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Cao Y, Shi H, Zhuo X. Occult endometrial cancer in women undergoing hysterectomy for benign indications: a retrospective cohort study in a tertiary hospital in China. Arch Gynecol Obstet 2024; 310:1215-1222. [PMID: 38727815 DOI: 10.1007/s00404-024-07532-z] [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: 12/11/2023] [Accepted: 04/24/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To evaluate the feasibility of further reducing the incidence of occult endometrial cancer in women undergoing hysterectomy for benign gynecological indications. METHODS Patients who underwent hysterectomies for presumed benign gynecologic conditions at Peking Union Medical College Hospital were retrospectively identified. Patients with occult endometrial cancer, which was defined as endometrial cancer diagnosed on postoperative histopathology with no preoperative confirmed malignancy, were selected. RESULTS 24/7558 (0.32%; 95% CI 0.20-0.47%) patients undergoing hysterectomy for benign indications had occult endometrial cancer. Asymptomatic patients with normal endometrial imaging all tended to have favorable pathology. Heavy menstrual bleeding was the most overlooked AUB pattern in the premenopausal group. In the postmenopausal group, all the patients with serous adenocarcinoma or G3 endometrioid adenocarcinoma histology/stage T1b disease/LVSI space invasion had a history of persistent or recurrent PMB ≥ 6 months and/or an intracavitary lesion > 20 mm in diameter. 3/4 of the samples of the postmenopausal patients did not have adequate endometrium for evaluation. CONCLUSION To further reduce the incidence of occult endometrial cancer, physicians should focus on the patient's bleeding pattern and actively implement endometrial sampling whenever indicated. Transvaginal ultrasonography is a valuable preoperative evaluation. Hysteroscopy with directed biopsy is the preferred procedure in postmenopausal patients.
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Affiliation(s)
- Yang Cao
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric and Gynecologic Disease, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Honghui Shi
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric and Gynecologic Disease, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Xiuping Zhuo
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric and Gynecologic Disease, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
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2
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Capasso I, Cucinella G, Wright DE, Takahashi H, De Vitis LA, Gregory AV, Kim B, Reynolds E, Fumagalli D, Occhiali T, Fought AJ, McGree ME, Packard AT, Causa Andrieu PI, Fanfani F, Scambia G, Langstraat CL, Famuyide A, Breitkopf DM, Mariani A, Glaser GE, Kline TL. Artificial intelligence model for enhancing the accuracy of transvaginal ultrasound in detecting endometrial cancer and endometrial atypical hyperplasia. Int J Gynecol Cancer 2024:ijgc-2024-005652. [PMID: 39089731 DOI: 10.1136/ijgc-2024-005652] [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: 08/04/2024] Open
Abstract
OBJECTIVES Transvaginal ultrasound is typically the initial diagnostic approach in patients with postmenopausal bleeding for detecting endometrial atypical hyperplasia/cancer. Although transvaginal ultrasound demonstrates notable sensitivity, its specificity remains limited. The objective of this study was to enhance the diagnostic accuracy of transvaginal ultrasound through the integration of artificial intelligence. By using transvaginal ultrasound images, we aimed to develop an artificial intelligence based automated segmentation model and an artificial intelligence based classifier model. METHODS Patients with postmenopausal bleeding undergoing transvaginal ultrasound and endometrial sampling at Mayo Clinic between 2016 and 2021 were retrospectively included. Manual segmentation of images was performed by four physicians (readers). Patients were classified into cohort A (atypical hyperplasia/cancer) and cohort B (benign) based on the pathologic report of endometrial sampling. A fully automated segmentation model was developed, and the performance of the model in correctly identifying the endometrium was compared with physician made segmentation using similarity metrics. To develop the classifier model, radiomic features were calculated from the manually segmented regions-of-interest. These features were used to train a wide range of machine learning based classifiers. The top performing machine learning classifier was evaluated using a threefold approach, and diagnostic accuracy was assessed through the F1 score and area under the receiver operating characteristic curve (AUC-ROC). RESULTS 302 patients were included. Automated segmentation-reader agreement was 0.79±0.21 using the Dice coefficient. For the classification task, 92 radiomic features related to pixel texture/shape/intensity were found to be significantly different between cohort A and B. The threefold evaluation of the top performing classifier model showed an AUC-ROC of 0.90 (range 0.88-0.92) on the validation set and 0.88 (range 0.86-0.91) on the hold-out test set. Sensitivity and specificity were 0.87 (range 0.77-0.94) and 0.86 (range 0.81-0.94), respectively. CONCLUSIONS We trained an artificial intelligence based algorithm to differentiate endometrial atypical hyperplasia/cancer from benign conditions on transvaginal ultrasound images in a population of patients with postmenopausal bleeding.
