormal uterine bleeding (AUB). Patients and Methods This descriptive study was conducted from January 1, 2016 to March 31, 2019. The inclusion criteria were premenopausal women, 35-50 years, presenting with AUB, low risk for endometrial hyperplasia or endometrial cancer, and having undergone endometrial sampling or uterine curettage. Nulliparous, obesity, diabetes mellitus, polycystic ovary syndrome, chronic anovulation, infertility, tamoxifen therapy and/or a family history of uterine, ovarian, breast and colon cancer were excluded. Data regarding baseline characteristics were collected, and histopathology reports were reviewed. Results During the study period, 644 subjects were recruited, 557 of whom had adequate endometrial tissue for histopathology study. The pathology demonstrated benign in most cases (96%). The rate of significant abnormal endometrial pathology was 4% (23 cases) including 19 cases of endometrial hyperplasia without atypia (3.3%), and 4 cases of endometrial cancer (0.7%). Conclusion The rate of significant abnormal endometrial pathology in premenopausal women at low risk for endometrial hyperplasia or endometrial cancer presenting with AUB was very low. This information should be incorporated into the counseling process regarding the risks and benefits of endometrial sampling.
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Affiliation(s)
- Pattarawadee Sattanakho
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pilaiwan Kleebkaow
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ussanee Sangkomkumhang
- Department of Obstetrics and Gynecology, Khon Kaen Regional Hospital, Khon Kaen, Khon Kaen Province, Thailand
| | - Sukjai Booranabunyat
- Department of Obstetrics and Gynecology, Mahasarakham Hospital, Mahasarakham Province, Thailand
| | - Pranom Buppasiri
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Al Nemer AM, Al Bayat MI, Al Qahtani NH. The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding. More conservative therapeutic approaches. Saudi Med J 2020; 40:815-819. [PMID: 31423519 PMCID: PMC6718861 DOI: 10.15537/smj.2019.8.24449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: Abnormal uterine bleeding (AUB) is a leading cause of hysterectomies, the cause of which is usually diagnosed with preoperative endometrial sampling. We planned this study to assess the accuracy of diagnosing the histologic patterns of endometrium in the preoperative sample in reference to the final histologic diagnosis in hysterectomy. Methods: We retrospectively reviewed medical charts between January 2011 and December 2015 at a tertiary hospital in Saudi Arabia and identified 43 cases of AUB with complete documentation. The histologic diagnoses were classified into normal and benign pathology group (N/B), or carcinoma and hyperplasia category (Ca/H). Measures of validity were used to compare endometrial sampling histological diagnoses to diagnoses following hysterectomy and Cohen’s kappa to assess for agreement between the 2 modalities. Results: The median age of all patients was 49 years. Preoperative histologic examination showed 53.8% sensitivity, 90% specificity, 70% positive predictive values and 81.8% negative predictive values, 30.1% false positive rates and 18.2% false negative rates. The agreement between preoperative and postoperative histologic diagnoses was moderate (79.1%, k=0.469). Conclusion: The accuracy of preoperative histologic examination was moderate. Our findings recommend cautious clinical decision making and limiting hysterectomy to women who do not respond to other therapeutic measures.
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Affiliation(s)
- Areej M Al Nemer
- Pathology Department, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia. E-mail.
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Is outpatient hysteroscopy accurate for the diagnosis of endometrial pathology among perimenopausal and postmenopausal women? Menopause 2019; 25:160-164. [PMID: 28763396 DOI: 10.1097/gme.0000000000000961] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the histological and visual accuracy of outpatient hysteroscopy. METHODS This was a retrospective analysis of all women referred to a tertiary center outpatient hysteroscopy clinic between March 2011 and October 2016 for the following indications: postmenopausal bleeding, suspected polyp, and/or thick endometrium. Histological accuracy was evaluated by comparing specimens obtained in hysteroscopy with those obtained by hysterectomy, and visual accuracy was evaluated by comparing visual findings with those obtained by biopsies. Sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio were calculated to assess visual accuracy. RESULTS The mean age of participants was 54.14 (interquartile range 43.0-64.0). A total of 408 pathological specimens were obtained from outpatient hysteroscopies during the 712 visits recorded in the clinic log. Histological accuracy was evaluated in 15 participants who eventually underwent hysterectomy. Total percent of agreement between hysteroscopy biopsies and final pathology obtained by hysterectomy was 73% (kappa = 0.47). Overall visual accuracy was calculated with a 93.1% sensitivity, 52.1% specificity, 90.4% positive predictive value, and 61.0% negative predictive value. Visual accuracy for benign pathology was generally higher compared with that for pre and malignant lesions. Visual accuracy was satisfactory for the diagnosis of endometrial carcinoma with sensitivity and specificity of 71.4% and 98.9%, respectively, but poor for diagnosing hyperplasia with sensitivity and specificity of 25.0% and 96.6%, respectively. CONCLUSIONS Outpatient hysteroscopy is an adequate and reliable tool for the evaluation of benign pathology in the uterine cavity. Visual findings may not suffice, and directed biopsies may be required to improve diagnostic accuracy.
