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Ray I, Möller-Levet CS, Michael A, Butler-Manuel S, Chatterjee J, Tailor A, Ellis PE, Meira LB. Circulating Adipocytokines and Insulin Like-Growth Factors and Their Modulation in Obesity-Associated Endometrial Cancer. Cancers (Basel) 2024; 16:531. [PMID: 38339282 PMCID: PMC10854745 DOI: 10.3390/cancers16030531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
The rising global incidence of uterine cancer is linked to the escalating prevalence of obesity. Obesity results in alterations in adipocytokines and IGFs, driving cancer progression via inflammation, increased cell proliferation, and apoptosis inhibition, although the precise mechanisms are still unclear. This study examined a set of six markers, namely, adiponectin, leptin, IL6, TNFα, IGF1, and IGF2 and compared them between fifty age-matched endometrial cancer patients (study group) and non-cancer patients with benign gynaecological conditions (control group). We also assessed the relationship of these markers with obesity and explored the correlation between these markers and various tumour characteristics. In the cancer population, these markers were also assessed 24 h and 6 months post-surgery. Remarkably, low adiponectin levels were associated with a 35.8% increase in endometrial cancer risk. Interestingly, compared to control subjects where IGF levels decreased after menopause, post-menopausal women in the study group showed elevated IGF1 and IGF2 levels, suggesting a potential influence of endometrial cancer on the IGF system, particularly after menopause. Lastly, it is noteworthy that a discernible inverse relationship trend was observed in the levels of adipocytokines and IGFs 6 months post-surgery. This indicates that treatment for endometrial cancer may have a differential impact on adipocytokines and IGFs, potentially holding clinical significance that merits further investigation.
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Affiliation(s)
- Irene Ray
- Department of Clinical and Experimental Medicine, University of Surrey, Daphne Jackson Road, Guildford GU2 7WG, UK
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Egerton Road, Guildford GU2 7XX, UK
| | - Carla S. Möller-Levet
- Bioinformatics Core Facility, University of Surrey, Daphne Jackson Road, Guildford GU2 7WG, UK
| | - Agnieszka Michael
- Department of Clinical and Experimental Medicine, University of Surrey, Daphne Jackson Road, Guildford GU2 7WG, UK
- Department of Oncology, Royal Surrey NHS Foundation Trust, Egerton Road, Guildford GU2 7XX, UK
| | - Simon Butler-Manuel
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Egerton Road, Guildford GU2 7XX, UK
| | - Jayanta Chatterjee
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Egerton Road, Guildford GU2 7XX, UK
- Department of Life Sciences, Brunel University London, Kingston Lane Uxbridge, Middlesex, Uxbridge UB8 3PH, UK
| | - Anil Tailor
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Egerton Road, Guildford GU2 7XX, UK
| | - Patricia E. Ellis
- Department of Clinical and Experimental Medicine, University of Surrey, Daphne Jackson Road, Guildford GU2 7WG, UK
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust, Egerton Road, Guildford GU2 7XX, UK
| | - Lisiane B. Meira
- Department of Clinical and Experimental Medicine, University of Surrey, Daphne Jackson Road, Guildford GU2 7WG, UK
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Scepanovic B, Andjelic N, Mladenovic-Segedi L, Kozic D, Vuleta D, Molnar U, Nikolic O. Diagnostic value of the apparent diffusion coefficient in differentiating malignant from benign endometrial lesions. Front Oncol 2023; 13:1109495. [PMID: 37124536 PMCID: PMC10140411 DOI: 10.3389/fonc.2023.1109495] [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: 11/27/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Magnetic resonance imaging (MRI) with its innovative techniques, such as diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC), increases the diagnostic accuracy in distinguishing between malignant and benign lesions of the endometrium. The aim of the study was MRI differentiation between malignant and benign endometrial lesions and correlation with histopathological findings with a special emphasis on quantitative analysis. An additional aim was to correlate the ADC values and histological tumor grades. Methods The prospective study included 119 female patients with or without vaginal bleeding and pathological values of endometrial thickness, who underwent MRI examinations. According to MRI reports the patients were divided into 45 suspicious malignant and 74 suspicious benign endometrial lesions. The radiological diagnosis was compared to the histopathological evaluation, which confirmed 37 malignant lesions while the rest were benign. Results The mean ADC value for malignant lesions was 0.761 ± 0.13×10-3 mm2/s and for benign lesions was 1.318 ± 0.20×10-3 mm2/s. The ADC values for malignant lesions were expectedly lower than those of benign lesions (p<0.001). The ADC cut-off value was 1.007×10-3 mm2/s with a sensitivity of 100%, specificity of 92.7%, a positive predictive value of 60.3%, and a negative predictive value of 100%. In comparison with the histopathological findings, the sensitivity of MRI was 100%, specificity 90.2%, positive predictive value was 82.2%, and negative predictive value was 100%. Observing the histological grades 1, 2, and 3 of endometrial carcinoma, no statistically significant differences of mean ADC values were found. The mean ADC values for histological tumor grades 1,2 and 3 were 0.803 ± 0.13×10-3 mm2/s, 0.754 ± 0.12×10-3 mm2/s and 0.728 ± 0.13×10-3 mm2/s, respectively. Conclusion DWI and ADC values represent clinically useful tools for the differentiation between malignant and benign endometrial lesions with high sensitivity and good specificity, but the results failed to demonstrate their usefulness in differentiating histological grades of endometrial cancer.