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Affiliation(s)
- Ilaria Capasso
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe Cucinella
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
| | - Darryl E Wright
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Luigi Antonio De Vitis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Gynecology, Istituto Europeo di Oncologia, Milano, Italy
| | | | - Bohyun Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Evelyn Reynolds
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Diletta Fumagalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Gynecologic Surgery, IRCCS San Gerardo dei Tintori Foundation Hospital, Monza, Italy
| | - Tommaso Occhiali
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Obstetrics and Gynecology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Angela J Fought
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela E McGree
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Annie T Packard
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Francesco Fanfani
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Abimbola Famuyide
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel M Breitkopf
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy L Kline
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Vitale SG, Angioni S, D'Alterio MN, Ronsini C, Saponara S, De Franciscis P, Riemma G. Risk of endometrial malignancy in women treated for breast cancer: the BLUSH prediction model - evidence from a comprehensive multicentric retrospective cohort study. Climacteric 2024:1-7. [PMID: 39023103 DOI: 10.1080/13697137.2024.2376189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This study aimed to evaluate characteristics of endometrial surveillance in women treated for breast cancer to build a clinical prediction model. DESIGN A multicentric retrospective cohort study was conducted at two tertiary-care university hospitals from January 2020 to June 2023. Perimenopausal and postmenopausal women treated for breast cancer were categorized into two groups: patients with and without diagnosis of endometrial malignancy (endometrial carcinoma) or premalignancy (atypical endometrial hyperplasia). Characteristics of breast cancer and ultrasonographic and hysteroscopic examinations were compared. A prediction model for endometrial malignancy was built using logistic regression. Predictive accuracy was assessed using the receiver operating characteristic (ROC) curve and goodness of fit using the Hosmer-Lemeshow test. RESULTS One hundred and thirty-two (28 with premalignancy or malignancy and 104 without malignancy) women were analyzed. A nomogram was produced for prediction model development utilizing the presence and duration in months of abnormal uterine (BL)eeding, ultrasound (US) vascular pattern and echogenicity and (H)ysteroscopic appearance of endometrium (BLUSH) as determined by logistic regression. Sensitivity and specificity were 79.17% and 95.19%, respectively, with an area under ROC curve of 0.965, indicating good accuracy. Good goodness of fit and prediction stability were indicated by the calibration curve and Hosmer-Lemeshow test (χ2 = 26.36; p = 0.999). CONCLUSIONS Breast cancer survivors undergoing endometrial surveillance might benefit from a potentially useful prediction model based on hysteroscopic appearance, ultrasonographic uniformity of endometrium, Doppler flow and presence of abnormal uterine bleeding.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maurizio Nicola D'Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Carlo Ronsini
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Arena A, Palermo R, De Benedetti P, Caprara G, Vitale SG, Di Spiezio Sardo A, Seracchioli R, Casadio P. "RAIL BIOPSY" A Novel and Useful Technique for Hysteroscopic Endometrial Target Biopsy. J Minim Invasive Gynecol 2024:S1553-4650(24)00278-4. [PMID: 38944338 DOI: 10.1016/j.jmig.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/12/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
STUDY OBJECTIVE Endometrial biopsy (EB) is one of the most common gynecologic procedures. Office-based EB has replaced procedures involving general/loco-regional anesthesia and cervical dilatation performed in the operating room [1-3]. The Grasp Biopsy seems to be the most appropriate EB technique for reproductive-aged women [1,2,4]. Recently, the Visual D&C performed with hysteroscopic tissue removal devices has shown to be a valid alternative [5]. However, it is often difficult to obtain an adequate specimens in peri/post-menopausal women with hypo/atrophic endometrium [2]. Our aim is to show a novel hysteroscopic EB technique called "Rail Biopsy" which requires widespread and cheap instruments. DESIGN A step-by-step explanation of surgical techinque with narrated video footage. SETTING Tertiary Level Academic Hospital "IRCCS Azienda Ospedaliero-Universitaria di Bologna" Bologna, Italy. INTERVENTIONS We performed the "Rail Biopsy" technique with a 5.0 mm Continuous Flow Operative Hysteroscope with a 30° Lens and a 5Fr operative channel. We identify the endometrial target area (ETA), and we create a first track cutting through the endometrium in a caudo-cranial direction using cold scissors. We repeat the