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Pados G, Zouzoulas D, Tsolakidis D. Recent management of endometrial cancer: a narrative review of the literature. Front Med (Lausanne) 2024; 10:1244634. [PMID: 38235267 PMCID: PMC10792696 DOI: 10.3389/fmed.2023.1244634] [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: 06/22/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
Endometrial cancer is a common female gynecological neoplasia and its incidence rate has increased in the past years. Due to its predominant symptoms, most women will present uterine bleeding. It is usually diagnosed at an early stage and surgery has an important role in the treatment plan. The prognosis and quality of life of these patients can be quite favorable, if proper treatment is offered by surgeons. Traditionally, more invasive approaches and procedures were offered to these patients, but recent data suggest that more conservative and minimal invasive choices can be adopted in the treatment algorithm. Minimal invasive surgery, such as laparoscopy and robotic surgery, should be considered as an acceptable alternative, compared to laparotomy with less comorbidities and similar oncological and survival outcomes. Furthermore, sentinel lymph node biopsy has emerged in the surgical staging of endometrial cancer, in order to replace comprehensive lymphadenectomy. It is associated with less intra- and postoperative complications, while preliminary data show no difference in survival rates. However, sentinel lymph node biopsy should be offered within a strict algorithm, to avoid residual metastatic disease. The aim of this review is to analyze all the available data for the application of minimal invasive surgery in early endometrial cancer and especially the role of sentinel lymph node biopsy.
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Affiliation(s)
- George Pados
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
- Center for Endoscopic Surgery “Diavalkaniko” Hospital, Thessaloniki, Greece
| | - Dimitrios Zouzoulas
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
| | - Dimitrios Tsolakidis
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
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Xiong L, Chen C, Lin Y, Mao W, Song Z. A computer-aided determining method for the myometrial infiltration depth of early endometrial cancer on MRI images. Biomed Eng Online 2023; 22:103. [PMID: 37907955 PMCID: PMC10617104 DOI: 10.1186/s12938-023-01169-w] [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: 06/07/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
To classify early endometrial cancer (EC) on sagittal T2-weighted images (T2WI) by determining the depth of myometrial infiltration (MI) using a computer-aided diagnosis (CAD) method based on a multi-stage deep learning (DL) model. This study retrospectively investigated 154 patients with pathologically proven early EC at the institution between January 1, 2018, and December 31, 2020. Of these patients, 75 were in the International Federation of Gynecology and Obstetrics (FIGO) stage IA and 79 were in FIGO stage IB. An SSD-based detection model and an Attention U-net-based segmentation model were trained to select, crop, and segment magnetic resonance imaging (MRl) images. Then, an ellipse fitting algorithm was used to generate a uterine cavity line (UCL) to obtain MI depth for classification. In the independent test datasets, the uterus and tumor detection model achieves an average precision rate of 98.70% and 87.93%, respectively. Selecting the optimal MRI slices method yields an accuracy of 97.83%. The uterus and tumor segmentation model with mean IOU of 0.738 and 0.655, mean PA of 0.867 and 0.749, and mean DSC of 0.845 and 0.779, respectively. Finally, the CAD method based on the calculated MI depth reaches an accuracy of 86.9%, a sensitivity of 81.8%, and a specificity of 91.7% for early EC classification. In this study, the CAD method implements an end-to-end early EC classification and is found to be on par with radiologists in terms of performance. It is more intuitive and interpretable than previous DL-based CAD methods.
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Affiliation(s)
- Liu Xiong
- School of Optoelectronic and Communication Engineering, Xiamen University of Technology, No. 600 Ligong Road, Jimei District, Xiamen, 361024, Fujian, China
| | - Chunxia Chen
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Gulou District, Fuzhou, 350001, Fujian, China
| | - Yongping Lin
- School of Optoelectronic and Communication Engineering, Xiamen University of Technology, No. 600 Ligong Road, Jimei District, Xiamen, 361024, Fujian, China.
