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Kang L, Ji G, Liu D, Wang Y, Meng J, Li H. Screening of prognostic factors and survival analysis based on histological type for perimenopausal endometrial carcinoma treated with hysterectomy. Discov Oncol 2024; 15:518. [PMID: 39358650 PMCID: PMC11447193 DOI: 10.1007/s12672-024-01403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/26/2024] [Indexed: 10/04/2024] Open
Abstract
PURPOSE This study aimed to explore the prognostic factors and survival patterns based on the histological type for the perimenopausal endometrial carcinoma (PIPEC) patients treated with hysterectomy. METHODS The PIPEC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Methods of random survival forest (RSF) and Cox regression were used to identify the possible prognostic factors of PIPEC patients. Then overall survival (OS) and cancer-specific survival (CSS) of PIPEC data were analyzed by histological types with regional lymph nodes status and SEER-stage to investigate the survival patterns of the PIPEC patients. RESULTS A total of 14,178 PIPEC patients were included in the study. We found tumor size, grade, histology, SEER-stage, AJCC-stage, AJCC-T stage, metastasis to distant organs and regional lymph nodes status had a significant survival outcome for PIPEC both for OS and CSS (all p < 0.05). Regardless of regional lymph nodes status and SEER-stage for OS and CSS, the low-grade endometrioid carcinoma had the best prognosis outcome, followed by the mix cell adenocarcinoma and high-grade endometrioid carcinoma, while the carcinosarcoma and undifferentiated carcinoma had relatively poor prognosis outcome. And the survival patterns of different histological types of PIPEC were diverse and changed along with the time. CONCLUSION We identified the possible prognostic factors of PIPEC patients treated with hysterectomy. And survival analysis based on the regional lymph nodes status and SEER-stage revealed the different histological types of PIPEC had diverse survival patterns, which will be helpful for guiding clinical practice.
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Affiliation(s)
- Luyao Kang
- Department of Gynecologic Oncology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Gaili Ji
- Department of Gynecologic Oncology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Duan Liu
- Department of Gynecologic Oncology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yaping Wang
- Department of Gynecologic Oncology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Jie Meng
- Department of Gynecologic Oncology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Hongyu Li
- Department of Gynecologic Oncology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
- The Zhengzhou Key Laboratory of Gynecological Oncology, Zhengzhou, 450052, Henan, China.
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Liu D, Huang J, Zhang Y, Shen H, Wang X, Huang Z, Chen X, Qiao Z, Hu C. Multimodal MRI-based radiomics models for the preoperative prediction of lymphovascular space invasion of endometrial carcinoma. BMC Med Imaging 2024; 24:252. [PMID: 39304802 DOI: 10.1186/s12880-024-01430-1] [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: 08/05/2024] [Accepted: 09/17/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE To evaluate the predictive capabilities of MRI-based radiomics for detecting lymphovascular space invasion (LVSI) in patients diagnosed with endometrial carcinoma (EC). MATERIALS AND METHODS A retrospective analysis was conducted on 160 female patients diagnosed with EC. The radiomics model including T2-weighted and dynamic contrast-enhanced MRI (DCE-MRI) images was established. Additionally, a conventional MRI model, which incorporated MRI-reported FIGO stage, deep myometrial infiltration (DMI), adnexal involvement, and vaginal/parametrial involvement, was established. Finally, a combined model was created by integrating the radiomics signature and conventional MRI characteristics. The predictive performance was validated by the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. A stratified analysis was conducted to compare the differences between the three models by Delong test. RESULTS In predicting LVSI, the radiomics model outperformed the clinical model in the training cohort (AUC: 0.899 vs. 0.8862) but not in the test cohort (AUC: 0.812 vs. 0.8758). The combined model demonstrated superior performance in both the training and test cohorts (training cohort: AUC = 0.934, 95% CI: 0.8807-0.9873; testing cohort: AUC = 0.905, 95% CI: 0.7679-1). CONCLUSIONS The combined model exhibited utility in preoperatively predicting LVSI in patients with EC, offering potential benefits for clinical decision-making.
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Affiliation(s)
- Dong Liu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinyu Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yufeng Zhang
- Department of Radiology, Luodian Hospital, Baoshan district, Shanghai, China
| | - Hailin Shen
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medical, Suzhou, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhou Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xue Chen
- Department of Radiology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China.
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Petrila O, Nistor I, Romedea NS, Negru D, Scripcariu V. Can the ADC Value Be Used as an Imaging "Biopsy" in Endometrial Cancer? Diagnostics (Basel) 2024; 14:325. [PMID: 38337842 PMCID: PMC10855861 DOI: 10.3390/diagnostics14030325] [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: 11/27/2023] [Revised: 01/07/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The tumor histological grade is closely related to the prognosis of patients with endometrial cancer (EC). Multiparametric MRI, including diffusion-weighted imaging (DWI), provides information about the cellular density that may be useful to differentiate between benign and malignant uterine lesions. However, correlations between apparent diffusion coefficient (ADC) values and histopathological grading in endometrial cancer remain controversial. MATERIAL AND METHODS We retrospectively evaluated 92 patients with endometrial cancers, including both endometrioid adenocarcinomas (64) and non-endometrioid adenocarcinomas (28). All patients underwent DWI procedures, and mean ADC values were calculated in a region of interest. These values were then correlated with the tumor grading offered by the histopathological examination, which was considered the gold standard. In this way, the patients were divided into three groups (G1, G2, and G3). The ADC values were then compared to the results offered by the biopsy to see if the DWI sequence and ADC map could replace this procedure. We also compared the mean ADC values to the myometrial invasion (>50%) and lymphovascular space invasion. RESULTS We have divided the ADC values into three categories corresponding to three grades: >0.850 × 10-3 mm2/s (ADC1), 0.730-0.849 × 10-3 mm2/s (ADC2) and <0.730 × 10-3 mm2/s (ADC3). The diagnostic accuracy of the ADC value was 85.71% for ADC1, 75.76% for ADC2, and 91.66% for ADC3. In 77 cases out of 92, the category in which they were placed using the ADC value corresponded to the result offered by the histopathological exam with an accuracy of 83.69%. For only 56.52% of patients, the biopsy result included the grading system. For each grading category, the mean ADC value showed better results than the biopsy; for G1 patients, the mean ADC value had an accuracy of 85.71% compared to 66.66% in the biopsy, G2 had 75.76% compared to 68.42%, and G3 had 91.66 compared to 75%. For both deep myometrial invasion and lymphovascular space invasion, there is a close, inversely proportional correlation with the mean ADC value. CONCLUSIONS Mean endometrial tumor ADC on MR-DWI is inversely related to the histological grade, deep myometrial invasion and lymphovascular space invasion. Using this method, the patients could be better divided into risk categories for personalized treatment.
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Affiliation(s)
- Octavia Petrila
- Faculty of General Medicine, The University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (V.S.)
- Department of Radiology, “Dr. C.I. Parhon” Clinical Hospital, 700503 Iasi, Romania
| | - Ionut Nistor
- Faculty of General Medicine, The University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (V.S.)
- Department of Nephrology, “Dr. C.I. Parhon” Clinical Hospital, 700503 Iasi, Romania
| | - Narcis Sandy Romedea
- Department of Surgery, “Dr. Iacob Czihac” Clinical Emergency Hospital, 700506 Iasi, Romania;
| | | | - Viorel Scripcariu
- Faculty of General Medicine, The University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania (V.S.)
- Department of Surgery, Regional Oncology Institute, 700483 Iasi, Romania
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Yan B, Jia Y, Li Z, Ding C, Lu J, Liu J, Zhang Y. Preoperative prediction of lymphovascular space invasion in endometrioid adenocarcinoma: an MRI-based radiomics nomogram with consideration of the peritumoral region. Acta Radiol 2023; 64:2636-2645. [PMID: 37312525 DOI: 10.1177/02841851231181681] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lymphovascular space invasion (LVSI) of endometrial cancer (EC) is a postoperative histological index, which is associated with lymph node metastases. A preoperative acknowledgement of LVSI status might aid in treatment decision-making. PURPOSE To explore the utility of multiparameter magnetic resonance imaging (MRI) and radiomic features obtained from intratumoral and peritumoral regions for predicting LVSI in endometrioid adenocarcinoma (EEA). MATERIAL AND METHODS A total of 334 EEA tumors were retrospectively analyzed. Axial T2-weighted (T2W) imaging and apparent diffusion coefficient (ADC) mapping were conducted. Intratumoral and peritumoral regions were manually annotated as the volumes of interest (VOIs). A support vector machine was applied to train the prediction models. Multivariate logistic regression analysis was used to develop a nomogram based on clinical and tumor morphological parameters and the radiomics score (RadScore). The predictive performance of the nomogram was assessed by the area under the receiver operator characteristic curve (AUC) in the training and validation cohorts. RESULTS Among the features obtained from different imaging modalities (T2W imaging and ADC mapping) and VOIs, the RadScore had the best performance in predicting LVSI classification (AUCtrain = 0.919, and AUCvalidation = 0.902). The nomogram based on age, CA125, maximum anteroposterior tumor diameter on sagittal T2W images, tumor area ratio, and RadScore was established to predict LVSI had AUC values in the training and validation cohorts of 0.962 (sensitivity 94.0%, specificity 86.0%) and 0.965 (sensitivity 90.0%, specificity 85.3%), respectively. CONCLUSION The intratumoral and peritumoral imaging features were complementary, and the MRI-based radiomics nomogram might serve as a non-invasive biomarker to preoperatively predict LVSI in patients with EEA.