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Allameh T, Danesh-Pour S, Afshar Moghadam N, Danesh-Pour S. Diagnostic Value of Cytology in Detecting Endometrial Hyperplasia and Endometrial and Ovarian Cancers in Patients Undergoing Hysterectomy or Salpingo-Oophorectomy. Adv Biomed Res 2019; 8:20. [PMID: 31016178 PMCID: PMC6446583 DOI: 10.4103/abr.abr_191_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Ovarian cancer (OC) is one of the most common cancers among women in the world. This study aimed to compare the results of endometrial and endocervical cytology with the ultimate outcome of the uterus, ovary, and fallopian tube (derived from hysterectomy or salpingo-oophorectomy) in diagnosing endometrial hyperplasia, endometrial, and OC. Materials and Methods: This cross-sectional study was conducted on 30 women with endometrial hyperplasia, 90 cases of endometrial cancer, 30 cases of OC, and 30 normal controls undergoing hysterectomy or salpingo-oophorectomy referring to Al-Zahra and Shahid Beheshti Hospitals in 2015–2017. Their basic and clinical characteristics were recorded, and then, endometrial cytology was performed by a specialist and sent to a pathological center. Results: Diagnostic value of cytology showed that out of 90 individuals with endometrial cancer, 78 (86.7%) ones were positive and 12 (13.3%) were negative with sensitivity and specificity of 86.67% and 100%, respectively. Its positive predictive values (PPVs) and negative predictive values (NPVs) were 100% and 71.4% (AUC = 0.933; P < 0.0001). In diagnosing endometrial hyperplasia out of 30 individuals with endometrial hyperplasia, there were 24 (80.0%) positive and 6 (20.0%) negative with sensitivity and specificity of 80.00% and 100%, respectively. Its PPVs and NPVs were 100% and 83.3%, respectively (AUC = 0.9000; P < 0.0001). In diagnosing, OC cytology could not detect any one of the 30 individuals with OC, with sensitivity and specificity of 0% and 100.0%, respectively. Its PPVs and NPVs were 0% and 50%, respectively (AUC = 0.500; P = 1.00). Conclusion: Cytology has a good diagnostic value for detecting endometrial hyperplasia and endometrial cancer compared to pathology; however, due to very low sensitivity in detection of OC, it could not be considered as a good diagnostic tool.
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Affiliation(s)
- Tajossadat Allameh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Danesh-Pour
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Iran
| | - Nooshin Afshar Moghadam
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Iran
| | - Shima Danesh-Pour
- Department of Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan Iran
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Vilos AG, Zhu C, Abu-Rafea B, Ettler HC, Weir MM, Vilos GA. Uterine Tumors Resembling Ovarian Sex Cord Tumors Identified at Resectoscopic Endometrial Ablation: Report of 2 Cases. J Minim Invasive Gynecol 2019; 26:105-109. [DOI: 10.1016/j.jmig.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 12/28/2022]
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Emons G, Steiner E, Vordermark D, Uleer C, Bock N, Paradies K, Ortmann O, Aretz S, Mallmann P, Kurzeder C, Hagen V, van Oorschot B, Höcht S, Feyer P, Egerer G, Friedrich M, Cremer W, Prott FJ, Horn LC, Prömpeler H, Langrehr J, Leinung S, Beckmann MW, Kimmig R, Letsch A, Reinhardt M, Alt-Epping B, Kiesel L, Menke J, Gebhardt M, Steinke-Lange V, Rahner N, Lichtenegger W, Zeimet A, Hanf V, Weis J, Mueller M, Henscher U, Schmutzler RK, Meindl A, Hilpert F, Panke JE, Strnad V, Niehues C, Dauelsberg T, Niehoff P, Mayr D, Grab D, Kreißl M, Witteler R, Schorsch A, Mustea A, Petru E, Hübner J, Rose AD, Wight E, Tholen R, Bauerschmitz GJ, Fleisch M, Juhasz-Boess I, Sigurd L, Runnebaum I, Tempfer C, Nothacker MJ, Blödt S, Follmann M, Langer T, Raatz H, Wesselmann S, Erdogan S. Interdisciplinary Diagnosis, Therapy and Follow-up of Patients with Endometrial Cancer. Guideline (S3-Level, AWMF Registry Nummer 032/034-OL, April 2018) - Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer. Geburtshilfe Frauenheilkd 2018; 78:949-971. [PMID: 30364388 PMCID: PMC6195426 DOI: 10.1055/a-0713-1218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/30/2022] Open
Abstract
Summary
The first German interdisciplinary S3-guideline on the diagnosis, therapy and follow-up of patients with endometrial cancer was published in April 2018. Funded by German Cancer Aid as part of an Oncology Guidelines Program, the lead coordinators of the guideline were the German Society of Gynecology and Obstetrics (DGGG) and the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG).
Purpose
The use of evidence-based, risk-adapted therapy to treat low-risk women with endometrial cancer avoids unnecessarily radical surgery and non-useful adjuvant radiotherapy and/or chemotherapy. This can significantly reduce therapy-induced morbidity and improve the patientʼs quality of life as well as avoiding unnecessary costs. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimal surgical radicality together with the appropriate chemotherapy and/or adjuvant radiotherapy where required. The evidence-based optimal use of different therapeutic modalities should improve survival rates and the quality of life of these patients. The S3-guideline on endometrial cancer is intended as a basis for certified gynecological cancer centers. The aim is that the quality indicators established in this guideline will be incorporated in the certification processes of these centers.