| | - Wei Mao
- School of Optoelectronic and Communication Engineering, Xiamen University of Technology, No. 600 Ligong Road, Jimei District, Xiamen, 361024, Fujian, China
| | - Zhiyu Song
- School of Optoelectronic and Communication Engineering, Xiamen University of Technology, No. 600 Ligong Road, Jimei District, Xiamen, 361024, Fujian, China
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Pintican R, Bura V, Zerunian M, Smith J, Addley H, Freeman S, Caruso D, Laghi A, Sala E, Jimenez-Linan M. MRI of the endometrium - from normal appearances to rare pathology. Br J Radiol 2021; 94:20201347. [PMID: 34233457 DOI: 10.1259/bjr.20201347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
MRI was recently included as a standard pre-operative diagnostic tool for patients with endometrial cancer. MR findings allow a better risk assessment and ultimately guides the surgical planning. Therefore, it is vital that the radiological interpretation is as accurate as possible. This requires essential knowledge regarding the appropriate MRI protocol, as well as different appearances of the endometrium, ranging from normal peri- and post-menopausal changes, benign findings (e.g. endometrial hyperplasia, polyp, changes due to exogenous hormones) to common and rare endometrium-related malignancies. Furthermore, this review will emphasize the role of MRI in staging endometrial cancer patients and highlight pitfalls that could result in the underestimation or overestimation of the disease extent.
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Affiliation(s)
- Roxana Pintican
- "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca,Romania; County Clinical Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Vlad Bura
- County Clinical Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Marta Zerunian
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Addley
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Susan Freeman
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Damiano Caruso
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Laghi
- Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Evis Sala
- Department of Radiology and CRUK Cambridge Center, Cambridge Biomedical Campus, Cambridge, UK
| | - Mercedes Jimenez-Linan
- Department of Histopathology, Cambridge University Hospital NHS foundation Trust, Cambridge, UK
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Duwa R, Jeong JH, Yook S. Immunotherapeutic strategies for the treatment of ovarian cancer: current status and future direction. J IND ENG CHEM 2021. [DOI: 10.1016/j.jiec.2020.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mohammadian S, Pouresmaeili F, Mohammadian A. Prognostic impact of ABO blood group on type I endometrial cancer in a population of Iranian patients. Hum Antibodies 2020; 28:313-317. [PMID: 32508322 DOI: 10.3233/hab-200416] [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: 11/15/2022]
Abstract
BACKGROUND Inherited ABO blood group has been shown to play an important role in the pathogenesis of various gynecological cancers including endometrial carcinoma (EC). OBJECTIVE Our study aimed to determine the prevalence of ABO blood groups in Iranian patients with EC and to investigate the relationship between the blood group and several clinicopathologic parameters in Imam Hossein Hospital. METHODS One hundred and seventy-five EC patients were selected and analyzed for their clinicopathologic details including ABO blood group, age, menopausal status, body mass index (BMI), tumor grade, and stage of the International Federation of Obstetrics and Gynecology (FIGO). RESULTS Endometrioid carcinoma was the most common histological type in this case study. Early stages (I and II) were present in 135 individuals (77.1%) and advanced stages (III and IV) appeared in 40 (22.9%) patients. Blood group A was prominent in patients with EC. There was a significant relationship between blood group A and cancer grade (P= 0.024). 23.1% of group A had grade III EC, while this grade appeared in 35.2% of the non-A blood group. There was no significant association between ABO blood groups and other EC clinic-pathological results (P> 0.05). CONCLUSION Although there was no significant relationship between the ABO blood group and the patients' clinicopathological characteristics, more studies could provide extensive information about any possible relation between the blood group, especially blood group A, EC, and the grade of the tumor.
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Affiliation(s)
- Shima Mohammadian
- Preventive Gynecology Research Center, Shahid Beheshti University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Farkhondeh Pouresmaeili
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Mohammadian
- Shahid Beheshti Hospital, Qom University of Medical sciences, School of Medicine, Qom, Iran
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Yan B, Liang X, Zhao T, Ding C, Zhang M. Is the standard deviation of the apparent diffusion coefficient a potential tool for the preoperative prediction of tumor grade in endometrial cancer? Acta Radiol 2020; 61:1724-1732. [PMID: 32366108 DOI: 10.1177/0284185120915596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The tumor histological grade is closely related to the prognosis of endometrial cancer (EC). The use of the apparent diffusion coefficient (ADC), tumor volume, and MRI-based texture analysis has allowed exciting advances in predicting EC grade before surgery. However, whether this constitutes a simple, convenient, and powerful diagnostic method remains unknown. PURPOSE To explore the utility of standard deviation (SD) of the ADC (ADCSD) for predicting the tumor grade in patients with EC. MATERIAL AND METHODS We retrospectively evaluated 138 patients with EC. All patients underwent unenhanced MRI and diffusion-weighted imaging (DWI). The mean ADC value (ADCmean) and SD were obtained using a freehand region of interest traced on the ADC map. Spearman's linear correlation coefficients were calculated to analyze the correlations between the indexes (including ADCSD and the ADCmean) and the Ki-67 index. The Kruskal-Wallis and Mann-Whitney U tests were used to compare differences in the index results among tumor grades. RESULTS A significant difference in ADCSD was observed among the tumor grades (P=0.000), and the ADCSD value was significantly higher for high-grade EC than for low-grade tumors (289.7 vs. 216.3×10-6mm2 /s, P=0.000). A statistically significant positive correlation was observed between ADCSD and the Ki-67 index (r=0.364, P=0.000). According to the receiver operating characteristic curve, ADCSD ≥240.2×10-6mm2 /s predicted high-grade EC with a sensitivity, specificity, and accuracy of 73.1%, 80.2%, and 77.5%, respectively. CONCLUSION Based on the intratumor heterogeneity of EC, ADCSD represents a potential method for the preoperative prediction of high-grade EC, although further studies are needed.
