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Choi CH, Lee YY, Lai YL, Chang K, Kim HS, Chen J, Chen YL. Outcomes of extended progestin therapy in atypical endometrial hyperplasia patients without an initial response to progestin: a retrospective study from two tertiary centers in Korea and Taiwan. J Gynecol Oncol 2025; 36:e18. [PMID: 39028151 PMCID: PMC11964964 DOI: 10.3802/jgo.2025.36.e18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE In this study, we evaluated the role of prolonged progestin treatment on atypical endometrial hyperplasia (AEH) patients who did not achieve complete regression (CR) after at least 3 months of progestin treatment. Possible prognostic factors predicting disease regression and recurrence were also assessed. METHODS We retrospectively identified patients who had histologically confirmed persistent disease after at least 3 months of progestin treatment at two tertiary centers in Korea and Taiwan. Clinicopathologic factors and clinical outcomes were obtained from medical records. Logistic regression was used to analyze the relationship between covariates and the probability of CR and relapse. RESULTS Fifty-two patients were included. Thirty-seven of 52 patients (71.2%) achieved CR after prolonged progestin treatment. Median time from starting progestin treatment to CR was 12.0 months. Daily administration of medroxyprogesterone acetate ≥200 mg or megestrol acetate ≥80 mg was associated with higher probability of regression. Nineteen of 37 patients (51.4%) experienced recurrence, with median time from CR to relapse of 15.0 months. Body mass index ≥27 was associated with higher relapse probability. Twelve of 16 patients with disease progression to endometrial carcinoma underwent surgery. The 12 cases had stage I tumors and lived without disease. CONCLUSION Extension of progestin treatment course is feasible for AEH patients without an initial response to progestin. Higher daily progestin dosage was associated with higher probability of CR, and obesity was associated with higher risk of relapse. The patients without an initial response to progestins and whose AEH progressed to endometrial carcinoma had good prognoses.
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Affiliation(s)
- Chel-Hun Choi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yen-Ling Lai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Koping Chang
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Nagai S, Kitazawa S, Shirane T, Sera A, Fukutake M, Sakai T, Fujioka Y, Hino M, Hattori Y, Kurahashi T. Characteristics of Patients Undergoing Laparoscopic Hysterectomy for Atypical Endometrial Hyperplasia. Cureus 2025; 17:e79856. [PMID: 40166529 PMCID: PMC11955778 DOI: 10.7759/cureus.79856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2025] [Indexed: 04/02/2025] Open
Abstract
OBJECTIVE This study aimed to investigate the potential risk of a final pathological diagnosis of endometrial cancer in laparoscopic surgery for preoperatively diagnosed atypical endometrial hyperplasia (AEH), considering literature reports indicating a 40% coexistence rate of AEH with endometrial cancer. METHODOLOGY A retrospective analysis was conducted on 17 patients with preoperative AEH undergoing laparoscopic surgery at our hospital. The median age was 50 (37-74) years, and the median body mass index (BMI) was 25.1 (16.9-44.3) kg/m2. Surgical procedures included total hysterectomy and bilateral adnexectomy, accounting for the possible coexistence of endometrial cancer. Diagnostic methods comprised histological examination, dilatation and curettage, and pelvic MRI. Clinicopathological factors were thoroughly examined. RESULTS Postoperative diagnoses were AEH in 10 cases, atypical polypoid adenomyoma (APAM) in one case, and endometrial cancer in six cases. Comparison between the AEH group and the endometrial cancer group showed that the proportion of postmenopausal women was higher in the endometrial cancer group (33.3% vs. 66.7%), as was the presence of endometrial thickening on imaging (20% vs. 66.7%), although these differences were not statistically significant. However, patients in the endometrial cancer group were significantly older than those in the AEH group (median age: 59.5 vs. 47.5 years, P = 0.02). All endometrial cancer cases were endometrioid carcinoma Grade 1, with five cases classified as FIGO (International Federation of Gynecology and Obstetrics) stage IA and one case as stage IB. CONCLUSIONS Despite nonsignificant differences in factors other than age, our study underscores the critical consideration of endometrial cancer during laparoscopic surgery for AEH, even with comprehensive preoperative examinations. This emphasizes the need for vigilant management strategies and heightened awareness of the surgical approach to AEH cases.
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Affiliation(s)
- Shimpei Nagai
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
- Obstetrics and Gynecology, Keio University, Tokyo, JPN
| | - Shoko Kitazawa
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Terumi Shirane
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Asako Sera
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Marie Fukutake
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Tomomi Sakai
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Yoko Fujioka
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Makiko Hino
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Yoshihisa Hattori
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
| | - Takashi Kurahashi
- Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, JPN
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Lou Y, Jiang F, Du Y, Guan J. Nomogram using human epididymis protein 4 predicted concurrent endometrial cancer from endometrial atypical hyperplasia before surgery. Front Oncol 2024; 14:1442127. [PMID: 39309739 PMCID: PMC11412798 DOI: 10.3389/fonc.2024.1442127] [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: 06/01/2024] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
Objective To establish a nomogram based on presurgical predictors of concurrent endometrial cancer (EC) for patients diagnosed with endometrial atypical hyperplasia before definitive surgery (preoperative-EAH) to improve the risk stratification and clinical application. Methods Preoperative-EAH patients who underwent hysterectomy in a tertiary hospital from January 2020 to December 2022 were retrospectively analyzed. Independent predictors from the multivariate logistic regression model were used to establish a nomogram, and bootstrap resampling was used for internal validation. Results Of 370 preoperative-EAH patients, 23.4% were diagnosed with EC after definitive surgery (final-EC). Multivariate analyses found three independent predictors of final EC: human epididymis protein 4 (HE4) ≥43.50 pmol/L [odds ratio (OR) = 3.70; 95% confidence intervals (CI) = 2.06-6.67], body mass index (BMI) ≥ 28 kg/m2 (OR = 2.05; 95% CI = 1.14-3.69), and postmenopausal status, particularly at postmenopausal time ≥5 years (OR = 5.84, 95% CI = 2.51-13.55), which were used to establish a nomogram model. The bootstrap-corrected C-index of the nomogram was 0.733 (95% CI = 0.68-0.79), which was significantly higher than that of each individual factor. The calibration curve and decision curve showed good consistency and clinical net benefit of the model. At the maximum Youden index, 49.4% (43/87) of women in the high-risk group defined by nomogram had concurrent EC, versus 16.6% in the low-risk group (P< 0.001). Conclusion The nomogram based on HE4, menopausal status, and BMI was found with an improved predictive value to stratify preoperative-EAH patients at high risk of concurrent EC for better clinical management.
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Affiliation(s)
- Yaochen Lou
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Du
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jun Guan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Vasilevska D, Rudaitis V, Lewkowicz D, Širvienė D, Mickys U, Semczuk M, Obrzut B, Semczuk A. Expression Patterns of Cytokeratins (CK7, CK20, CK19, CK AE1/AE3) in Atypical Endometrial Hyperplasia Coexisting with Endometrial Cancer. Int J Mol Sci 2024; 25:9084. [PMID: 39201770 PMCID: PMC11354644 DOI: 10.3390/ijms25169084] [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: 06/26/2024] [Revised: 07/31/2024] [Accepted: 08/17/2024] [Indexed: 09/03/2024] Open
Abstract
Few studies have evaluated cytokeratin's (CK) staining patterns in atypical endometrial hyperplasia (AEH) coexisting with early-stage endometrial cancer (EC). We aimed to assess the staining patterns of selected CKs (CK7, CK19, CK20, CK AE1/AE3) in 74 patients with coexisting AEH and EC by independently analyzing both morphological variables. Specimens were collected from women with AEH and EC who underwent surgical interventions between 2012 and 2019 at the Department of Obstetrics and Gynecology of Vilnius University Hospital "Santaros Klinikos" in Vilnius, Lithuania. Immunostaining was also qualitatively classified as being heterogeneous or intense. The results revealed heterogeneous CK7 expression in all AEH cases and intense staining in 95.95% cases of AEH. The heterogeneous expression of CK7 was detected in all EC specimens. Intense CK7 expression was observed in 95.09% cases of EC G1 and in all G2 ECs. Heterogenous CK19 expression was present in all AEH specimens with intense staining in 92.42% of cases. Heterogeneous CK19 expression was observed in all EC samples with intense expression in 86.27% cases of EC G1 and 100% cases of EC G2. Interestingly, a significant relationship was found when comparing the heterogeneous expression of CK19 between AEH and well-differentiated EC. A significant difference was reported in the intense expression of CK AE1/AE3 (p = 0.031; p = 0.029) between AEH and G2 ECs and in the intense expression of CK AE1/AE3 between G1 and G2 ECs. CK20 staining was not a characteristic feature for AEH and early-stage EC. CK staining is present either in AEH or in early-stage endometrioid-subtype EC in different manners. Heterogeneous CK19 expression was significantly more common in AEH than in EC. CK20 expression was not associated with either AEH nor early-stage EC. An intense expression of CK AE1/AE3 was mainly present in moderately differentiated ECs, whereas the intense reactivity of AE1/AE3 showed a significant difference in well to moderately differentiated uterine tumors. The clinical implication of CK staining may aid in the more accurate diagnosis of AEH and early-stage EC as well as detect micrometastases leading to better oncological outcomes.