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Affiliation(s)
- Bojana Scepanovic
- Department of Radiological Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
- *Correspondence: Bojana Scepanovic, ; Nikola Andjelic,
| | - Nikola Andjelic
- Department of Radiological Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- *Correspondence: Bojana Scepanovic, ; Nikola Andjelic,
| | - Ljiljana Mladenovic-Segedi
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Dusko Kozic
- Department of Radiological Diagnostics, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Dusan Vuleta
- Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Una Molnar
- Faculty of Sciences, University of Novi Sad, Novi Sad, Serbia
- Center for Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Olivera Nikolic
- Department of Radiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Radiology, Clinical Center of Vojvodina, Novi Sad, Serbia
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Mandić A, Kokanov D, Maričić S, Ivković Kapicl T, Šolajić N. HISTOPATHOLOGIC PARAMETERS OF POSITIVE LYMPH NODE PREDICTABILITY IN ENDOMETRIAL CANCER. Acta Clin Croat 2022; 61:206-213. [PMID: 36818933 PMCID: PMC9934038 DOI: 10.20471/acc.2022.61.02.06] [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: 12/30/2019] [Accepted: 04/20/2020] [Indexed: 02/10/2023] Open
Abstract
Endometrial cancer is the most common malignancy of the female reproductive tract. Lymph node metastases are an important prognostic factor in endometrial cancer. Several prognostic factors have been shown to correlate with lymph node metastasis, including depth of myometrial invasion, cervical infiltration, histologic grade of the tumor, tumor diameter, histology type, lymphovascular invasion, and positive peritoneal cytology. The aim of the study was to identify the histopathologic parameters that would indicate with greater certainty the possibility of metastases into lymph nodes, which would serve as a basis to assess whether patients should undergo lymphadenectomy or not. This retrospective study included patients with endometrial cancer having undergone surgery at the Oncology Institute of Vojvodina during the 2012-2018 period. The study included 120 patients having undergone hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy. Among patients who had lymph node metastases, there were statistically significantly more patients (p<0.01) with endometrial cancer histologic type 2, depth of myometrial invasion greater than 50%, cervical stroma infiltration, lymphovascular invasion, and positive peritoneal cytology. In conclusion, histopathologic parameters such as type 2 endometrial cancer, myometrial invasion depth greater than 50%, cervical stroma infiltration, lymphovascular invasion and positive peritoneal cytology increased the likelihood of lymph node metastases. Tumor size (>2 cm), as well as histologic grade did not correlate with a higher incidence of lymph node metastases. In this study, both parametrial infiltration and the number of lymph nodes removed were found to have clinical relevance but not statistical significance.