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Affiliation(s)
- Bin Yan
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
- Department of Radiology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Xiufen Liang
- Department of Radiology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Tingting Zhao
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Caixia Ding
- Department of Pathology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
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Hosseini MS, Mohammadian S, Farzaneh F, Arab M, Ashrafganjoei T. Diagnostic Role of Papanicolaou Smear, Hemoglobin, Blood Group, and Other Clinical Symptoms in Detecting Endometrial Carcinoma: A Clinicopathological Study of 175 Iranian Women with Endometrial Carcinoma. Gynecol Minim Invasive Ther 2020; 9:131-138. [PMID: 33101913 PMCID: PMC7545046 DOI: 10.4103/gmit.gmit_93_19] [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: 10/23/2019] [Revised: 02/04/2020] [Accepted: 03/18/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives: Endometrial carcinoma (EC) is a common gynecologic malignancy in the female genital tract, especially in postmenopausal women. The current study aimed to analyze Papanicolaou (Pap) smear in patients with EC to assess the relationship between EC and abnormal cells in Pap smear, ABO blood group, and hemoglobin anemia. Materials and Methods: A retrospective study was conducted on 175 patients with EC in Imam Hossein Hospital, Tehran, Iran, during the period from 2013 to 2019. The histology information of cases was extracted from the hospital database, and Pap smear slides were taken from pathological archives. The acquired information and slides were then reviewed by an expert pathologist in the hospital. The data were analyzed in SPSS (version 18) by the Chi-square test, Fisher's exact test, and independent-samples t-test. P < 0.05 was assigned as significant. Results: The mean age of patients was 54.47 ± 11.34, ranging from 32 to 85 years, and 31.4% of the patients were premenopausal women. Grade III, invasion ≥ 50% of myometrial, and advanced stage (III and IV) were diagnosed in 30%, 7.4%, and 22.86% of the patients, respectively. The most common histological types of EC were endometrioid (66.9%), papillary (10.3%), and malignant mixed Mullerian tumor (5.7%). The abnormal Pap smear was achieved only in 37 EC patients (21.1%). Endometrial cells, atypical squamous cells of undetermined significance, and atypical glandular cells were observed in 56.8%, 29.7%, and 13.5% of the patients > 40 years of age with abnormal Pap smears, respectively. In patients with normal Pap smears, the most common results were inflammation in 75.1% and atrophy in 14.6% of the patients. Abnormal uterine bleeding was the most important problem observed in patients with EC. Conclusion: The efficacy of Pap smear in detecting EC is limited. Therefore, women with EC, >40 years of age, with heavy bleeding, anemia, O blood group, inflammation, and atrophy in Pap smear in the past 3 years need to be precisely checked up for EC. These items can be added as new criteria for EC screening procedures.