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Affiliation(s)
- Bin Yan
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
- Department of Radiology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Yuxia Jia
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, PR China
| | - Zhihao Li
- GE Healthcare China, Xi'an, Shaanxi, PR China
| | - Caixia Ding
- Department of Pathology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Jianrong Lu
- Department of Pathology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, PR China
| | - Yuchen Zhang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, PR China
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5
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Zheng T, Pan J, Du D, Liang X, Yi H, Du J, Wu S, Liu L, Shi G. Preoperative assessment of high-grade endometrial cancer using a radiomic signature and clinical indicators. Future Oncol 2023; 19:587-601. [PMID: 37097730 DOI: 10.2217/fon-2022-0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Aim: To develop and validate a radiomics-based combined model (ModelRC) to predict the pathological grade of endometrial cancer. Methods: A total of 403 endometrial cancer patients from two independent centers were enrolled as training, internal validation and external validation sets. Radiomic features were extracted from T2-weighted images, apparent diffusion coefficient map and contrast-enhanced 3D volumetric interpolated breath-hold examination images. Results: Compared with the clinical model and radiomics model, ModelRC showed superior performance; the areas under the receiver operating characteristic curves were 0.920 (95% CI: 0.864-0.962), 0.882 (95% CI: 0.779-0.955) and 0.881 (95% CI: 0.815-0.939) for the training, internal validation and external validation sets, respectively. Conclusion: ModelRC, which incorporated clinical and radiomic features, exhibited excellent performance in the prediction of high-grade endometrial cancer.
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Affiliation(s)
- Tao Zheng
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, PR China
| | - Jiangyang Pan
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, PR China
| | - Dan Du
- Department of Medical Imaging Center, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, PR China
| | - Xin Liang
- Department of Medical Imaging Center, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, PR China
| | - Huiling Yi
- Department of Medical Imaging Center, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, PR China
| | - Juan Du
- Department of Medical Imaging Center, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, PR China
| | - Shuo Wu
- Department of Medical Imaging Center, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, PR China
| | - Lanxiang Liu
- Department of Medical Imaging Center, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, PR China
| | - Gaofeng Shi
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, PR China
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Abu-Rustum N, Yashar C, Arend R, Barber E, Bradley K, Brooks R, Campos SM, Chino J, Chon HS, Chu C, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Giuntoli R, Han E, Holmes J, Howitt BE, Lea J, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Podoll M, Salani R, Schorge J, Siedel J, Sisodia R, Soliman P, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian NR, Aggarwal S. Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:181-209. [PMID: 36791750 DOI: 10.6004/jnccn.2023.0006] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Adenocarcinoma of the endometrium (also known as endometrial cancer, or more broadly as uterine cancer or carcinoma of the uterine corpus) is the most common malignancy of the female genital tract in the United States. It is estimated that 65,950 new uterine cancer cases will have occurred in 2022, with 12,550 deaths resulting from the disease. Endometrial carcinoma includes pure endometrioid cancer and carcinomas with high-risk endometrial histology (including uterine serous carcinoma, clear cell carcinoma, carcinosarcoma [also known as malignant mixed Müllerian tumor], and undifferentiated/dedifferentiated carcinoma). Stromal or mesenchymal sarcomas are uncommon subtypes accounting for approximately 3% of all uterine cancers. This selection from the NCCN Guidelines for Uterine Neoplasms focuses on the diagnosis, staging, and management of pure endometrioid carcinoma. The complete version of the NCCN Guidelines for Uterine Neoplasms is available online at NCCN.org.
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Affiliation(s)
| | | | | | - Emma Barber
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Susana M Campos
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | | | | | | | | | | | | | | | | | - Jordan Holmes
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Larissa Nekhlyudov
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | - John Schorge
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Rachel Sisodia
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | - Kristine Zanotti
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Akış S, Öztürk UK, Keleş E, Alınca CM, Api M, Kabaca C. The percentage of peripheral eosinophils as a sensitive marker for differentiating FIGO grade in endometrial adenocarcinomas. J Turk Ger Gynecol Assoc 2022; 23:99-105. [PMID: 35263838 PMCID: PMC9161002 DOI: 10.4274/jtgga.galenos.2022.2021-9-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Studies on eosinophils have mostly been directed to parasitic infections and allergic diseases, but the role of eosinophils in oncology has been largely ignored. Eosinophils are an important modulator of the immune response and components of the inflammatory process against the tumor. This study was performed to investigate the pre-operative peripheral blood eosinophil percentages in patients with a histopathologically diagnosed pure endometrioid type endometrial carcinoma. Material and Methods: Patients’ data were analyzed in two groups as present/absent according to whether there are tumor metastases in the adnexes, lymph nodes, cervical stroma, and whether there was lymphovascular space invasion. FIGO grade was taken as the basis of the tumor grade: Low-grade equated to grade 1 or 2, and high-grade equated to grade 3. The requirement for lymph node dissection was based on the Mayo criteria. Results: The data of a total of 268 patients were included. The mean percentage of eosinophils in high-grade patients (n=29) was 2.75±0.35, and was significantly higher than the mean percentage of eosinophils of found in low-grade patients (n=239), which was 1.79±0.09 (p=0.013). Receiver operator curve analysis showed that a cut-off eosinophil percentage of 1.95% resulted in a sensitivity of 62% and specificity of 67% (p=0.004). Conclusion: Eosinophil percentages, which are a simple, easily accessible, and inexpensive can be an important pre-operative predictive tool. Eosinophil percentages can be used in determining the need for surgical staging in endometrial cancer.
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Jain K, Kakkar C, Gupta K, Narang V, Singh A, Saggar K, Bansal N, Cioni D, Neri E. Diagnostic accuracy of calculated tumor volumes and apparent diffusion coefficient values in predicting endometrial cancer grade. Int J Appl Basic Med Res 2022; 12:37-42. [PMID: 35265479 PMCID: PMC8848552 DOI: 10.4103/ijabmr.ijabmr_553_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Magnetic resonance imaging (MRI) has been shown to be an accurate imaging technique for the preoperative assessment of local staging of endometrial cancer and for evaluating the depth of myometrial invasion. Materials and Methods: This was a single-center retrospective study performed on patients with histopathologically proven endometrial carcinoma who underwent an MRI examination of the pelvis between October 2017 and May 2020. Results: In the present analysis, mean apparent diffusion coefficient (ADC) values for each histologic grade were 0.72 ± 0.13 × 10−3 mm2/s (G1), 0.76 ± 0.17 × 10−3 mm2/s (G2), and 0.74 ± 0.12 × 10−3 mm2/s (G3), respectively, showing no significant correlation between ADC values and tumor grade (P = 0.73). Overall, ADC minimum was significant in differentiating grades of endometrial carcinoma (P = 0.02) with the ability to differentiate Grade I and II lesions (P = 0.01). A mean tumor volume of 25.2 cc could differentiate low-grade tumors (Grade I and Grade II) from high-grade tumors (Grade III) with a sensitivity and specificity of 88% and specificity of 89%. The tumor volume/uterine volume ratio (TV/UV) differentiates high-grade tumors from low-grade tumors (P < 0.001), however, no significant difference in the ratio was observed among Grade I and II lesions (P = 0.48). The area under the curve of tumor volume was 0.875 (95% confidence interval 0.0–1.00) (P = 0.001), indicating that tumor volume was an effective tool for distinguishing high-grade and low-grade endometrioid adenocarcinomas. The corresponding sensitivity and specificity were 88.0% and 89.0%, respectively. Conclusion: Preoperative noninvasive radiological assessment for tumor volume, TV/ UV or tumor volume/uterine volume is important surrogate markers for preoperative prognostication of endometrial carcinoma.