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Affiliation(s)
- Danuta Vasilevska
- Department of Gynecology, Vilnius University Hospital “Santaros Klinikos”, 08406 Vilnius, Lithuania
| | - Vilius Rudaitis
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Dorota Lewkowicz
- Department of Clinical Pathology, Lublin Medical University, 20-090 Lublin, Poland
| | | | - Ugnius Mickys
- National Centre of Pathology, Vilnius University Hospital “Santaros Klinikos”, 08406 Vilnius, Lithuania;
| | - Marek Semczuk
- Faculty of Medicine, Radom University, 26600 Radom, Poland
| | - Bogdan Obrzut
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, Medical College, University of Rzeszow, 35-301 Rzeszow, Poland;
| | - Andrzej Semczuk
- IInd Department of Gynecological Surgery and Gynecological Oncology, Lublin Medical University, 20090 Lublin, Poland
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Raffone A, Insabato L, Raimondo D, Del Piano I, Ricciardiello M, Cretella P, Neola D, Arciuolo D, Santoro A, Seracchioli R, Guida M, Travaglino A, Zannoni GF. Integrated histological parameters define prognostically relevant groups in atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia. Int J Gynecol Cancer 2024; 34:1183-1188. [PMID: 38719279 DOI: 10.1136/ijgc-2024-005367] [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: 02/09/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To assess the risk of endometrial carcinoma following a diagnosis of atypical hyperplasia/endometrioid intraepithelial neoplasia by endometrial biopsy, stratified based on integrated histological parameters. METHODS All women with atypical hyperplasia/endometrioid intraepithelial neoplasia undergoing hysterectomy within 1 year of diagnosis without progestin treatment were included. Patients were subdivided into three study groups, based on two criteria: (a) grade of nuclear atypia and (b) foci (<2 mm) of confluent glands with no intervening stroma: low-grade, high-grade, and confluent glands. The rate of endometrial carcinoma on the subsequent hysterectomy was assessed in each study group, and differences between study groups were assessed using Fisher's exact test, with a significant p value <0.05. Reproducibility was assessed by using Cohen's κ. RESULTS Ninety-six patients were included. Overall, 36 of 96 patients (37.5%) had endometrial carcinoma on the subsequent hysterectomy. The number of endometrial carcinomas was 4 of 42 (9.5%) in the low-grade group, 14 of 28 (50.0%) in the high-grade group, and 18 of 26 (69.2%) in the confluent glands group. The rate of endometrial carcinoma was significantly higher in the high-grade group than in the low-grade group (p<0.001), whereas it did not significantly differ between the high-grade group and the confluent glands group (p=0.176). The reproducibility among pathologists was moderate for low-grade versus high-grade (κ=0.58) and substantial for confluent glands versus low-grade (κ=0.63) and high-grade (κ=0.63). CONCLUSION Atypical hyperplasia/endometrioid intraepithelial neoplasia can be stratified into prognostically relevant groups based on integrated histological parameters, with a possible major impact on patient management.
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Affiliation(s)
- Antonio Raffone
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Del Piano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
| | - Marialuisa Ricciardiello
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Cretella
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
| | - Daniele Neola
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Damiano Arciuolo
- Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Roma, Italy
| | - Angela Santoro
- Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Roma, Italy
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizio Guida
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
- Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Gian Franco Zannoni
- Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Roma, Italy
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Ueda M, Watanabe T, Momma T, Kanke Y, Kato A, Okabe C, Sato T, Kamo N, Endo Y, Furukawa S, Soeda S, Fujimori K. Diaphragmatic clear cell carcinoma with Lynch syndrome after surgery for atypical endometrial hyperplasia and ovarian endometriosis: A case report. Mol Clin Oncol 2024; 21:46. [PMID: 38826696 PMCID: PMC11140286 DOI: 10.3892/mco.2024.2744] [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: 02/10/2024] [Accepted: 04/22/2024] [Indexed: 06/04/2024] Open
Abstract
Clear cell carcinoma (CCC) of the diaphragm is rare, with an origin that is reported to be associated with malignant transformation of extraperitoneal endometriosis. Lynch syndrome (LS) is an autosomal dominant hereditary cancer syndrome caused by germline pathogenic variants in one of the DNA mismatch repair (MMR) genes, MLH1, MSH2, MSH6 and PMS2. Women with LS have a significantly increased lifetime risk of endometrial and ovarian cancer. CCC is a common histology of endometriosis- and LS-associated malignancy. The present study describes the case of a 51-year-old woman with an intra-abdominal mass found during a routine physical examination. The patient had undergone total hysterectomy and bilateral adnexectomy for atypical endometrial hyperplasia (AEH) and ovarian endometriosis, respectively, 3 years previously. Enhanced computed tomography showed a mass on the surface of the liver. Laparoscopic examination of the abdominal cavity revealed a tumor on the underside of the right diaphragm, which was then surgically excised. Pathological examination of the excised tumor, along with immunohistochemistry, led to a diagnosis of CCC. Since LS was suspected due to the genetic family history of the patient, microsatellite instability analysis was performed on the diaphragmatic tumor, and the results were positive. Immunohistochemistry was performed for MMR proteins in AEH and CCC cells, both of which revealed loss of MSH2 and MSH6 expression. Following detailed genetic counseling, genetic testing of MMR genes was performed, revealing a germline pathogenic variant in MSH2 (c.1000C>T, p.Gln344*), thus confirming the diagnosis of LS. To the best of our knowledge, this is the first case report of concurrent diaphragmatic CCC and LS. Patients with LS and endometriosis are at risk of developing ovarian cancer or intra-abdominal malignant tumors. In addition, immunohistochemistry screening for MMR proteins should be considered in patients with AEH and a family history of LS-related cancer, to enable early clinical intervention in cases of endometrial cancer.
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Affiliation(s)
- Makiko Ueda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tomoyuki Momma
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yasuyuki Kanke
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Asami Kato
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Chikako Okabe
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tetsu Sato
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Norihito Kamo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Yuta Endo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Agusti N, Kanbergs A, Nitecki R. Potential of molecular classification to guide fertility-sparing management among young patients with endometrial cancer. Gynecol Oncol 2024; 185:121-127. [PMID: 38402734 PMCID: PMC11275632 DOI: 10.1016/j.ygyno.2024.02.020] [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: 11/27/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
The traditional histological classification system for endometrial carcinoma falls short in addressing the disease's molecular heterogeneity, prompting the need for alternative stratification methods. Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) has emerged as a clinically efficient tool to categorize endometrial cancers according to mismatch repair deficiency, POLE exonuclease domain mutations, and p53 expression. However, the application of this classification to fertility-sparing treatments remains unexplored, and current guidelines lack specificity in how it should be used. In this review, we summarize the available literature and establish the framework for future investigations focused on molecular profiling-based risk assessment of endometrial cancer, with the goal of utilizing precision medicine to optimally counsel patients seeking fertility-sparing treatment. While the available evidence is limited and of low quality, it does provide insights and frames future perspectives for managing fertility-sparing approaches on the basis of molecular subtypes. Evidence suggests that mismatch repair-deficient tumors are likely to recur despite progestin therapy, emphasizing the need for alternative treatments, with targeted therapies being a new landscape that still needs to be explored. Tumors with POLE mutations exhibit a favorable prognosis, but the safety of hysteroscopic resection alone requires further investigation. p53 abnormal tumors have an unfavorable prognosis, raising questions about their suitability for fertility-sparing treatment. Lastly, the no specific molecular profile (or p53 wild-type) tumors, while having a relatively good prognosis, are heterogeneous and require more precise biomarkers to effectively guide therapy for those with poorer prognoses. Addressing these research gaps will lead to more precise guidelines to ensure optimal selection for fertility-sparing treatment.
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Affiliation(s)
- Nuria Agusti
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Alexa Kanbergs
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Giannella L, Grelloni C, Bernardi M, Cicoli C, Lavezzo F, Sartini G, Natalini L, Bordini M, Petrini M, Petrucci J, Terenzi T, Delli Carpini G, Di Giuseppe J, Ciavattini A. Atypical Endometrial Hyperplasia and Concurrent Cancer: A Comprehensive Overview on a Challenging Clinical Condition. Cancers (Basel) 2024; 16:914. [PMID: 38473276 DOI: 10.3390/cancers16050914] [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: 01/23/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The present review regarding atypical endometrial hyperplasia (AEH) focused on the main debated factors regarding this challenging clinical condition: (i) predictive variables of occult endometrial cancer (EC); (ii) the rate of EC underestimation according to different endometrial sampling methods; and (iii) the appropriateness of lymph node status assessment. When cancer is detected, approximately 90% of cases include low-risk EC, although intermediate/high-risk cases have been found in 10-13% of women with cancer. Older age, diabetes, high BMI, and increased endometrial thickness are the most recurrent factors in women with EC. However, the predictive power of these independent variables measured on internal validation sets showed disappointing results. Relative to endometrial sampling methods, hysteroscopic endometrial resection (Hys-res) provided the lowest EC underestimation, ranging between 6 and 11%. Further studies, including larger sample sizes of women undergoing Hys-res, are needed to confirm these findings. These data are urgently needed, especially for female candidates for conservative treatment. Finally, the evaluation of lymph node status measured on 660 of over 20,000 women showed a lymph node positivity of 2.3%. Although there has been an increase in the use of this procedure in AEH in recent years, the present data cannot recommend this option in AEH based on a cost/risk/benefit ratio.
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Affiliation(s)
- Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Camilla Grelloni
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Marco Bernardi
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Camilla Cicoli
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Federica Lavezzo
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Gianmarco Sartini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Leonardo Natalini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Mila Bordini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Martina Petrini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Jessica Petrucci
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Tomas Terenzi
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
| | - Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy
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Wu P, Shan W, Xue Y, Wang L, Liu S, Chen X, Luo X. Impacts of ovarian reserve on conservative treatment for endometrial cancer and atypical hyperplasia. Front Endocrinol (Lausanne) 2024; 14:1286724. [PMID: 38250737 PMCID: PMC10796988 DOI: 10.3389/fendo.2023.1286724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives Real-world data indicated that some endometrial atypical hyperplasia (EAH) and early endometrial carcinoma (EEC) patients of fertility preservation had a normal ovarian reserve, while some had a decreased ovarian reserve (DOR). This study was designed to investigate the effect of baseline ovarian reserve on the treatment of EAH and EEC patients who ask for preservation of fertility. Methods This was a prospective cohort study conducted at a single university-affiliated fertility center. A total of 102 EAH and EEC patients who received fertility-preserving treatment between March 2019 and August 2020 were included and divided into a DOR group (n=22) and a non-DOR group (n=80). Results The 32-week CR rate of the non-DOR group was significantly higher than that of the DOR group (60.3% vs. 33.3%, P =0.028). The DOR group had a longer treatment duration to achieve CR than the non-DOR group (40.07 vs. 29.71 weeks, P=0.008, HR: 0.54, 95% CI: 0.36-0.86). Multivariate logistic regression analyses demonstrated that DOR (OR: 0.35, 95% CI: 0.13-0.99, P=0.049) and BMI ≥25 kg/m2 (OR: 0.40, 95% CI: 0.17-0.92, P=0.031) were negatively associated with 32-week CR. Conclusions Decreased baseline ovarian reserve is negatively correlated with the efficacy of fertility-preserving treatment in EAH and EEC patients, as this group has a lower CR rate and a longer treatment duration to achieve CR than those without DOR.
