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Raffone A, Insabato L, Raimondo D, Del Piano I, Ricciardiello M, Cretella P, Neola D, Arciuolo D, Santoro A, Seracchioli R, Guida M, Travaglino A, Zannoni GF. Integrated histological parameters define prognostically relevant groups in atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia. Int J Gynecol Cancer 2024; 34:1183-1188. [PMID: 38719279 DOI: 10.1136/ijgc-2024-005367] [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: 05/18/2024] Open
Abstract
OBJECTIVE To assess the risk of endometrial carcinoma following a diagnosis of atypical hyperplasia/endometrioid intraepithelial neoplasia by endometrial biopsy, stratified based on integrated histological parameters. METHODS All women with atypical hyperplasia/endometrioid intraepithelial neoplasia undergoing hysterectomy within 1 year of diagnosis without progestin treatment were included. Patients were subdivided into three study groups, based on two criteria: (a) grade of nuclear atypia and (b) foci (<2 mm) of confluent glands with no intervening stroma: low-grade, high-grade, and confluent glands. The rate of endometrial carcinoma on the subsequent hysterectomy was assessed in each study group, and differences between study groups were assessed using Fisher's exact test, with a significant p value <0.05. Reproducibility was assessed by using Cohen's κ. RESULTS Ninety-six patients were included. Overall, 36 of 96 patients (37.5%) had endometrial carcinoma on the subsequent hysterectomy. The number of endometrial carcinomas was 4 of 42 (9.5%) in the low-grade group, 14 of 28 (50.0%) in the high-grade group, and 18 of 26 (69.2%) in the confluent glands group. The rate of endometrial carcinoma was significantly higher in the high-grade group than in the low-grade group (p<0.001), whereas it did not significantly differ between the high-grade group and the confluent glands group (p=0.176). The reproducibility among pathologists was moderate for low-grade versus high-grade (κ=0.58) and substantial for confluent glands versus low-grade (κ=0.63) and high-grade (κ=0.63). CONCLUSION Atypical hyperplasia/endometrioid intraepithelial neoplasia can be stratified into prognostically relevant groups based on integrated histological parameters, with a possible major impact on patient management.
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Affiliation(s)
- Antonio Raffone
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Irene Del Piano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
| | - Marialuisa Ricciardiello
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Cretella
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
| | - Daniele Neola
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Damiano Arciuolo
- Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Roma, Italy
| | - Angela Santoro
- Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Roma, Italy
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maurizio Guida
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Campania, Italy
- Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Gian Franco Zannoni
- Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Roma, Italy
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McCoy CA, Coleman HG, McShane CM, McCluggage WG, Wylie J, Quinn D, McMenamin ÚC. Factors associated with interobserver variation amongst pathologists in the diagnosis of endometrial hyperplasia: A systematic review. PLoS One 2024; 19:e0302252. [PMID: 38683770 PMCID: PMC11057740 DOI: 10.1371/journal.pone.0302252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Reproducible diagnoses of endometrial hyperplasia (EH) remains challenging and has potential implications for patient management. This systematic review aimed to identify pathologist-specific factors associated with interobserver variation in the diagnosis and reporting of EH. METHODS Three electronic databases, namely MEDLINE, Embase and Web of Science, were searched from 1st January 2000 to 25th March 2023, using relevant key words and subject headings. Eligible studies reported on pathologist-specific factors or working practices influencing interobserver variation in the diagnosis of EH, using either the World Health Organisation (WHO) 2014 or 2020 classification or the endometrioid intraepithelial neoplasia (EIN) classification system. Quality assessment was undertaken using the QUADAS-2 tool, and findings were narratively synthesised. RESULTS Eight studies were identified. Interobserver variation was shown to be significant even amongst specialist gynaecological pathologists in most studies. Few studies investigated pathologist-specific characteristics, but pathologists were shown to have different diagnostic styles, with some more likely to under-diagnose and others likely to over-diagnose EH. Some novel working practices were identified, such as grading the "degree" of nuclear atypia and the incorporation of objective methods of diagnosis such as semi-automated quantitative image analysis/deep learning models. CONCLUSIONS This review highlighted the impact of pathologist-specific factors and working practices in the accurate diagnosis of EH, although few studies have been conducted. Further research is warranted in the development of more objective criteria that could improve reproducibility in EH diagnostic reporting, as well as determining the applicability of novel methods such as grading the degree of nuclear atypia in clinical settings.