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Affiliation(s)
- Aljoša Mandić
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;,Oncology Institute of Vojvodina, Novi Sad, Serbia
| | | | | | - Tatjana Ivković Kapicl
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;,Oncology Institute of Vojvodina, Novi Sad, Serbia
| | - Nenad Šolajić
- University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia;,Oncology Institute of Vojvodina, Novi Sad, Serbia
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Bhardwaj V, Sharma A, Parambath SV, Gul I, Zhang X, Lobie PE, Qin P, Pandey V. Machine Learning for Endometrial Cancer Prediction and Prognostication. Front Oncol 2022; 12:852746. [PMID: 35965548 PMCID: PMC9365068 DOI: 10.3389/fonc.2022.852746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Endometrial cancer (EC) is a prevalent uterine cancer that remains a major contributor to cancer-associated morbidity and mortality. EC diagnosed at advanced stages shows a poor therapeutic response. The clinically utilized EC diagnostic approaches are costly, time-consuming, and are not readily available to all patients. The rapid growth in computational biology has enticed substantial research attention from both data scientists and oncologists, leading to the development of rapid and cost-effective computer-aided cancer surveillance systems. Machine learning (ML), a subcategory of artificial intelligence, provides opportunities for drug discovery, early cancer diagnosis, effective treatment, and choice of treatment modalities. The application of ML approaches in EC diagnosis, therapies, and prognosis may be particularly relevant. Considering the significance of customized treatment and the growing trend of using ML approaches in cancer prediction and monitoring, a critical survey of ML utility in EC may provide impetus research in EC and assist oncologists, molecular biologists, biomedical engineers, and bioinformaticians to further collaborative research in EC. In this review, an overview of EC along with risk factors and diagnostic methods is discussed, followed by a comprehensive analysis of the potential ML modalities for prevention, screening, detection, and prognosis of EC patients.
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Affiliation(s)
- Vipul Bhardwaj
- Tsinghua Berkeley Shenzhen Institute, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Arundhiti Sharma
- Tsinghua Berkeley Shenzhen Institute, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | | | - Ijaz Gul
- Institute of Biopharmaceutical and Health Engineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Xi Zhang
- Shenzhen Bay Laboratory, Shenzhen, China
| | - Peter E. Lobie
- Tsinghua Berkeley Shenzhen Institute, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
- Institute of Biopharmaceutical and Health Engineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
- Shenzhen Bay Laboratory, Shenzhen, China
| | - Peiwu Qin
- Tsinghua Berkeley Shenzhen Institute, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
- Institute of Biopharmaceutical and Health Engineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Vijay Pandey
- Tsinghua Berkeley Shenzhen Institute, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
- Institute of Biopharmaceutical and Health Engineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
- *Correspondence: Vijay Pandey,
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Metabolic Activity of Visceral Adipose Tissue Is Associated with Metastatic Status of Lymph Nodes in Endometrial Cancer: A 18F-FDG PET/CT Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010092. [PMID: 35010352 PMCID: PMC8751038 DOI: 10.3390/ijerph19010092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
Obesity contributes to increased cancer incidence and aggressiveness in patients with endometrial cancer. Inflamed metabolic activity of visceral adipose tissue (VAT) is regarded as a key underlying mechanism of adverse consequences of obesity. The aim of this study was to investigate the association between inflammatory metabolic activity of VAT evaluated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and metastatic status of lymph nodes (LN) in patients with endometrial cancer. In total, 161 women with newly diagnosed endometrial cancer, who received preoperative 18F-FDG PET/CT, were enrolled. VAT inflammatory metabolic activity was defined as V/S ratio and measured from the maximum standardized uptake value (SUVmax) of VAT normalized to the SUVmax of subcutaneous adipose tissue (SAT). The positive LN metastasis group exhibited a significantly higher V/S ratio than the negative LN metastasis group. Systemic inflammatory surrogate markers including high sensitivity C-reactive protein, spleen SUVmax, and bone marrow SUVmax were also higher in the LN metastasis group than in the negative LN metastasis group, showing significant correlations with V/S ratio. In multivariate logistic regression analysis, V/S ratio was independently associated with LN metastasis. V/S ratio is independently associated with the LN metastasis status in patients with endometrial cancer. This finding could be useful as a potential surrogate marker of obesity-induced VAT inflammation associated with tumor aggressiveness.
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Saleh M, Virarkar M, Bhosale P, Elsherif S, Javadi S, Faria SC. Endometrial Cancer, the Current International Federation of Gynecology and Obstetrics Staging System, and the Role of Imaging. J Comput Assist Tomogr 2020; 44:714-729. [PMID: 32842057 DOI: 10.1097/rct.0000000000001025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Imaging plays a crucial role in the diagnosis, staging, and follow-up of endometrial cancer. Endometrial cancer is staged surgically using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Preoperative imaging can complement surgical staging but is not yet considered a required component in the current FIGO staging system. Preoperative imaging can help identify some tumor characteristics and tumor spread, both locally and distally. More accurate assessment of endometrial cancers optimizes management and treatment plan, including degree of surgical intervention. In this article, we review the epidemiology, FIGO staging system, and the importance of imaging in the staging of endometrial cancer.