Methods
The guideline was compiled in accordance with the requirements for S3-level guidelines. This includes, in the first instance, the adaptation of source guidelines selected using the DELBI instrument for appraising guidelines. Other consulted sources include reviews of evidence which were compiled from literature selected during systematic searches of literature databases using the PICO scheme. In addition, an external biostatistics institute was commissioned to carry out a systematic search and assessment of the literature for one area of the guideline. The identified materials were used by the interdisciplinary working groups to develop suggestions for Recommendations and Statements, which were then modified during structured consensus conferences and/or additionally amended online using the DELPHI method with consent being reached online. The guideline report is freely available online.
Recommendations
Part 1 of this short version of the guideline presents recommendations on epidemiology, screening, diagnosis and hereditary factors, The epidemiology of endometrial cancer and the risk factors for developing endomentrial cancer are presented. The options for screening and the methods used to diagnose endometrial cancer including the pathology of the cancer are outlined. Recommendations are given for the prevention, diagnosis, and therapy of hereditary forms of endometrial cancer.
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Affiliation(s)
- Günter Emons
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Eric Steiner
- Frauenklinik, GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
| | | | - Christoph Uleer
- Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Hildesheim, Germany
| | - Nina Bock
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Olaf Ortmann
- Frauenheilkunde und Geburtshilfe, Universität Regensburg, Regensburg, Germany
| | - Stefan Aretz
- Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Universitätsklinikum Bonn, Bonn, Germany
| | | | | | - Volker Hagen
- Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Birgitt van Oorschot
- Interdisziplinäres Zentrum Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Stefan Höcht
- Xcare, Praxis für Strahlentherapie, Saarlouis, Saarlouis, Germany
| | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Gerlinde Egerer
- Zentrum für Innere Medizin, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Heinrich Prömpeler
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Jan Langrehr
- Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus, Berlin, Germany
| | | | | | - Rainer Kimmig
- Women's Department, University Hospital of Essen, Essen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Reinhardt
- Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Bernd Alt-Epping
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ludwig Kiesel
- Obstetrics and Gynecology, Reproductive Medicine, University of Muenster, Germany, Münster, Germany
| | - Jan Menke
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Marion Gebhardt
- Frauenselbsthilfe nach Krebs e. V., Erlangen, Erlangen/Forchheim, Germany
| | - Verena Steinke-Lange
- MGZ - Medizinisch Genetisches Zentrum, München und Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, München, Germany
| | - Nils Rahner
- Institut für Humangenetik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Werner Lichtenegger
- Frauenklinik Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | - Alain Zeimet
- Frauenheilkunde, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Volker Hanf
- Frauenklinik Nathanstift - Klinikum Fürth, Fürth, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Michael Mueller
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Rita K Schmutzler
- Center for Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany
| | - Alfons Meindl
- Frauenklinik am Klinikum rechts der Isar, München, Germany
| | - Felix Hilpert
- Mammazentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Joan Elisabeth Panke
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V., Essen, Germany
| | - Vratislav Strnad
- Strahlenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | | | - Timm Dauelsberg
- Winkelwaldklinik Nordrach, Fachklinik für onkologische Rehabilitation, Nordrach, Germany
| | - Peter Niehoff
- Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
| | - Doris Mayr
- Pathologisches Institut, LMU München, München, Germany
| | - Dieter Grab
- Frauenklinik Klinikum Harlaching, München, Germany
| | - Michael Kreißl
- Universitätsklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Ralf Witteler
- Obstetrics and Gynecology, Reproductive Medicine, University of Muenster, Germany, Münster, Germany
| | | | | | - Edgar Petru
- Frauenheilkunde, Medizinische Universität Graz, Graz, Austria
| | - Jutta Hübner
- Klinikum für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Edward Wight
- Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Gerd J Bauerschmitz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Markus Fleisch
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Ingolf Juhasz-Boess
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Saar, Germany
| | - Lax Sigurd
- Institut für Pathologie, Landeskrankenhaus Graz West, Graz, Austria
| | | | - Clemens Tempfer
- Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | | | | | - Markus Follmann
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Thomas Langer
- Deutsche Krebsgesellschaft, Office des Leitlinienprogramms Onkologie, Berlin, Germany
| | - Heike Raatz
- Institut für Klinische Epidemiologie & Biostatistik (CEB), Basel, Switzerland
| | | | - Saskia Erdogan
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
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Tumor Grade Correlation Between Preoperative Biopsy and Final Surgical Specimen in Endometrial Cancer: The Use of Different Diagnostic Methods and Analysis of Associated Factors. Int J Gynecol Cancer 2018; 28:1258-1263. [DOI: 10.1097/igc.0000000000001304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
ObjectiveThis study aimed to identify the correlation between histology tumor grade of the preoperative biopsy using dilatation and curettage (D&C), Pipelle, or hysteroscopy and final surgical specimen in women with endometrioid endometrial cancer.Materials and MethodsPatients on whom a preoperative biopsy was performed between 2009 and 2016 were reviewed and cases with apparent early-stage endometrioid endometrial cancer were included in the study. The accuracy of preoperative biopsy performed before hysterectomy using D&C, Pipelle, or hysteroscopy was compared.ResultsA total of 332 patients were included. The diagnostic method was D&C in 43 cases (13%), Pipelle in 102 (31%), and hysteroscopy in 187 (56%). The preoperative diagnosis included G1 tumors in 177 cases (53.3%), G2 in 103 (31%), and G3 in 52 (15.6%). The surgical specimen confirmed endometrioid endometrial tumor in 309 patients (93%).The accuracy rates of preoperative biopsy and surgical specimen were 74.69%, 73.19%, and 89.75% for G1, G2, and G3, respectively. Hysteroscopy showed better κ index (κ = 0.551) than did D&C (κ = 0.392) and Pipelle (κ = 0.430). Tumor diameter greater than 30 mm was the only factor independently associated with absence of correlation between preoperative and postoperative tumor grade (odds ratio [95% confidence interval], 1.959 [1.096–3.504], P = 0.023).ConclusionsPreoperative biopsy, regardless of the method, has its limitations in predicting the tumor grade compared with final surgical specimen in women with endometrioid endometrial cancer at an apparent early stage. Concordance between the biopsy and hysterectomy specimen is less likely to happen in the case of preoperative G1 or G2 tumors, as well as in big tumors. Although hysteroscopy was associated with the highest tumor grade agreement, no differences in correlation between the 3 methods (D&C, Pipelle, and hysteroscopy) were found.