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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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10
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Lukanović D, Matjašič M, Kobal B. Accuracy of preoperative sampling diagnosis for predicting final pathology in patients with endometrial carcinoma: a review. Transl Cancer Res 2020; 9:7785-7796. [PMID: 35117381 PMCID: PMC8798103 DOI: 10.21037/tcr-20-2228] [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: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
Endometrial cancer (EC) is the most common gynecologic cancer. The most frequent symptom of this disease is postmenopausal bleeding. Diagnosis of EC must be histologically confirmed, and there are several methods for endometrial sampling to obtain cells or endometrial tissue. The first step in diagnosis should be ultrasound measurement of endometrial thickness, followed by endometrial sampling, which can be performed by office endometrial biopsy, hysteroscopic biopsy, or dilatation and curettage (D&C). The review in this article was carried out to present previously published studies, comprehensively evaluate method performance (i.e., overall accuracy of preoperative sampling in patients with endometrial carcinoma, and overall agreement on grade and histological subtype between preoperative endometrial sampling and final diagnosis), and determine which sampling method is most accurate on the basis of the statistical data in the studies analyzed. From the literature analyzed and examined, it can be concluded that preoperative endometrial sampling is not always the best predictor of final histology in EC and has its limitations. In surgical decisions based only on preoperative sampling, a biopsy should be made with caution, and it is necessary to take other parameters into account. Inadequate grading leads to suboptimal clinical management, mainly in early-stage tumors. This review showed that, although hysteroscopic biopsy was mainly associated with the highest tumor grade agreement, and although D&C showed the highest overall accuracy in detecting endometrial carcinoma, the data do not therefore reliably indicate which method yields the most precise results. The results of this review indicate that further studies on larger samples and with greater statistical power are needed to accurately define the role and type of preoperative sampling methods.
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Affiliation(s)
- David Lukanović
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Matjašič
- Center for Social Informatics, Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Kobal
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Center, Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Ramanathan S, Tirumani SH, Ojili V. Nodal metastasis in gynecologic malignancies: Update on imaging and management. Clin Imaging 2020; 59:157-166. [DOI: 10.1016/j.clinimag.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/25/2019] [Accepted: 11/14/2019] [Indexed: 01/18/2023]
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12
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Seagle BLL, Kocherginsky M, Shahabi S. Association of Pelvic and Para-Aortic Lymphadenectomy With Survival in Stage I Endometrioid Endometrial Cancer: Matched Cohort Analyses From the National Cancer Database. JCO Clin Cancer Inform 2019; 1:1-14. [PMID: 30657385 DOI: 10.1200/cci.17.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To estimate whether pelvic and para-aortic lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer. METHODS We performed matched cohort analyses of women with stage I endometrioid endometrial cancer who underwent hysterectomy with no lymphadenectomy, pelvic lymphadenectomy, or combined pelvic and para-aortic lymphadenectomy. Cox proportional hazards survival analyses were performed with inverse probability weights. Hazard ratios (HRs) were covariate and propensity score adjusted. Covariates included cancer center type, age, race, Hispanic ethnicity, insurance type, community median income quartile, comorbidity score, history of prior cancer, depth of myometrial invasion, tumor grade, tumor size, lymphovascular space invasion, cytology status, surgical margin status, hospital volume, and use of adjuvant radiotherapy or chemotherapy. Additional analyses included subset analyses by grade, sensitivity analyses with imputation of missing data, and testing for sensitivity to possible unmeasured confounding. RESULTS Median (interquartile range [IQR]) lymph node counts were 0, 10 (5-15), and 20 (15-27) nodes in the no lymphadenectomy, pelvic, and combined pelvic and para-aortic lymphadenectomy-matched cohorts, respectively. Matched cohorts were well balanced. Two analyses were performed: no lymphadenectomy (n = 7,487) versus pelvic lymphadenectomy (n = 7,487), and pelvic lymphadenectomy (n = 7,060) versus combined pelvic and para-aortic lymphadenectomy (n = 7,060). Performance of pelvic lymphadenectomy was associated with increased survival compared with no lymphadenectomy (5-year survival [95% CI], 91.4% [90.2% to 92.6%] v 87.3% [85.9% to 88.8%]; HR, 0.71 [95% CI, 0.64 to 0.78]; P < .001). Addition of para-aortic lymphadenectomy was associated with increased survival compared with pelvic lymphadenectomy alone (5-year survival [95% CI], 91.0% [89.8% to 92.2%] v 89.8% [88.4% to 91.1%]; HR, 0.85 [95% CI, 0.77 to 0.95]; P = .003). Associations were robust to sensitivity analyses. CONCLUSION Lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer. An adequately powered randomized trial is needed.
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Affiliation(s)
| | - Masha Kocherginsky
- All authors: Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shohreh Shahabi
- All authors: Northwestern University Feinberg School of Medicine, Chicago, IL
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Yue W, Meng N, Wang J, Liu W, Wang X, Yan M, Han D, Cheng J. Comparative analysis of the value of diffusion kurtosis imaging and diffusion-weighted imaging in evaluating the histological features of endometrial cancer. Cancer Imaging 2019; 19:9. [PMID: 30764876 PMCID: PMC6376714 DOI: 10.1186/s40644-019-0196-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/07/2019] [Indexed: 01/02/2023] Open
Abstract
Purpose This study evaluated and compared the performances of diffusion kurtosis imaging (DKI) and diffusion-weighted imaging (DWI) for diagnosing and histologically grading endometrial cancer. Materials and methods In this retrospective study, DKI and DWI data for 61 patients with endometrial cancer and 30 patients with a normal endometrium were analyzed, and the mean kurtosis (MK), mean diffusion coefficient (MD) and apparent diffusion coefficient (ADC) values for the endometrial cancer tissue and normal endometrial tissue were acquired. The parameters for the normal endometrium group (G0) and the endometrial cancer groups (G1, G2 and G3) were compared and analyzed. The receiver operating characteristic (ROC) curve was used to evaluate each parameter’s diagnostic accuracy and threshold. Spearman correlation analysis was used to analyze the correlations between all parameters and histological grades. Results The MK values for the G0, G1, G2 and G3 groups increased gradually, while the MD and ADC values decreased gradually. Except for the differences in the ADC values between G0 and G1, the differences among the groups were statistically significant (P < 0.05). The MK values had the highest diagnostic accuracy in differentiating G0 and (G1 + G2 + G3), G0 and G1, G1 and G2, and G2 and G3 (AUC = 0.93, 0.76, 0.91, 0.91, P < 0.05). MK was maximally correlated with histological grade, followed by MD and ADC (MK > MD > ADC; r = − 0.85, + 0.82, + 0.76, P < 0.01). Conclusion Both DKI and DWI can be used to evaluate the diagnosis and histological grading of endometrial cancer. Compared with DWI, the DKI model is a more complete mathematical model with more sensitive parameters, which can more effectively evaluate the pathological and physiological characteristics of endometrial cancer.
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Affiliation(s)
- Wei Yue
- Department of MRI, The First Affiliated Hospital, Zhengzhou University, 1 Janshe East Road, Zhengzhou, 450000, People's Republic of China
| | - Nan Meng
- Department of MRI, The First Affiliated Hospital, Xinxiang Medical University, 88 Jiankang Road, Weihui, 453100, People's Republic of China
| | - Jing Wang
- Department of MRI, The First Affiliated Hospital, Xinxiang Medical University, 88 Jiankang Road, Weihui, 453100, People's Republic of China
| | - Wenling Liu
- Department of MRI, The First Affiliated Hospital, Xinxiang Medical University, 88 Jiankang Road, Weihui, 453100, People's Republic of China
| | - Xuejia Wang
- Department of MRI, The First Affiliated Hospital, Xinxiang Medical University, 88 Jiankang Road, Weihui, 453100, People's Republic of China
| | - Minghuan Yan
- Department of MRI, The First Affiliated Hospital, Xinxiang Medical University, 88 Jiankang Road, Weihui, 453100, People's Republic of China
| | - Dongming Han
- Department of MRI, The First Affiliated Hospital, Xinxiang Medical University, 88 Jiankang Road, Weihui, 453100, People's Republic of China
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital, Zhengzhou University, 1 Janshe East Road, Zhengzhou, 450000, People's Republic of China.