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Affiliation(s)
- Maryam Sadat Hosseini
- Preventive Gynecology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Mohammadian
- Preventive Gynecology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Farzaneh
- Preventive Gynecology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Arab
- Preventive Gynecology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Ashrafganjoei
- Preventive Gynecology Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yan BC, Li Y, Ma FH, Feng F, Sun MH, Lin GW, Zhang GF, Qiang JW. Preoperative Assessment for High-Risk Endometrial Cancer by Developing an MRI- and Clinical-Based Radiomics Nomogram: A Multicenter Study. J Magn Reson Imaging 2020; 52:1872-1882. [PMID: 32681608 DOI: 10.1002/jmri.27289] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High- and low-risk endometrial cancer (EC) differ in whether lymphadenectomy is performed. Assessment of high-risk EC is essential for planning surgery appropriately. PURPOSE To develop a radiomics nomogram for high-risk EC prediction preoperatively. STUDY TYPE Retrospective. POPULATION In all, 717 histopathologically confirmed EC patients (mean age, 56 years ± 9) divided into a primary group (394 patients from Center A), validation groups 1 and 2 (146 patients from Center B and 177 patients from Centers C-E). FIELD STRENGTH/SEQUENCE 1.5/3T scanners; T2 -weighted imaging, diffusion-weighted imaging, apparent diffusion coefficient, and contrast enhancement sequences. ASSESSMENT A radiomics nomogram was generated by combining the selected radiomics features and clinical parameters (metabolic syndrome, cancer antigen 125, age, tumor grade following curettage, and tumor size). The area under the curve (AUC) of the receiver operator characteristic was used to evaluate the predictive performance of the radiomics nomogram for high-risk EC. The surgical procedure suggested by the nomogram was compared with the actual procedure performed for the patients. Net benefit of the radiomics nomogram was evaluated by a clinical decision curve (CDC), net reclassification index (NRI), and integrated discrimination improvement (IDI). STATISTICAL TESTS Binary least absolute shrinkage and selection operator (LASSO) logistic regression, linear regression, and multivariate binary logistic regression were used to select radiomics features and clinical parameters. RESULTS The AUC for prediction of high-risk EC for the radiomics nomogram in the primary group, validation groups 1 and 2 were 0.896 (95% confidence interval [CI]: 0.866-0.926), 0.877 (95% CI: 0.825-0.930), and 0.919 (95% CI: 0.879-0.960), respectively. The nomogram achieved good net benefit by CDC analysis for high-risk EC. NRIs were 1.17, 1.28, and 1.51, and IDIs were 0.41, 0.60, and 0.61 in the primary group, validation groups 1 and 2, respectively. DATA CONCLUSION The radiomics nomogram exhibited good performance in the individual prediction of high-risk EC, and might be used for surgical management of EC. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2 J. MAGN. RESON. IMAGING 2020;52:1872-1882.
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Affiliation(s)
- Bi Cong Yan
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Feng Hua Ma
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Feng Feng
- Departments of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Hua Sun
- Departments of Radiology, Huadong Hospital of Fudan University, Fudan University, Shanghai, China
| | - Guang Wu Lin
- Departments of Radiology, Cancer Hospital of Nantong University, Nantong, China
| | - Guo Fu Zhang
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
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Allam MM, Allam MS, Mehasseb MK. Recurrent postmenopausal bleeding: a survey of practice among gynecologists in Scotland. ACTA ACUST UNITED AC 2020; 72:64-69. [PMID: 32403905 DOI: 10.23736/s0026-4784.20.04432-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The definition and management of recurrent postmenopausal bleeding (PMB) are not well described in the literature, with no consensus among the clinicians and no available contemporary UK evidence-based guidelines. We conducted this survey to examine the practice of gynecologists based in Scotland in relation to recurrent postmenopausal bleeding. METHODS A web-based questionnaire was sent to 200 non-training grade gynecologists in Scotland exploring their views on the definition, investigation and management of recurrent PMB. Data were extracted from the 61 responses received. RESULTS Seventy-seven percent of responders defined recurrent PMB as two or more episodes of PMB, while 21% defined it after three episodes. A bleed-free interval of 3 and 6 months was needed to identify a recurrence by 46% and 44% of responders, respectively. 70% would investigate recurrent PMB with a combination of transvaginal sonography, hysteroscopy and biopsy. Only 19% would arrange a pelvic MRI routinely, while 43% would never offer one. 72% would consider a hysterectomy at some stage, with 22% of responders offering it after 3 episodes of PMB with negative investigation. 18% would never offer a hysterectomy without an identified pathology. 32% of responders felt that the management of recurrent PMB required an individualized case-by-case approach. CONCLUSIONS This survey highlights the need for a clinical guideline to address the wide variation in the management of recurrent PMB.
