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Łaniewski P, Cui H, Mahnert ND, Mourad J, Borst MP, Willmott L, Chase DM, Roe DJ, Herbst-Kralovetz MM. Protein biomarkers in cervicovaginal lavages for detection of endometrial cancer. Biomark Res 2022; 10:88. [PMID: 36461062 PMCID: PMC9717501 DOI: 10.1186/s40364-022-00438-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Rates of endometrial cancer (EC) are increasing. For a definitive diagnosis, women undergo various time-consuming and painful medical procedures, such as endometrial biopsy with or without hysteroscopy, and dilation and curettage, which may create a barrier to early detection and treatment, particularly for women with inadequate healthcare access. Thus, there is a need to develop robust EC diagnostics based on non- or minimally-invasive sampling. The objective of this study was to quantify a broad range of immuno-oncology proteins in cervicovaginal lavage (CVL) samples and investigate these proteins as predictive diagnostic biomarkers for EC. METHODS One hundred ninety-two women undergoing hysterectomy for benign or malignant indications were enrolled in this cross-sectional study. Classification of women to four disease groups: benign conditions (n = 108), endometrial hyperplasia (n = 18), low-grade endometrioid carcinoma (n = 53) and other EC subtypes (n = 13) was based on histopathology of biopsy samples collected after the surgery. CVL samples were collected in the operating room during the standard-of-care hysterectomy procedure. Concentrations of 72 proteins in CVL samples were evaluated using multiplex immunoassays. Global protein profiles were assessed using principal component and hierarchical clustering analyses. The relationships between protein levels and disease groups and disease severity were determined using Spearman correlation, univariate and multivariate receiver operating characteristics, and logistic regression analyses. RESULTS Women with EC and benign conditions exhibited distinctive cervicovaginal protein profiles. Several proteins in CVL samples (e.g., an immune checkpoint protein, TIM-3, growth factors, VEGF, TGF-α, and an anti-inflammatory cytokine, IL-10) discriminated EC from benign conditions, particularly, when tested in combinations with CA19-9, CA125, eotaxin, G-CSF, IL-6, MCP-1, MDC, MCP-3 and TRAIL (sensitivity of 86.1% and specificity of 87.9%). Furthermore, specific biomarkers (e.g., TIM-3, VEGF, TGF-α, TRAIL, MCP-3, IL-15, PD-L2, SCF) associated with histopathological tumor characteristics, including histological type and grade, tumor size, presence and depth of myometrial invasion or mismatch repair protein status, implying their potential utility for disease prognosis or monitoring therapies. CONCLUSIONS This proof-of-principle study demonstrated that cervicovaginal sampling coupled with multiplex immunoassay technology can offer a minimally to non-invasive method for EC detection.
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Affiliation(s)
- Paweł Łaniewski
- College of Medicine - Phoenix, University of Arizona, 425 N. 5th St, Phoenix, AZ, 85004, USA
| | - Haiyan Cui
- UA Cancer Center, University of Arizona, 3838 N. Campbell Ave, Tucson, AZ, 85719, USA
| | - Nichole D Mahnert
- College of Medicine - Phoenix, University of Arizona, 425 N. 5th St, Phoenix, AZ, 85004, USA
- Banner - University Medical Center, 1033 E. McDowell Rd, Phoenix, AZ, 85006, USA
| | - Jamal Mourad
- College of Medicine - Phoenix, University of Arizona, 425 N. 5th St, Phoenix, AZ, 85004, USA
- Banner - University Medical Center, 1033 E. McDowell Rd, Phoenix, AZ, 85006, USA
| | - Matthew P Borst
- College of Medicine - Phoenix, University of Arizona, 425 N. 5th St, Phoenix, AZ, 85004, USA
- Banner - University Medical Center, 1033 E. McDowell Rd, Phoenix, AZ, 85006, USA
| | - Lyndsay Willmott
- Arizona Center for Cancer Care, 2222 E. Highland Ave, Phoenix, AZ, 85016, USA
| | - Dana M Chase
- Arizona Center for Cancer Care, 2222 E. Highland Ave, Phoenix, AZ, 85016, USA
| | - Denise J Roe
- UA Cancer Center, University of Arizona, 3838 N. Campbell Ave, Tucson, AZ, 85719, USA
| | - Melissa M Herbst-Kralovetz
- College of Medicine - Phoenix, University of Arizona, 425 N. 5th St, Phoenix, AZ, 85004, USA.
- UA Cancer Center, University of Arizona, 3838 N. Campbell Ave, Tucson, AZ, 85719, USA.