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Nardone V, Tini P, Marciello L, Battaglia G, Pastina P, Crociani M, Cancemi C, Vannini M, Sebaste L, Pirtoli L. Role of the Appropriateness of the Pelvic Lymphadenectomy and Adjuvant Radiation Therapy in Early-Stage Poorly Differentiated Endometrial Carcinoma. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tumor Grade Correlation Between Preoperative Biopsy and Final Surgical Specimen in Endometrial Cancer: The Use of Different Diagnostic Methods and Analysis of Associated Factors. Int J Gynecol Cancer 2018; 28:1258-1263. [DOI: 10.1097/igc.0000000000001304] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
ObjectiveThis study aimed to identify the correlation between histology tumor grade of the preoperative biopsy using dilatation and curettage (D&C), Pipelle, or hysteroscopy and final surgical specimen in women with endometrioid endometrial cancer.Materials and MethodsPatients on whom a preoperative biopsy was performed between 2009 and 2016 were reviewed and cases with apparent early-stage endometrioid endometrial cancer were included in the study. The accuracy of preoperative biopsy performed before hysterectomy using D&C, Pipelle, or hysteroscopy was compared.ResultsA total of 332 patients were included. The diagnostic method was D&C in 43 cases (13%), Pipelle in 102 (31%), and hysteroscopy in 187 (56%). The preoperative diagnosis included G1 tumors in 177 cases (53.3%), G2 in 103 (31%), and G3 in 52 (15.6%). The surgical specimen confirmed endometrioid endometrial tumor in 309 patients (93%).The accuracy rates of preoperative biopsy and surgical specimen were 74.69%, 73.19%, and 89.75% for G1, G2, and G3, respectively. Hysteroscopy showed better κ index (κ = 0.551) than did D&C (κ = 0.392) and Pipelle (κ = 0.430). Tumor diameter greater than 30 mm was the only factor independently associated with absence of correlation between preoperative and postoperative tumor grade (odds ratio [95% confidence interval], 1.959 [1.096–3.504], P = 0.023).ConclusionsPreoperative biopsy, regardless of the method, has its limitations in predicting the tumor grade compared with final surgical specimen in women with endometrioid endometrial cancer at an apparent early stage. Concordance between the biopsy and hysterectomy specimen is less likely to happen in the case of preoperative G1 or G2 tumors, as well as in big tumors. Although hysteroscopy was associated with the highest tumor grade agreement, no differences in correlation between the 3 methods (D&C, Pipelle, and hysteroscopy) were found.
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Touhami O, Grégoire J, Renaud MC, Sebastianelli A, Grondin K, Plante M. The utility of sentinel lymph node mapping in the management of endometrial atypical hyperplasia. Gynecol Oncol 2017; 148:485-490. [PMID: 29290489 DOI: 10.1016/j.ygyno.2017.12.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the risk of endometrial cancer (EC) and lymph node involvement in patients with a preoperative diagnosis of "AH-only" versus "AH - cannot rule out carcinoma" and to study the value of SLN mapping. METHODS We reviewed all patients with a preoperative diagnosis of atypical hyperplasia, who underwent primary surgery with SLN mapping followed by pelvic lymphadenectomy. Sensitivity and negative predictive value (NPV) of SLN and rates of endometrial cancer were calculated. RESULTS Overall, 64/120 (53.3%) patients were found to have EC on final pathology: 58 stage IA, 3 IB, and 3 IIIC1. In patients with preoperative diagnosis of "AH", 44.3% (31/70) had EC on final pathology compared to 66% (33/50) in patients with "AH - cannot rule out cancer" (p=0.02). Overall, 3.3% of the patients (4/120) had lymph node involvement. In patients with EC with a pre-operative diagnosis of "AH", none had lymph node metastasis (0/31), compared to 12.1% (4/33) in patients with "AH - cannot rule out cancer" (p=0.06). Elevated preoperative CA125 levels (>25U/mL) were statistically associated with the risk of lymph node metastasis on final pathology (p=0.024). Unilateral and bilateral SLN detection occurred in 93.7% and 78.1% respectively. In patients with EC and bilateral SLN mapping, sensitivity and NPV were respectively 66.6% and 97.9%. There was one false negative (ITCs in non-SLN). CONCLUSION Our data indicate that the risk of lymph node involvement in patients with a preoperative diagnosis of "AH-only" is null. Lymph node assessment could be omitted in those patients. Conversely this risk is significant in patients with "AH - cannot rule out cancer". SLN mapping could be a valuable staging procedure in these patients.
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Affiliation(s)
- Omar Touhami
- 'C' Department of Obstetrics and Gynecology, Tunis Maternity and Neonatology Center, El Manar University, Tunis City, Tunisia
| | - Jean Grégoire
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie-Claude Renaud
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Alexandra Sebastianelli
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Katherine Grondin
- Pathology Department, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie Plante
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
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Bartosch C, Pires M, Jerónimo C, Lopes JM. The role of pathology in the management of patients with endometrial carcinoma. Future Oncol 2017; 13:1003-1020. [PMID: 28481146 DOI: 10.2217/fon-2016-0570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pathology plays a critical role in every step in the management of endometrial carcinoma patients. In this review, we describe the state of the art of pathological examination, including examination of endometrium biopsy; intra-operative evaluation with gross examination and frozen section; and grossing of hysterectomy specimen and its histological and immunohistochemistry study. The main pathologic findings in each step are described, as well as limitations and difficulties that may ensue. We highlight the important pathologic parameters that determine treatment options and prognosis of endometrial cancer patients.
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Affiliation(s)
- Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal.,Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Cancer Biology & Epigenetics Group, Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (PCCC), Porto, Portugal
| | - Mónica Pires
- Porto Comprehensive Cancer Center (PCCC), Porto, Portugal.,Department of Gynecology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Carmen Jerónimo
- Cancer Biology & Epigenetics Group, Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (PCCC), Porto, Portugal.,Department of Pathology & Molecular Immunology, Institute of Biomedical Sciences Abel Salazar-ICBAS, University of Porto, Porto, Portugal
| | - José Manuel Lopes
- Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto, Portugal.,Department of Pathology, Centro Hospitalar de São João, Porto, Portugal.,IPATIMUP (Institute of Molecular Pathology & Immunology, University of Porto) & I3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal
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Chen T, Li Y, Lu SS, Zhang YD, Wang XN, Luo CY, Shi HB. Quantitative evaluation of diffusion-kurtosis imaging for grading endometrial carcinoma: a comparative study with diffusion-weighted imaging. Clin Radiol 2017; 72:995.e11-995.e20. [DOI: 10.1016/j.crad.2017.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023]
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Taşkın S, Kan Ö, Dai Ö, Taşkın EA, Koyuncu K, Alkılıç A, Güngör M, Ortaç F. Lymph node dissection in atypical endometrial hyperplasia. J Turk Ger Gynecol Assoc 2017; 18:127-132. [PMID: 28890426 PMCID: PMC5590208 DOI: 10.4274/jtgga.2017.0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: The rate of concomitant endometrial carcinoma in patients with atypical endometrial hyperplasia is high. We aimed to investigate the role of lymphadenectomy in deciding adjuvant treatment in patients with concomitant atypical endometrial hyperplasia and endometrial carcinoma. Material and Methods: Women with atypical endometrial hyperplasia were enrolled in this retrospective study. Lymph node dissection was performed in only some patients who gave informed consent if their surgeon elected to do so, or if the intraoperative findings necessitated. The final histopathologic evaluations of surgical specimens were compared with endometrial biopsy results. Results: Eighty eligible patients were evaluated. Seventy-two (90%) patients had complex hyperplasia with atypia, and 8 (10%) patients had simple hyperplasia with atypia. Hysterectomy and bilateral salpingo-oophorectomy were performed to all patients; 37 also underwent lymph node dissection. Lymph node dissection was extended to the paraaortic region in 9 of 37 patients. The concomitant endometrial carcinoma rate was 50%. Two patients had lymph node metastasis. Among 40 cases of carcinoma, 17 had deep myometrial invasion and/or cervical or ovarian involvement or grade 2 tumors with superficial myometrial invasion on hysterectomy specimens; 27.5% of all carcinomas were stage Ib or higher. Conclusion: The concomitant endometrial carcinoma rate was high in patients with atypical endometrial hyperplasia. Nearly half of these patients had risk factors for extrauterine spread. Lymph node dissection might be helpful to decide adjuvant treatment.