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Affiliation(s)
- Marwa M Allam
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Mohammed S Allam
- Department of Obstetrics and Gynecology, University Hospital of Wishaw, Wishaw, UK
| | - Mohamed K Mehasseb
- Department of Gynecological Oncology, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK -
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Yamada I, Miyasaka N, Kobayashi D, Wakana K, Oshima N, Wakabayashi A, Sakamoto J, Saida Y, Tateishi U, Eishi Y. Endometrial Carcinoma: Texture Analysis of Apparent Diffusion Coefficient Maps and Its Correlation with Histopathologic Findings and Prognosis. Radiol Imaging Cancer 2019; 1:e190054. [PMID: 33778684 PMCID: PMC7983694 DOI: 10.1148/rycan.2019190054] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/28/2019] [Accepted: 10/16/2019] [Indexed: 05/10/2023]
Abstract
PURPOSE To determine the feasibility of texture analysis (TA) of apparent diffusion coefficient (ADC) maps for predicting histologic grade (HG) and recurrence-free survival (RFS) in patients with endometrial carcinoma (EMC). MATERIALS AND METHODS One hundred twenty-one patients with EMC were examined by using a 1.5-T MRI system and diffusion-weighted imaging (DWI) with b values of 0 and 1000 sec/mm2. Software with volumes of interest on ADC maps was used to extract 45 texture features including higher-order texture features. Receiver operating characteristic analysis was performed to compare the diagnostic performance of the random forest (RF) model and ADC values for HG and recurrence. RESULTS Area under the curve (AUC) for predicting high-grade EMCs was significantly larger for RF model than for ADC values (0.967 vs 0.898; P = .0336). AUC for predicting recurrence was larger for the RF model than for ADC values (0.890 vs 0.875; P = .7248), although the difference was not significant. Mean RFS was significantly shorter for high-grade EMCs than for low-grade EMCs (P = .0002; hazard ratio, 4.9) and for ADC values less than or equal to 0.802 × 10-3 mm2/sec than for ADC values greater than 0.802 × 10-3 mm2/sec (P < .0001; hazard ratio, 32.9). RF model showed that the mean RFS was significantly shorter for the presence of recurrence than for its absence (P < .0001; hazard ratio, 94.7). CONCLUSION TA of ADC maps had significantly higher diagnostic performance than did ADC values for predicting HG and was a more useful indicator than HG and ADC values for predicting RFS in patients with EMC.Keywords: Comparative Studies, Genital/Reproductive, MR-Diffusion Weighted Imaging, MR-Imaging, Neoplasms-Primary, Pathology, Pelvis, Tissue Characterization, Uterus© RSNA, 2019.
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Endometrial Biopsy in an Outpatient Gynaecological Setting: Overinvestigation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1309-1314. [PMID: 29937135 DOI: 10.1016/j.jogc.2018.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/08/2018] [Accepted: 01/06/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We reviewed the indications for endometrial biopsy at the general gynaecology outpatient clinic of the Université de Montréal Hospital Center and measured their compliance with the Society of Obstetricians and Gynaecologists of Canada and other international guidelines. METHODS Three hundred and seventy-one files of patients who had an endometrial biopsy between January and October 2015 were reviewed. Indication for endometrial biopsy and pathology results were noted. Files were separated into four categories. RESULTS In the postmenopausal bleeding category, all files complied with the SOGC. We found hyperplasia or neoplasia in 13% of patients. In the asymptomatic endometrial thickening category, 9% of the files did not show sufficient indication for biopsy. None of the patients presented hyperplasia or neoplasia. In the abnormal uterine bleeding (AUB) - under 41 years old category, there was no indication for biopsy in 23% of the files. We found hyperplasia or neoplasia in 13% of patients, but only in patients with an indication for biopsy. In patients with AUB - over 40, non-compliance with SOGC was 3%. But according to international guidelines, 42% of patients with AUB between 41 and 45 years old did not have an indication for biopsy and none showed hyperplasia or neoplasia. CONCLUSION We demonstrated clinically significant overinvestigation in patients with AUB. Indications should be reviewed carefully before performing an endometrial biopsy in women under 41. In addition, the value of endometrial biopsies in patients between 41 and 45 years old with menorrhagia and no additional risk factor should be reevaluated.
