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Çakıroğlu Y, Doğer E, Yıldırım Kopuk Ş, Özcan C, Nalbant B, Çorakçı A, Yücesoy İ. Prediction of tumor grade and stage in endometrial carcinoma by preoperative assessment of sonographic endometrial thickness: Is it possible? Turk J Obstet Gynecol 2014; 11:211-214. [PMID: 28913022 PMCID: PMC5558363 DOI: 10.4274/tjod.35651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 07/21/2014] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate preopertive accuracy of endometrial thickness for assesment of histologic grade and stage of endometrial carcinoma and also determining a cut-off value for the determination of grade of endometrial carcinoma. Materials and Methods: Clinical data of 105 patients who underwent surgical staging with endometrial carcinoma were reviewed retrospectively. Preoperatively endometrial thickness were recorded and correlated with pathologic information. Results: A statistically significant correlation was found in between endometrial thickness and grade of the disease (r=0.746, p=0.001). Besides, no correlation was found between endometrial thickness and stage (r=0.153, p=0.119). The endometrial thickness at 9 mm revealed the optimal sensitivity and specificity (93.33 and 26.2, respectively) for turning through grade1 to grade 2 with 68.2% positive predictive value and 66.7% negative predictive value. We indicated the endometrial thickness at 27 mm as the optimal value with sensitivity and specificity (27.27 and 95.65, respectively) for turning through grade 2 to grade 3 with 66.7% positive predictive value and 77.5% negative predictive value. Conclusion: In conlusion, sonographic evaluation of the endometrial thickness is economical, simple and can be used as a prognostic tool for endometrial cancer grading. The operating team may have the chance to get prepared before the operation and may have the chance to inform the patient about the operation.
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Affiliation(s)
- Yiğit Çakıroğlu
- Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Emek Doğer
- Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Şule Yıldırım Kopuk
- Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Canan Özcan
- Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Betül Nalbant
- Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Aydın Çorakçı
- Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
| | - İzzet Yücesoy
- Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, Kocaeli, Turkey
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Arafa M, Somja J, Dehan P, Kridelka F, Goffin F, Boniver J, Delvenne P. Current concepts in the pathology and epigenetics of endometrial carcinoma. Pathology 2011; 42:613-7. [PMID: 21080868 DOI: 10.3109/00313025.2010.520307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the Western world, endometrial carcinoma is the most common malignant tumour of the female genital tract and is the fourth most common cancer in women. Two different clinicopathological subtypes are recognised: the oestrogen-related (type I, endometrioid) and the non-oestrogen related (type II, non-endometrioid). This article reviews the epidemiology, risk factors, genetic alterations during endometrial carcinogenesis, features of tumours and precursors and early detection of the disease. Insights into the epigenetic alterations, with emphasis on DNA methylation during endometrial carcinogenesis, and their diagnostic value are also provided.
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Affiliation(s)
- Mohammad Arafa
- Department of Pathology, Faculty of Medicine, Mansoura University, Egypt
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3
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Value of 3-dimensional sonohysterography for detection of intrauterine lesions in women with abnormal uterine bleeding. J Minim Invasive Gynecol 2010; 17:200-4. [PMID: 20226408 DOI: 10.1016/j.jmig.2009.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/06/2009] [Accepted: 12/16/2009] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To compare 2-dimensional (2D) sonohysterography (SHG) and 3D-SHG with saline solution infusion vs diagnostic hysteroscopy for investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding. DESIGN Comparative observational cross-sectional study (Canadian Task Force classification II-1). SETTING University hospital. PATIENTS Fifty perimenopausal and 20 postmenopausal women with abnormal intrauterine bleeding with clinically or ultrasonically suspected intrauterine lesions. INTERVENTIONS Conventional 2D- and 3D ultrasonography and 2D- and 3D-SHG with saline solution infusion followed by diagnostic hysteroscopy, and endometrial curettage or subsequent operative treatment (e.g., hysterectomy, myomectomy, or polypectomy). Ultrasonographic and hysteroscopic findings were compared with histopathologic findings. MEASUREMENTS AND MAIN RESULTS For 2D-SHG, sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio for a positive result, and likelihood ratio for a negative result were 79%, 72%, 89%, 54%, 76%, 2.82, and 0.29, respectively, and for 3D-SHG, were 92%, 89%, 96%, 80%, 91%, 8.36, and 0.09, respectively; and for diagnostic hysteroscopy, were 94%, 89%, 96%, 84%, 93%, 8.55, and 0.07, respectively. Thus, 3D-SHG was superior to 2D SHG (p = .02) and comparable to diagnostic hysteroscopy (p = .75) for diagnosis of intrauterine lesions. CONCLUSION 3D-SHG can be used in the initial investigation of intrauterine lesions in perimenopausal and postmenopausal women with abnormal uterine bleeding before resorting to invasive procedures such as diagnostic hysteroscopy. Further studies of computer-reconstructed 3D-SHG virtual hysteroscopy are recommended.