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Affiliation(s)
- Salih Taşkın
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Özgür Kan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Ömer Dai
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif A Taşkın
- Department of Obstetrics and Gynecology, Losante Hospital, Ankara, Turkey
| | - Kazibe Koyuncu
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Ayşegül Alkılıç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Mete Güngör
- Department of Obstetrics and Gynecology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Fırat Ortaç
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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Histopathology Discrepancy of Preoperative Endometrial Sampling and Final Specimen: How Does This Influence Selective Lymph Node Dissection? Int J Gynecol Cancer 2017; 27:297-301. [DOI: 10.1097/igc.0000000000000866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
ObjectivePreoperative histology is a major component in the perioperative selective lymph node (LN) dissection decision process. Discrepancy between preoperative endometrial sampling and final specimen histopathology is generally accepted. The goals of this project are to determine if discrepancy of histopathology is associated with alteration of adjuvant treatment or outcome.Materials and MethodsWe performed a retrospective cross-sectional analysis of all patients undergoing surgery for endometrial cancer at a single institution from 2010 to 2014. All patients had preoperative endometrial sampling. Histopathology discrepancy was evaluated for potential in variation of perioperative LN dissection. Criteria for not performing LN dissection was defined as preoperative endometrioid histology, grade 1 or 2 lesion, myometrial invasion of 50% or less, and primary tumor diameter 2 cm or less.ResultsA total of 352 patients were identified; 44 were excluded because of no preoperative pathology or no residual disease on final pathology. Discrepancy of histopathology was noted in 64/308 (20.8%; 95% confidence interval [CI], 16.2%–25.3%) patients. Preoperative endometrioid histology was noted in 272 patients, and 17/272 (6.3%; 95% CI, 3.4%–9.1%) had preoperative sampling reviewed as a grade 1 or 2 endometrioid lesion and final specimen was upgraded to grade 3. Downstaging occurred in 3/272 (1.1%; 95% CI, 0%–2.3%) patients with preoperative grade 3 lesion and final specimen demonstrated grade 1 or 2 disease. All 3 patients' primary tumor diameter was greater than 2 cm and therefore received LN dissection. Histopathological discrepancy that would alter perioperative LN dissection decision based on the aforementioned criteria occurred in 2/272 (0.7%; 95% CI, 0%–1.8%).ConclusionsDespite a 20% discrepancy of preoperative and postoperative histopathology, discrepancy that would alter a perioperative decision for LN dissection occurs in only 0.7% of cases in this retrospective single-institutional experience. Myometrial invasion and tumor size may be more influential than histology in LN selection criteria.
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Cetinkaya K, Atalay F, Bacinoglu A. Risk factors of lymph node metastases with endometrial carcinoma. Asian Pac J Cancer Prev 2017; 15:6353-6. [PMID: 25124624 DOI: 10.7314/apjcp.2014.15.15.6353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate and evaluate risk factors for lymph node metastases (LNM) in cases of endometrial cancer (EC). MATERIALS AND METHODS A retrospective single institution analysis of patients surgically staged for EC at Ankara Oncology Education and Research Hospital from 1996 to 2010 was performed. Roles of prognostic factors, such as age, histological type, grade, depth of myometrial invasion, cervical involvement, peritoneal cytology, and tumor size, in the prediction of LNM were evaluated. Fisher's exact test and logistic regression analysis were used to assess the effects of various factors on LNM. RESULTS LNM was observed in 22 out of 247 patients (8.9%) and was significantly more common in the presence of tumors of higher grade, deep myometrial invasion (DMI), cervical involvement, size>2 cm, and with positive peritoneal cytology. Logistic regression analysis revealed that DMI remained the only independent risk factor for LNM. NPV, PPV, sensitivity, and specificity for satisfying LNM risk were 98.0, 19.5, 86.3, and 65.3%, respectively for DMI. CONCLUSIONS The incidence of LNM is influenced independently by DMI. If data support a conclusion of DMI, LND should be seriously considered.
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Affiliation(s)
- Kadir Cetinkaya
- Department of Obstetrics and Gynecology, Ankara Oncology Education and Research Hospital, Ankara, Turkey E-mail :
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Giede C, Le T, Power P. Rôle de la chirurgie en matière de cancer de l'endomètre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S197-S207. [PMID: 28063535 DOI: 10.1016/j.jogc.2016.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Endometrioid Endometrial Cancer: Concordance Between Preoperative and Final Surgical Histopathology. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0090-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Miller DS. Patients with endometrial cancer at risk for lymphatic metastasis should undergo pelvic and periaortic lymphadenectomy as part of their initial surgery. Cancer 2016; 123:192-196. [PMID: 28067950 DOI: 10.1002/cncr.30418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 11/11/2022]
Affiliation(s)
- David Scott Miller
- Division of Gynecologic Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Laloglu E, Kumtepe Y, Aksoy H, Topdagi Yilmaz EP. Serum endocan levels in endometrial and ovarian cancers. J Clin Lab Anal 2016; 31. [PMID: 27734523 DOI: 10.1002/jcla.22079] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/01/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Ovarian and endometrial carcinomas are the two most common malignancies of the female reproductive system. Endocan is a proteoglycan that is specific to vascular endothelial cells. Increased serum levels have been reported in some tumors. The aim of this study was to investigate serum endocan levels in cases of endometrial and ovarian cancer. METHODS Levels of serum endocan were assessed in 27 patients with endometrial cancer and 20 with ovarian cancer, and in 38 control subjects with benign ovarian or endometrial disorders. Thirty-five healthy subjects were also included. Serum endocan levels were measured using a specific enzyme-linked immunosorbent assay. Serum CA-125 levels were also measured in the patient and control groups. RESULTS All patients had detectable serum endocan levels among endometrial and ovarian cancer groups except six cases. However, in the benign and healthy control groups, all endocan levels were undetectable except for two cases in the benign group and three in the healthy control group. Serum endocan levels were significantly higher in the entire patient group than in the controls (P<.0001 for both). Serum endocan levels in cases of endometrial cancer and ovarian cancer were higher than in both the control groups (P<.0001 for both). Evaluation of all groups revealed a positive correlation between serum CA-125 and endocan levels (r=.43, P<.0001). CONCLUSION Although benign ovarian or endometrial disorders do not lead to expression of endocan, malignant cases can result in measurable endocan levels. This may be useful in differentiating benign and malign diseases of the endometrium or ovary.
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Affiliation(s)
- Esra Laloglu
- Department of Biochemistry, Medical School of Atatürk University, Erzurum, Turkey
| | - Yakup Kumtepe
- Department of Obstetrics and Gynecology, Medical School of Atatürk University, Erzurum, Turkey
| | - Hulya Aksoy
- Department of Biochemistry, Medical School of Atatürk University, Erzurum, Turkey
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Molecular classification of endometrial carcinoma on diagnostic specimens is highly concordant with final hysterectomy: Earlier prognostic information to guide treatment. Gynecol Oncol 2016; 143:46-53. [PMID: 27421752 DOI: 10.1016/j.ygyno.2016.07.090] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/30/2016] [Accepted: 07/06/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Categorization and risk stratification of endometrial carcinomas is inadequate; histomorphologic assessment shows considerable interobserver variability, and risk of metastases and recurrence can only be derived after surgical staging. We have developed a Proactive Molecular Risk classification tool for Endometrial cancers (ProMisE) that identifies four distinct prognostic subgroups. Our objective was to assess whether molecular classification could be performed on diagnostic endometrial specimens obtained prior to surgical staging and its concordance with molecular classification performed on the subsequent hysterectomy specimen. METHODS Sequencing of tumors for exonuclease domain mutations (EDMs) in POLE and immunohistochemistry for mismatch repair (MMR) proteins and p53 were applied to both pre- and post-staging archival specimens from 60 individuals to identify four molecular subgroups: MMR-D, POLE EDM, p53 wild type, p53 abn (abnormal). Three gynecologic subspecialty pathologists assigned histotype and grade to a subset of samples. Concordance of molecular and clinicopathologic subgroup assignments were determined, comparing biopsy/curetting to hysterectomy specimens. RESULTS Complete molecular and pathologic categorization was achieved in 57 cases. Concordance metrics for pre- vs. post-staging endometrial samples categorized by ProMisE were highly favorable; average per ProMisE class sensitivity(0.9), specificity(0.96), PPV(0.9), NPV(0.96) and kappa statistic 0.86(95%CI, 0.72-0.93), indicating excellent agreement. We observed the highest level of concordance for 'p53 abn' tumors, the group associated with the worst prognosis. In contrast, grade and histotype assignment from original pathology reports pre- vs. post-staging showed only moderate levels of agreement (kappa=0.55 and 0.44 respectively); even with subspecialty pathology review only moderate levels of agreement were observed. CONCLUSION Molecular classification can be achieved on diagnostic endometrial samples and accurately predicts the molecular features in the final hysterectomy specimens, demonstrating concordance superior to grade and histotype. This biologically relevant information, available at initial diagnosis, has the potential to inform management (surgery, adjuvant therapy) from the earliest time point in cancer care.