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Affiliation(s)
- Mohammed Saleh
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mayur Virarkar
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Priya Bhosale
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherif Elsherif
- Department of Internal Medicine, Weiss Memorial Hospital, Affiliate of the University of Illinois at Chicago, Chicago, IL
| | - Sanaz Javadi
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Silvana C Faria
- From the Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Chen J, He B, Dong D, Liu P, Duan H, Li W, Li P, Wang L, Fan H, Wang S, Zhang L, Tian J, Huang Z, Chen C. Noninvasive CT radiomic model for preoperative prediction of lymph node metastasis in early cervical carcinoma. Br J Radiol 2020; 93:20190558. [PMID: 31957473 DOI: 10.1259/bjr.20190558] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To build and validate a CT radiomic model for pre-operatively predicting lymph node metastasis in early cervical carcinoma. METHODS AND MATERIALS A data set of 150 patients with Stage IB1 to IIA2 cervical carcinoma was retrospectively collected from the Nanfang hospital and separated into a training cohort (n = 104) and test cohort (n = 46). A total of 348 radiomic features were extracted from the delay phase of CT images. Mann-Whitney U test, recursive feature elimination, and backward elimination were used to select key radiomic features. Ridge logistics regression was used to build a radiomic model for prediction of lymph node metastasis (LNM) status by combining radiomic and clinical features. The area under the receiver operating characteristic curve (AUC) and κ test were applied to verify the model. RESULTS Two radiomic features from delay phase CT images and one clinical feature were associated with LNM status: log-sigma-2-0 mm-3D_glcm_Idn (p = 0.01937), wavelet-HL_firstorder_Median (p = 0.03592), and Stage IB (p = 0.03608). Radiomic model was built consisting of the three features, and the AUCs were 0.80 (95% confidence interval: 0.70 ~ 0.90) and 0.75 (95% confidence intervalI: 0.53 ~ 0.93) in training and test cohorts, respectively. The κ coefficient was 0.84, showing excellent consistency. CONCLUSION A non-invasive radiomic model, combining two radiomic features and a International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma. This model could serve as a pre-operative tool. ADVANCES IN KNOWLEDGE A noninvasive CT radiomic model, combining two radiomic features and the International Federation of Gynecology and Obstetrics stage, was built for prediction of LNM status in early cervical carcinoma.
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Affiliation(s)
- Jiaming Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bingxi He
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Duan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengfei Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lu Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huijian Fan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Siwen Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Liwen Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Zhipei Huang
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Digital Medical Laboratory of Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Candido EC, Rangel Neto OF, Toledo MCS, Torres JCC, Cairo AAA, Braganca JF, Teixeira JC. Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100020. [PMID: 31403112 PMCID: PMC6687380 DOI: 10.1016/j.eurox.2019.100020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/20/2019] [Accepted: 04/09/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. Study design 194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression. Results SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m2 (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group vs. 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group vs. 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88–22.39; p = 0.003) associated with less DFS. Conclusion SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women.
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Affiliation(s)
- Elaine C Candido
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP, 13083-881, Brazil
| | - Osmar F Rangel Neto
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP, 13083-881, Brazil
| | - Maria Carolina S Toledo
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP, 13083-881, Brazil
| | - José Carlos C Torres
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP, 13083-881, Brazil
| | - Aurea A A Cairo
- Department of Obstetrics and Gynecology, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, s/n - Jd. Ipaussurama, Campinas, SP, 13060-904 Brazil
| | - Joana F Braganca
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP, 13083-881, Brazil
| | - Julio C Teixeira
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitaria, Campinas, SP, 13083-881, Brazil
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Kulkarni R, Bhat RA, Dhakharia V, Kallur K, Gangoli A. Role of Positron Emission Tomography/Computed Tomography in Preoperative Assessment of Carcinoma Endometrium-a Retrospective Analysis. Indian J Surg Oncol 2018; 10:225-231. [PMID: 30948905 DOI: 10.1007/s13193-018-0826-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023] Open
Abstract