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Moodley M, Roberts C. Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection. J OBSTET GYNAECOL 2009; 24:736-41. [PMID: 15763777 DOI: 10.1080/014436104100009394] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Postmenopausal bleeding (PMB) accounts for about 5% of all office gynaecology visits. The causes of PMB are varied. Many women with endometrial cancer present with this symptom. Although many investigations are described, the most appropriate approach is often unclear. In a patient with no obvious local cause, the emphasis should be on uterine and adnexal evaluation. Based on a literature review, the evidence favours a conservative approach if the endometrial thickness (ET) is < 4mm, unless there are risk factors. All patients with ET 4 mm should have outpatient endometrial sampling. If this is unsuccessful, then outpatient hysteroscopy with directed biopsy or inpatient hysteroscopy is favoured. The role of ancillary investigations are described.
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Affiliation(s)
- M Moodley
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, Congella, Durban 4000, South Africa.
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Batzer FR. Abnormal uterine bleeding: imaging techniques for evaluation of the uterine cavity and endometrium before minimally invasive surgery--the case for transvaginal ultrasonography. J Minim Invasive Gynecol 2007; 14:9-11. [PMID: 17218222 DOI: 10.1016/j.jmig.2006.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 08/24/2006] [Indexed: 11/23/2022]
Abstract
Transvaginal ultrasound has been utilized for first line evaluation of abnormal uterine bleeding since its development in the early 1980's. The benefits and diagnostic effectiveness of transvaginal ultrasound in assessing the uterus, unlike hysteroscopy, extends to the complete pelvis. The ease of application, patient acceptance, and immediacy of results are rapidly apparent. Comparisons with hysteroscopic evaluation are discussed. While tissue diagnosis is still the gold standard, transvaginal sonography lets one know what surgical procedure to plan for from hysteroscopy to Endoscopy or laparotomy, including when no further surgical evaluation is necessary.
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6
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Hoad CL, Raine-Fenning NJ, Fulford J, Campbell BK, Johnson IR, Gowland PA. Uterine tissue development in healthy women during the normal menstrual cycle and investigations with magnetic resonance imaging. Am J Obstet Gynecol 2005; 192:648-54. [PMID: 15696017 DOI: 10.1016/j.ajog.2004.07.032] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE High-resolution magnetic resonance imaging (MRI) was used to monitor both uterine endometrial and junctional zone morphometry during the normal menstrual cycle. STUDY DESIGN Twenty-four healthy, ovulating women were studied during a single menstrual cycle. Three scans were performed to prospectively coincide with the follicular, periovulatory, and luteal phases of the cycle. RESULTS MRI data showed a significant increase in endometrial and junctional zone volume, between the follicular and periovulatory phases, with a significant decrease in endometrial volume observed from the periovulatory to luteal phases. The regularity index, which is a novel subjective assessment of junctional zone structure, varied significantly and demonstrated a less regular junctional zone in the luteal phase. CONCLUSION This study has quantified the normal developmental changes of uterine tissue during the menstrual cycle with MRI. Junctional zone data from MRI may play a major role in future studies that investigate menstrual disorders, subfertility, and pathologic changes.