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Temkin SM, Tanner EJ, Dewdney SB, Minasian LM. Reducing Overtreatment in Gynecologic Oncology: The Case for Less in Endometrial and Ovarian Cancer. Front Oncol 2016; 6:118. [PMID: 27242958 PMCID: PMC4860790 DOI: 10.3389/fonc.2016.00118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023] Open
Abstract
A growing awareness of the harms of overtreatment in cancer care has reached physicians, patients, health policy makers, and medical researchers. Overtreatment exposes patients to the risk of adverse events from procedures or medications that were not necessary. This review examines common practices in gynecologic malignancies that are unlikely to produce direct benefit to patients with these malignancies, but are likely to produce harms. Specifically, we will explore the utility of lymphadenectomy and adjuvant radiation for women with early-stage endometrial cancer; and screening for recurrence and continuous chemotherapy for advanced-stage ovarian cancer patients.
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Affiliation(s)
- Sarah M Temkin
- The Division of Cancer Prevention, The National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
| | - Edward J Tanner
- The Kelly Gynecologic Oncology Service, Johns Hopkins School of Medicine , Baltimore, MD , USA
| | - Summer B Dewdney
- Division of Gynecologic Oncology, Rush University School of Medicine , Chicago, IL , USA
| | - Lori M Minasian
- The Division of Cancer Prevention, The National Cancer Institute, National Institutes of Health , Bethesda, MD , USA
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Batista TP, Cavalcanti CLC, Tejo AAG, Bezerra ALR. Accuracy of preoperative endometrial sampling diagnosis for predicting the final pathology grading in uterine endometrioid carcinoma. Eur J Surg Oncol 2016; 42:1367-71. [PMID: 27052799 DOI: 10.1016/j.ejso.2016.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/07/2016] [Accepted: 03/04/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To explore the accuracy of preoperative endometrial sampling diagnosis for predicting the final pathology grading in endometrial cancer. METHODS A cross-sectional study was carried out on patients who underwent surgical treatment for clinically early-stage endometrioid carcinoma of uterus at our Centers from March, 1991 to June, 2012. The agreement levels for the histological grading between the preoperative endometrial sampling diagnosis and the final surgical pathology were analyzed by the Kappa (κ) statistics with 95% confidence intervals (CI). The statistical analyses were also based on frequency data and diagnostic agreement of the procedures. RESULTS We retrospectively selected 79 patients that fit the criteria of this analysis. The overall level of agreement between preoperative and postoperative grading was "fair" according to Kappa (κ) statistics (κ = 0.221; 95%CI = 0.389-0.053; p = 0.01). Accordingly, the overall concordance was 48/79 (60.75%)-39/58 (67.24%) for G1, 7/16 (43.75%) for G2, and 2/5 (40%) for G3 tumors. The preoperative grade 1 diagnosis was upgraded to grade 2 (n = 6) or 3 (n = 1) in 15.2% of patients after hysterectomy. Sensitivity, specificity, NPV, PPV, and accuracy of preoperative endometrial sampling diagnosis to predict grade 1 at the final surgical pathology was 67.2%, 66.7%, 42.4%, 84.8% and 67.1%, respectively. CONCLUSIONS Preoperative endometrial sampling was found to be only a modest overall predictor of postoperative histological grading. A selective staging policy based on predictive models to avoid lymph node dissections in endometrial cancer should take into account additional parameters.
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Affiliation(s)
- T P Batista
- HCP - Hospital de Câncer de Pernambuco, Avenida Cruz Cabugá, 1597, CEP: 50040-000, Recife, PE, Brazil(c); FPS/IMIP - Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Rua dos Coelhos, 300 - Boa Vista, CEP: 50070-550, Recife, PE, Brazil(d).
| | - C L C Cavalcanti
- FPS/IMIP - Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Rua dos Coelhos, 300 - Boa Vista, CEP: 50070-550, Recife, PE, Brazil(d)
| | - A A G Tejo
- FPS/IMIP - Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Rua dos Coelhos, 300 - Boa Vista, CEP: 50070-550, Recife, PE, Brazil(d)
| | - A L R Bezerra
- HCP - Hospital de Câncer de Pernambuco, Avenida Cruz Cabugá, 1597, CEP: 50040-000, Recife, PE, Brazil(c); FPS/IMIP - Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Rua dos Coelhos, 300 - Boa Vista, CEP: 50070-550, Recife, PE, Brazil(d)
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Arsène E, Bleu G, Merlot B, Boulanger L, Vinatier D, Kerdraon O, Collinet P. Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer. J Gynecol Oncol 2016; 26:125-33. [PMID: 25872893 PMCID: PMC4397228 DOI: 10.3802/jgo.2015.26.2.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/13/2015] [Accepted: 03/01/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. METHODS This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. RESULTS Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. CONCLUSION Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
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Affiliation(s)
- Emmanuelle Arsène
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.
| | - Géraldine Bleu
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Benjamin Merlot
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Loïc Boulanger
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Denis Vinatier
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France
| | - Olivier Kerdraon
- Department of Anatomopathology, University Hospital of Lille, Lille, France
| | - Pierre Collinet
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France
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How JA, Lau S, Gotlieb WH. Current Role of Sentinel Lymph Node Mapping in Endometrial Cancer. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wu Y, Zhu H, Sun J, Wang X. Accuracy of frozen section in management and prediction of lymph node metastasis in endometrial carcinoma. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Changing Trends in Lymphadenectomy for Endometrioid Adenocarcinoma of the Endometrium. Obstet Gynecol 2015; 126:815-822. [DOI: 10.1097/aog.0000000000001063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kokcu A, Kurtoglu E, Celik H, Kefeli M, Tosun M, Onal M. Is Surgical Staging Necessary for Patients with Low-risk Endometrial Cancer? A Retrospective Clinical Analysis. Asian Pac J Cancer Prev 2015. [PMID: 26225674 DOI: 10.7314/apjcp.2015.16.13.5331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this study was to compare the tumor-free and overall survival rates between patients with low-risk endometrial cancer who underwent surgical staging and those who did not undergo surgical staging. MATERIALS AND METHODS Data, including demographic characteristics, grade of the tumor, myometrial invasion, cervical involvement, peritoneal washing, lymph node involvement, lymphovascular space invasion, postoperative complication, adjuvant treatment, cancer recurrence, and tumor-free and overall survival rates, for patients with low-risk endometrioid endometrial cancer who were treated surgically with and without pelvic and paraaortic lymph node dissection (LND) were analyzed retrospectively. The patients diagnosed with endometrioid endometrial cancer including the following criteria were considered low-risk: 1) a grade 1 (G1) or grade 2 (G2) endometrioid histology; 2) myometrial invasion of <50% upon magnetic resonance imaging (MRI); 3) no stromal glandular or stromal invasion upon MRI; and 4) no evidence of intra-abdominal metastasis. Then the patients at low-risk were divided into two groups; group 1 (n=117): patients treated surgically with pelvic and paraaortic LND and group 2 (n=170): patients treated surgically without pelvic and paraaortic LND. RESULTS There was no statistical significance when the groups were compared in terms of lymphovascular space invasion, cervical involvement, positive cytology, and recurrence, whereas the administration of an adjuvant therapy was higher in group 2 (p<0.005). The number of patients with positive pelvic nodes and the number of metastatic pelvic nodes were significantly higher in the group with positive LVI than in the group without LVI (p<0.005). No statistically significant differences were detected between the groups in terms of tumor-free survival (p=0.981) and overall survival (p=0.166). CONCLUSIONS Total hysterectomy with bilateral salpingo-oophorectomy and stage-adapted postoperative adjuvant therapy without pelvic and/or paraaortic lymphadenectomy may be safe and efficient treatments for low-risk endometrial cancer.
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Affiliation(s)
- Arif Kokcu
- Department of Obstetrics and Gynecology, Ondokuz Mayis University, Samsun, Turkey E-mail :
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Direct Comparison of Logistic Regression and Recursive Partitioning to Predict Lymph Node Metastasis in Endometrial Cancer. Int J Gynecol Cancer 2015; 25:1037-43. [DOI: 10.1097/igc.0000000000000451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
ObjectiveThe purpose was to compare logistic regression model (LRM) and recursive partitioning (RP) to predict lymph node metastasis in early-stage endometrial cancer.Methods/MaterialsThree models (1 LRM and 2 RP, a simple and a complex) were built in a same training set extracted from the Surveillance, Epidemiology, and End Results database for 18,294 patients who underwent hysterectomy and lymphadenectomy for stage I or II endometrial cancer. The 3 models were validated in a same validation set of 499 patients. Model performance was quantified with respect to discrimination (evaluated by the areas under the receiver operating characteristics curves) and calibration.ResultsIn the training set, the areas under the receiver operating characteristics curves were similar for LRM (0.80 [95% confidence interval [CI], 0.79–0.81]) and the complex RP model (0.79 [95% CI, 0.78–0.80]) and higher when compared with the simple RP model (0.75 [95% CI, 0.74–0.76]). In the validation set, LRM (0.77 [95% CI, 0.75–0.79]) outperformed the simple RP model (0.72 [95% CI, 0.70–0.74]). The complex RP model had good discriminative performances (0.75 [95% CI, 0.73–0.77]). Logistic regression model also outperformed the simple RP model in terms of calibration.ConclusionsIn these real data sets, LRM outperformed the simple RP model to predict lymph node metastasis in early-stage endometrial cancer. It is therefore more suitable for clinical use considering the complexity of an RP complex model with similar performances.
