The accuracy of endometrial sampling for the diagnosis of patterns of endometrial pathology in women presenting with abnormal uterine bleeding. More conservative therapeutic approaches

Optimizing Final Pathology Determination in Endometrial Cancer: The Role of PET/CT, MRI, and Biopsy in Serous, Mixed Cell, Clear Cell, and Grade 3 Endometrioid Subtypes

Background: Accurate and timely diagnosis of endometrial cancer is crucial for guiding effective treatment and improving patient survival. Endometrial cancer diagnosis, staging, metastasis detection, and treatment planning utilize endometrial biopsy, magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET/CT) scanning as crucial diagnostic modalities. Aggressive subtypes such as serous, mixed cell, clear cell, and grade 3 endometrioid carcinomas present considerable diagnostic and therapeutic obstacles given their unfavorable prognosis, underscoring the importance of accurate preoperative evaluation. Methods: A retrospective analysis was conducted using data from seventy patients diagnosed with serous, mixed cell, clear cell, or grade 3 endometrioid endometrial cancer, who received surgical treatment from 2020 to 2023. To assess the diagnostic capabilities of each modality in determining final pathology and disease staging, a comparison was performed using results from preoperative endometrial biopsy, MRI, PET/CT, and postoperative histopathology. Cohen's kappa coefficient was employed to determine the level of agreement observed between pre- and postoperative results. Results: Endometrial biopsy demonstrated moderate yet statistically significant concordance with definitive histopathological diagnoses (κ = 0.537, p < 0.001); however, diagnostic errors were observed, especially in instances of mixed and clear cell carcinomas. MRI demonstrated efficacy in identifying local tumor invasion, yet its capacity to detect distant metastases was demonstrably limited. PET/CT was most effective in identifying distant metastases and omental involvement in advanced-stage disease. Conclusions: Definitive pathological diagnosis and staging of endometrial carcinoma are effectively established using endometrial biopsy and MRI. The utility of PET/CT is particularly pronounced in identifying distant metastases in patients with serous carcinoma and advanced-stage disease. Integrating biopsy, MRI, and PET/CT into a multimodal diagnostic strategy enhances diagnostic accuracy and enables personalized treatment planning, particularly for aggressive tumor subtypes.

Preoperative MRI and immunohistochemical examination for the prediction of high-risk endometrial cancer

Background

Magnetic resonance imaging (MRI) and immunohistochemical (IHC) examination provides useful information for the risk stratification of endometrial cancer (EC). However, the use of the combination of MRI and IHC for the prediction of high-risk EC is controversial. The aim of this study was to evaluate the value of preoperative MRI and IHC examination in prediction of patients with high-risk EC.

Methods

This retrospective case-control study was conducted from January 1, 2018 to May 1, 2021 at two hospitals. A primary cohort (n=102) comprised patients with histologically confirmed EC in one hospital between January 1, 2018 and May 31, 2020. An additional external cohort (n=35) comprising patients with histologically confirmed EC in a different hospital from January 1, 2020 to May 1, 2021 was included for validation. Imaging features including tumor size, tumor margin, relative T2 value, tumor signal intensity on diffusion-weighted imaging (DWI), T1-weighted imaging (T1WI), T2-weighted imaging (T2WI) were determined from preoperative MRI images. IHC markers including ER, PR, p53 and Ki67 were determined through IHC staining of preoperative curettage specimen. Patients were divided into high-risk and low-intermediate- risk group based on the final histological results. Differences between categorical and numerical variables were assessed using chi-square test and independent-sample t-test, respectively. Multivariate binary logistic regression analyses were used for construction of the prediction model A fusion prediction model was constructed by combining MRI features and IHC markers. The predictive performance of the model was then validated using the external cohort.

Results

Imaging and IHC markers were significantly associated with risk ranks. Model 1 based on MRI features showed an area under the curve (AUC) of 0.822 [95% confidence interval (CI), 0.741-0.903] whereas Model 2 based on IHC markers showed an AUC of 0.894 (95% CI, 0.829-0.960). Notably, model 3 integrating independent MRI and IHC risk factors demonstrated good calibration and high differentiation ability with an AUC of 0.958 (95% CI, 0.923-0.993), and showed good discrimination with an AUC of 0.84 (95% CI, 0.677-0.942) using the external validation set.

Conclusions

This study proposes a comprehensive predictive model comprising MRI and IHC features as a powerful tool for preoperative risk stratification to assist in clinical decision-making for EC patients.

Pathology findings among women with alterations in uterine bleeding patterns in cameroon

PURPOSE

Endometrial cancer is on the rise in high-income countries but it has not been adequately studied in low-and-middle income countries especially in sub-Saharan Africa (SSA), likely due to scarce pathology facilities. The purpose of this study was to characterize and quantify the prevalence of endometrial hyperplasia or cancer in a cohort of women with abnormal uterine bleeding (AUB) who underwent endometrial biopsy in Cameroon.

METHODS

We designed a cross-sectional study using medical records to characterize women who underwent endometrial biopsy in the Cameroon Baptist Convention Health Services (CBCHS) from 2008 to 2019. Pathologic diagnoses were classified as either endometrial hyperplasia, endometrial cancer, or no endometrial hyperplasia/cancer. We reported the overall prevalence of endometrial hyperplasia or cancer. Bivariate analyses compared patient characteristics between women with endometrial cancer, endometrial hyperplasia, and neither.

RESULTS

The average age was 46.2 years and women had an average of 5.1 parity. We found that, 61 [(36.7% of 166 women; 95% CI (27.6-47.0%)] had endometrial hyperplasia or cancer. There were no cases of hyperplasia with atypia and 13 women had endometrial cancer. The remainder were comprised of benign or infectious pathologic findings. In bivariate analysis, mean ages were statistically different among the three groups (hyperplasia, cancer, and no hyperplasia/cancer), p < 0.001, and women with cancer had the highest age. Parity was statistically significantly different among the three groups (p = 0.002) and women with endometrial cancer had higher parity.

CONCLUSION

We found that just over 1 in 3 women with AUB who underwent endometrial biopsy at a health system in SSA were found to have pathologic findings of endometrial hyperplasia or cancer, with no cases of hyperplasia with atypia. Women with endometrial cancer had higher mean age and parity.