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Affiliation(s)
- Caroline L Hoad
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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7
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Raine-Fenning NJ, Campbell BK, Clewes JS, Kendall NR, Johnson IR. Defining endometrial growth during the menstrual cycle with three-dimensional ultrasound. BJOG 2004; 111:944-9. [PMID: 15327609 DOI: 10.1111/j.1471-0528.2004.00214.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To define the changes in endometrial morphometry that occur during the normal menstrual cycle and to examine the discriminatory power of volumetric analysis over conventional two-dimensional measurements in quantifying the effect of compounding factors on endometrial growth. DESIGN The design was that of a longitudinal observational study. Subjects were seen on an alternate-day basis until ovulation and then every four days until the next menstrual period. SETTING A University teaching hospital. POPULATION Thirty women with regular cycles and acceptable "normal", menstrual patterns. METHODS Three-dimensional ultrasound data were acquired and subsequently analysed by a single observer. MAIN OUTCOME MEASURES Endometrial thickness and volume. RESULTS Both endometrial volume and thickness increased significantly during the follicular phase (P < 0.001), reaching a plateau around the time of ovulation and remaining relatively stable throughout the luteal phase. These changes in endometrial thickness and volume were highly correlated (R(2)= 0.767; P < 0.001). Parity was associated with a significantly greater endometrial volume than nulliparity (4.159 vs 2.234 cm(3); P < 0.05). CONCLUSIONS This study has defined the relative and absolute changes in endometrial growth, both in terms of thickness and volume, throughout the normal menstrual cycle. These data provide a reference for future three-dimensional studies investigating menstrual disorders, pathophysiological change and subfertility.
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Affiliation(s)
- Nicholas J Raine-Fenning
- School of Human Development, University of Nottingham, Queens Medical Centre, East Block, Nottingham NG7 2UH, UK
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8
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Münstedt K, Grant P, Woenckhaus J, Roth G, Tinneberg HR. Cancer of the endometrium: current aspects of diagnostics and treatment. World J Surg Oncol 2004; 2:24. [PMID: 15268760 PMCID: PMC506786 DOI: 10.1186/1477-7819-2-24] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Accepted: 07/21/2004] [Indexed: 12/24/2022] Open
Abstract
Background Endometrial cancer represents a tumor entity with a great variation in its incidence throughout the world (range 1 to 25). This suggests enormous possibilities of cancer prevention due to the fact that the incidence is very much endocrine-related, chiefly with obesity, and thus most frequent in the developed world. As far as treatment is concerned, it is generally accepted that surgery represents the first choice of treatment. However, several recommendations seem reasonable especially with lymphadenectomy, even though they are not based on evidence. All high-risk cases are generally recommended for radiotherapy. Methods A literature search of the Medline was carried out for all articles on endometrial carcinoma related to diagnosis and treatment. The articles were systematically reviewed and were categorized into incidence, etiology, precancerosis, early diagnosis, classification, staging, prevention, and treatment. The article is organized into several similar subheadings. Conclusions In spite of the overall good prognosis during the early stages of the disease, the survival is poor in advanced stages or recurrences. Diagnostic measures are very well able to detect asymptomatic recurrences. These only seem justified if patients' chances are likely to improve, otherwise such measures increases costs as well as decrease the patients' quality of life. To date neither current nor improved concepts of endocrine treatment or chemotherapy have been able to substantially increase patients' chances of survival. Therefore, newer concepts into the use of antibodies e.g. trastuzumab in HER2-overexpressing tumors and the newer endocrine compounds will need to be investigated. Furthermore, it would seem highly desirable if future studies were to identify valid criteria for an individualized management, thereby maximizing the benefits and minimizing the risks.
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Affiliation(s)
- Karsten Münstedt
- Department of Obstetrics and Gynecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany
| | - Phillip Grant
- Department of Psychology, Justus-Liebig-University Giessen, Otto-Behagel-Str. 10F, D 35394 Giessen, Germany
| | - Joachim Woenckhaus
- Institute of Pathology, Justus-Liebig-University Giessen, Langhansstrasse 10, D 35385 Giessen, Germany
| | - Gabriele Roth
- Department of Obstetrics and Gynecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany
| | - Hans-Rudolf Tinneberg
- Department of Obstetrics and Gynecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany
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Bruchim I, Biron-Shental T, Altaras MM, Fishman A, Beyth Y, Tepper R, Aviram R. Combination of endometrial thickness and time since menopause in predicting endometrial cancer in women with postmenopausal bleeding. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:219-224. [PMID: 15124187 DOI: 10.1002/jcu.20020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This study was conducted to assess the combination of endometrial thickness, as measured by transvaginal sonography, and time since menopause, in predicting the presence of endometrial cancer in women with postmenopausal bleeding. METHODS The study group consisted of 95 women with postmenopausal bleeding who underwent sonographic measurement of endometrial thickness followed by endometrial biopsy. No patient had ever received hormone replacement therapy. RESULTS The mean endometrial thickness was significantly lower in the absence of endometrial carcinoma (6.9 +/- 4.3 mm) than in its presence (13.5 +/- 7.7 mm) (p < 0.005). The incidence of endometrial carcinoma increased with increases in endometrial thickness and the number of years since menopause. No patient had carcinoma when the endometrium was less than 5 mm thick, but 18.5% did when the thickness exceeded 9 mm. The incidence of cancer was 2.6% in women who had undergone menopause less than 5 years earlier but was 21.4% in women who had undergone menopause more than 15 years prior. Multiple logistic regression analysis showed that time since menopause and endometrial thickness were statistically significant predictors of endometrial carcinoma. CONCLUSIONS Time since menopause and endometrial thickness together define cutoff points for the diagnostic biopsy of tissue samples for endometrial carcinoma; that is, within a particular time interval, sampling should not be performed if the thickness is below a given value. When using cutoff points of 6 mm of endometrial thickness for women experiencing menopause 5-15 years prior and 5 mm in those going through menopause 15 or more years prior, approximately 60% of invasive procedures may be avoided. In addition, models derived by multiple logistic regression can be used to calculate a patient's risk of cancer based on her age and endometrial thickness.