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Nougaret S, Reinhold C, Alsharif SS, Addley H, Arceneau J, Molinari N, Guiu B, Sala E. Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade. Radiology 2015; 276:797-808. [PMID: 25928157 DOI: 10.1148/radiol.15141212] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. MATERIALS AND METHODS The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. RESULTS No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P < .0001). There was no significant difference in the ADCs between grades 1 and 2 tumors (P > .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P < .02). CONCLUSION The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.
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Affiliation(s)
- Stephanie Nougaret
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Caroline Reinhold
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Shaza S Alsharif
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Helen Addley
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Jocelyne Arceneau
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Nicolas Molinari
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Boris Guiu
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Evis Sala
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
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Koskas M, Rouzier R, Amant F. Staging for endometrial cancer: The controversy around lymphadenectomy - Can this be resolved? Best Pract Res Clin Obstet Gynaecol 2015; 29:845-57. [PMID: 25817745 DOI: 10.1016/j.bpobgyn.2015.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022]
Abstract
Endometrial cancer remains the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors, and stratification into pelvic lymph node invasion (stage IIIC1) and para-aortic lymph node invasion (stage IIIC2) improved the predictive value of the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification. Radiological examination methods such as magnetic resonance imaging and positron emission tomography-computed tomography do not have good-enough sensitivity to avoid lymphadenectomy for the assessment of lymph node invasion. Prediction scores are becoming increasingly valuable to exclude lymph node metastasis in low-risk groups, and biomarkers could help to identify patients with high-risk lymph node metastatic probability. The therapeutic role of lymph node dissection remains a matter of debate. Several end points can be considered to evaluate the opportunity of lymphadenectomy in endometrial cancer. First, we compare survival according to the realization, the extent, and the numbers of nodes removed during lymphadenectomy. Second, we assess the opportunity of lymphadenectomy in order to tailor adjuvant treatment modalities. Third, we analyze the surgical complication rate after pelvic lymphadenectomy.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/surgery
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Carcinosarcoma/diagnosis
- Carcinosarcoma/pathology
- Carcinosarcoma/surgery
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Humans
- Lymph Node Excision
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Magnetic Resonance Imaging
- Multimodal Imaging
- Neoplasm Staging
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pelvis
- Positron-Emission Tomography
- Prognosis
- Radiography
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Affiliation(s)
- Martin Koskas
- Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University Paris 07, Paris, France
| | - Roman Rouzier
- Department of Gynaecology Institut Curie, Paris, France
| | - Frederic Amant
- Gynecologic Oncology, University Hospitals Leuven, and Department of Oncology, KU Leuven, Leuven, Belgium.
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Comparative effectiveness research in gynecologic oncology. Cancer Treat Res 2015; 164:237-59. [PMID: 25677027 PMCID: PMC4484275 DOI: 10.1007/978-3-319-12553-4_13] [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: 02/10/2023]
Abstract
The field of gynecologic oncology is faced with a number of challenges including how to incorporate new drugs and procedures into practice, how to balance therapeutic efficacy and toxicity of treatment, how to individualize therapy to particular patients or groups of patients, and how to contain the rapidly rising costs associated with oncologic care. In this chapter we examine three common and highly debated clinical scenarios in gynecologic oncology: the initial management of ovarian cancer, the role of lymphadenectomy in the treatment of endometrial cancer, and the choice of adjuvant therapy for ovarian cancer.
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Woo S, Cho JY, Kim SY, Kim SH. Histogram analysis of apparent diffusion coefficient map of diffusion-weighted MRI in endometrial cancer: a preliminary correlation study with histological grade. Acta Radiol 2014; 55:1270-7. [PMID: 24316663 DOI: 10.1177/0284185113514967] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Until now, several investigators have explored the value of diffusion-weighted magnetic resonance imaging (DWI) for the preoperative tumor grading of endometrial cancer. However, the diagnostic value of DWI with quantitative analysis of apparent diffusion coefficient (ADC) has been controversial. PURPOSE To explore the role of histogram analysis of ADC maps based on entire tumor volume in determining the grade of endometrial cancer. MATERIAL AND METHODS This study was IRB-approved with waiver of informed consent. Thirty-three patients with endometrial cancer underwent DWI (b = 0, 600, 1000 s/mm(2)), and corresponding ADC maps were acquired. Regions of interest (ROIs) were drawn on all slices of the ADC map in which the tumor was visualized including areas of necrosis to derive volume-based histographic ADC data. Histogram parameters (5th-95th percentiles, mean, standard deviation, skewness, kurtosis) were correlated with histological grade using one-way ANOVA with Tukey-Kramer test for post hoc comparisons, and were compared between high (grade 3) and low (grades 1/2) grade using Student t-test. ROC curve analysis was performed to determine the optimum threshold value for each parameter, and their corresponding sensitivity and specificity. RESULTS The standard deviation, quartile, 75th, 90th, and 95th percentiles of ADC showed significant differences between grades (P ≤ 0.03 for all) and between high and low grades (P ≤ 0.024 for all). There were no significant correlations between tumor grade and other parameters. ROC curve analysis yielded sensitivities and specificities of 75% and 96%, 62.5% and 92%, 100% and 52%, 100% and 72%, and 100% and 88%, using standard deviation, quartile, 75th, 90th, and 95th percentiles for determining high grade with corresponding areas under the curve (AUCs) of 0.787, 0.792, 0.765, 0.880, and 0.925, respectively. CONCLUSION Histogram analysis of ADC maps based on entire tumor volume can be useful for predicting the histological grade of endometrial cancer. The 90th and 95th percentiles of ADC were the most promising parameters for differentiating high from low grade.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Katsoulakis E, Mattes MD, Rineer JM, Nabhani T, Mourad WF, Choi K, Schreiber D. Contemporary analysis of pelvic and para-aortic metastasis in endometrial cancer using the SEER registry. Int J Gynaecol Obstet 2014; 127:293-6. [DOI: 10.1016/j.ijgo.2014.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/12/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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Worley MJ, Davis M, Berhie SH, Muto MG, Feltmate CM, Berkowitz RS, Horowitz NS, Campos SM. Mucinous differentiation does not impact stage or risk of recurrence among patients with grade 1, endometrioid type, endometrial carcinoma. Gynecol Oncol 2014; 135:54-7. [PMID: 25088333 DOI: 10.1016/j.ygyno.2014.07.098] [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: 04/27/2014] [Revised: 07/21/2014] [Accepted: 07/25/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether the presence of mucinous differentiation influences histopathologic findings, stage distribution, or rate of recurrence among women with grade 1, endometrioid type, endometrial carcinoma. METHODS This was a retrospective cohort study of all patients with grade 1, endometrioid type, endometrial carcinoma between January 2005 and December 2012. Patients were separated by the presence or absence of mucinous differentiation and then compared. RESULTS Of 655 patients, mucinous differentiation was present in 137 (20.9%) and absent in 518 (79.1%) patients. Compared to the group without mucinous differentiation, the group containing mucinous differentiation was older at diagnosis (mean: 61.1 vs. 58.5 years, OR, 95% CI; 1.03, 1.01-1.05) and more likely to have myometrial invasion (61.3% vs. 51.5%, OR, 95% CI; 1.49, 1.01-2.19). Additional histopathologic findings including: tumor size, cervical stromal invasion, adnexal involvement, LVI and/or the presence of positive lymph nodes were similar between groups. Mucinous differentiation did not affect stage distribution, as most patients were stage 1A (85.4% vs. 86.3%). The median PFS for the entire group has yet to be reached. The mean PFS for the entire study sample was 94.7 months. There was no difference in mean PFS when comparing the group with mucinous differentiation to the group without mucinous differentiation (98 vs. 93.4 months, p=0.07). CONCLUSIONS In the setting of grade 1, endometrioid type, endometrial carcinoma, mucinous differentiation is more common in older patients and is associated with an increased likelihood of myometrial invasion. However, stage distribution and risk of recurrence are not affected.
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Affiliation(s)
- Michael J Worley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Michelle Davis
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Michael G Muto
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Colleen M Feltmate
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Ross S Berkowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Neil S Horowitz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, United States
| | - Susana M Campos
- Division of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States.