procedure, creating a second parallel track, thus completing our "rail" and isolating a wide ETA. Then, in the caudo-cranial direction, we cut through the stromal layer beneath the ETA. With a 5Fr cold grasping forceps, we clench the cranial edge of the ETA, and we remove it from the uterine cavity. A high-quality specimen, even in the case of hypo/atrophic endometrium or focal sessile lesions, can be obtained with this technique. The crucial aspect of the "Rail Biopsy" indeed is cutting through the stromal tissue while the endometrium is minimally touched, avoiding thermal damage deriving from electrosurgery. The instruments required are widespread and cheap. Moreover, this technique can be performed on any wall of the uterus, under vision, and, in the majority of patients, in an office-setting without cervical dilatation or general/loco-regional anesthesia, making it an attractive alternative to hysteroscopy performed in the operating room setting. Further studies comparing "Rail Biopsy" to other EB techniques are needed. CONCLUSION We showed a novel approach for hysteroscopic EB that may be particularly useful in patients with hypo/atrophic endometrium, easy to learn and with low costs. VIDEO ABSTRACT.
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Affiliation(s)
- Alessandro Arena
- Division of Gynaecology and Human Reproduction Physiopathology (Drs. Arena, Palermo, Benedetti, Seracchioli and Casadio); IRCCS Azienda Ospedaliero - Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC) (Drs. Arena, Palermo, Benedetti, Seracchioli, and Casadio)
| | - Roberto Palermo
- Division of Gynaecology and Human Reproduction Physiopathology (Drs. Arena, Palermo, Benedetti, Seracchioli and Casadio); IRCCS Azienda Ospedaliero - Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC) (Drs. Arena, Palermo, Benedetti, Seracchioli, and Casadio)
| | - Pierandrea De Benedetti
- Division of Gynaecology and Human Reproduction Physiopathology (Drs. Arena, Palermo, Benedetti, Seracchioli and Casadio); IRCCS Azienda Ospedaliero - Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC) (Drs. Arena, Palermo, Benedetti, Seracchioli, and Casadio).
| | - Giacomo Caprara
- University of Bologna, Pathology Unit, Department of Haematology (Dr. Caprara)
| | - Salvatore G Vitale
- Oncology and Clinical Pathology, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Division of Gynecology and Obstetrics (Dr. Vitale)
| | - Attilio Di Spiezio Sardo
- Department of Surgical Sciences, University of Cagliari, Cagliari, and Department of Public Health (Dr. Sardo), University of Naples Federico II, Naples, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology (Drs. Arena, Palermo, Benedetti, Seracchioli and Casadio); IRCCS Azienda Ospedaliero - Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC) (Drs. Arena, Palermo, Benedetti, Seracchioli, and Casadio)
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology (Drs. Arena, Palermo, Benedetti, Seracchioli and Casadio); IRCCS Azienda Ospedaliero - Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC) (Drs. Arena, Palermo, Benedetti, Seracchioli, and Casadio)
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5
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Cheney M, Shihab S, Vegunta S. Postmenopausal Bleeding: Assessment and Management. J Womens Health (Larchmt) 2024; 33:692-694. [PMID: 38629289 DOI: 10.1089/jwh.2023.0878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Megan Cheney
- Obstetrics and Gynecology, Mayo Clinic, Phoenix, Arizona, USA
| | - Sara Shihab
- Division of Women's Health-Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Suneela Vegunta
- Division of Women's Health-Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA
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Gallo A, D'alisa R, Di Spiezio Sardo A, Guerra S, Berardi G, Vitale SG, Palumbo M, Cretella P, Angioni S, Bifulco G, Musella M. Hysteroscopy and weight loss in treatment of endometrial cancer: case report and literature review. MINIM INVASIV THER 2024; 33:109-119. [PMID: 38108527 DOI: 10.1080/13645706.2023.2294993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Fertility-sparing treatments have become important for young women with atypical endometrial hyperplasia (AEH) or endometrial carcinoma (EC) who wish to preserve their reproductive potential. Evidence indicates a strong relationship between weight and EC and the effect of weight loss on reducing the risk of EC. We report the case of a young obese woman with a body mass index (BMI) of 46.6 kg/m2, diagnosed with grade 2 endometrial endometrioid adenocarcinoma, who underwent a combined fertility-sparing treatment with hysteroscopic resection followed by insertion of a levonorgestrel intrauterine system. After twelve months of failure to achieve a complete response, bariatric surgery was proposed to lose weight and improve the response to treatment. Histologic regression was achieved three months after surgery, with a weight loss of 30 kg and fifteen months after combined treatment of endometrial cancer. We reviewed the literature to summarize the evidence on the role of bariatric surgery and weight loss in modifying the oncologic and reproductive outcomes of women undergoing fertility-sparing treatment for atypical endometrial lesions.