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Affiliation(s)
- Pengfei Wu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Weiwei Shan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yu Xue
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Lulu Wang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Sijia Liu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, 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, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Golia D'Augè T, Cuccu I, Santangelo G, Muzii L, Giannini A, Bogani G, Di Donato V. Novel Insights into Molecular Mechanisms of Endometrial Diseases. Biomolecules 2023; 13:biom13030499. [PMID: 36979434 PMCID: PMC10046407 DOI: 10.3390/biom13030499] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Endometrial diseases are the most common gynecological pathologies in Western Countries [...].
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Affiliation(s)
- Tullio Golia D'Augè
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Ilaria Cuccu
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Giusi Santangelo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
| | - Andrea Giannini
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, 00185 Rome, Italy
| | - Giorgio Bogani
- Gynecological Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, 00100 Rome, Italy
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11
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Lechartier C, Bernard J, Renaud MC, Plante M. Robotic-assisted surgery for endometrial cancer is safe in morbidly and extremely morbidly obese patients. Gynecol Oncol 2023; 172:15-20. [PMID: 36905768 DOI: 10.1016/j.ygyno.2023.02.014] [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: 12/04/2022] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Obesity has risen to affect >25% of the Canadian population. Perioperative challenges with increased morbidity are encountered. We evaluated the outcome of robotic-assisted surgery for endometrial cancer (EC) in obese patients. METHODS We retrospectively reviewed all robotic surgeries performed for EC in women with BMI ≥40 kg/m2, from 2012 to 2020 in our center. Patients were divided into 2 groups (class III: 40-49 kg/m2, class IV: ≥50 kg/m2). Complications and outcome were compared. RESULTS 185 patients were included: 139 class III and 46 class IV. The main histology was endometrioid adenocarcinoma (70,5% of class III and 58,1% of class IV (p = 0,138)). The mean blood loss, overall sentinel node detection and median length of stay were similar in both groups. Six class III (4,3%) and 3 class IV (6,5%) patients required conversion to laparotomy due to poor surgical field exposure (p = 0,692). The rate of intraoperative complications was similar between the 2 groups (1.4% in class III vs none in class IV, p = 1). There were 10 class III (7,2%) and 10 class IV (21,7%) post-operative complications (p = 0.011), but most were grade 2 (3,6% in class III vs 13% in class IV, p = 0.029)). Grade 3 and 4 postoperative complications were low (2.7%) and not statistically different between the 2 groups. Readmission rate was low in both groups (4 in each group, p = 1.07). Recurrence occurred in 5,8% of class III and 4,3% of class IV patients (p = 1). CONCLUSION Robotic-assisted surgery for EC in class III and class IV obese patients is a safe and feasible procedure, with low complication rate, similar oncologic outcome, conversion rate, blood loss, readmission rate and length of hospital stay.
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Affiliation(s)
- Céline Lechartier
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
| | - Juliette Bernard
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie-Claude Renaud
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie Plante
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
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12
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Zong X, Guo Y, Li H, Li R, Qiao J. Obstetric and perinatal outcomes following frozen and fresh embryo transfer in patients with endometrial hyperplasia and carcinoma: a retrospective study in a high-volume reproductive center. BMC Pregnancy Childbirth 2023; 23:92. [PMID: 36737751 PMCID: PMC9896787 DOI: 10.1186/s12884-023-05418-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is ongoing debate regarding which embryo transfer procedure can achieve a higher live birth rate. Research has suggested that frozen ET might be beneficial for certain populations, such as hyper-responders. This study aimed to compare outcomes of pregnancies between frozen and fresh embryo transfer cycles in patients with endometrial hyperplasia and carcinoma. METHODS This retrospective cohort study was conducted at a high-volume reproductive center from January 2010 to January 2022. Patients who were diagnosed with endometrial hyperplasia with atypia and endometrial carcinoma were included. They all underwent in vitro fertilization after conservative treatment. The primary outcome was live birth after frozen and fresh embryo transfer cycles, and secondary outcomes included perinatal complications and other pregnancy outcomes. RESULTS Overall, 259 ET cycles (130 fresh and 129 frozen) were included. The rate of live births per embryo transfer cycle of the whole cohort was 20.8% (54/259), and no significant between-group difference was found after adjusting for potential confounding factors (23.8% vs. 17.8%; adjusted OR, 0.47; 95% CI, 0.21-1.06; p=0.068). Compared to fresh embryo transfer group, the incidence of total maternal complications in the frozen embryo transfer group was significantly higher (30.4% vs. 6.5%, p=0.019). Analyzing each complication as a separate entity, patients in the frozen embryo transfer group had a higher incidence of hypertensive disorders of pregnancy (p=0.028). Multiple logistic regression analysis showed that frozen embryo transfer was related with an increased occurrence of maternal complications (OR, 6.68, 95% CI, 1.01-44.19, p=0.040). CONCLUSIONS Among patients with endometrial hyperplasia and carcinoma, the rate of live births was comparable between both embryo transfer procedures, while frozen embryo transfer might be associated with a higher risk of maternal complications compared to that with fresh embryo transfer.
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Affiliation(s)
- Xuan Zong
- grid.411642.40000 0004 0605 3760Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, 100191 China
| | - Yaxing Guo
- grid.411642.40000 0004 0605 3760Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, 100191 China
| | - Hongzhen Li
- grid.411642.40000 0004 0605 3760Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, 100191 China ,grid.411642.40000 0004 0605 3760National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital), Beijing, 100191 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191 China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191 China
| | - Rong Li
- grid.411642.40000 0004 0605 3760Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, 100191 China ,grid.411642.40000 0004 0605 3760National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital), Beijing, 100191 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191 China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191 China
| | - Jie Qiao
- grid.411642.40000 0004 0605 3760Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, 100191 China ,grid.411642.40000 0004 0605 3760National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital), Beijing, 100191 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191 China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology (Peking University Third Hospital), Beijing, 100191 China
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Does the presence of single compared to multiple endometrial polyps alter the risk of cancer in post-menopausal women? Eur J Obstet Gynecol Reprod Biol 2022; 279:118-121. [DOI: 10.1016/j.ejogrb.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/16/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
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Zhang J, Zhang Q, Wang T, Song Y, Yu X, Xie L, Chen Y, Ouyang H. Multimodal MRI-Based Radiomics-Clinical Model for Preoperatively Differentiating Concurrent Endometrial Carcinoma From Atypical Endometrial Hyperplasia. Front Oncol 2022; 12:887546. [PMID: 35692806 PMCID: PMC9186045 DOI: 10.3389/fonc.2022.887546] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To develop and validate a radiomics model based on multimodal MRI combining clinical information for preoperative distinguishing concurrent endometrial carcinoma (CEC) from atypical endometrial hyperplasia (AEH). Materials and Methods A total of 122 patients (78 AEH and 44 CEC) who underwent preoperative MRI were enrolled in this retrospective study. Radiomics features were extracted based on T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. After feature reduction by minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithm, single-modal and multimodal radiomics signatures, clinical model, and radiomics-clinical model were constructed using logistic regression. Receiver operating characteristic (ROC) analysis, calibration curves, and decision curve analysis were used to assess the models. Results The combined radiomics signature of T2WI, DWI, and ADC maps showed better discrimination ability than either alone. The radiomics-clinical model consisting of multimodal radiomics features, endometrial thickness >11mm, and nulliparity status achieved the highest area under the ROC curve (AUC) of 0.932 (95% confidential interval [CI]: 0.880-0.984), bootstrap corrected AUC of 0.922 in the training set, and AUC of 0.942 (95% CI: 0.852-1.000) in the validation set. Subgroup analysis further revealed that this model performed well for patients with preoperative endometrial biopsy consistent and inconsistent with postoperative pathologic data (consistent group, F1-score = 0.865; inconsistent group, F1-score = 0.900). Conclusions The radiomics model, which incorporates multimodal MRI and clinical information, might be used to preoperatively differentiate CEC from AEH, especially for patients with under- or over-estimated preoperative endometrial biopsy.
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Affiliation(s)
- Jieying Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingting Wang
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Song
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoduo Yu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lizhi Xie
- MR Research China, GE Healthcare, Beijing, China
| | - Yan Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Do myometrial lesions affect the discrepancy of pathological findings in women with endometrial hyperplasia? JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1071697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Prip CM, Stentebjerg M, Bennetsen MH, Petersen LK, Bor P. Risk of atypical hyperplasia and endometrial carcinoma after initial diagnosis of non-atypical endometrial hyperplasia: A long-term follow-up study. PLoS One 2022; 17:e0266339. [PMID: 35413062 PMCID: PMC9004759 DOI: 10.1371/journal.pone.0266339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/19/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The strong association between atypical endometrial hyperplasia and endometrial carcinoma is well established, but data on the risk of atypical hyperplasia and carcinoma in Danish women with non-atypical endometrial hyperplasia are almost non-existent. This study aimed to investigate the prevalence of atypical hyperplasia and endometrial carcinoma diagnosed within 3 months of initial diagnosis (defined as concurrent disease) and the risk of atypical hyperplasia and carcinoma more than 3 months after initial diagnosis (classified as progressive disease) in Danish women initially diagnosed with non-atypical endometrial hyperplasia. DESIGN This cohort study recruited 102 women diagnosed with non-atypical endometrial hyperplasia at Randers Regional Hospital in Randers, Denmark, between 2000 and 2015. METHODS The endometrium was evaluated by transvaginal ultrasound examination and office mini-hysteroscopy with biopsies in all non-hysterectomized women. Data regarding subsequent hysterectomy or endometrial sampling were obtained from medical records and the Danish Pathology Registry (Patobank). RESULTS A total of 15 women were diagnosed with atypical hyperplasia or carcinoma during follow-up. Concurrent atypical hyperplasia or carcinoma was seen in 2.9% (3/102), and among women who remained at risk for more than 3 months after initial diagnosis of non-atypical endometrial hyperplasia (n = 94), progression to atypical hyperplasia or carcinoma was seen in 13% (median follow-up 5.2 years, range 3.6 months to 15.1 years). Sixty-six percent of the women with progressive disease were diagnosed with atypical hyperplasia or carcinoma more than 1 year after initial diagnosis, but only two were diagnosed later than 5 years (5.2 and 9 years). CONCLUSIONS The risk of being diagnosed with atypical endometrial hyperplasia or endometrial carcinoma more than 5 years after an initial diagnosis of non-atypical endometrial hyperplasia seems to be low in Danish women. Specialized follow-up more than 5 years after diagnosis of non-atypical endometrial hyperplasia may not be warranted.