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Ma T, Readman E, Hicks L, Porter J, Cameron M, Ellett L, Mcilwaine K, Manwaring J, Maher P. Is outpatient hysteroscopy the new gold standard? Results from an 11 year prospective observational study. Aust N Z J Obstet Gynaecol 2016; 57:74-80. [PMID: 27861704 DOI: 10.1111/ajo.12560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND In Australia, gynaecologists continue to investigate women with abnormal bleeding and suspected intrauterine pathology with inpatient hysteroscopy despite some evidence in the literature that that there is no difference in safety and outcome when compared to an outpatient procedure. AIMS This prospective study assessed the safety, effectiveness and acceptability of outpatient hysteroscopy over 11 years at a tertiary hospital in Australia. Resource savings were then calculated. MATERIALS AND METHODS A prospective database was analysed from March 2003 to January 2014 (130 months, 990 women). RESULTS Successful hysteroscopic access was obtained in 94% of cases. Twenty-six percent of patients required a second procedure, including 132 for endometrial polyps and 33 for submucosal fibroids that were not able to be treated in the outpatient setting. On questioning, 88% of women would be happy to have the procedure again. Factors affecting success were pre-procedure pain, menopausal status and previous vaginal delivery. The difference between pain experienced versus pain expected was a major factor in patient acceptability. A vasovagal episode occurred in 5% of cases. CONCLUSION Outpatient hysteroscopy was demonstrated to be safe, effective and acceptable to women. Provision of an outpatient hysteroscopy service saves theatre time and approximately $1000 per case. Improved techniques and technology will allow progression to a 'see and treat' service, providing further savings. With budget constraints, increasing wait times for major procedures and concerns about trainee surgical experience, an outpatient hysteroscopy service should be considered the 'gold standard' investigation over hysteroscopy in theatre.
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Affiliation(s)
- Tony Ma
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Emma Readman
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Lauren Hicks
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Jenny Porter
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Melissa Cameron
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Lenore Ellett
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Kate Mcilwaine
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Janine Manwaring
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
| | - Peter Maher
- Department of Endosurgery, Mercy Hospital For Women, Melbourne, Victoria, Australia
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Adequacy of the endometrial samples obtained by the uterine explora device and conventional dilatation and curettage: a comparative study. Int J Reprod Med 2014; 2014:578193. [PMID: 25763401 PMCID: PMC4334055 DOI: 10.1155/2014/578193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022] Open
Abstract
Aims. Our aim is to compare the adequacy and diagnostic yield of samples obtained by the endometrial Explora Sampler I-MX120 with endometrial specimens obtained by conventional dilatation and curettage (D&C). Methods. A total of 1270 endometrial samples were received in the histopathology laboratories at the King Khalid University Hospital, Riyadh, Saudi Arabia, between 2007 and 2010. In the outpatient clinic, the Uterine Explora Model I was used to obtain 996 samples. The remaining 274 samples were obtained by conventional D&C. Sample adequacy and the clustering of inadequate specimens according to age groups by the two different techniques were compared and statistically analyzed. Results. Out of 1270 endometrial samples, 253 (19.9%) were inadequate. The Uterine Explora was used in 88.5% of these inadequate samples (253 samples), and the remaining 11.5% were obtained by D&C. The insufficient tissue incidence was higher with the Explora (17.6%) than with the D&C (2.2%) and the difference was statistically significant (P < 0.0001). The ages of the patients, as well as the clinical indications for the procedures, were recorded. Conclusion. This retrospective study demonstrated better specimen adequacy when D&C was used compared to the higher rate of sample insufficiency obtained with the Explora.
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Dacco' MD, Moustafa M, Papoutsis D, Georgantzis D, Halmos G, Magos A. An audit of using the H Pipelle for endometrial sampling at outpatient hysteroscopy and literature review comparison with the Pipelle de Cornier. Eur J Obstet Gynecol Reprod Biol 2012; 165:299-301. [PMID: 22884589 DOI: 10.1016/j.ejogrb.2012.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 06/29/2012] [Accepted: 07/24/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To analyse the efficiency of the H Pipelle endometrial sampler at "no touch" (vaginoscopic) diagnostic hysteroscopy in terms of biopsy adequacy for histological diagnosis. STUDY DESIGN Retrospective descriptive study of 200 premenopausal women including comparison with previously published data on traditional biopsy instruments. RESULTS Biopsy was adequate in 82% of cases overall, rising to 87% in those without submucous fibroids or polyps. Comparison with published data on other biopsy instruments shows that the H Pipelle is at least as efficient. CONCLUSION The H Pipelle appears to be at least as effective as traditional endometrial samplers even after hysteroscopy but allows hysteroscopy and biopsy to be done using a purely "no touch" (vaginoscopic) technique.
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Affiliation(s)
- Maria Diletta Dacco'
- Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.
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Török P, Major T. [Office hysteroscopy: a new examination method in gynecological practice]. Orv Hetil 2011; 152:51-4. [PMID: 21177231 DOI: 10.1556/oh.2011.28997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hysteroscopy is a widely used endoscopic method, the "gold standard" for the examination of uterine cavity changes. Office hysteroscopy is an intervention that makes the accomplishment of ambulant examination, opposite to the traditional method. Due to the small diameter of the device the anesthesia is unnecessary, because there is no need of the dilatation of the cervix. Indications of the examination are wide-ranging. Besides the abnormal uterine bleeding, it can be used in the examination of infertility, and those intrauterine changes (polyp, submucosus myoma, adhesion), that were diagnosed by other imagining methods that cause infertility complaints. The aim of our present review is recommend the use of this method because it does not need any preparation and it is minimal invasive. The use of traditional method that needs longer preparation, observation, anesthesia and operating theatre, is only suggested in cases of proven pathology.
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Affiliation(s)
- Péter Török
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Szülészeti és Nőgyógyászati Klinika, Debrecen Nagyerdei krt. 98., 4032.
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