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Muinelo-Romay L, Casas-Arozamena C, Abal M. Liquid Biopsy in Endometrial Cancer: New Opportunities for Personalized Oncology. Int J Mol Sci 2018; 19:E2311. [PMID: 30087246 PMCID: PMC6121388 DOI: 10.3390/ijms19082311] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/24/2018] [Accepted: 08/02/2018] [Indexed: 12/16/2022] Open
Abstract
The identification of new molecular targets and biomarkers associated with high risk of recurrence and response to therapy represents one of the main clinical challenges in the management of advanced disease in endometrial cancer. In this sense, the field of liquid biopsy has emerged as a great revolution in oncology and is considered "the way" to reach personalised medicine. In this review, we discuss the promising but already relatively limited advances of liquid biopsy in endometrial cancer compared to other types of tumours like breast, colorectal or prostate cancer. We present recent data analysing circulating tumour material in minimally-invasive blood samples, but also in alternative forms of liquid biopsy like uterine aspirates. Proteomic and genomic studies focused on liquid-based uterine samples are resulting not only in optimal diagnostic tools but also in reliable approaches to address tumour heterogeneity. Likewise, circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA) represent an opportunity for the correct stratification of patients, for the assessment of early recurrent disease or for the real-time monitoring of therapy responses. Appropriately designed studies and implementation in clinical trials will determine the value of liquid biopsy for precision oncology in endometrial cancer.
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Affiliation(s)
- Laura Muinelo-Romay
- Liquid Biopsy Analysis Unit, Translational Medical Oncology Group (Oncomet), CIBERONC, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela (SERGAS), Trav. Choupana s/n, 15706 Santiago de Compostela, Spain.
| | - Carlos Casas-Arozamena
- Translational Medical Oncology Group (Oncomet), CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela (SERGAS), Trav. Choupana s/n, 15706 Santiago de Compostela, Spain.
| | - Miguel Abal
- Translational Medical Oncology Group (Oncomet), CIBERONC, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela (SERGAS), Trav. Choupana s/n, 15706 Santiago de Compostela, Spain.
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Narice BF, Delaney B, Dickson JM. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC FAMILY PRACTICE 2018; 19:135. [PMID: 30060741 PMCID: PMC6066914 DOI: 10.1186/s12875-018-0817-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 07/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND One million women per year seek medical advice for abnormal uterine bleeding (AUB) in the United Kingdom. Many low-risk patients who could be managed exclusively in primary care are referred to hospital based gynaecology services. Performing endometrial sampling (ES) in the community may improve care, reduce the rate of referrals and minimise costs. We aimed to search and synthesise the literature on the effectiveness of ES (Pipelle versus other devices) in managing AUB in low-risk patients. METHODS We undertook an electronic literature search in MEDLINE via OvidSP, Scopus, and Web of Science for relevant English-language articles from 1984 to 2016 using a combination of MeSH and keywords. Two reviewers independently pre-selected 317 articles and agreed on 60 articles reporting data from over 7300 patients. Five themes were identified: sample adequacy, test performance, pain and discomfort, cost-effectiveness, and barriers and complications of office ES. RESULTS Pipelle seems to perform as well as dilation and curettage and, as well or better than other ES devices in terms of sampling adequacy and sensitivity. It also seems to be better regarding pain/discomfort and costs. However, Pipelle can disrupt the sonographic appearance of the endometrium and may be limited by cervical stenosis, pelvic organ prolapse and endometrial atrophy. CONCLUSIONS The current evidence supports the use of Pipelle in the management of low-risk women presenting in the outpatient setting with symptomatic AUB when combined with clinical assessment and ultrasound scanning. However, the implications of its widespread use in primary care are uncertain and more research is required.
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Affiliation(s)
- Brenda F. Narice
- Clinical Research Fellow in Obstetrics & Gynaecology; Academic Unit of Reproductive and Developmental Unit, University of Sheffield, Sheffield, S10 2SF UK
| | - Brigitte Delaney
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, S5 7AU UK
| | - Jon M. Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, S5 7AU UK
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Xie B, Qian C, Yang B, Ning C, Yao X, Du Y, Shi Y, Luo X, Chen X. Risk Factors for Unsuccessful Office-Based Endometrial Biopsy: A Comparative Study of Office-Based Endometrial Biopsy (Pipelle) and Diagnostic Dilation and Curettage. J Minim Invasive Gynecol 2018; 25:724-729. [DOI: 10.1016/j.jmig.2017.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
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Occult Malignancy Incidence and Preoperative Assessment in Hysterectomies with Morcellation. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Abstract
Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose.