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Intraoperative staging by surgeons in patients with rectal cancer after preoperative chemoradiation: diagnostic accuracy and prognostic value. J Cancer Res Clin Oncol 2014; 140:1221-7. [DOI: 10.1007/s00432-014-1657-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/19/2014] [Indexed: 01/02/2023]
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Fiorelli JL, Herzog TJ, Wright JD. Current treatment strategies for endometrial cancer. Expert Rev Anticancer Ther 2014; 8:1149-57. [DOI: 10.1586/14737140.8.7.1149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ulker V, Tunca A, Numanoglu C, Akbayir O, Akyol A, Erim A, Ongut C. Should omentectomy be a part of surgical staging in patients with endometrioid adenocarcinoma of the uterine corpus? Gynecol Obstet Invest 2013; 77:58-63. [PMID: 24356379 DOI: 10.1159/000357270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 11/13/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND The purpose of the study was to determine the prevalence of omental metastasis in endometrioid adenocarcinoma and to correlate risk variables with this spread. METHODS A retrospective analysis of patients with endometrioid adenocarcinoma who underwent omentectomy in addition to staging laparotomy was performed. RESULTS Omental metastases were noted in 11 of the 322 patients with endometrioid adenocarcinoma (3.4%). Multivariate analyses showed that there was a significant correlation between omental metastasis and positive peritoneal cytology, adnexal involvement, and grade 3 tumor (p = 0.028, p = 0.001, and p = 0.01, respectively). There was no statistical relationship between omental metastasis and lymphovascular space involvement, deep myometrial invasion, and lymph node metastasis (p = 0.087, p = 0.97, and p = 0.92, respectively). CONCLUSION Grade 3 endometrioid adenocarcinomas, especially those that are complicated by deep myometrial invasion, have a pattern of intra-abdominal spread similar to more aggressive endometrial cancers, with frequent involvement of the omentum. Overall, we conclude that 37.5% (3/8) of patients who had a grade 3 tumor and omental metastasis stage IV disease would have been missed if a staging operation similar to that employed for ovarian cancer had not been performed.
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Affiliation(s)
- Volkan Ulker
- Department of Obstetrics and Gynecology, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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Predictive value of serum human epididymis protein 4 and cancer antigen 125 concentrations in endometrial carcinoma. Am J Obstet Gynecol 2013; 209:142.e1-6. [PMID: 23583212 DOI: 10.1016/j.ajog.2013.04.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/22/2013] [Accepted: 04/04/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of preoperative serum levels of human epididymis protein 4 (HE4) and cancer antigen 125 (CA125) in the prediction of the presence of metastases in endometrial carcinoma. STUDY DESIGN Preoperative sera were collected from 98 women with a diagnosis of endometrial carcinoma. The concentrations of HE4 and CA125 were assessed by enzyme-linked immunosorbent assay and correlated with the results of the final histopathologic report. RESULTS Fourteen patients had metastases (≥stage IIIA, International Federation of Gynecology and Obstetrics 2009 classification). The serum concentrations of HE4 and CA125 were higher in the group with metastases than in the group without metastases (median [interquartile range], 148.6 pmol/L [71.6-219.1 pmol/L] vs 77.2 pmol/L [52.9-99.3 pmol/L]; P = .001; and 20.0 U/mL [10.1-70.8 U/mL] vs 4.3 U/mL [2.9-10.4 U/mL]; P < .001, respectively). By a multivariate analysis, the combination of HE4 and CA125 (a risk score algorithm) was the only predictive factor for the presence of metastases (odds ratio, 21.562; 95% confidence interval, 5.472-84.963; P < .001), and the grade was the predictor for a deep (≥50%) myometrial invasion by the tumor (odds ratio, 2.005; 95% confidence interval, 1.123-3.581; P = .019). The sensitivity, specificity, positive predictive value, and negative predictive value for the combination of the markers to predict the presence of metastases were 71.4%, 89.5%, 55.6%, and 94.4%, respectively. CONCLUSION A combination of preoperative HE4 and CA125 seems to be a better predictor of metastatic disease than either 1 alone in endometrial carcinoma.
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Prevalence of and factors contributing to missing lymph tissue in uterine cancer staging surgery. Gynecol Oncol 2013; 130:54-7. [PMID: 23632206 DOI: 10.1016/j.ygyno.2013.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 04/14/2013] [Accepted: 04/20/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We wished to investigate the prevalence of missing lymph nodes (MLN), factors contributing to MLN, and the effect of MLN on progression free survival (PFS). METHODS Patients with uterine cancer undergoing abdominal hysterectomy and lymphadenectomy were recruited. All surgeries adhered to the Gynecologic Oncology Group protocol in collecting all the lymph node tissues in paraaortic, common iliac, obturator fossa, and external and internal iliac bilaterally. Data regarding race, age, body mass index (BMI), lymph node counts, staging, location of missing lymph nodes, length of surgery, and estimated blood loss were collected and analyzed in reference to missing lymph nodes. The definition of missing lymph node was an incomplete nodal specimen obtained without actual lymph node tissue. RESULTS Between April 2003 and January 2010, 235 consecutive patients were enrolled prospectively; 108 patients had missing lymph nodes post-operatively (46%), and 127 patients had complete lymph nodes. We found no correlation between MLN relative to race (P = 0.97), age (P = 0.25), BMI (P = 0.09), estimated blood loss (P = 0.38), American Society of Anaesthesiologist physical status classification system (P = 0.18), surgery time (P = 0.22), hospital stay (P = 0.05), nodes without cancer (P =0.12), nodes with cancer (P = 0.99), stage (P = 0.90), grade (P = 0.17), or PFS (P = 0.29). CONCLUSION In our study, although prevalence of missing lymph nodes seems relatively high, none of the perioperative variables studied appeared to contribute to missing lymph nodes. Finally, missing lymph nodes did not affect progression free survival.
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Huang CY, Ho CM, Chen YL, You SL, Chen CA, Cheng WF. Impact of lymphadenectomy in uterine endometrioid carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2013; 39:350-7. [PMID: 23462243 DOI: 10.1016/j.ejso.2013.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/15/2012] [Accepted: 01/09/2013] [Indexed: 11/12/2022]
Abstract
AIMS To investigate the role of lymphadenectomy in uterine endometrioid carcinoma based on the 2009 FIGO staging system. METHODS Using an institution-maintained cancer registry database, all patients who were treated surgically for endometrial cancer from 1991 to 2008 in two medical centers were analyzed. Kaplan-Meier and Cox proportional hazards methods were used to determine the role of lymphadenectomy. RESULTS From 961 women with uterine endometrioid carcinoma, 680 underwent lymphadenectomy and 281 did not. Young age, early-stage disease, low-grade tumor, and lymphadenectomy were favorable independent prognostic factors. The five-year disease-specific survival (DSS) of stages IA, IB, II, and III, and the two-year DSS of stage IV patients who underwent lymphadenectomy were 97.8%, 88.3%, 91.5%, 70.5%, and 32.1%, respectively, compared to 98.7%, 70.0%, 73.3%, 42.9%, and 16.6% in those without lymphadenectomy (p > 0.05 for stage IA; p < 0.01 for stages IB-IV, log-rank test). In high-risk patients (i.e., poorly-differentiated, outer-half myometrial invasion, and stages II-IV), more extensive lymph node resection was associated with an improved five-year DSS, from 71.3% (1-10 nodes removed) and 85.3% (11-20 nodes removed) to 86.8% (>20 nodes removed) (p = 0.02, log-rank test). For stage IIIC-IV patients with nodal metastasis, the extent of node resection also significantly improved the five-year DSS, from 34.4% (1-10 nodes removed) and 62.4% (11-20 nodes removed) to 79.6% (>20 nodes removed) (p = 0.04, log-rank test). CONCLUSIONS Lymphadenectomy improves the survival of patients with uterine endometrioid carcinoma stage IB to stage IV. The extent of lymphadenectomy also improves the survival of high-risk patients and those with nodal disease.
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Affiliation(s)
- C-Y Huang
- Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
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Accuracy of sentinel lymph node detection following intra-operative cervical injection for endometrial cancer: A prospective study. Gynecol Oncol 2012; 127:332-7. [DOI: 10.1016/j.ygyno.2012.08.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/13/2012] [Accepted: 08/13/2012] [Indexed: 11/20/2022]
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Lowery WJ, Gehrig PA, Ko E, Secord AA, Chino J, Havrilesky LJ. Surgical staging for endometrial cancer in the elderly — Is there a role for lymphadenectomy? Gynecol Oncol 2012; 126:12-5. [DOI: 10.1016/j.ygyno.2012.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/01/2012] [Accepted: 05/05/2012] [Indexed: 11/27/2022]
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