PET/CT has made significant inroads into routine oncological practice in recent times. In our study, we aim to determine its value in preoperative assessment of endometrial carcinoma. A retrospective study between January 2011 and March 2016 was conducted; we included all cases of carcinoma endometrium with a preoperative PET/CT scan. PET/CT images were analyzed and correlated with histological findings after surgical staging. A total of 46 cases were analyzed, mean age was 59.8 years, BMI 30.8 kg/m2, and most common histology endometrioid type (69.5%). We correlated PET/CT findings with histopathology as reference standard. PET/CT had a sensitivity of 40%, moderate specificity (75%) and accuracy (71.7%), good NPV (91.2%), but poor PPV (16.7%) for lymph node involvement. A total of 10 (21.7%) cases were detected to have distant metabolically active lesions on PET/CT, seven out of these were positive for malignancy. And 90% of them were either non-endometrioid type or grade two and higher. We found that SUV of primary tumor was significantly higher in patients with deep myometrial invasion (p = 0.018), and high-risk histological type of tumor (p = 0.022), though not statistically significant when lymph nodal involvement (p = 0.9), cervical involvement (p = 0.56), or histological grade (p = 0.84) were considered. Sensitivity and specificity of PET/CT in staging endometrial cancer is not high enough to reliably tailor lymphadenectomy. Although SUV of the primary tumor was significantly higher in patients with deep myometrial invasion and high-risk histological type, it's usefulness in classifying patients into predefined risk groups seems to be limited. However, it is useful in detecting distant metastasis especially in high-grade and non-endometrioid type of tumors. Thus, implementation of PET/CT as a surrogate for surgical staging of endometrial cancer remains enigmatic and is open to further research.
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Affiliation(s)
- Rohini Kulkarni
- 1Department of Gynaecological Oncology, HCG hospital, Bengaluru, India.,2Department of Gynaecological Oncology, HCG Hospital, Bengaluru, India
| | - Rani Akhil Bhat
- 2Department of Gynaecological Oncology, HCG Hospital, Bengaluru, India
| | | | - Kumar Kallur
- 3Radiodiagnosis and Nuclear Medicine, HCG hospital, Bengaluru, India
| | - Aparna Gangoli
- 4Department of Onco - Pathology, HCG hospital, Bengaluru, India
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10
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Taşkın S, Şükür YE, Altın D, Ersöz CC, Turgay B, Kankaya D, Güngör M, Ortaç F. Laparoscopic near-infrared fluorescent imaging as an alternative option for sentinel lymph node mapping in endometrial cancer: A prospective study. Int J Surg 2017; 47:13-17. [PMID: 28919095 DOI: 10.1016/j.ijsu.2017.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To evaluate feasibility of sentinel lymph node (SLN) mapping by using near-infrared fluorescent imaging and indocyanine green (NIR/ICG) integrated laparoscopic system in clinically uterine-confined endometrial cancer. MATERIALS AND METHODS Patients with clinically early-stage endometrial cancer were included in this prospective study. ICG was injected to the uterine cervix and NIR/ICG integrated laparoscopic system (Spies Full HD D-Light P ICG technology, Karl Storz, Tuttlingen, Germany) was used during the operations. SLN and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. Systematic lymphadenectomy was completed following SLN algorithm steps. RESULTS Seventy-one eligible patients were analyzed. The overall, unilateral and bilateral SLN detection rates were 95.7%, 18.3%, 77.4%, respectively. There were 8 (11.2%) patients with lymph node metastasis. One of them was isolated para-aortic node metastasis. Negative predictive value, sensitivity and false negative rate for detecting lymphatic spread were 98.4%, 87.5% and 1.5%, respectively. CONCLUSION Sentinel lymph node mapping can easily be performed with high accuracy by using NIR/ICG integrated conventional laparoscopic system in endometrial cancer and almost all lymphatic spread can be detected.
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Affiliation(s)
- Salih Taşkın
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Duygu Altın
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | | | - Batuhan Turgay
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Duygu Kankaya
- Department of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Mete Güngör
- Department of Obstetrics and Gynecology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Fırat Ortaç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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11
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Mahajan A, Sable NP, Popat PB, Bhargava P, Gangadhar K, Thakur MH, Arya S. Magnetic Resonance Imaging of Gynecological Malignancies: Role in Personalized Management. Semin Ultrasound CT MR 2016; 38:231-268. [PMID: 28705370 DOI: 10.1053/j.sult.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gynecological malignancies are a leading cause of mortality and morbidity in women and pose a significant health problem around the world. Currently used staging systems for management of gynecological malignancies have unresolved issues, the most important being recommendations on the use of imaging. Although not mandatory as per the International Federation of Gynecology and Obstetrics recommendations, preoperative cross-sectional imaging is strongly recommended for adequate and optimal management of patients with gynecological malignancies. Standardized disease-specific magnetic resonance imaging protocols help assess disease spread accurately and avoid pitfalls. Multiparametric imaging holds promise as a roadmap to personalized management in gynecological malignancies. In this review, we will highlight the role of magnetic resonance imaging in cervical, endometrial, and ovarian carcinomas.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Nilesh P Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Palak B Popat
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | | | - Supreeta Arya
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India.