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Affiliation(s)
- Clara M. Prip
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
- * E-mail:
| | - Maria Stentebjerg
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
| | - Mary H. Bennetsen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Lone K. Petersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Open Patient Explorative Data Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pinar Bor
- Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark
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Contreras NA, Sabadell J, Verdaguer P, Julià C, Fernández-Montolí ME. Fertility-Sparing Approaches in Atypical Endometrial Hyperplasia and Endometrial Cancer Patients: Current Evidence and Future Directions. Int J Mol Sci 2022; 23:ijms23052531. [PMID: 35269674 PMCID: PMC8910633 DOI: 10.3390/ijms23052531] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/12/2022] Open
Abstract
Endometrial cancer (EC) is the fourth most common cancer in women in developed countries. Although it is usually diagnosed in postmenopausal women, its incidence has increased in young women, as well in recent decades, with an estimated rate of 4% in those under 40 years of age. Factors involved in this increase, particularly in resource-rich countries, include delayed childbearing and the rise in obesity. The new molecular classification of EC should help to personalize treatment, through appropriate candidate selection. With the currently available evidence, the use of oral progestin either alone or in combination with other drugs such as metformin, levonorgestrel-releasing intrauterine devices and hysteroscopic resection, seems to be feasible and safe in women with early-stage EC limited to the endometrium. However, there is a lack of high-quality evidence of the efficacy and safety of conservative management in EC. Randomized clinical trials in younger women and obese patients are currently underway.
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Affiliation(s)
| | - Jordi Sabadell
- Department of Gynaecology, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Paula Verdaguer
- Department of Gynaecology-ASSIR, Ronda General Prim 35, Mataró, 08302 Barcelona, Spain;
| | - Carla Julià
- Department of Gynaecology, Hospital de Viladecans, Avda de Gavà 38, Viladecans, 08840 Barcelona, Spain;
| | - Maria-Eulalia Fernández-Montolí
- Department of Gynaecology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Feixa Llarga s/n, L´Hospitalet de LLobregat, 08907 Barcelona, Spain
- Correspondence: or
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Nees LK, Heublein S, Steinmacher S, Juhasz-Böss I, Brucker S, Tempfer CB, Wallwiener M. Endometrial hyperplasia as a risk factor of endometrial cancer. Arch Gynecol Obstet 2022; 306:407-421. [PMID: 35001185 PMCID: PMC9349105 DOI: 10.1007/s00404-021-06380-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/23/2021] [Indexed: 12/30/2022]
Abstract
Endometrial hyperplasia (EH) is the precursor lesion for endometrioid adenocarcinoma of the endometrium (EC), which represents the most common malignancy of the female reproductive tract in industrialized countries. The most important risk factor for the development of EH is chronic exposure to unopposed estrogen. Histopathologically, EH can be classified into EH without atypia (benign EH) and atypical EH/endometrial intraepithelial neoplasia (EIN). Clinical management ranges from surveillance or progestin therapy through to hysterectomy, depending on the risk of progression to or concomitant EC and the patient´s desire to preserve fertility. Multiple studies support the efficacy of progestins in treating both benign and atypical EH. This review summarizes the evidence base regarding risk factors and management of EH. Additionally, we performed a systematic literature search of the databases PubMed and Cochrane Controlled Trials register for studies analyzing the efficacy of progestin treatment in women with EH.
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Affiliation(s)
- Lisa K Nees
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sabine Heublein
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
| | - Sahra Steinmacher
- Department of Obstetrics and Gynecology, Universität Tübingen, Tübingen, Germany
| | - Ingolf Juhasz-Böss
- Department of Obstetrics and Gynecology, Universität Freiburg, Freiburg, Germany
| | - Sara Brucker
- Department of Obstetrics and Gynecology, Universität Tübingen, Tübingen, Germany
| | - Clemens B Tempfer
- Comprehensive Cancer Center, Ruhr University Bochum (RUCCC), Bochum, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
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Lou Y, Liao J, Shan W, Xu Z, Chen X, Guan J. Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery †. Diagnostics (Basel) 2021; 12:diagnostics12010006. [PMID: 35054175 PMCID: PMC8775082 DOI: 10.3390/diagnostics12010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/04/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023] Open
Abstract
About 10–66% of patients with atypical endometrial hyperplasia diagnosed before surgery (preoperative-AEH) are found to have concurrent endometrial cancer (EC) at definitive hysterectomy, leading to incomplete primary surgery and delayed adjuvant treatment. This study aims to investigate the potential risk factors of concurrent EC in preoperative-AEH patients in a clinical setting with a gynecological pathology review. All patients diagnosed with AEH by endometrial biopsy or curettage that then underwent definitive hysterectomy from January 2016 to December 2019 in a tertiary hospital were retrospectively analyzed. All diagnoses were reviewed by gynecological pathologists. A total of 624 preoperative-AEH patients were included, 30.4% of whom had concurrent EC. In multivariate analysis, postmenopausal status and CA125 ≥ 35 U/mL significantly correlated with concurrent EC (OR = 3.57; 95% CI = 1.80–7.06; OR = 2.15; 95% CI = 1.15–4.03). This risk was remarkably increased in patients with both postmenopausal status and CA125 ≥ 35 U/mL (OR = 16.20; 95% CI = 1.73–151.44). Notably, concurrent EC seemed to occur more frequently in women with postmenopausal time ≥ 5 years (OR = 4.04, 95% CI = 1.80–5.85). In addition, CA125 ≥ 35 U/mL seemed to be an independent risk factor (OR = 5.74; 95% CI = 1.80–18.27) for concurrent intermediate-high-risk EC. Intermediate-high-risk EC was also more commonly seen in preoperative-AEH women with postmenopausal time ≥ 5 years (OR = 5.52, 95% CI = 1.21–25.19, p = 0.027). In conclusion, preoperative-AEH patients with postmenopausal status or elevated level of CA125 might have a high risk of concurrent EC. Adequate pre-surgical evaluation might be suggested for such patients.
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Affiliation(s)
- Yaochen Lou
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; (Y.L.); (J.L.); (W.S.); (Z.X.)
| | - Jiongbo Liao
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; (Y.L.); (J.L.); (W.S.); (Z.X.)
| | - Weiwei Shan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; (Y.L.); (J.L.); (W.S.); (Z.X.)
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Zhiying Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; (Y.L.); (J.L.); (W.S.); (Z.X.)
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; (Y.L.); (J.L.); (W.S.); (Z.X.)
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- Correspondence: (X.C.); (J.G.)
| | - Jun Guan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China; (Y.L.); (J.L.); (W.S.); (Z.X.)
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- Correspondence: (X.C.); (J.G.)
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Carabineanu A, Zaharia C, Blidisel A, Ilina R, Miclaus C, Ardelean O, Preda M, Mazilu O. Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57101003. [PMID: 34684040 PMCID: PMC8539967 DOI: 10.3390/medicina57101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79–14.06) than the others of being identified postoperatively with more advanced lesions.
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Affiliation(s)
- Adrian Carabineanu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Claudia Zaharia
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania;
| | - Alexandru Blidisel
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
- Correspondence:
| | - Razvan Ilina
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Codruta Miclaus
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Ovidiu Ardelean
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Marius Preda
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Octavian Mazilu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
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21
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Zhao J, Hu Y, Zhao Y, Chen D, Fang T, Ding M. Risk factors of endometrial cancer in patients with endometrial hyperplasia: implication for clinical treatments. BMC WOMENS HEALTH 2021; 21:312. [PMID: 34433451 PMCID: PMC8390278 DOI: 10.1186/s12905-021-01452-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/02/2021] [Indexed: 12/31/2022]
Abstract
Background Endometrial hyperplasia (EH) is commonly-seen in the patients with endometrial cancer (EC), we aimed to evaluated the risk factors of EC in patients with EH, to provide evidence to the clinical prevention and treatment of EC. Methods This study was a retrospective study design. EH patients confirmed by pathological examinations and treated with hysterectomy in our hospital from June 1, 2018 to February 28, 2021 were included. The clinical characteristics of EC and no-EC patients were compared and analyzed. Logistics regression analyses were conducted to evaluate the risk factors of EC in patients with EH. Results A total of 228 EH patients were included, the incidence of EC in the EH patients was 31.58%. There were significant differences in the age, BMI, diabetes, hypertension and pathology of EH between EC and no EC groups (all P < 0.05), no significant differences in the hyperlipidemia, preoperative CA125, number of deliveries, menopause and endometrial thickness between EC and no EC groups were found (all P > 0.05). Logistic regression analyses indicated that age > 50 y (OR 3.064, 95% CI 1.945–5.931), BMI ≥ 25 kg/m2 (OR 2.705, 95% CI 1.121–3.889), diabetes (OR 3.049, 95% CI 1.781–5.114), hypertension (OR 2.725, 95% CI 1.108–3.431) and severe hyperplasia (OR 3.181, 95% CI 1.496–4.228) were the risk factors of EC in patients with EH (all P < 0.05). Conclusions The risk of EC in EH patients is high, especially for those patients with age > 50 y, BMI ≥ 25 kg/m2, diabetes, hypertension and severe hyperplasia, special attentions should be paid for occurrence of EC and early diagnosis and early treatment are needed for those patients.