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Ueno Y, Forghani B, Forghani R, Dohan A, Zeng XZ, Chamming's F, Arseneau J, Fu L, Gilbert L, Gallix B, Reinhold C. Endometrial Carcinoma: MR Imaging-based Texture Model for Preoperative Risk Stratification-A Preliminary Analysis. Radiology 2017; 284:748-757. [PMID: 28493790 DOI: 10.1148/radiol.2017161950] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate the associations among mathematical modeling with the use of magnetic resonance (MR) imaging-based texture features and deep myometrial invasion (DMI), lymphovascular space invasion (LVSI), and histologic high-grade endometrial carcinoma. Materials and Methods Institutional review board approval was obtained for this retrospective study. This study included 137 women with endometrial carcinomas measuring greater than 1 cm in maximal diameter who underwent 1.5-T MR imaging before hysterectomy between January 2011 and December 2015. Texture analysis was performed with commercial research software with manual delineation of a region of interest around the tumor on MR images (T2-weighted, diffusion-weighted, and dynamic contrast material-enhanced images and apparent diffusion coefficient maps). Areas under the receiver operating characteristic curve and diagnostic performance of random forest models determined by using a subset of the most relevant texture features were estimated and compared with those of independent and blinded visual assessments by three subspecialty radiologists. Results A total of 180 texture features were extracted and ultimately limited to 11 features for DMI, 12 for LVSI, and 16 for high-grade tumor for random forest modeling. With random forest models, areas under the receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were estimated at 0.84, 79.3%, 82.3%, 81.0%, 76.7%, and 84.4% for DMI; 0.80, 80.9%, 72.5%, 76.6%, 74.3%, and 79.4% for LVSI; and 0.83, 81.0%, 76.8%, 78.1%, 60.7%, and 90.1% for high-grade tumor, respectively. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of visual assessment for DMI were 84.5%, 82.3%, 83.2%, 77.7%, and 87.8% (reader 3). Conclusion The mathematical models that incorporated MR imaging-based texture features were associated with the presence of DMI, LVSI, and high-grade tumor and achieved equivalent accuracy to that of subspecialty radiologists for assessment of DMI in endometrial cancers larger than 1 cm. However, these preliminary results must be interpreted with caution until they are validated with an independent data set, because the small sample size relative to the number of features extracted may have resulted in overfitting of the models. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Yoshiko Ueno
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Behzad Forghani
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Reza Forghani
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Anthony Dohan
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Xing Ziggy Zeng
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Foucauld Chamming's
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Jocelyne Arseneau
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Lili Fu
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Lucy Gilbert
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Benoit Gallix
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
| | - Caroline Reinhold
- From the Departments of Diagnostic Radiology (Y.U., R.F., A.D., B.G., C.R.), Obstetrics and Gynecology (X.Z.Z., L.G.), and Pathology (J.A., L.F.), Royal Victoria Hospital, McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, Canada H4A 3J1; Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.U.); Reza Forghani Medical Services, Montreal, Canada (B.F., R.F.); Department of Radiology, Jewish General Hospital, Montreal, Canada (R.F.); Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Diderot-Paris 7 and INSERM U965, Paris, France (A.D.); and Department of Radiology, Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France (F.C.)
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Rižner TL. Discovery of biomarkers for endometrial cancer: current status and prospects. Expert Rev Mol Diagn 2016; 16:1315-1336. [DOI: 10.1080/14737159.2016.1258302] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Yasa C, Dural O, Bastu E, Ugurlucan FG, Nehir A, İyibozkurt AC. Evaluation of the diagnostic role of transvaginal ultrasound measurements of endometrial thickness to detect endometrial malignancy in asymptomatic postmenopausal women. Arch Gynecol Obstet 2016; 294:311-6. [DOI: 10.1007/s00404-016-4054-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/16/2016] [Indexed: 11/29/2022]
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Elkholi DGE, Nagy HM. Unexplained postmenopausal uterine bleeding from atrophic endometrium: Histopathological and hormonal studies. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Mahmud A, Smith P, Clark J. The role of hysteroscopy in diagnosis of menstrual disorders. Best Pract Res Clin Obstet Gynaecol 2015; 29:898-907. [DOI: 10.1016/j.bpobgyn.2015.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