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12
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Kito M, Motoyama S, Fujita K, Miura M, Nanjo H, Sato N, Shimizu D, Sato T, Makino K, Sugawara T, Kato A, Tamura D, Takahashi K, Kumazawa Y, Sato W, Miura H, Shirasawa H, Sato A, Kumagai J, Terada Y. CRP 1846C>T Genetic Polymorphism Is Associated with Lymph Node Metastasis and/or Severe Lymphatic Invasion in Endometrial Cancer. TOHOKU J EXP MED 2016; 237:25-30. [PMID: 26310275 DOI: 10.1620/tjem.237.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endometrial cancer (EC) rates are rising in Japan. Lymph node (LN) metastasis is an important prognostic factor in EC, and its risk is increased with higher tumor grade, deep myometrial invasion, larger tumor size, and lymphovascular space invasion (LVSI). Current methodologies to assess these factors are unreliable. We previously showed the association between C-reactive protein (CRP) 1846C>T (rs1205) polymorphism and LN metastasis in esophageal, non-small cell lung, and breast cancers. The CRP gene is located on chromosome 1q21-q23, and the polymorphism in the noncoding region (1846C>T) of this gene decreases serum CRP levels. We investigated the relationship between CRP 1846C>T genetic polymorphism and LN metastasis or LVSI in 130 EC patients using polymerase chain reaction-restriction fragment length polymorphism. The CRP 1846C/T genotype was C/C in 11 patients, C/T in 58 patients and T/T in 61 patients. The patients were divided into two groups based on their CRP 1846 genotypes: "C/C" and "C/T + T/T". Nine (7%) and 18 (13%) patients, all with the polymorphism, had LN metastasis and moderate or prominent lymphatic invasion, respectively. LN metastasis and/or severe lymphatic invasion were observed in the C/T + T/T group, while patients with the C/C genotype had no LN metastases or severe lymphatic invasion. Univariate and multivariate logistic regression models revealed that the C/T + T/T patients had a significant likelihood of developing LN metastasis and/or severe lymphatic invasion. Our results suggest that CRP genetic polymorphism is a novel risk predictor of LN metastasis and/or lymphatic invasion in EC.
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Affiliation(s)
- Masahiko Kito
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine
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13
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Yang B, Shan B, Xue X, Wang H, Shan W, Ning C, Zhou Q, Chen X, Luo X. Predicting Lymph Node Metastasis in Endometrial Cancer Using Serum CA125 Combined with Immunohistochemical Markers PR and Ki67, and a Comparison with Other Prediction Models. PLoS One 2016; 11:e0155145. [PMID: 27163153 PMCID: PMC4862644 DOI: 10.1371/journal.pone.0155145] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 04/25/2016] [Indexed: 01/02/2023] Open
Abstract
We aimed to evaluate the value of immunohistochemical markers and serum CA125 in predicting the risk of lymph node metastasis (LNM) in women with endometrial cancer and to identify a low-risk group of LNM. The medical records of 370 patients with endometrial endometrioid adenocarcinoma who underwent surgical staging in the Obstetrics & Gynecology Hospital of Fudan University were collected and retrospectively reviewed. Immunohistochemical markers were screened. A model using serum cancer antigen 125 (CA125) level, the immunohistochemical markers progesterone receptor (PR) and Ki67 was created for prediction of LNM. A predicted probability of 4% among these patients was defined as low risk. The developed model was externally validated in 200 patients from Shanghai Cancer Center. The efficiency of the model was compared with three other reported prediction models. Patients with serum CA125 < 30.0 IU/mL, either or both of positive PR staining > 50% and Ki67 < 40% in cancer lesion were defined as low risk for LNM. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.82. The model classified 61.9% (229/370) of patients as being at low risk for LNM. Among these 229 patients, 6 patients (2.6%) had LNM and the negative predictive value was 97.4% (223/229). The sensitivity and specificity of the model were 84.6% and 67.4% respectively. In the validation cohort, the model classified 59.5% (119/200) of patients as low-risk, 3 out of these 119 patients (2.5%) has LNM. Our model showed a predictive power similar to those of two previously reported prediction models. The prediction model using serum CA125 and the immunohistochemical markers PR and Ki67 is useful to predict patients with a low risk of LNM and has the potential to provide valuable guidance to clinicians in the treatment of patients with endometrioid endometrial cancer.