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Affiliation(s)
- Alessandra Gallo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Rossella D'alisa
- Department of Maternal and Child Health and Urology, "Sapienza" University of Rome, Rome, Italy
| | | | - Serena Guerra
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanna Berardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Mario Palumbo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Cretella
- Department of Advanced Biomedical Sciences, Pathology Unit, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Bottura B, Haddad RF, Alvarenga-Bezerra V, Campos V, Perez L, Resende C, Asencio FDA, Liao AW, Gomes MTV, Zlotnik E, Moretti-Marques R. Developing a Nomogram for Prioritizing Hysteroscopy in Endometrial Cancer Diagnosis: A Case-Control Study. J Clin Med 2024; 13:1145. [PMID: 38398458 PMCID: PMC10889308 DOI: 10.3390/jcm13041145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The pandemic led to significant healthcare disruptions, resulting in postponed surgeries and extended waiting times for non-urgent treatments, including hysteroscopies essential for diagnosing endometrial cancer. This study aims to formulate a risk stratification model to enhance the prioritization of hysteroscopy procedures in Brazil; (2) Methods: A case-control study was conducted at Vila Santa Catarina Hospital in São Paulo, analyzing the medical records of 2103 women who underwent hysteroscopy between March 2019 and March 2022. We used bivariate analysis and multivariate linear regression to identify risk factors associated with endometrial cancer and formulate a nomogram; (3) Results: The findings revealed a 5.5% incidence of pre-invasive and invasive endometrial disease in the study population, with an average waiting time of 120 days for hysteroscopy procedures. The main risk factors identified were hypertension, diabetes, postmenopausal bleeding, and obesity; (4) Conclusions: This research highlights the urgent need for efficient prioritization of hysteroscopy procedures in the wake of the pandemic. The developed nomogram is an innovative tool for identifying patients at higher risk of endometrial cancer, thus facilitating timely diagnosis and treatment and improving overall patient outcomes in a strained healthcare system.
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Affiliation(s)
- Bruna Bottura
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Raphael Federicci Haddad
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Vanessa Alvarenga-Bezerra
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Vinicius Campos
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Luiza Perez
- Weill Cornell Medicine, New York, NY 10075, USA;
| | - Carolina Resende
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Fernanda de Almeida Asencio
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Adolfo Wenjaw Liao
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Mariano Tamura Vieira Gomes
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Eduardo Zlotnik
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
| | - Renato Moretti-Marques
- Ginecologia Oncológica, Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, São Paulo 04378-500, SP, Brazil; (B.B.); (V.A.-B.); (R.M.-M.)
- Programa de Saúde da Mulher, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (V.C.); (F.d.A.A.); (A.W.L.); (E.Z.)