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Affiliation(s)
- Pratibha Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Martinez-Garcia E, Lesur A, Devis L, Cabrera S, Matias-Guiu X, Hirschfeld M, Asberger J, van Oostrum J, Casares de Cal MDLÁ, Gómez-Tato A, Reventos J, Domon B, Colas E, Gil-Moreno A. Targeted Proteomics Identifies Proteomic Signatures in Liquid Biopsies of the Endometrium to Diagnose Endometrial Cancer and Assist in the Prediction of the Optimal Surgical Treatment. Clin Cancer Res 2017; 23:6458-6467. [PMID: 28790116 DOI: 10.1158/1078-0432.ccr-17-0474] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/05/2017] [Accepted: 08/03/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Endometrial cancer (EC) diagnosis relies on the observation of tumor cells in endometrial biopsies obtained by aspiration (i.e., uterine aspirates), but it is associated with 22% undiagnosed patients and up to 50% of incorrectly assigned EC histotype and grade. We aimed to identify biomarker signatures in the fluid fraction of these biopsies to overcome these limitations.Experimental Design: The levels of 52 proteins were measured in the fluid fraction of uterine aspirates from 116 patients by LC-PRM, the latest generation of targeted mass-spectrometry acquisition. A logistic regression model was used to assess the power of protein panels to differentiate between EC and non-EC patients and between EC histologic subtypes. The robustness of the panels was assessed by the "leave-one-out" cross-validation procedure performed within the same cohort of patients and an independent cohort of 38 patients.Results: The levels of 28 proteins were significantly higher in patients with EC (n = 69) compared with controls (n = 47). The combination of MMP9 and KPYM exhibited 94% sensitivity and 87% specificity for detecting EC cases. This panel perfectly complemented the standard diagnosis, achieving 100% of correct diagnosis in this dataset. Nine proteins were significantly increased in endometrioid EC (n = 49) compared with serous EC (n = 20). The combination of CTNB1, XPO2, and CAPG achieved 95% sensitivity and 96% specificity for the discrimination of these subtypes.Conclusions: We developed two uterine aspirate-based signatures to diagnose EC and classify tumors in the most prevalent histologic subtypes. This will improve diagnosis and assist in the prediction of the optimal surgical treatment. Clin Cancer Res; 23(21); 6458-67. ©2017 AACR.
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Affiliation(s)
- Elena Martinez-Garcia
- Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Antoine Lesur
- Luxembourg Clinical Proteomics Center (LCP), Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Laura Devis
- Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
| | - Silvia Cabrera
- Gynecology Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Xavier Matias-Guiu
- Pathological Oncology Group and Pathology Department, University Hospital Arnau de Vilanova, and University Hospital Bellvitge, IRBLLEIDA and Idibell, University of Lleida, CIBERONC, Barcelona, Spain
| | - Marc Hirschfeld
- Department of Obstetrics and Gynecology, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
- Institute of Veterinary Medicine, Georg-August-University Goettingen, Germany
| | - Jasmin Asberger
- Department of Obstetrics and Gynecology, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
| | - Jan van Oostrum
- Luxembourg Clinical Proteomics Center (LCP), Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | | | - Antonio Gómez-Tato
- Faculty of Mathematics, University of Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - Jaume Reventos
- Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
- Basic Sciences Department, International University of Catalonia, CIBERONC, Barcelona, Spain
| | - Bruno Domon
- Luxembourg Clinical Proteomics Center (LCP), Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Eva Colas
- Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain.
| | - Antonio Gil-Moreno
- Biomedical Research Group in Gynecology, Vall Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain.
- Gynecology Department, Vall Hebron University Hospital, Barcelona, Spain
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Martinelli F, Ditto A, Bogani G, Signorelli M, Chiappa V, Lorusso D, Haeusler E, Raspagliesi F. Accuracy of pre-operative hysteroscopic guided biopsy for predicting final pathology in uterine malignancies. J Cancer Res Clin Oncol 2017; 143:1275-1279. [PMID: 28247037 DOI: 10.1007/s00432-017-2371-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/12/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate concordance (C) between pre-operative hysteroscopic-directed sampling and final pathology in uterine cancers. METHODS A retrospective cross-sectional evaluation of prospectively collected data of women who underwent hysterectomy for uterine malignancies and a previous hysteroscopic-guided biopsy was performed. Diagnostic concordance between pre-operative (hysteroscopic biopsy) and postoperative (uterine specimen) histology was evaluated. In endometrioid-endometrial cancers cases Kappa (k) statistics was applied to evaluate agreement for grading (G) between the preoperative and final pathology. RESULTS A total 101 hysterectomies for uterine malignancies were evaluated. There were 23 non-endometrioid cancers: 7 serous (C:5/7, 71.4%); 10 carcinosarcomas (C:7/10, 70%, remaining 3 cases only epithelial component diagnosed); 3 clear cell (C:3/3, 100%); 3 sarcomas (C:3/3, 100%). In 78 cases an endometrioid endometrial cancer was found. In 63 cases there was a histological C (63/78, 80.8%) between hysteroscopic-guided biopsy and final pathology, while in 15 cases (19.2%) only hyperplasia (with/without atypia) was found preoperatively. Overall accuracy to detect endometrial cancer was 80.2%. In 50 out of 63 endometrial cancers (79.4%) grading was concordant. The overall level of agreement between preoperative and postoperative grading was "substantial" according to Kappa (k) statistics (k 0.64; 95% CI: 0.449-0.83; p < 0.001), as well as for G1 (0.679; 95% CI: 0.432-0.926; p < 0.001) and G3 (0.774; 94% CI: 0.534-1; p < 0.001), while for G2 (0.531; 95% CI: 0.286-0.777; p < 0.001) it was moderate. CONCLUSIONS In our series we found an 80% C between pre-operative hysteroscopic-guided biopsy and final pathology, in uterine malignancies. Moreover, hysteroscopic biopsy accurately predicted endometrial cancer in 80% of cases and "substantially" predicted histological grading. Hysteroscopic-guided uterine sampling could be a useful tool to tailor treatment in patients with uterine malignancies.