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Affiliation(s)
- Bingyi Yang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Boer Shan
- Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaohong Xue
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Huaying Wang
- Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Weiwei Shan
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Chengcheng Ning
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Qiongjie Zhou
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- * E-mail: (XC); (XL)
| | - Xuezhen Luo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai 200011, China
- * E-mail: (XC); (XL)
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Petersen H, Holdgaard PC, Madsen PH, Knudsen LM, Gad D, Gravergaard AE, Rohde M, Godballe C, Engelmann BE, Bech K, Teilmann-Jørgensen D, Mogensen O, Karstoft J, Johansen J, Christensen JB, Johansen A, Høilund-Carlsen PF. FDG PET/CT in cancer: comparison of actual use with literature-based recommendations. Eur J Nucl Med Mol Imaging 2015; 43:695-706. [PMID: 26519292 PMCID: PMC4764641 DOI: 10.1007/s00259-015-3217-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/06/2015] [Indexed: 12/22/2022]
Abstract
Purpose The Region of Southern Denmark (RSD), covering 1.2 of Denmark’s 5.6 million inhabitants, established a task force to (1) retrieve literature evidence for the clinical use of positron emission tomography (PET)/CT and provide consequent recommendations and further to (2) compare the actual use of PET/CT in the RSD with these recommendations. This article summarizes the results. Methods A Work Group appointed a professional Subgroup which made Clinician Groups conduct literature reviews on six selected cancers responsible for 5,768 (62.6 %) of 9,213 PET/CT scans in the RSD in 2012. Rapid Evidence Assessment was applied, using the methodology of systematic reviews with predefined limitations to search PubMed, Embase and the Cochrane Library for articles published in English/Danish/Swedish/Norwegian since 2002. PICO questions were defined, data recorded and quality appraised and rated with regard to strength and evidence level. Consequent recommendations for applications of PET/CT were established. The actual use of PET/CT was compared with these, where grades A and B indicated “established” and “useful” and grades C and D “potentially useful” and “non-recommendable” indications, respectively. Results Of 11,729 citations, 1,729 were considered for review, and 204 were included. The evidence suggested usefulness of PET/CT in lung, lymphoma, melanoma, head and neck, and colorectal cancers, whereas evidence was sparse in gynaecological cancers. The agreement between actual use of PET/CT and literature-based recommendations was high in the first five mentioned cancers in that 96.2 % of scans were made for grade A or B indications versus only 22.2 % in gynaecological cancers. Conclusion Evidence-based usefulness was reported in five of six selected cancers; evidence was sparse in the sixth, gynaecological cancers. Actual use of PET/CT agreed well with recommendations. Electronic supplementary material The online version of this article (doi:10.1007/s00259-015-3217-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Henrik Petersen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | | | | | | | - Dorte Gad
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Max Rohde
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark
| | | | - Karsten Bech
- Organ Centre, Aabenraa Sygehus, Aabenraa, Denmark
| | | | - Ole Mogensen
- Department of Gynaecoligcal and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jens Karstoft
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Allan Johansen
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
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15
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AlHilli MM, Mariani A. Preoperative selection of endometrial cancer patients at low risk for lymph node metastases: useful criteria for enrollment in clinical trials. J Gynecol Oncol 2015; 25:267-9. [PMID: 25310031 PMCID: PMC4195293 DOI: 10.3802/jgo.2014.25.4.267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Mariam M AlHilli
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
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16
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Hildebrandt MG, Kodahl AR, Teilmann-Jørgensen D, Mogensen O, Jensen PT. [18F]Fluorodeoxyglucose PET/Computed Tomography in Breast Cancer and Gynecologic Cancers. PET Clin 2015; 10:89-104. [DOI: 10.1016/j.cpet.2014.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Werner HMJ, Salvesen HB. Current Status of Molecular Biomarkers in Endometrial Cancer. Curr Oncol Rep 2014; 16:403. [DOI: 10.1007/s11912-014-0403-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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