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Affiliation(s)
- Jie Zhao
- Department of Obstetrics and Gynecology, Fuping County Hospital, Weinan, China
| | - Yongting Hu
- Department of Obstetrics and Gynecology, Fuping County Hospital, Weinan, China
| | - Yanan Zhao
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107 Road Yanjiang West, Guangzhou, China
| | - Dongmei Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107 Road Yanjiang West, Guangzhou, China
| | - Tingfeng Fang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107 Road Yanjiang West, Guangzhou, China
| | - Miao Ding
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, No. 107 Road Yanjiang West, Guangzhou, China.
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22
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Kender Erturk N, Basaran D, Salman C. Comparison of endometrial cancer risk in patients with endometrial precancerous lesions: WHO 1994 vs EIN classification. J OBSTET GYNAECOL 2021; 42:692-695. [PMID: 34415826 DOI: 10.1080/01443615.2021.1943338] [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: 10/20/2022]
Abstract
Our aim was to investigate the frequency of concurrent endometrial cancer in patients with endometrial precancerous lesions (PCLs) using World Health Organization 1994 (WHO94) and endometrial intraepithelial neoplasia (EIN) systems. We retrospectively investigated patients that underwent surgery for endometrial PCLs according to WHO94 or EIN systems at Hacettepe University Gynecology Clinic between January 2002 and June 2014. Of the 267 patients, 189 (70.9%) were in the WHO94 group, 78 (29.2%) were in the EIN group. Mean age of patients was 50.2 years. Sixteen patients (8.5%) in WHO94 group and 15 (%19.2) patients in the EIN group had EC (p = 0.013). In WHO94 group, EC rate in patients with atypical EH (32.6%) was significantly more than patients with non-atypical EH (1.4%) (p < .001). Atypical EH and EIN are actual PCLs which could be accompanied by EC. Therefore, atypical EH and EIN should be treated surgically if there is no desire for fertility. IMPACT STATEMENTWhat is already known on this subject? Endometrial hyperplasias are precursors lesion in the pathogenesis of endometrium adenocarcinomas. There are two classification systems: World Health Organization System and endometrial intraepithelial neoplasia system (WHO and EIN).What do the results of this study add? In this paper, we report on endometrial precancerous lesions. Controversy continues over the endometrial precancerous lesion classification. We also share our experiences in this regard. We concluded that the EIN system was superior in determining concurrent cancer risk.What are the implications of these findings for clinical practice and / or further research? The paper should be of interest to readers in the areas of gynecology.It is important to clarify the classifications of precancerous lesions in order to guide clinicians in the treatment of patients with endometrial precancerous lesions. In this context, it could be suggested to use the EIN system more widely.
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Affiliation(s)
- Nergis Kender Erturk
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Derman Basaran
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Hacettepe University, Ankara, Turkey
| | - Coskun Salman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Hacettepe University, Ankara, Turkey
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Uptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia. Obstet Gynecol 2021; 137:924-934. [PMID: 33831939 DOI: 10.1097/aog.0000000000004352] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia. METHODS Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation. RESULTS Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P<.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P<.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P<.001). CONCLUSION Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.
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24
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Le Frère-Belda MA. [Endometrial biopsy and curretage histoseminar. Cas n o 3 and 4]. Ann Pathol 2021; 41:361-365. [PMID: 34172304 DOI: 10.1016/j.annpat.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Marie-Aude Le Frère-Belda
- Service de pathologie, APHP, centre, hôpital européen Georges-Pompidou, 20, rue Leblanc, Paris, France.
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25
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Puechl AM, Spinosa D, Berchuck A, Secord AA, Drury KE, Broadwater G, Wong J, Whitaker R, Devos N, Corcoran DL, Strickland KC, Previs RA. Molecular Classification to Prognosticate Response in Medically Managed Endometrial Cancers and Endometrial Intraepithelial Neoplasia. Cancers (Basel) 2021; 13:cancers13112847. [PMID: 34200374 PMCID: PMC8201008 DOI: 10.3390/cancers13112847] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate whether molecular classification prognosticates treatment response in women with endometrial cancers and endometrial intraepithelial neoplasia (EIN) treated with levonorgestrel intrauterine system (LNG-IUS). METHODS Patients treated with LNG-IUS for endometrial cancer or EIN from 2013 to 2018 were evaluated. Using immunohistochemistry and single gene sequencing of POLE, patients were classified into four groups as per the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE): POLE-mutated, mismatch repair-deficient (MMRd), p53 wild type (p53wt), and p53-abnormal (p53abn). Groups were assessed relative to the primary outcome of progression or receipt of definitive treatment. RESULTS Fifty-eight subjects with endometrioid endometrial cancer or EIN treated with LNG-IUS were included. Of these, 22 subjects (37.9%) had endometrial cancer and 36 subjects (62.1%) had EIN. Per the ProMisE algorithm, 44 patients (75.9%) were classified as p53wt, 6 (10.3%) as MMRd, 4 (6.9%) as p53abn, and 4 (6.9%) as POLE-mutated. Of the 58 patients, 11 (19.0%) progressed or opted for definitive therapy. Median time to progression or definitive therapy was 7.5 months, with p53abn tumors having the shortest time to progression or definitive therapy. CONCLUSIONS Molecular classification of endometrial cancer and EIN prior to management with LNG-IUS is feasible and may predict patients at risk of progression.
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Affiliation(s)
- Allison M. Puechl
- Atrium Health, Division of Gynecologic Oncology, Levine Cancer Institute, Charlotte, NC 29204, USA
- Correspondence: ; Tel.: +1-980-442-2000
| | - Daniel Spinosa
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC 27710, USA; (D.S.); (K.E.D.); (J.W.)
| | - Andrew Berchuck
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA; (A.B.); (A.A.S.); (R.W.); (R.A.P.)
| | - Angeles Alvarez Secord
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA; (A.B.); (A.A.S.); (R.W.); (R.A.P.)
| | - Kerry E. Drury
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC 27710, USA; (D.S.); (K.E.D.); (J.W.)
| | | | - Janice Wong
- Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, NC 27710, USA; (D.S.); (K.E.D.); (J.W.)
| | - Regina Whitaker
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA; (A.B.); (A.A.S.); (R.W.); (R.A.P.)
| | - Nicolas Devos
- GCB, Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27710, USA;
| | - David L. Corcoran
- Duke Center for Genomics and Computational Biology, Durham, NC 27710, USA;
| | - Kyle C. Strickland
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Rebecca A. Previs
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA; (A.B.); (A.A.S.); (R.W.); (R.A.P.)
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Fertility-Sparing Treatment for Atypical Endometrial Hyperplasia and Endometrial Cancer: A Cochrane Systematic Review Protocol. Adv Ther 2021; 38:2717-2731. [PMID: 33830463 DOI: 10.1007/s12325-021-01693-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/02/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Endometrial cancer is the fifth most common cancer in women and atypical endometrial hyperplasia is a precancerous lesion. Obesity is an important risk factor for endometrioid endometrial adenocarcinoma and endometrial hyperplasia. Progesterone is recommended as first-line treatment in endometrial cancer or atypical endometrial hyperplasia in women who wish to preserve fertility, but optimal treatment schedules have not been defined. Metformin or bariatric surgery may also be useful in these women. The effectiveness and safety of fertility-preserving treatments being used for women with atypical endometrial hyperplasia and stage IA grade 1 endometrial cancer is unclear. Therefore, the systematic review aims to determine this point. METHODS We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registers, conference proceedings, abstracts, cooperative trial groups and reference lists. We will include randomised controlled trials (RCTs) that compare fertility-preserving therapy including orally administered progesterone versus a levonorgestrel-releasing intrauterine system (IUS), metformin, other pharmacological interventions or bariatric surgery, and any of these interventions with womb-removing surgery. Quasi-randomised trials, non-randomised trials and cohort studies will be included. Two review authors will independently assess study eligibility and risk of bias and extract data. The primary outcomes are complete pathologic response and live birth rate. Secondary outcomes include overall survival, progression-free survival, pregnancy rate, need for hysterectomy, adverse events, psychological symptoms and quality of life. PLANNED OUTCOMES This review aims to clarify the effectiveness and risks of fertility-preserving treatments, including complete pathologic response rate, live birth rates, need for surgical treatment, adverse events, psychological symptoms and quality of life. The broad scope of the review includes the use of progesterone, metformin to reverse insulin resistance, and bariatric surgery or operative hysteroscopy. RESULTS The results may help to determine the optimal fertility-sparing treatment in endometrial cancer and atypical endometrial hyperplasia. SYSTEMATIC REVIEW REGISTRATION Prospero 2019 number CRD42019145991.
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Burrows A, Pudwell J, Bougie O. Preoperative Factors of Endometrial Carcinoma in Patients Undergoing Hysterectomy for Atypical Endometrial Hyperplasia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:822-830. [PMID: 33785467 DOI: 10.1016/j.jogc.2021.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify clinicopathological preoperative factors associated with concurrent endometrial carcinoma in patients undergoing surgical management of atypical endometrial hyperplasia. METHODS The records of all patients who underwent hysterectomy for preoperatively diagnosed atypical endometrial hyperplasia at a tertiary care hospital from April 2017 to April 2020 were retrospectively reviewed. Clinicopathological characteristics of patients were extracted. Patients who did not undergo hysterectomy or who had evidence of simple hyperplasia or carcinoma on initial biopsy were excluded. Univariate analysis was performed. A multivariate regression model for progression to endometrial carcinoma was developed. RESULTS A total of 126 patients were included. Of these patients, 19 (15.1%) had a final diagnosis of endometrial carcinoma, whereas 86 (68.2%) retained the diagnosis of atypical endometrial hyperplasia and 21 (16.7%) were found to have no residual atypical endometrial hyperplasia. The odds of a patient being diagnosed with endometrial carcinoma were 6.1 times higher (95% CI 1.32-27.68) if they had an endometrial stripe thickness >1.1 cm and 13.5 times higher (95% CI 3.56-51.1) if there was histological suspicion of carcinoma. The odds of a patient being diagnosed with endometrial carcinoma were significantly lower if the patient had an initial diagnosis of atypical endometrial hyperplasia in a polyp (OR 0.07; 95% CI 0.02-0.34). CONCLUSION Our results suggest that an endometrial stripe thickness >1.1 cm, a histological suspicion of carcinoma on preoperative pathology, and the absence of polyp involvement on initial diagnosis are the strongest predictors of endometrial carcinoma at the time of hysterectomy in patients with atypical endometrial hyperplasia.