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Affiliation(s)
- Ilan Bruchim
- Department of Obstetrics and Gynecology, Sapir Medical Center, 59 Tchernichovsky Street, Kfar Saba, 44281, Israel
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11
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Köse G, Aka N, Api M. Preoperative assessment of myometrial invasion and cervical involvement of endometrial cancer by transvaginal ultrasonography. Gynecol Obstet Invest 2004; 56:70-6. [PMID: 12904689 DOI: 10.1159/000072780] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2002] [Accepted: 05/26/2003] [Indexed: 11/19/2022]
Abstract
The aim of the study was to assess the depth of myometrial invasion and cervical involvement by endometrial cancer using preoperative 6.5-MHz, high-frequency transvaginal ultrasonography as compared with postoperative assessment using histopathological examination. The study included 47 patients with histologically proven cancers of the endometrium. All patients underwent transvaginal sonography before surgery. The depth of myometrial invasion was classified as none, inner half of the uterine wall, and outer half of the uterine wall. Cervical spread is recorded as positive or negative. Of 36 (76.6%) patients with proven myometrial invasion, 33 cases (91.66%) were revealed by sonography. Histologically proven cervical invasion that correlated with sonography was shown in 3 patients (75%). In 7 patients (14.9%) ultrasonography could not correctly predict the depth of myometrial invasion. The depth of invasion was underestimated in 4 (8.5%) cases and overestimated in 3 (6.4%) cases. Preoperative assessment of invasion of the uterine wall and cervical spread by transvaginal ultrasonography had an accuracy of 85 and 97.8% if correlated with the definitive histopathological examination. The role of transvaginal ultrasonography in preoperative assessment of the depth of myometrial invasion and cervical involvement in patients with endometrial cancer needs to be studied further before making reliable conclusions.
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Affiliation(s)
- Gültekin Köse
- Department of Obstetrics and Gynecology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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12
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Gupta JK, Chien PFW, Voit D, Clark TJ, Khan KS. Ultrasonographic endometrial thickness for diagnosing endometrial pathology in women with postmenopausal bleeding: a meta-analysis. Acta Obstet Gynecol Scand 2002; 81:799-816. [PMID: 12225294 DOI: 10.1034/j.1600-0412.2001.810902.x] [Citation(s) in RCA: 204] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Our aim was to determine the diagnostic accuracy of endometrial thickness measurement by pelvic ultrasonography for predicting endometrial carcinoma and disease (hyperplasia and/or carcinoma) during an investigation of postmenopausal bleeding. We performed a systematic quantitative review of the available published literature, which consisted of online searching the MEDLINE and EMBASE databases (1966-2000) coupled with scanning of bibliography of known primary and review articles. The selection of studies, assessment of study quality, and extraction of data were performed in duplicate under masked conditions. Included in the analyses were 57 studies with 9031 patients. Accuracy data were summarized using likelihood ratios for various cut-off levels of abnormal endometrial thickness. The commonest cut-offs were 4 mm (9 studies) and 5 mm (21 studies), measuring both endometrial layers. None of the nine studies using the < or = 4 mm cut-off level were of good quality. Only four studies (out of the 21) used the < or = 5 mm cut-off level, which employed the best-quality criteria. Using the pooled estimates from these four studies only, a positive test result raised the probability of carcinoma from 14.0% (95% CI 13.3-14.7) to 31.3% (95% CI 26.1-36.3), while a negative test reduced it to 2.5% (95% CI 0.9-6.4). In conclusion, ultrasound measurement of endometrial thickness alone, using the best-quality studies cannot be used to accurately rule. However, a negative result at < or = 5 mm cut-off level measuring both endometrial layers in the presence of endometrial pathology rules out endometrial pathology with good certainty.