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Wong ASW, Lao TTH, Cheung CW, Yeung SW, Fan HL, Ng PS, Yuen PM, Sahota DS. Reappraisal of endometrial thickness for the detection of endometrial cancer in postmenopausal bleeding: a retrospective cohort study. BJOG 2015; 123:439-46. [PMID: 25800522 DOI: 10.1111/1471-0528.13342] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To estimate the accuracy of transvaginal ultrasound (TVS) measurement of endometrial thickness (ET) in diagnosing endometrial cancer in postmenopausal women with vaginal bleeding (PMB). DESIGN Retrospective cohort study. SETTING One-stop PMB clinic in a Hong Kong teaching hospital. POPULATION A cohort of 4383 women with PMB. METHODS Transvaginal ultrasonic measurement of ET and endometrial biopsies were obtained in women presenting with PMB between 2002 and 2013. Endometrial histology was used as the reference standard to calculate accuracy estimates. MAIN OUTCOME MEASURES Accuracy data for TVS ET presented as sensitivity, specificity, and area under the receiver operator characteristic (ROC) curve. RESULTS Endometrial cancer was diagnosed in 3.8% of women. The median ET in those with endometrial cancer was significantly higher than those with benign conditions (15.7 versus 3.2 mm, P < 0.001). The area under the ROC curve was 0.92 (95% CI 0.89-0.94). The sensitivity for the detection of endometrial cancer at 3-, 4-, and 5-mm cut-offs were 97.0% (95% CI 94.5-99.6%), 94.1% (95% CI 90.5-97.6%), and 93.5% (95% CI 89.7-97.2%), respectively. The corresponding estimates of specificity at these thresholds were 45.3% (95% CI 43.8-46.8%), 66.8% (65.4-68.2%), and 74.0% (72.7-75.4%). CONCLUSIONS Transvaginal ultrasound using a 3-mm cut-off has high sensitivity for detecting endometrial cancer and can identify women with PMB who are highly unlikely to have endometrial cancer, thereby avoiding more invasive endometrial biopsy.
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Affiliation(s)
- A S-W Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong
| | - T T-H Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong
| | - C W Cheung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong
| | - S W Yeung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong
| | - H L Fan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong
| | - P S Ng
- Department of Obstetrics and Gynaecology, Union Hospital, Hong Kong City, Hong Kong
| | - P M Yuen
- Department of Obstetrics and Gynaecology, Hong Kong Sanatorium & Hospital, Hong Kong City, Hong Kong
| | - D S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong City, Hong Kong
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Bakkum-Gamez JN, Wentzensen N, Maurer MJ, Hawthorne KM, Voss JS, Kroneman TN, Famuyide AO, Clayton AC, Halling KC, Kerr SE, Cliby WA, Dowdy SC, Kipp BR, Mariani A, Oberg AL, Podratz KC, Shridhar V, Sherman ME. Detection of endometrial cancer via molecular analysis of DNA collected with vaginal tampons. Gynecol Oncol 2015; 137:14-22. [PMID: 25677060 DOI: 10.1016/j.ygyno.2015.01.552] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/31/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We demonstrate the feasibility of detecting EC by combining minimally-invasive specimen collection techniques with sensitive molecular testing. METHODS Prior to hysterectomy for EC or benign indications, women collected vaginal pool samples with intravaginal tampons and underwent endometrial brushing. Specimens underwent pyrosequencing for DNA methylation of genes reported to be hypermethylated in gynecologic cancers and recently identified markers discovered by profiling over 200 ECs. Methylation was evaluated individually across CpGs and averaged across genes. Differences between EC and benign endometrium (BE) were assessed using two-sample t-tests and area under the curve (AUC). RESULTS Thirty-eight ECs and 28 BEs were included. We evaluated 97 CpGs within 12 genes, including previously reported markers (RASSF1, HSP2A, HOXA9, CDH13, HAAO, and GTF2A1) and those identified in discovery work (ASCL2, HTR1B, NPY, HS3ST2, MME, ADCYAP1, and additional CDH13 CpG sites). Mean methylation was higher in tampon specimens from EC v. BE for 9 of 12 genes (ADCYAP1, ASCL2, CDH13, HS3ST2, HTR1B, MME, HAAO, HOXA9, and RASSF1) (all p<0.05). Among these genes, relative hypermethylation was observed in EC v. BE across CpGs. Endometrial brush and tampon results were similar. Within tampon specimens, AUC was highest for HTR1B (0.82), RASSF1 (0.75), and HOXA9 (0.74). This is the first report of HOXA9 hypermethylation in EC. CONCLUSION DNA hypermethylation in EC tissues can also be identified in vaginal pool DNA collected via intravaginal tampon. Identification of additional EC biomarkers and refined collection methods are needed to develop an early detection tool for EC.