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Affiliation(s)
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON
| | - Olga Bougie
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON.
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Rajadurai VA, Chivers P, Ayres C, Mohan GR, Stewart CJR, Leung YC, Wan KM, Cohen PA. Predictors of endometrial carcinoma in patients with atypical endometrial hyperplasia at a tertiary gynaecological cancer centre in Western Australia. Aust N Z J Obstet Gynaecol 2021; 61:275-283. [PMID: 33403680 DOI: 10.1111/ajo.13300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Abstract
AIM Our objective was to assess clinical and pathological factors associated with a final diagnosis of endometrial carcinoma in patients with atypical endometrial hyperplasia with a particular emphasis on the grading of atypia. MATERIALS AND METHODS A retrospective review over five years on patients (N = 97) who underwent hysterectomy for a diagnosis of atypical endometrial hyperplasia at a statewide public tertiary gynaecologic oncology centre. Clinical and pathological characteristics were obtained. RESULTS The rate of concurrent endometrial carcinoma was 34% (n = 33) with most being stage 1A endometrioid. A significant group difference was reported for age at diagnosis (t = -2.20 P = 0.031 d = 0.43) with carcinoma patients on average older (Mage = 60.2 (8.9) years) than patients without carcinoma (Mage = 55.5 (12.3) years). No significant group differences were found for body mass index, endometrial thickness or time between diagnosis and treatment. Significantly higher rates of carcinoma were reported in patients with moderate atypical hyperplasia (27.6%) and severe atypical hyperplasia (66.7%), compared to mild atypical hyperplasia (7.1%). Only severe atypical hyperplasia (odds ratio (OR) = 21.5, 95% CI 2.8-163.1, P = 0.003) and postmenopausal status (OR = 13.2, 95% CI 1.3-139.0, P = 0.032) significantly increased the risk of carcinoma in a multivariate model. CONCLUSION Severe atypical hyperplasia and postmenopausal status were significant predictors of concurrent endometrial carcinoma in patients with atypical endometrial hyperplasia. The grading of atypical hyperplasia may be utilised by gynaecologic oncologists in the triage and referral process of managing these patients; however, the grading system requires external validation in larger prospective studies.
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Affiliation(s)
- Vinita Angeline Rajadurai
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Paola Chivers
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Exercise Medicine Research Institute & School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Chloe Ayres
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Ganendra Raj Mohan
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Colin John Reid Stewart
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Histopathology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Yee Chit Leung
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - King Man Wan
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Paul Andrew Cohen
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Division of Gynaecological Oncology, St John of God Subiaco Hospital, Perth, Western Australia, Australia
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Karakas LA, Atilgan AO, Akilli H, Kuscu UE, Haberal A, Ayhan A. Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps. Int J Gynaecol Obstet 2020; 152:433-438. [PMID: 33118172 DOI: 10.1002/ijgo.13448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/16/2020] [Accepted: 10/27/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the risk of concurrent endometrial cancer in endometrium when endometrial intraepithelial neoplasia (EIN) is found within an endometrial polyp and to identify the possible predictive factors for concurrent endometrial cancer. METHODS Histopathologic data of women who underwent hysteroscopy for resection of endometrial polyps at Ankara Baskent University Hospital, between 2011 and 2019 were screened. Patients whose polypectomy report was EIN in a polyp, and who had a final report of the hysterectomy specimen were included. Patients were divided into two groups according to the presence of concurrent cancer in the hysterectomy material: group 1, concurrent cancer present and group 2, concurrent cancer absent. Statistical analyses were performed using SPSS. RESULTS A total of 4125 women underwent hysteroscopy for the resection of endometrial polyps. Of those women, 161 (3.9%) were diagnosed as having EIN and 115 met the criteria. The rate of concurrent endometrial cancer was 28.6% (33/115). According to multivariate analysis, nulliparity (odds ratio [OR] 0.38; 95% confidence interval [CI] 1.04-3.67; p = 0.036) and postmenopausal status (OR 0.64; 95% CI 0.42-0.98; p = 0.042) were found to be independent factors significantly associated with concurrent endometrial cancer. CONCLUSION The incidence of concurrent cancer is higher in postmenopausal or nulliparous women when EIN is detected in a polyp.
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Affiliation(s)
- Latife Atasoy Karakas
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Alev Ok Atilgan
- Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Huseyin Akilli
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Ulku Esra Kuscu
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Ali Haberal
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Ali Ayhan
- Department of Obstetrics and Gynecology, Baskent University Faculty of Medicine, Ankara, Turkey
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Lee N, Lee KB, Kim K, Hong JH, Yim GW, Seong SJ, Lee B, Lee JM, Cho J, Lim S, Ouh YT, Kim YB. Risk of occult atypical hyperplasia or cancer in women with nonatypical endometrial hyperplasia. J Obstet Gynaecol Res 2020; 46:2505-2510. [PMID: 32945047 DOI: 10.1111/jog.14474] [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: 06/12/2020] [Revised: 07/20/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to identify subsets of patients diagnosed with nonatypical endometrial hyperplasia (NAEH) by endometrial biopsy who had high risk for occult atypical endometrial hyperplasia (AEH) or endometrial cancer (EC). METHODS We retrospectively reviewed the medical records of 281 patients who underwent hysterectomy within 6 months after a diagnosis of NAEH. We collected data on age, body mass index, menopausal status, tamoxifen use, previous history of NAEH, details of endometrial biopsy (location, curettage vs. pipelle sampling), NAEH subtype (simple vs. complex), interval between endometrial biopsy and hysterectomy, indication of hysterectomy and the presence of occult AEH or EC in hysterectomy specimen. Associations between variables and occult AEH or EC were analyzed. Risk of occult AEH or EC in subsets were calculated and visualized using a heatmap. RESULTS Among 281 patients, 34 (12.1%) and 9 (3.2%) had occult AEH and EC in hysterectomy specimens, respectively. Using univariate analysis, we found age, menopausal status and subtype were associated with occult AEH or EC. Using multivariate analysis, older age (odds ratio = 1.09, P < 0.01) and complex subtype (odds ratio = 3.34, P < 0.01) were independent risk factors. Patients at an age ≥ 51 years with complex NAEH had about 50% risk of occult AEH or EC. CONCLUSION Women at an age ≥ 51 years with complex NAEH had high risk for occult AEH or EC and surgical treatment can be considered for these patients.
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Affiliation(s)
- Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Kwang-Beom Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Ga Won Yim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Banghyun Lee
- Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jong-Min Lee
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Republic of Korea
| | - Jaehyun Cho
- Department of Obstetrics and Gynecology Soon Chun Hyang University Hospital Seoul, Seoul, Republic of Korea
| | - Soyi Lim
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Yong Beom Kim
- Department of Obstetrics and Gynecology, College of Medicine, Seoul National University, Seoul, Republic of Korea
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Selen S, Kilic F, Kimyon Comert G, Unsal M, Kilic C, Karalok A, Turkmen O, Turan T. Can preoperative inflammatory markers differentiate endometrial cancer from complex atypical hyperplasia/endometrial intraepithelial neoplasia? J Obstet Gynaecol Res 2020; 46:1148-1156. [PMID: 32464701 DOI: 10.1111/jog.14314] [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: 02/24/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study was to identify the differences between complex atypical hyperplasia/endometrial intraepithelial neoplasia (CAH/EIN) and endometrioid-type grade 1 endometrial cancer in terms of preoperative systemic inflammatory markers and to evaluate the effectiveness of such markers in predicting cancer. METHODS Between January 2005 and September 2018, a total of 372 patients with final histopathologic diagnoses of CAH/EIN (n = 143) and endometrioid-type grade 1 endometrial cancer (n = 229) were included in the study. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and platelet distribution width (PDW) were used as preoperative inflammatory markers. Receiver operating characteristics (ROC) analysis was used to assess the diagnostic prediction of NLR, PLR and PDW values to distinguish the two groups. Univariate and multivariate logistic regression analysis was performed by regrouping the patients according to the cut-off values found in the ROC analysis. RESULTS The univariate analysis revealed that advanced age, decreases in PDW and also PLR could be predictors of cancer. The cut-off values were as ≤48.9% for PDW and ≤133.3 for PLR. The values defined using ROC analysis were found to be statistically significant for PDW and PLR in identifying endometrioid grade 1 endometrial cancer. For PDW, sensitivity, specificity, positive predictive value and negative predictive value were 52.8%, 62.2%, 68.9% and 45.5%, respectively (P = 0.001); for PLR, those were 55.9%, 59.4%, 68.8% and 45.7%, respectively (P = 0.005). In multivariate analysis, advanced age (>53 years), low PDW (≤48.9%) and low PLR (≤133.3) were related to statistically significant odds ratio for diagnostic prediction to differentiate endometrioid grade 1 cases from CAH/EIN of 8.01 (P < 0.001), 1.79 (P = 0.019) and 1.73 (P = 0.025), respectively. CONCLUSIONS The PLR and PDW values in the preoperative blood parameters could be used to differentiate endometrial cancer from precancerous lesions.
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Affiliation(s)
- Sevgi Selen
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Fatih Kilic
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Gunsu Kimyon Comert
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mehmet Unsal
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cigdem Kilic
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Alper Karalok
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Osman Turkmen
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Doherty MT, Sanni OB, Coleman HG, Cardwell CR, McCluggage WG, Quinn D, Wylie J, McMenamin ÚC. Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis. PLoS One 2020; 15:e0232231. [PMID: 32343732 PMCID: PMC7188276 DOI: 10.1371/journal.pone.0232231] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/09/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required. METHODS We identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs). RESULTS A total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%). CONCLUSIONS Overall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to cancer in atypical hyperplasia was high, but few studies were identified. Population-based estimates are required, in both atypical and non-atypical hyperplasia patients to better inform treatment strategies.