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Affiliation(s)
- Janesh K Gupta
- Birmingham Minimal Access and Surgical Training (MAST) Center, Academic Department of Obstetrics and Gynecology, Women's Hospital, University of Birmingham, Birmingham B15 2TG, UK.
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Imaging Techniques for Evaluation of the Uterine Cavity and Endometrium in Premenopausal Patients Before Minimally Invasive Surgery. Obstet Gynecol Surv 2002. [DOI: 10.1097/00006254-200206000-00024] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Endovaginal sonography in combination with HSG is an effective screening tool in evaluating patients with postmenopausal bleeding. Endovaginal sonography is highly sensitive for detecting endometrial carcinoma and can identify patients at low risk for endometrial disease obviating the need for endometrial sampling in this subgroup of patients. In patients with abnormal findings at sonography, a detailed morphologic analysis can be used to determine which patients can undergo blind endometrial sampling successfully versus those who would benefit from hysteroscopic guidance. In patients in whom endovaginal sonography and HSG are inadequate, MRI may provide additional information on the appearance of the endometrium, particularly in patients in whom endometrial sampling is difficult (eg, patients with cervical stenosis).
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Affiliation(s)
- Caroline Reinhold
- Department of Radiology, McGill University Health Center, Montreal, PQ, Canada.
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15
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Can Radiological Procedures Replace Histologic Examination in the Evaluation of Abnormal Vaginal Bleeding? Obstet Gynecol 2002. [DOI: 10.1097/00006250-200204000-00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kraus PA, Boston RJ. Saline infusion sonohysterogram as initial investigation of the endometrium and uterine cavity. Aust N Z J Obstet Gynaecol 2001; 41:433-5. [PMID: 11787920 DOI: 10.1111/j.1479-828x.2001.tb01324.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The results of 54 consecutive saline infusion sonohysterograms (SIS) are presented. Sonohysterogram, in conjunction with Pipelle endometrial sampling, was found to be a reliable and accurate method of initial investigation of the endometrium and uterine cavity with good correlation with other methods of investigation. It was well tolerated in an outpatient setting, saved two out of three of the women from needing a hysteroscopy and curettage, and yielded information beyond that available from hysteroscopy and curettage.
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Affiliation(s)
- P A Kraus
- Kirwan Hospital for Women, Townsville, Queensland, Australia
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17
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Kaku T, Yoshikawa H, Tsuda H, Sakamoto A, Fukunaga M, Kuwabara Y, Hataeg M, Kodama S, Kuzuya K, Sato S, Nishimura T, Hiura M, Nakano H, Iwasaka T, Miyazaki K, Kamura T. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 2001; 167:39-48. [PMID: 11323097 DOI: 10.1016/s0304-3835(01)00462-1] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Thirty-nine patients with endometrioid adenocarcinoma (EA) and atypical hyperplasia (AH) of the endometrium who received conservative treatment to preserve fertility were collected from member institutions of the Japan Gynecologic Oncology Study Group. Twenty-nine and ten were originally diagnosed with EA without myometrial invasion and AH, respectively. We performed a central pathological review to make definite diagnoses, and the diagnosis of EA in 29 cases was changed to AH in ten, complex hyperplasia in three and atypical polypoid adenomyoma in three, and AH in ten was changed to EA in one and simple hyperplasia in one. Nine of 12 women (75%) with EA and 15 of 18 women (83%) with AH had an initial response to medroxyprogesterone acetate (MPA) treatment. Two of nine responders with EA later developed relapse, and one of them had metastasis to the left obturator lymph node. Two became pregnant, and one delivered one full-term infant. One of the responders with AH had a relapse in the endometrium. Five became pregnant, and four delivered four normal infants. The young women with endometrial carcinoma localized in the endometrium who wish to preserve fertility may be treated as successfully with MPA as those with AH.