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Affiliation(s)
- Fabio Martinelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Antonino Ditto
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Mauro Signorelli
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Valentina Chiappa
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Domenica Lorusso
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Edward Haeusler
- Department of Anesthesiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesco Raspagliesi
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
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A Selective Biomarker Panel Increases the Reproducibility and the Accuracy in Endometrial Biopsy Diagnosis. Int J Gynecol Pathol 2017; 36:339-347. [DOI: 10.1097/pgp.0000000000000334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Munro MG. Practical aspects of the two FIGO systems for management of abnormal uterine bleeding in the reproductive years. Best Pract Res Clin Obstet Gynaecol 2017; 40:3-22. [DOI: 10.1016/j.bpobgyn.2016.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/23/2016] [Indexed: 02/01/2023]
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Sumangala G, Premalatha TS, Kulkarni KA, Acharya G, Bidkar VC, Crasta J, Vallikad E. Uterine Papillary Serous Carcinoma—Still an Enigma? INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Singh S, Best C, Dunn S, Leyland N, Wolfman WL. Saignements utérins anormaux chez les femmes préménopausées. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S231-S263. [PMID: 28063539 DOI: 10.1016/j.jogc.2016.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Luz R, MacDonald N, Mould T. Omental Biopsy for Surgical Staging of Uterine Serous Carcinoma. Int J Gynecol Cancer 2016; 26:1448-54. [PMID: 27465896 DOI: 10.1097/igc.0000000000000777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The aims of this study were to determine the role of omental sampling in staging of uterine serous carcinoma (USC) and to evaluate its impact on patient outcomes. MATERIALS AND METHODS A retrospective study of 106 women with USC who underwent primary surgery between 2005 and 2014 was done. Overall survival, disease-free survival, and progression and recurrence patterns were studied in 84 patients with follow-up over 1 year. Diagnostic characteristics were evaluated for preoperative imaging and operative findings. Univariate and multivariate analyses were performed to evaluate risk factors for omental metastasis. Survival curves were used to compare omental sampling status and the presence of omental metastasis. RESULTS Of the 106 patients, 66 underwent surgical staging with omental biopsy (54; 82%) or omentectomy (12, 18%). Eight (12%) patients had metastatic disease in the omental samplings. All 6 patients with macrometastasis had visible lesions or palpable nodules and preoperative computed tomography (CT) was suspicious in 3. In 2 (3%) patients, omentum was not suspicious on CT or intraoperatively but had micrometastases. The negative predictive value regarding the staging CT scan was 92% and of the operative findings was 97%. On multivariate analysis, no variable was associated with omental involvement. Disease progressed or recurred in 40 (48%) patients. The most frequent sites of recurrence or progression were the omentum (23; 27%), peritoneum (26; 31%), pelvis (15, 18%), lung (15, 18%), and liver (12, 14%). Comparing the groups with or without omental assessment, no significant difference was found regarding progression and recurrence patterns, overall survival, and disease-free survival. CONCLUSIONS Omental involvement in USC upstages patients to stage IV disease and traditional risk factors fail to predict extrauterine disease. Although omental sampling does not influence disease progression or survival, a comprehensive intraoperative evaluation of the omentum is advised as most cases have grossly visible lesions.
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Affiliation(s)
- Rita Luz
- *Obstetrics and Gynaecology Department, Setúbal Hospital Centre, Setúbal, Portugal; and †Gynaecological Cancer Centre, University College London Hospital, London, United Kingdom
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Endometrial adenomyoma polyp caused postmenopausal bleeding mimicking uterine malignancy. Gynecol Minim Invasive Ther 2016; 6:129-131. [PMID: 30254897 PMCID: PMC6135180 DOI: 10.1016/j.gmit.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/22/2022] Open
Abstract
This case report presents a 66-year-oId postmenopausal woman with a case of endometrial adenomyomatous polyp (EAP) that presented as postmenopausal vaginal bleeding and mimicked endometrial cancer. The ultrasonography revealed a mildly enlarged uterus approximately 7.1 cm × 3.7 cm in size. The endometrium was 1.9 cm in diameter. The findings of magnetic resonance image (MRI) comprised abnormal intrauterine lesions with multiloculated cystic components. Endometrial biopsy by Pipelle was performed, and revealed hematoma. The hysteroscopy was then arranged, and two polypoid tumors were found. Tumor resection was performed, and the histology of the tumor was adenomyoma. EAP is a rare benign tumor of the uterus that is not easy to differentiate from endometrial cancer by ultrasound or MRI. Hysteroscopy is recommended when the results of tissue sampling by Pipelle differ from the image findings.