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Affiliation(s)
- Michelle T. Doherty
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Omolara B. Sanni
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Helen G. Coleman
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, United Kingdom
| | - Chris R. Cardwell
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - W. Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Grosvenor Road, Belfast, Northern Ireland, United Kingdom
| | - Declan Quinn
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, United Kingdom
| | - James Wylie
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, United Kingdom
| | - Úna C. McMenamin
- Cancer Epidemiology Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
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33
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Morley H, Griffin Y. The utility of post-diagnostic imaging in cases of atypical endometrial hyperplasia. Clin Radiol 2020; 75:538-542. [PMID: 32336470 DOI: 10.1016/j.crad.2020.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022]
Abstract
AIM To contribute to the evidence base evaluating the usefulness of preoperative imaging in management of atypical endometrial hyperplasia. MATERIALS AND METHODS A single-centre retrospective observational study was conducted comparing preoperative, post-diagnostic radiological staging with surgicopathological staging. The effect on patient management and any changes in final histological diagnosis were recorded. RESULTS There were 38 patients who underwent preoperative imaging (32 magnetic resonance imaging [MRI], one MRI and computed tomography [CT], three CT, and two transvaginal ultrasound) for atypical endometrial hyperplasia from 2007 to 2018. Thirty-four women subsequently underwent surgery. The final histopathological diagnosis was upgraded to cancer in 35% (12/34) and downgraded in 38% (13/34). There was good concordance between preoperative CT/MRI and surgicopathological staging. Of the 12 patients with a malignant diagnosis, all were early-stage disease with 11/12 stage IA and 1/12 stage IB. CONCLUSION Preoperative staging with CT/MRI for atypical endometrial hyperplasia contributed no useful additional information, made no change to patient management, and is therefore not indicated.
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Affiliation(s)
- H Morley
- Department of Clinical Radiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Y Griffin
- Department of Clinical Radiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.
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Jacobs I, Tibosch R, Geomini P, Coppus S, Bongers MY, van Hanegem N. Atypical endometrial polyps and the incidence of endometrial cancer: a retrospective cohort study. BJOG 2020; 127:994-999. [PMID: 32133762 DOI: 10.1111/1471-0528.16194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the incidence of endometrial carcinoma, proven after hysterectomy, in patients diagnosed with atypical endometrial hyperplasia confined to a polyp. A secondary aim was to establish factors associated with (pre-)malignant alterations in a polyp. DESIGN A retrospective cohort study. SETTING Maastricht University Medical Centre (MUMC+) and Máxima Medical Centre in Eindhoven/Veldhoven (Máxima MC). POPULATION Women who underwent a hysteroscopic polyp resection between 2008 and 2016. METHODS Patient characteristics and histopathology results of the polyp and, in the case of a hysterectomy, uterus were collected from patients' charts. RESULTS A total of 1445 complete hysteroscopic polyp resections were included. Of those, 1390 polyps showed benign histopathology results, 39 polyps contained atypical hyperplasia and 16 polyps contained endometrial carcinoma. A hysterectomy was performed in 35 women who were diagnosed with atypical hyperplasia confined to a polyp after hysteroscopic polyp resection. Histopathological assessment showed no additional (pre-)malignant changes of the endometrium in 12 women (30.8%), atypical hyperplasia in 11 women (28.2%) and endometrial carcinoma in 12 women (30.8%). None of the prognostic factors under consideration were significantly associated with (pre-)malignant changes in a polyp. CONCLUSION The incidence of endometrial carcinoma in the surrounding endometrium after complete resection of a polyp with atypical hyperplasia is 30.8% in this study. This supports the current advice to perform a hysterectomy and bilateral salpingo-oophorectomy. No prognostic factor for (pre-)malignant changes in a polyp was established. TWEETABLE ABSTRACT The incidence of endometrial carcinoma after complete resection of a polyp with atypical hyperplasia is high.
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Affiliation(s)
- Ism Jacobs
- Gynaecology Department, Maastricht University Medical Centre, Maastricht, the Netherlands.,Emergency Medicine, Elkerliek Medical Centre, Helmond, the Netherlands
| | - Rmg Tibosch
- Gynaecology Department, Máxima Medical Centre, Veldhoven, the Netherlands.,Youth Health Care, GGD Hart voor Brabant, Hertogenbosch, the Netherlands
| | - Pmaj Geomini
- Gynaecology Department, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Sfpj Coppus
- Gynaecology Department, Máxima Medical Centre, Veldhoven, the Netherlands
| | - M Y Bongers
- Gynaecology Department, Maastricht University Medical Centre, Maastricht, the Netherlands.,Gynaecology Department, Máxima Medical Centre, Veldhoven, the Netherlands.,School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, the Netherlands
| | - N van Hanegem
- Gynaecology Department, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, the Netherlands
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Auclair MH, Yong PJ, Salvador S, Thurston J, Colgan T(TJ, Sebastianelli A. Guideline No. 390-Classification and Management of Endometrial Hyperplasia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1789-1800. [DOI: 10.1016/j.jogc.2019.03.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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36
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Directive clinique N° 390-Classification et prise en charge de l'hyperplasie de l'endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1801-1813. [DOI: 10.1016/j.jogc.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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37
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Morgan J, Hinz EK. Conservative management of endometrial intraepithelial neoplasia in a patient with cirrhosis undergoing orthotopic liver transplant. Menopause 2019; 26:1068-1070. [PMID: 31453972 DOI: 10.1097/gme.0000000000001342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to review the management of endometrial hyperplasia in a woman undergoing liver transplantation for alcoholic cirrhosis. METHODS This is a case presentation on a postmenopausal woman with a tissue diagnosis of endometrial intraepithelial neoplasia managed with a levonorgestrel intrauterine device, before and after liver transplantation. Full written informed consent was obtained from the patient to present her case. RESULTS The patient experienced resolution of her endometrial intraepithelial neoplasia with conversion to atrophic endometrium after management with levonorgestrel intrauterine device. CONCLUSIONS A large percentage of women with cirrhosis experience abnormal uterine bleeding, which may be due to the coagulopathy that accompanies liver disease, or endometrial hyperplasia or carcinoma. Although hysterectomy is the criterion standard of treatment for atypical endometrial hyperplasia in a postmenopausal woman, patients with cirrhosis severe enough to require transplant are usually poor surgical candidates. Multiple studies have shown success with conservative management of atypical hyperplasia. There is a paucity of literature on managing patients undergoing transplant with abnormal uterine bleeding and it is therefore important to highlight conservative management options for this patient population.
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Affiliation(s)
- Jessica Morgan
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL
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Wang Q, Guo X, Li L, Gao Z, Ji M. Treatment with metformin and sorafenib alleviates endometrial hyperplasia in polycystic ovary syndrome by promoting apoptosis via synergically regulating autophagy. J Cell Physiol 2019; 235:1339-1348. [PMID: 31256441 DOI: 10.1002/jcp.29051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/29/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Qian‐qing Wang
- Gynecologic Oncology Department Xinxiang City Central Hospital in Henan Province Xinxiang Henan China
| | - Xiang‐cui Guo
- Gynecologic Oncology Department Xinxiang City Central Hospital in Henan Province Xinxiang Henan China
| | - Li Li
- Gynecologic Oncology Department Xinxiang City Central Hospital in Henan Province Xinxiang Henan China
| | - Zhi‐hui Gao
- Gynecologic Oncology Department Xinxiang City Central Hospital in Henan Province Xinxiang Henan China
| | - Mei Ji
- Gynecology Department Zhengzhou University First Affiliated Hospital Zhengzhou Henan China
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Shalowitz DI, Goodwin A, Schoenbachler N. Does surgical treatment of atypical endometrial hyperplasia require referral to a gynecologic oncologist? Am J Obstet Gynecol 2019; 220:460-464. [PMID: 30527944 DOI: 10.1016/j.ajog.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 01/17/2023]
Abstract
Patients with atypical endometrial hyperplasia in the United States are commonly referred to a gynecologic oncologist, given a moderate risk of concurrent carcinoma. However, selective referral of patients to nononcologic gynecologic surgeons for surgical treatment of atypical endometrial hyperplasia may offer increased access to care without compromising clinical outcomes. Nononcologic surgeons who consider providing surgical treatment for atypical endometrial hyperplasia must be able to offer minimally invasive surgery when appropriate and have sufficient surgical volume to deliver optimal clinical outcomes. Patients considering referral to a nononcologic surgeon must be thoroughly counseled regarding the risk of occult malignancy, the possibility of a second surgery for lymph node evaluation and/or oophorectomy, and the risk of morbidity that may accompany a second surgery. Available data suggest that approximately 2-6% of patients will have postoperative risk factors meriting consideration of a second surgery. Patients who are high-risk surgical candidates or who may desire nonsurgical or fertility-sparing treatment should universally be referred for consultation with a gynecologic oncologist.
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40
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Wang Y, Nisenblat V, Tao L, Zhang X, Li H, Ma C. Combined estrogen-progestin pill is a safe and effective option for endometrial hyperplasia without atypia: a three-year single center experience. J Gynecol Oncol 2019; 30:e49. [PMID: 30887764 PMCID: PMC6424840 DOI: 10.3802/jgo.2019.30.e49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/03/2018] [Accepted: 01/01/2019] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the effectiveness of oral contraceptive pill (OCP) as therapy for endometrial hyperplasia (EH) without atypia in reproductive-aged women compared with oral progestin. Methods A retrospective cohort study was carried out in our reproductive center. Consecutive patients diagnosed with infertility and non-atypical EH identified through electronic database who met inclusion criteria (n=309). Patients were assigned to two treatment groups: OCP (n=216) and oral progestin (n=93); clinical and reproductive outcomes were recorded. Results Reversal of EH to normal endometrium, clinical pregnancy, live birth and miscarriage rate. Women in OCP group were younger, had higher prevalence of Polycystic Ovary Syndrome and other uterine pathology and longer duration of infertility than women in progestin group. Reversal of EH was observed in 93.52% women on OCP and in 86.02% women on progestin (p=0.032; adjusted odds ratio [aOR]= 2.35; 95% confidence interval [CI]=1.06-5.21) after the initial course of treatment for 2 to 6 months. Cyclic OCP (n=184) resulted in better response to treatment compared to continuous OCP (n=32) (95.11% vs. 84.38%; p=0.039; aOR =3.60; 95% CI =1.12-11.55). Clinical pregnancy rate in OCP group was marginally higher than progestin group (87/208, 41.83% vs. 27/90, 30.00%; p=0.054). Miscarriage (25.29% vs. 29.63%; p=0.654) and live birth rate (31.25% vs. 21.11%; p=0.074) were comparable between the groups. Conclusion For the first time we demonstrate that OCP is an effective therapy for non-atypical EH and is associated with higher remission rate compared with oral progestin. Reproductive outcomes are reassuring and comparable between the two groups.