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Ghasemian M, Zehtabi M, Dari MAG, Pour FK, Tabesh GA, Moramezi F, Jafari RM, Barati M, Uddin S, Farzaneh M. The emerging roles of long non-coding RNA (lncRNA) H19 in gynecologic cancers. BMC Cancer 2024; 24:4. [PMID: 38166752 PMCID: PMC10763168 DOI: 10.1186/s12885-023-11743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
Long non-coding RNA (lncRNA) H19 has gained significant recognition as a pivotal contributor to the initiation and advancement of gynecologic cancers, encompassing ovarian, endometrial, cervical, and breast cancers. H19 exhibits a complex array of mechanisms, demonstrating dualistic effects on tumorigenesis as it can function as both an oncogene and a tumor suppressor, contingent upon the specific context and type of cancer being investigated. In ovarian cancer, H19 promotes tumor growth, metastasis, and chemoresistance through modulation of key signaling pathways and interaction with microRNAs. Conversely, in endometrial cancer, H19 acts as a tumor suppressor by inhibiting proliferation, inducing apoptosis, and regulating epithelial-mesenchymal transition. Additionally, H19 has been implicated in cervical and breast cancers, where it influences cell proliferation, invasion, and immune evasion. Moreover, H19 has potential as a diagnostic and prognostic biomarker for gynecologic cancers, with its expression levels correlating with clinical parameters and patient outcomes. Understanding the functional roles of H19 in gynecologic cancers is crucial for the development of targeted therapeutic strategies and personalized treatment approaches. Further investigation into the intricate molecular mechanisms underlying H19's involvement in gynecologic malignancies is warranted to fully unravel its therapeutic potential and clinical implications. This review aims to elucidate the functional roles of H19 in various gynecologic malignancies.
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Affiliation(s)
- Majid Ghasemian
- Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojtaba Zehtabi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahrokh Abouali Gale Dari
- Department of Obstetrics and Gynecology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Khojasteh Pour
- Department of Obstetrics and Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghasem Azizi Tabesh
- Genomic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farideh Moramezi
- Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Razieh Mohammad Jafari
- Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojgan Barati
- Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahab Uddin
- Translational Institute and Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
- Department of Biosciences, Integral University, Lucknow, Uttar Pradesh, 22602, India
| | - Maryam Farzaneh
- Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Pérez-Cejuela BA, Vitale SG, Pérez-Medina T, Rios-Vallejo M, Della Corte L, Vicente AR, Angioni S, Calles-Sastre L. Hysteroscopic versus histopathological agreement in the diagnosis of chronic endometritis: results from a retrospective observational study. Arch Gynecol Obstet 2023; 308:1817-1822. [PMID: 37737882 PMCID: PMC10579145 DOI: 10.1007/s00404-023-07163-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: 06/21/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To evaluate the agreement rate between hysteroscopy and pathological examination in case of chronic endometritis. METHODS A retrospective observational study carried out at Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, Spain, from January 2021 to June 2022 was performed by obtaining data from 115 medical records of women who underwent office hysteroscopies that was compared with the findings of final histological examination of endometrial biopsy. Cohen's kappa index was used to evaluate this agreement rate. In addition, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were obtained. RESULTS The agreement between hysteroscopic findings and histological examination showed a modest result with a Cohen's kappa index of 34%. In addition, we obtained a specificity of 70% and a sensitivity of 64%. The positive and negative predictive value were 60.8% and 73.4%, respectively. An excellent agreement rate (100%) between histological and hysteroscopic results was observed in presence of hyperemia and micropolyps. CONCLUSION Although the sample size is not as large as that of other studies published so far, the first glance of our experience is that hysteroscopic signs are not yet sufficient to make an accurate diagnosis of chronic endometritis, thus requiring a histopathological confirmation to make it.
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Affiliation(s)
- Belén Almoguera Pérez-Cejuela
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Tirso Pérez-Medina
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain.
| | - Mar Rios-Vallejo
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80131, Naples, Italy
| | - Ana Royuela Vicente
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Laura Calles-Sastre
- Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, 28223, Majadahonda, Madrid, Spain
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10
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Fang Y, Wei Y, Liu X, Qin L, Gao Y, Yu Z, Xu X, Cha G, Zhu X, Wang X, Xu L, Cao L, Chen X, Jiang H, Zhang C, Zhou Y, Zhu J. A self-supervised classification model for endometrial diseases. J Cancer Res Clin Oncol 2023; 149:17855-17863. [PMID: 37947870 PMCID: PMC10725391 DOI: 10.1007/s00432-023-05467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Ultrasound imaging is the preferred method for the early diagnosis of endometrial diseases because of its non-invasive nature, low cost, and real-time imaging features. However, the accurate evaluation of ultrasound images relies heavily on the experience of radiologist. Therefore, a stable and objective computer-aided diagnostic model is crucial to assist radiologists in diagnosing endometrial lesions. METHODS Transvaginal ultrasound images were collected from multiple hospitals in Quzhou city, Zhejiang province. The dataset comprised 1875 images from 734 patients, including cases of endometrial polyps, hyperplasia, and cancer. Here, we proposed a based self-supervised endometrial disease classification model (BSEM) that learns a joint unified task (raw and self-supervised tasks) and applies self-distillation techniques and ensemble strategies to aid doctors in diagnosing endometrial diseases. RESULTS The performance of BSEM was evaluated using fivefold cross-validation. The experimental results indicated that the BSEM model achieved satisfactory performance across indicators, with scores of 75.1%, 87.3%, 76.5%, 73.4%, and 74.1% for accuracy, area under the curve, precision, recall, and F1 score, respectively. Furthermore, compared to the baseline models ResNet, DenseNet, VGGNet, ConvNeXt, VIT, and CMT, the BSEM model enhanced accuracy, area under the curve, precision, recall, and F1 score in 3.3-7.9%, 3.2-7.3%, 3.9-8.5%, 3.1-8.5%, and 3.3-9.0%, respectively. CONCLUSION The BSEM model is an auxiliary diagnostic tool for the early detection of endometrial diseases revealed by ultrasound and helps radiologists to be accurate and efficient while screening for precancerous endometrial lesions.