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Body N, Lavoué V, De Kerdaniel O, Foucher F, Henno S, Cauchois A, Laviolle B, Leblanc M, Levêque J. Are preoperative histology and MRI useful for classification of endometrial cancer risk? BMC Cancer 2016; 16:498. [PMID: 27430321 PMCID: PMC4950781 DOI: 10.1186/s12885-016-2554-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background The 2010 guidelines of the French National Cancer Institute (INCa) classify patients with endometrial cancer into three risk groups for lymph node invasion and recurrence on the basis of MRI and histological analysis of an endometrial specimen obtained preoperatively. The classification guides therapeutic choices, which may include pelvic and/or para-aortic lymphadenectomy. The purpose of this study was to evaluate the diagnostic performance of preoperative assessment to help identify intermediate- or high-risk patients requiring lymphadenectomy. Methods The study included all patients who underwent surgery for endometrial cancer between January 2010 and December 2013 at either Rennes University Hospital or Vannes Regional Hospital. The criteria for eligibility included a preoperative assessment with MRI and histological examination of an endometrial sample. A histological comparison was made between the preoperative and surgical specimens. Results Among the 91 patients who underwent a full preoperative assessment, the diagnosis of intermediate- or high-risk endometrial cancer was established by MRI and histology with a sensitivity of 70 %, specificity of 82 %, positive predictive value (PPV) of 87 %, negative predictive value (NPV) of 61 %, positive likelihood ratio (LR+) of 3.8 and negative likelihood ratio (LR-) of 0.3. The risk group was underestimated in 32 % of patients and overestimated in 7 % of patients. MRI underestimated endometrial cancer stage in 20 % of cases, while endometrial sampling underestimated the histological type in 4 % of cases and the grade in 9 % of cases. Conclusion The preoperative assessment overestimated or underestimated the risk of recurrence in nearly 40 % of cases, with errors in lesion type, grade or stage. Erroneous preoperative risk assessment leads to suboptimal initial surgical management of patients with endometrial cancer.
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Affiliation(s)
- Noemie Body
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France
| | - Vincent Lavoué
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France. .,Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France. .,University of Rennes 1, Faculty of Medicine, Rennes, France.
| | | | - Fabrice Foucher
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.,Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France
| | - Sébastien Henno
- Pathology Department, CHU Pontchaillou, Rennes University Hospital, Rennes, France
| | - Aurélie Cauchois
- Pathology Department, CHU Pontchaillou, Rennes University Hospital, Rennes, France
| | - Bruno Laviolle
- Clinical Pharmacology Department, Rennes University Hospital, CIC Inserm 0203, Hôpital Pontchaillou, Rennes, France
| | - Marc Leblanc
- Gynaecology Department, Bretagne Atlantique Hospital, Vannes, France
| | - Jean Levêque
- Gynaecology Department, Rennes University Hospital, Hôpital Sud, Rennes, France.,Oncogenesis, Stress and Signaling, ER 4440, CRCL CRLCC Eugène Marquis, Rennes, France.,University of Rennes 1, Faculty of Medicine, Rennes, France
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Nelson AL, Vasquez L, Tabatabai R, Im SS. The yield of endometrial aspiration in women with various risk factors and bleeding abnormalities. Contracept Reprod Med 2016; 1:9. [PMID: 29201398 PMCID: PMC5693553 DOI: 10.1186/s40834-016-0020-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/23/2016] [Indexed: 12/27/2022] Open
Abstract
Background Even in the face of a substantial increase in the numbers of endometrial cancer cases and in the numbers of women who have risk factors, there is no clear agreement about the indications for assessing the endometria of women with abnormal bleeding or about the tools to use in that assessment. This study sought to determine in a group of high risk women with abnormal uterine bleeding, the probability that an outpatient endometrial aspiration would identify significant pathology. Methods Retrospective cohort study of the histology from endometrial aspirations performed from 2001 to 2008 for abnormal uterine bleeding at Harbor-UCLA Medical Center and its satellite public health clinics. Medical records were reviewed in detail to assess risk factors, descriptions of bleeding abnormalities and histologic results. Results The charts of 1601 women who underwent 1636 endometrial biopsies for a wide variety of abnormal uterine bleeding patterns yielded 73 (4.6 %) cases of endometrial carcinoma, 43 cases of atypical endometrial hyperplasia (2.7 %), for an overall yield of significant pathology of 7.2 %. Hyperplasia without atypia was found in another 83 cases (5.2 %). Obesity, diabetes and postmenopausal age are associated with an increased risk of significant pathology. Bleeding patterns were so poorly documented that analysis of yield by this factor should be viewed with caution. Conclusions The probability of detecting significant uterine pathology is greatest among obese, diabetic postmenopausal women with diabetes (26.3 %). Conversely, the probability of identifying significant pathology in younger women without risk factors is less than 2 %. For women who perceive their individualized risk estimate to be too small to justify an endometrial biopsy, it may be possible to offer oral higher dose progestin therapy on the condition that persistent abnormal bleeding will require more intensive evaluation. These estimates of absolute risk of being diagnosed with significant pathology on endometrial biopsy may be helpful to patients as they consider giving informed consent for the procedure.