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Affiliation(s)
- Yang Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Key laboratory of Assisted Reproduction, Ministry of Education, Beijing, China
| | - Victoria Nisenblat
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Key laboratory of Assisted Reproduction, Ministry of Education, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - XinYu Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Key laboratory of Assisted Reproduction, Ministry of Education, Beijing, China
| | - Hongzhen Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Key laboratory of Assisted Reproduction, Ministry of Education, Beijing, China
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Key laboratory of Assisted Reproduction, Ministry of Education, Beijing, China.
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Park JK, Otsuka N, Tomaru U, Suzuki H, Azuma M, Okamoto K, Yamashiro K, Kasahara M. Clinicopathological significance of PSF3 expression in uterine endometrial carcinomas. Hum Pathol 2018; 80:104-112. [PMID: 29936059 DOI: 10.1016/j.humpath.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/30/2018] [Accepted: 06/09/2018] [Indexed: 01/03/2023]
Abstract
PSF3 (Partner of SLD Five 3) is a member of the heterotetrameric complex termed GINS. Previous studies have shown that PSF3 is up-regulated in several cancers and is associated with tumor malignancy. However, the clinicopathological significance of PSF3 expression in endometrial lesions is still poorly understood. To investigate whether PSF3 could serve as a useful biomarker for endometrial carcinomas, we performed immunohistochemical analysis of PSF3 expression. In 155 cases of endometrial carcinomas (ECs), the mean tumor proportion score of PSF3 expression was 30.7% in G1 endometrioid carcinoma, 55.0% in G2 endometrioid carcinoma, 59.0% in G3 endometrioid carcinoma, and 58.9% in nonendometrioid carcinomas. In 25 cases of atypical hyperplasia, the mean tumor proportion score of PSF3 expression was significantly lower (10.4%). High expression of PSF3 was associated with more advanced pathologic T stage (P = .000), lymphatic invasion (P = .001), and poor clinical outcomes such as shorter relapse-free survival (P = .000) and overall survival (P = .001). When we compared the immunostaining of PSF3 and Ki-67, the proportions of PSF3-positive cells in tumor epithelial cells were comparable to those of Ki-67-positive cells. However, PSF3-positive cells were selectively found in tumor cells, whereas Ki-67-positive cells were also found in tumor stromal cells. These results demonstrated that PSF3 immunostaining was valuable as a histopathologic marker for differential diagnosis between atypical hyperplasia and ECs, for tumor histologic grading, and for determining a patient's prognosis. PSF3 may play a crucial role in tumor progression in EC.
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Affiliation(s)
- Jong Kun Park
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan; Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Noriyuki Otsuka
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
| | - Utano Tomaru
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hiroaki Suzuki
- Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Manabu Azuma
- Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Kazuhira Okamoto
- Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Katsushige Yamashiro
- Department of Surgical Pathology, National Hospital Organization, Hokkaido Cancer Center, Sapporo 003-0804, Japan
| | - Masanori Kasahara
- Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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Fernandez-Montoli ME, Sabadell J, Martínez-García JM, Contreras Perez NA. Fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer. Hippokratia 2018. [DOI: 10.1002/14651858.cd013111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Jordi Sabadell
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona; Department of Gynecology; Barcelona Spain
| | - José Manuel Martínez-García
- Hospital Universitari de Bellvitge, Universitat de Barcelona - IDIBELL; Department of Gynecology; Barcelona Spain
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Erdem B, Aşıcıoğlu O, Seyhan NA, Peker N, Ülker V, Akbayır Ö. Can concurrent high-risk endometrial carcinoma occur with atypical endometrial hyperplasia? Int J Surg 2018; 53:350-353. [DOI: 10.1016/j.ijsu.2018.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/22/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
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Sladkevicius P, Opolskiene G, Valentin L. Prospective temporal validation of mathematical models to calculate risk of endometrial malignancy in patients with postmenopausal bleeding. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:649-656. [PMID: 27072497 DOI: 10.1002/uog.15941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 04/04/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To validate prospectively five mathematical models published in 2007 for calculating the risk of endometrial malignancy in a defined high-risk group of patients with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm. METHODS Of 1012 consecutive patients, 379 fulfilled our inclusion criteria, which were the same as those of the original study in which the models were created (endometrial thickness ≥ 4.5 mm, no fluid in the uterine cavity, detectable Doppler signals in the endometrium). A standardized history was taken, and clinical and transvaginal grayscale and power Doppler ultrasound examinations were performed following the study protocol. All data were collected prospectively and the five models were applied prospectively to the study patients' data to assess their risk of endometrial malignancy. Using the histological diagnosis of the endometrium as gold standard, we calculated the area under the receiver-operating characteristics curve (AUC), and sensitivity, specificity and likelihood ratios when using the same cut-offs as in the original study, for each of the five models. RESULTS Ninety-three (25%) patients had malignant endometrium. The performance of the models was similar to that in the original study, with AUCs ranging from 0.86 to 0.90. The model with the best diagnostic performance included endometrial thickness, heterogeneous endometrial echogenicity and areas of densely packed vessels on power Doppler (AUC, 0.90; sensitivity, 81%; specificity, 84% at preselected cut-off). The models were well calibrated. CONCLUSIONS On temporal validation, the five models for calculating the risk of endometrial malignancy in a defined high-risk group of patients retained their good diagnostic performance and were well calibrated. The models make it possible to reclassify high-risk patients as having a low or relatively low risk, moderately high risk or very high risk of endometrial cancer, and so can be used for individualized patient management. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - G Opolskiene
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
- The Center of Obstetrics and Gynecology, Vilnius University Hospital Santariskes, Vilnius University, Vilnius, Lithuania
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
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Bourdel N, Chauvet P, Tognazza E, Pereira B, Botchorishvili R, Canis M. Sampling in Atypical Endometrial Hyperplasia: Which Method Results in the Lowest Underestimation of Endometrial Cancer? A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2016; 23:692-701. [DOI: 10.1016/j.jmig.2016.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/25/2022]
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Safety of Manual Morcellation After Vaginal or Laparoscopic-assisted Vaginal Hysterectomy. J Minim Invasive Gynecol 2016; 23:542-7. [DOI: 10.1016/j.jmig.2016.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 11/19/2022]
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Prospective validation of two mathematical models to calculate the risk of endometrial malignancy in patients with postmenopausal bleeding and sonographic endometrial thickness ≥4.5 mm. Eur J Cancer 2016; 59:179-188. [DOI: 10.1016/j.ejca.2016.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 11/24/2022]
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Endometrial cancer arising from atypical complex hyperplasia: The significance in an endometrial biopsy and a diagnostic challenge. Obstet Gynecol Sci 2015; 58:468-74. [PMID: 26623410 PMCID: PMC4663224 DOI: 10.5468/ogs.2015.58.6.468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/09/2015] [Accepted: 07/28/2015] [Indexed: 12/27/2022] Open
Abstract
Objective We investigated the features of endometrial hyperplasia with concurrent endometrial cancer that had been diagnosed by endometrial sampling. Further, we attempted to identify an accurate differential diagnostic method. Methods We retrospectively studied 125 patients who underwent a diagnostic endometrial biopsy or were diagnosed after the surgical treatment of other gynecological lesions, such as leiomyoma or polyps. Patients were diagnosed between January 2005 and December 2013 at Busan Paik Hospital. Clinical and histopathological characteristics were compared in patients who had atypical endometrial hyperplasia with and without concurrent endometrial cancer. Results The patients were grouped based on the final pathology reports. One hundred seventeen patients were diagnosed with endometrial hyperplasia and eight patients were diagnosed with endometrioid adenocarcinoma arising from atypical hyperplasia. Of the 26 patients who had been diagnosed with atypical endometrial hyperplasia by office-based endometrial biopsy, eight (30.8%) were subsequently diagnosed with endometrial cancer after they had undergone hysterectomy. The patients with endometrial cancer arising from endometrial hyperplasia were younger (39.1 vs. 47.2 years, P=0.0104) and more obese (body mass index 26.1±9.6 vs. 23.8±2.8 kg/m2, P=0.3560) than the patients with endometrial hyperplasia. The correlation rate between the pathology of the endometrial samples and the final diagnosis of endometrial hyperplasia was 67.3%. Conclusion In patients with atypical endometrial hyperplasia, the detection of endometrial cancer before hysterectomy can decrease the risk of suboptimal treatment. The accuracy of endometrial sampling for the diagnosis of concurrent endometrial carcinoma was much lower than that for atypical endometrial hyperplasia. Therefore, concurrent endometrial carcinoma should be suspected and surgical intervention should be considered in young or obese patients who present with atypical endometrial hyperplasia.
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Rutgers JKL. Update on pathology, staging and molecular pathology of endometrial (uterine corpus) adenocarcinoma. Future Oncol 2015; 11:3207-18. [PMID: 26551559 DOI: 10.2217/fon.15.262] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Endometrial carcinoma is comprised of two major groups: type I that is hormonally driven with a good prognosis and type II that is hormone independent with a poor prognosis. The two most common subtypes are endometrioid adenocarcinoma, the prototypic type I cancer, and uterine serous carcinoma, the prototypic type II cancer, each with their own distinct precursor lesion. The histologic type, as codified by the WHO Tumor Classification system, grade, and stage are used to guide treatment. There is an increasing interest in screening for familial risk factors, specifically Lynch syndrome. A molecular classification of endometrial cancers holds promise for future improvements in care.
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Affiliation(s)
- Joanne K L Rutgers
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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