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Affiliation(s)
- Chloe A. McCoy
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Charlene M. McShane
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - W. Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - James Wylie
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, United Kingdom
| | - Declan Quinn
- Department of Obstetrics and Gynaecology, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, United Kingdom
| | - Úna C. McMenamin
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
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Lai J, Rao B, Tian Z, Zhai QJ, Wang YL, Chen SK, Huang XT, Zhu HL, Cui H. Postmenopausal endometrial non-benign lesion risk classification through a clinical parameter-based machine learning model. Comput Biol Med 2024; 172:108243. [PMID: 38484694 DOI: 10.1016/j.compbiomed.2024.108243] [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: 09/02/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE This study aimed to develop and evaluate a machine learning model utilizing non-invasive clinical parameters for the classification of endometrial non-benign lesions, specifically atypical hyperplasia (AH) and endometrioid carcinoma (EC), in postmenopausal women. METHODS Our study collected clinical parameters from a cohort of 999 patients with postmenopausal endometrial lesions and conducted preprocessing to identify 57 relevant characteristics from these irregular clinical data. To predict the presence of postmenopausal endometrial non-benign lesions, including atypical hyperplasia and endometrial cancer, we employed various models such as eXtreme Gradient Boosting (XGBoost), Random Forest (RF), Logistic Regression (LR), Support Vector Machine (SVM), Back Propagation Neural Network (BPNN), as well as two ensemble models. Additionally, a test set was performed on an independent dataset consisting of 152 patients. The performance evaluation of all models was based on metrics including the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, and F1 score. RESULTS The RF model demonstrated superior recognition capabilities for patients with non-benign lesions compared to other models. In the test set, it attained a sensitivity of 88.1% and an AUC of 0.93, surpassing all alternative models evaluated in this study. Furthermore, we have integrated this model into our hospital's Clinical Decision Support System (CDSS) and implemented it within the outpatient electronic medical record system to continuously validate and optimize its performance. CONCLUSIONS We have trained a model and deployed a system with high discriminatory power that may provide a novel approach to identify patients at higher risk of postmenopausal endometrial non-benign lesions who may benefit from more tailored screening and clinical intervention.
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Affiliation(s)
- Jin Lai
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Bo Rao
- Peking University Chongqing Research Institute of Big Data, China
| | - Zhao Tian
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Qing-Jie Zhai
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Yi-Ling Wang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Si-Kai Chen
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Xin-Ting Huang
- Peking University Chongqing Research Institute of Big Data, China
| | - Hong-Lan Zhu
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China.
| | - Heng Cui
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
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Vieira-Serna S, Viveros-Carreño D, Pareja R. Response to: Correspondence on "Sentinel lymph node assessment in patients with atypical endometrial hyperplasia: a systematic review and meta-analysis" by Vieira-Serna et al and Restaino et al. Int J Gynecol Cancer 2024; 34:655. [PMID: 38471673 DOI: 10.1136/ijgc-2024-005304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Affiliation(s)
- Santiago Vieira-Serna
- Department of Gynecologic Oncology, Clínica Universitaria Colombia, Bogotá, Colombia
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
- Department of Obstetrics and Gynecology, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - David Viveros-Carreño
- Department of Gynecologic Oncology, Clínica Universitaria Colombia, Bogotá, Colombia
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
- Deparment of Gynecologic Oncology, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC, Bogotá, Colombia
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
- Department of Gynecologic Oncology, Clínica Astorga, Medellín, Colombia
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Yu K, Wang Y. The Advance and Correlation of KRAS Mutation With the Fertility-Preservation Treatment of Endometrial Cancer in the Background of Molecular Classification Application. Pathol Oncol Res 2021; 27:1609906. [PMID: 34975345 PMCID: PMC8716400 DOI: 10.3389/pore.2021.1609906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022]
Abstract
The annually increasing incidence of endometrial cancer in younger women has created a growing demand for fertility preservation. However, the diverse therapeutic efficacy among patients under the same histological subtype and the same tumor grade suggests the potential interference of the innate molecular characteristics. The molecular classification has now been applied in clinical practice and might help to stratify the endometrial cancer patients and individualize the therapy, but the candidates for the fertility-spared treatment are most likely to be subdivided in the subgroup lacking the specific signature. KRAS mutation has been linked to the malignant transition of the endometrium, while its role in molecular classification and fertility preservation is vague. Here, we mainly review the advance of molecular classification and the role of KRAS in endometrial cancer, as well as their correlation with fertility-preservation treatment.
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