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Affiliation(s)
- T Kaku
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, 812-8582, Fukuoka, Japan.
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18
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Bernard JP, Rizk E, Camatte S, Robin F, Taurelle R, Lecuru F. Saline contrast sonohysterography in the preoperative assessment of benign intrauterine disorders. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 17:145-149. [PMID: 11251924 DOI: 10.1046/j.1469-0705.2001.00336.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To assess the value of saline contrast sonohysterography (SCSH) in the preoperative evaluation of benign intrauterine lesions. DESIGN Patients presenting with abnormal bleeding related to benign uterine pathologies and scheduled for surgical treatment were prospectively enrolled in a study conducted between 1 January 1996 and 31 December 1997. SCSH was first carried out with the intention of establishing further surgical management (hysterectomy or hysteroscopy). The end point of the study was to compare the surgical option ultimately carried out with the one decided after SCSH. In addition, size and location of intrauterine lesions determined by SCSH were compared with those issued from surgical records. Similarly, pathologic results were juxtaposed to SCSH diagnosis. Statistical analysis used non-parametric and correlation tests. RESULTS Two hundred and thirty-three patients were included in the study, 39.5% of whom were postmenopausal. SCSH was consistently effective in the choice of the best surgical method, because no hysterectomy was required when an operative hysteroscopy was indicated on SCSH data. Similarly, only one patient treated by hysterectomy (5.8%) could have undergone a more conservative approach. But this patient had a genital prolapse, and thus hysterectomy was a part of the treatment. SCSH correlated well with surgery for the location and size of intrauterine lesions (P < 0.001). SCSH was accurate in the diagnosis of polyps and submucous myomas (sensitivity 85.7%, specificity 95.4%). CONCLUSIONS SCSH appears an important tool for preoperative assessment of benign intrauterine pathologies. It should be used in the selection of patients that should be scheduled for an operative hysteroscopy.
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Affiliation(s)
- J P Bernard
- Service de Gynécologie-Obstétrique, Hôpital Boucicaut, Paris, France
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Chittacharoen A, Theppisai U, Linasmita V, Manonai J. Sonohysterography in the diagnosis of abnormal uterine bleeding. J Obstet Gynaecol Res 2000; 26:277-81. [PMID: 11049238 DOI: 10.1111/j.1447-0756.2000.tb01322.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the value of sonohysterography in diagnosis of patients with abnormal uterine bleeding. METHOD Fifty-five patients with abnormal uterine bleeding and transvaginal sonography suggested an abnormal endometrial echo were enrolled in the study. Sonohysterography was performed on all patients, using saline instilled through an endocervically placed catheter. The histologic or pathologic finding was evaluated after surgical procedures and compared with sonohysterography results. RESULTS Sonohysterography was successfully completed in 52 cases (94.54%). Three cases had cervical stenosis and failed to pass the catheter into the uterine cavity. Mean age was 41.56 +/- 7.82 years (range 29-58 years). Forty-six of 52 sonohysterography demonstrated intrauterine abnormalities (29 endometrial polyps, 15 submucous myomas, 2 endometrial hyperplasia). The pathologic finding demonstrated 46 intrauterine pathologic cases (28 endometrial polyps, 15 submucous myomas, 3 endometrial hyperplasia). Sonohysterography had 97.82% sensitivity, 83.33% specificity, 97.82% positive predictive value, 83.33% negative predictive value, and 96.15% accuracy. CONCLUSION Sonohysterography is a highly sensitive, specific, and accurate screening procedure for the evaluation of uterine cavity in abnormal uterine bleeding and is a simple, minimally invasive, and effective tool to use in the evaluation of patients.