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Affiliation(s)
- Yun Fang
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Yanmin Wei
- Tianjin Normal University, Tianjin, 300387, China
| | - Xiaoying Liu
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Liufeng Qin
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Yunxia Gao
- The Second People's Hospital of Quzhou, Quzhou, 324000, Zhejiang, China
| | - Zhengjun Yu
- Kaihua County People's Hospital, Quzhou, 324300, Zhejiang, China
| | - Xia Xu
- Changshan County People's Hospital, Quzhou, 324200, Zhejiang, China
| | - Guofen Cha
- People's Hospital of Quzhou Kecheng, Quzhou, 324000, Zhejiang, China
| | - Xuehua Zhu
- Quzhou Maternal and Child Health Care Hospital, Quzhou, 324000, Zhejiang, China
| | - Xue Wang
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Lijuan Xu
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Lulu Cao
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China
| | - Xiangrui Chen
- Changshan County People's Hospital, Quzhou, 324200, Zhejiang, China
| | - Haixia Jiang
- Kaihua County People's Hospital, Quzhou, 324300, Zhejiang, China
| | - Chaozhen Zhang
- People's Hospital of Quzhou Kecheng, Quzhou, 324000, Zhejiang, China
| | - Yuwang Zhou
- Quzhou People's Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, Zhejiang, China.
| | - Jinqi Zhu
- Tianjin Normal University, Tianjin, 300387, China.
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11
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Libretti A, Vitale SG, Saponara S, Corsini C, Aquino CI, Savasta F, Tizzoni E, Troìa L, Surico D, Angioni S, Remorgida V. Hysteroscopy in the new media: quality and reliability analysis of hysteroscopy procedures on YouTube™. Arch Gynecol Obstet 2023; 308:1515-1524. [PMID: 37568070 PMCID: PMC10520162 DOI: 10.1007/s00404-023-07172-9] [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: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Hysteroscopy plays a crucial role in diagnosing and managing various intrauterine pathologies. However, its execution can be influenced by patients' perception and understanding, which are often shaped by digital resources such as YouTubeTM. Given its popularity and accessibility, YouTubeTM has the potential to greatly influence patients' knowledge and expectations about this procedure, highlighting the need for accurate and reliable information. PURPOSE This study aims to assess the reliability and quality of hysteroscopy information available to patients on YouTubeTM. Understanding the nature of information patients' access can help address their fears and potential misunderstandings about the procedure, consequently reducing the likelihood of suspension or postponement due to anxiety. METHODS A comprehensive analysis of YouTubeTM was conducted, simulating the search process of a patient seeking information about hysteroscopy. The study evaluated the reliability and quality of 90 out of the first 100 hysteroscopy-related videos on YouTubeTM, scored by four gynecologists-two experienced hysteroscopists and two trainees. The videos were assessed for reliability and quality using the mDISCERN and Global Quality Scale (GQS) scores. RESULTS The average mDISCERN and GQS scores for the evaluated videos were below the optimal three points, highlighting the lack of fluency, comprehensiveness, and reliability of the available information. Notably, while videos produced by experts, including doctors and professional channels, had higher scores, they still fell short of the minimum score of 3. These videos also were not considered more suitable for either patients or trainees. Videos that were assessed as reliable (mDISCERN ≥ 3) were observed to be longer and were more frequently produced by doctors. These videos were suggested more to trainees rather than patients. Similarly, videos deemed as fluent and comprehensive (GQS ≥ 3) were longer and were more often recommended to patients. CONCLUSIONS While YouTubeTM is a widely used source of medical information, the quality and reliability of hysteroscopy videos on the platform are poor. The strategic use of selected, high-quality hysteroscopy videos can enhance procedure success and alleviate patient fears. However, the unsupervised discovery of information by patients could potentially lead to procedure failure or an elevated level of stress due to misleading or incorrect information.