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Affiliation(s)
- Anita L Nelson
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA USA.,1457 3rd Street, Manhattan Beach, CA 90266 USA
| | - Lisa Vasquez
- Department Obstetrics and Gynecology, Healthcare Partners, Montebello, CA USA
| | - Roya Tabatabai
- Department of Hematology and Oncology, Olive View-UCLA Medical Center, Sylmar, CA USA
| | - Samuel S Im
- Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, CA USA
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Yang B, Shan B, Xue X, Wang H, Shan W, Ning C, Zhou Q, Chen X, Luo X. Predicting Lymph Node Metastasis in Endometrial Cancer Using Serum CA125 Combined with Immunohistochemical Markers PR and Ki67, and a Comparison with Other Prediction Models. PLoS One 2016; 11:e0155145. [PMID: 27163153 PMCID: PMC4862644 DOI: 10.1371/journal.pone.0155145] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 04/25/2016] [Indexed: 01/02/2023] Open
Abstract
We aimed to evaluate the value of immunohistochemical markers and serum CA125 in predicting the risk of lymph node metastasis (LNM) in women with endometrial cancer and to identify a low-risk group of LNM. The medical records of 370 patients with endometrial endometrioid adenocarcinoma who underwent surgical staging in the Obstetrics & Gynecology Hospital of Fudan University were collected and retrospectively reviewed. Immunohistochemical markers were screened. A model using serum cancer antigen 125 (CA125) level, the immunohistochemical markers progesterone receptor (PR) and Ki67 was created for prediction of LNM. A predicted probability of 4% among these patients was defined as low risk. The developed model was externally validated in 200 patients from Shanghai Cancer Center. The efficiency of the model was compared with three other reported prediction models. Patients with serum CA125 < 30.0 IU/mL, either or both of positive PR staining > 50% and Ki67 < 40% in cancer lesion were defined as low risk for LNM. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.82. The model classified 61.9% (229/370) of patients as being at low risk for LNM. Among these 229 patients, 6 patients (2.6%) had LNM and the negative predictive value was 97.4% (223/229). The sensitivity and specificity of the model were 84.6% and 67.4% respectively. In the validation cohort, the model classified 59.5% (119/200) of patients as low-risk, 3 out of these 119 patients (2.5%) has LNM. Our model showed a predictive power similar to those of two previously reported prediction models. The prediction model using serum CA125 and the immunohistochemical markers PR and Ki67 is useful to predict patients with a low risk of LNM and has the potential to provide valuable guidance to clinicians in the treatment of patients with endometrioid endometrial cancer.
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Affiliation(s)
- Bingyi Yang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Boer Shan
- Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaohong Xue
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Huaying Wang
- Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Weiwei Shan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Chengcheng Ning
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Qiongjie Zhou
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- * E-mail: (XC); (XL)
| | - Xuezhen Luo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- * E-mail: (XC); (XL)
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A Cell Type Independent Binary Grading System Does Not Significantly Improve Endometrial Biopsy Interpretation. Int J Gynecol Pathol 2016; 35:256-63. [DOI: 10.1097/pgp.0000000000000239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cetinkaya N, Selcuk İ, Ozdal B, Meydanli MM, Gungor T. Diagnostic Impacts of Serum CA-125 Levels, Pap Smear Evaluation, and Endometrial Sampling in Women with Endometrial Clear Cell Carcinoma. Oncol Res Treat 2016; 39:283-8. [PMID: 27173475 DOI: 10.1159/000445860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/01/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endometrial clear cell carcinoma (ECCC) is a rare variant of endometrial cancer with an unfavorable prognosis. The aim of this study was to determine the relationships, if any, between preoperative serum cancer antigen 125 (CA-125) levels, the last Papanicolaou (Pap) smear, the results of endometrial biopsy and tumor histology, and disease-stage according to permanent histopathology. MATERIALS AND METHODS The data of 26 women with ECCC were collected from their medical records to compare demographics, preoperative serum CA-125 levels, Pap test results, histological diagnosis of the endometrial biopsy, and tumor histology, as well as the disease stage according to permanent histopathology. RESULTS The mean age at diagnosis was 64.0 years. There were 17 (65.3%) women with pure ECCC and 8 (30.7%) women with a mixed histology. Stage III-IV disease was diagnosed in 12 (46.2%) women and occurred more frequently in pure ECCC (n = 11, 91.7%). CA-125 values were significantly higher in advanced stage disease. Cytological evaluation indicated the presence of 71.4% (10/14) cytological abnormalities in pure ECCC. The overall sensitivity of endometrial sampling for the detection of malignancy was 92.3% (24/26), whereas the accurate diagnosis of ECCC was only 34.7% (8/23) with the Pipelle sampler. CONCLUSION Pap test abnormalities are frequent in ECCC. Although it is less accurate in the diagnosis of ECCC than in the detection of malignancy, endometrial sampling is still the main procedure for the diagnosis of ECCC. Higher preoperative CA-125 concentrations imply the presence of advanced stage ECCC.
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Affiliation(s)
- Nilufer Cetinkaya
- Department of Gynecological Oncology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
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