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Affiliation(s)
- A Chittacharoen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Archer DF, Lobo RA, Land HF, Pickar JH. A comparative study of transvaginal uterine ultrasound and endometrial biopsy for evaluating the endometrium of postmenopausal women taking hormone replacement therapy. Menopause 1999; 6:201-8. [PMID: 10486789 DOI: 10.1097/00042192-199906030-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compare transvaginal uterine ultrasound and endometrial biopsy in evaluating the endometrium of postmenopausal women who are taking estrogen replacement therapy (ERT) or hormone replacement therapy (HRT; estrogen and progestin). DESIGN Prospective multicenter study done in the United States with 148 healthy women with an intact uterus. A total of 121 women used hormonal preparations prescribed by personal physicians. Continuous combined HRT regimens, nonoral forms of ERT or HRT, and intrauterine devices were not allowed for 3 months before the study began. Endometrial biopsy samples were taken within 3 days of transvaginal ultrasound measurement. The uterus was scanned transversely and longitudinally. Endometrial thickness was measured at the thickest part of the longitudinal plane. RESULTS Endometrial thickness ranged from 1.0 to 25.0 mm. The range in 126 women with a normal endometrium (determined by diagnoses of endometrial biopsies) was 1.0-25.0 mm (median, 5.0 mm); in 15 women with an abnormal endometrium, the range was 2.8-23.0 mm (median, 6.2 mm). A significant difference (p = 0.006) in endometrial thickness was seen between the 38 subjects taking ERT and HRT (median, 6.1 mm) with unexpected bleeding or spotting and the 26 untreated women in the control group (median, 4.0 mm). Overall, results were clinically inconclusive. CONCLUSIONS Results of ultrasound as a screening technique in postmenopausal women who were taking ERT or HRT did not correlate well with results of endometrial biopsy. Unscheduled bleeding in postmenopausal women should be investigated regardless of results of ultrasonographically determined endometrial thickness. Abnormalities may be found with an endometrial thickness of less than 4 mm with or without HRT and even with no bleeding.
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Affiliation(s)
- D F Archer
- Clinical Research Center, Eastern Virginia Medical School, Norfolk 23507-1912, USA
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Sherer DM, Schwartz BM, Otero FJ, Eisenberg C, Abulafia O. Transvaginal sonographic depiction of aborting pedunculated intracavitary uterine leiomyoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 1999; 27:405-408. [PMID: 10440790 DOI: 10.1002/(sici)1097-0096(199909)27:7<405::aid-jcu8>3.0.co;2-k] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We present an unusual case in which, following indeterminate findings on transabdominal sonographic assessment, transvaginal sonography clearly depicted an aborting pedunculated intracavitary leiomyoma within the uterine cervix. The lesion measured 4x4 cm and exhibited central cystic degenerative changes.
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Affiliation(s)
- D M Sherer
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, The Albert Einstein College of Medicine, 1825 Eastchester Road, Room 703, Bronx, New York 10461, USA
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Abstract
Office hysteroscopy has developed into an easy, safe, quick, and effective method of intrauterine evaluation that provides immediate results, offers the capacity of direct targeted biopsies of suspicious focal lesions, and offers the direct treatment of some intrauterine conditions. It has been facilitated by the availability of small-caliber endoscopes. Because of its simplicity and ease, the procedure is applicable as a screening method for patients with abnormal uterine bleeding or questionable hysterograms and for patients with suspected intrauterine pathology. Office hysteroscopy can be undertaken in a short period of time with minimal morbidity and inconvenience to the patient. It is important, nonetheless, to select the patients appropriately and time the examination strictly to the early follicular phase, once menstruation has ceased. When suction aspiration plastic cannulas are used for endometrial sampling, the combined procedure, hysteroscopy-suction sampling, offers an excellent method in the evaluation of patients with abnormal uterine bleeding. Transvaginal sonography with or without fluid enhancement complements the uterine evaluation, rather than replacing hysteroscopy, by outlining intramural uterine lesions such as myomas, adenomyosis, and other adnexal pathology not susceptible to hysteroscopic evaluation. Although some patients may not require analgesia or anesthesia for office hysteroscopy, the majority will benefit from a paracervical block or topical anesthesia, particularly if a suction endometrial aspiration will follow hysteroscopy or if any hysteroscopic intervention is performed, including a targeted biopsy. The success office hysteroscopy depends on the appropriate selection of the patient, the absence of contraindications, adequate instrumentation, and meticulous technique.
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Affiliation(s)
- R F Valle
- Northwestern University Medical School, Chicago, Illinois, USA
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Abstract
There is a need for clinical trials to evaluate the use of pelvic ultrasound in asymptomatic women before it can ever be recommended as part of a routine gynaecological examination. Gynaecologists need to acquire ultrasonic skills as part of their basic training in order to provide a proper service to their patients.
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Affiliation(s)
- M J Bennett
- School of Obstetrics and Gynaecology, University of New South Wales, Royal Hospital for Women, Sydney, Australia
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