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Affiliation(s)
- Alessandro Libretti
- Department of Gynaecology and Obstetrics, University Hospital Maggiore Della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Christian Corsini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Carmen Imma Aquino
- Department of Gynaecology and Obstetrics, University Hospital Maggiore Della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Federica Savasta
- Department of Gynaecology and Obstetrics, University Hospital Maggiore Della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Eleonora Tizzoni
- Department of Gynaecology and Obstetrics, Filippo Del Ponte Hospital, Varese, Italy
| | - Libera Troìa
- Department of Gynaecology and Obstetrics, University Hospital Maggiore Della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Daniela Surico
- Department of Gynaecology and Obstetrics, University Hospital Maggiore Della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Valentino Remorgida
- Department of Gynaecology and Obstetrics, University Hospital Maggiore Della Carità, Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, Novara, Italy
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12
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Li YT, Yang ST, Wang PH. Ultrasonography for menopausal endometrium. Taiwan J Obstet Gynecol 2023; 62:797-798. [PMID: 38008495 DOI: 10.1016/j.tjog.2023.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
- Yiu-Tai Li
- Department of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan
| | - Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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13
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Gu J, Sun Q, Qi Y, Hu F, Cao Y. The effect of chronic endometritis and treatment on patients with unexplained infertility. BMC Womens Health 2023; 23:345. [PMID: 37391747 PMCID: PMC10311816 DOI: 10.1186/s12905-023-02499-6] [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: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE This paper was mainly conducted to investigate the effect of chronic endometritis (CE) on the clinical outcome of patients with unexplained infertility. MATERIALS AND METHODS 145 patients with unexplained infertility from the Reproductive Center of our hospital from January 2018 to December 2021 were selected as the unexplained infertility group. 42 patients with definite infertility causes were selected as the control group during the same period. Both groups of patients underwent hysteroscopy and immunohistochemical tests for CD38 and CD138. According to the results of hysteroscopy and immunohistochemistry, the incidence of CE between the two groups was analyzed. Patients with CE as CE group accepted oral antibiotic therapy for 14 days. Another 58 patients with unexplained infertility who did not undergo hysteroscopy and immunohistochemical tests for CD38 and CD138 were selected as the unexamined group. Both groups of patients were expected natural pregnancy. Follow-up lasted for 1 year, and the pregnant patients were followed up until delivery.The clinical pregnancy rate, spontaneous abortion rate and baby-carrying home rate of the two groups were compared. RESULTS There were 75 patients with CE in the unexplained infertility group, and the prevalence rate was 51.7% (75/145). Compared with the control group (28.6%), the incidence of CE was significantly higher (P < 0.05). After treated with antibiotic treatment, the patients' clinical pregnancy rate was 61.3% (46/75) and baby-carrying home rate was 60% (45/75) in the CE group, which were higher than those in the unexamined group(43.1% & 36.2%) (P < 0.05), while the spontaneous abortion rate was 2.2% (1/46),which was lower than that in the unexamined group (16.0%) (P < 0.05). CONCLUSIONS For patients with unexplained infertility, hysteroscopy combined with endometrial immunohistochemical detection of CD38 and CD138 should be performed in time to exclude CE. The clinical pregnancy outcome of CE patients can be significantly improved by antibiotic treatment.
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Affiliation(s)
- Juan Gu
- Reproductive Medical Center of Xuzhou Central Hospital, 221000, Xuzhou, China
| | - Qingqing Sun
- Reproductive Medical Center of Xuzhou Central Hospital, 221000, Xuzhou, China.
| | - Yujuan Qi
- Reproductive Medical Center of Xuzhou Central Hospital, 221000, Xuzhou, China
| | - Fangfang Hu
- Reproductive Medical Center of Xuzhou Central Hospital, 221000, Xuzhou, China
| | - Yijuan Cao
- Reproductive Medical Center of Xuzhou Central Hospital, 221000, Xuzhou, China
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