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Affiliation(s)
- Jamie N Bakkum-Gamez
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Nicolas Wentzensen
- Hormonal and Reproductive Branch (HREB), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kieran M Hawthorne
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jesse S Voss
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Trynda N Kroneman
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Abimbola O Famuyide
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amy C Clayton
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kevin C Halling
- Department of Laboratory Medicine and Pathology, Division of Laboratory Genetics, Mayo Clinic, Rochester, MN, USA
| | - Sarah E Kerr
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - William A Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ann L Oberg
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Karl C Podratz
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Viji Shridhar
- Department of Laboratory Medicine and Pathology, Division of Experimental Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mark E Sherman
- Hormonal and Reproductive Branch (HREB), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), USA
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Miller KL, Baraldi CA. Geriatric gynecology: promoting health and avoiding harm. Am J Obstet Gynecol 2012; 207:355-67. [PMID: 22607665 DOI: 10.1016/j.ajog.2012.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 04/03/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
Age increases vulnerability, commonly accompanied by greater reliance on others and susceptibility to maltreatment. Physiologic processes become less resilient; the potential for harm from medical care increases. Awareness of frailty, functional, social, and potential maltreatment issues enables early referrals to help the patient maintain her independence. Health issues that may impede both gynecologic care and self-sufficiency include sensory deficits, physical disability, and cognitive impairment. Speaking slowly and providing contextual information enhance patient comprehension. Cancer screening depends on life expectancy. Osteoporosis treatment requires managing fall risk. Gynecologic symptoms more likely have multiple contributing factors than one etiology. Incontinence is a particularly complex issue, but invariably includes bladder diary assessment and pelvic floor muscle training. Function and frailty measures best predict perioperative morbidity. Communication with the patient, her family, other providers, and health care organizations is an important frontier in avoiding errors and adverse outcomes.
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Manchanda R, Saridogan E, Abdelraheim A, Johnson M, Rosenthal AN, Benjamin E, Brunell C, Side L, Gessler S, Jacobs I, Menon U. Annual outpatient hysteroscopy and endometrial sampling (OHES) in HNPCC/Lynch syndrome (LS). Arch Gynecol Obstet 2012; 286:1555-62. [PMID: 22865035 DOI: 10.1007/s00404-012-2492-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 07/19/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND LS women have a 40-60% lifetime risk of endometrial cancer (EC). Most international guidelines recommend screening. However, data on efficacy are limited. PURPOSE To assess the performance of OHES for EC screening in LS and compare it with transvaginal ultrasound (TVS) alone. METHODS A prospective observational cohort study of LS women attending a tertiary high-risk familial gynaecological cancer clinic was conducted. LS women opting for EC screening underwent annual OHES and TVS. Histopathological specimens were processed using a strict protocol. Data of women screened between October 2007 and March 2010 were analysed from a bespoke database. Histology was used as the gold standard. Diagnostic accuracy of OHES was compared with TVS using specificity, and positive (PLR) and negative (NLR) likelihood ratios. RESULTS Forty-one LS women underwent 69 screens (41 prevalent, 28 incident). Four (three prevalent, one incident) women were detected to have EC/atypical endometrial hyperplasia (AEH), five had endometrial polyps and two had endometrial hyperplasia (EH) on OHES. TVS detected two of four EC/AEH. OHES had similar specificity of 89.8% (CI 79.2, 96.2%), but higher PLR 9.8 (CI 4.6, 21) and lower NLR (zero) compared to TVS: specificity 84.75%(CI 73, 92.8%), PLR 3.28 (CI 1.04, 10.35) and NLR 0.59 (CI 0.22, 1.58). No interval cancers occurred over a median follow-up of 22 months. The annual incidence was 3.57% (CI 0.09, 18.35) for EC, 10.71% (CI 2.27, 28.23) for polyps and 21.4% (CI 8.3, 40.1) for any endometrial pathology. CONCLUSIONS Our findings suggest that in LS, annual OHES is acceptable and has high diagnostic accuracy for EC/AEH screening. Larger international studies are needed for confirmation, given the relatively small numbers of LS women at individual centres. It reinforces the current recommendation that endometrial sampling is crucial when screening these women.
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Affiliation(s)
- Ranjit Manchanda
- Department of Gynaecological Oncology, EGA Institute for Women's Health, Gynaecological Cancer Research Centre, University College London, and Department of Gynaecology, University College London Hospital, First floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Juhasz-Böss I, Haggag H, Baum S, Kerl S, Rody A, Solomayer E. Laparoscopic and laparotomic approaches for endometrial cancer treatment: a comprehensive review. Arch Gynecol Obstet 2012; 286:167-72. [DOI: 10.1007/s00404-012-2254-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/14/2012] [Indexed: 11/29/2022]
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