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Burrows A, Pudwell J, Bougie O. Preoperative Factors of Endometrial Carcinoma in Patients Undergoing Hysterectomy for Atypical Endometrial Hyperplasia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:822-830. [PMID: 33785467 DOI: 10.1016/j.jogc.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify clinicopathological preoperative factors associated with concurrent endometrial carcinoma in patients undergoing surgical management of atypical endometrial hyperplasia. METHODS The records of all patients who underwent hysterectomy for preoperatively diagnosed atypical endometrial hyperplasia at a tertiary care hospital from April 2017 to April 2020 were retrospectively reviewed. Clinicopathological characteristics of patients were extracted. Patients who did not undergo hysterectomy or who had evidence of simple hyperplasia or carcinoma on initial biopsy were excluded. Univariate analysis was performed. A multivariate regression model for progression to endometrial carcinoma was developed. RESULTS A total of 126 patients were included. Of these patients, 19 (15.1%) had a final diagnosis of endometrial carcinoma, whereas 86 (68.2%) retained the diagnosis of atypical endometrial hyperplasia and 21 (16.7%) were found to have no residual atypical endometrial hyperplasia. The odds of a patient being diagnosed with endometrial carcinoma were 6.1 times higher (95% CI 1.32-27.68) if they had an endometrial stripe thickness >1.1 cm and 13.5 times higher (95% CI 3.56-51.1) if there was histological suspicion of carcinoma. The odds of a patient being diagnosed with endometrial carcinoma were significantly lower if the patient had an initial diagnosis of atypical endometrial hyperplasia in a polyp (OR 0.07; 95% CI 0.02-0.34). CONCLUSION Our results suggest that an endometrial stripe thickness >1.1 cm, a histological suspicion of carcinoma on preoperative pathology, and the absence of polyp involvement on initial diagnosis are the strongest predictors of endometrial carcinoma at the time of hysterectomy in patients with atypical endometrial hyperplasia.
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Affiliation(s)
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON
| | - Olga Bougie
- Department of Obstetrics and Gynaecology, Kingston Health Sciences Centre, Kingston, ON.
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Cornel KMC, Wouters K, Van de Vijver KK, van der Wurff AAM, van Engeland M, Kruitwagen RFPM, Pijnenborg JMA. Gene Promoter Methylation in Endometrial Carcinogenesis. Pathol Oncol Res 2019; 25:659-667. [PMID: 30430425 PMCID: PMC6449282 DOI: 10.1007/s12253-018-0489-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
Up to 60% of untreated atypical hyperplastic endometrium will develop into endometrial carcinoma (EC), and for those who underwent a hysterectomy a coexisting EC is found in up to 50%. Gene promoter methylation might be related to the EC development. The aim of this study is to determine changes in gene promoter profiles in normal endometrium, atypical hyperplasia (AH) and EC in relation to K-Ras mutations. A retrospective study was conducted in patients diagnosed with endometrial hyperplasia with and without subsequent EC. Promoter methylation of APC, hMLh1, O6-MGMT, P14, P16, RASSF1, RUNX3 was analysed on pre-operative biopsies, and correlated to the final histological diagnosis, and related to the presence of K-Ras mutations. In the study cohort (n=98), differences in promoter methylation were observed for hMLH1, O6-MGMT, and P16. Promoter methylation of hMLH1 and O6-MGMT gradually increased from histologically normal endometrium to AH to EC; 27.3, 36.4% and 38.0% for hMLH1 and 8.3%, 18.2% and 31.4% for O6-MGMT, respectively. P16 promoter methylation was significantly different in AH (7.7%) compared to EC (38%). K-Ras mutations were observed in 12.1% of AH, and in 19.6% of EC cases. No association of K-Ras mutation with promoter methylation of any of the tested genes was found. In conclusion, hMLH1 and O6-MGMT promoter methylation are frequently present in AH, and thus considered to be early events in the carcinogenesis of EC, whereas P16 promoter methylation was mainly present in EC, and not in precursor lesions supporting a late event in the carcinogenesis.
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Affiliation(s)
- Karlijn M C Cornel
- GROW- School for Oncology &Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands.
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Kim Wouters
- Department of Pathology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Manon van Engeland
- GROW- School for Oncology &Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Pathology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roy F P M Kruitwagen
- GROW- School for Oncology &Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Shokouhi B. Role of transvaginal ultrasonography in diagnosing endometrial hyperplasia in pre- and post-menopause women. Niger Med J 2016; 56:353-6. [PMID: 26778888 PMCID: PMC4698852 DOI: 10.4103/0300-1652.170390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Abnormal uterine bleeding (AUB) is the most common presenting symptom of endometrial hyperplasia (EH). Transvaginal ultrasonography (TVS) is a diagnostic tool in the evaluation of AUB and EH with various sensitivity and specificity. However, the exact accuracy of TVS in diagnosing EH had not been evaluated. In this study, we aim to evaluate the accuracy of TVS in detecting EH. Materials and Methods: In this retrospective study, 120 women (mean age of 48.64 ± 6.74 years) with AUB with suspicious/or possible EH were evaluated. TVS and pathology findings of possible EH were recorded. Sensitivity, specificity, positive, and negative predictive value (PPV and NPV) was calculated. Results: Sixty-eight patients were premenopause, and 52 were postmenopause. TVS reported EH in 85 cases (70.83%). Pathology results showed EH in 85 cases (70.83%) including simple cystic hyperplasia in 82 cases, atypical, simple hyperplasia in one case and complex hyperplasia in two cases. Among these 85 cases, EH was confirmed by pathology in 81 cases. The accuracy, sensitivity, specificity, PPV, and NPV were 88.25%, 90.7%, 84%, 97.7%, and 84% in premenopause and 100% in postmenopause women. Conclusion: TVS is an appropriate diagnostic tool in premenopause and postmenopause women presenting with AUB, especially in detecting EH. However, further studies are needed to determine the exact accuracy of TVS in diagnosing TVS.
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Affiliation(s)
- Behrooz Shokouhi
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Nooh AM, Abdeldayem HM, Girbash EF, Arafa EM, Atwa K, Abdel-Raouf SM. Depo-Provera Versus Norethisterone Acetate in Management of Endometrial Hyperplasia Without Atypia. Reprod Sci 2015; 23:448-54. [DOI: 10.1177/1933719115623643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ahmed Mohamed Nooh
- Obstetrics and Gynecology Department, Zagazig University Students’ Hospital, Zagazig, Egypt
| | | | - Ehab F. Girbash
- Obstetrics and Gynecology Department, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Essa M. Arafa
- Obstetrics and Gynecology Department, Zagazig University Faculty of Medicine, Zagazig, Egypt
| | - Khalid Atwa
- Obstetrics and Gynecology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
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Kadirogullari P, Atalay CR, Ozdemir O, Sari ME. Prevalence of Co-existing Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia. J Clin Diagn Res 2015; 9:QC10-4. [PMID: 26557570 DOI: 10.7860/jcdr/2015/12484.6618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 08/07/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Endometrial hyperplasia has been associated with the presence of concomitant endometrial carcinoma. In this study, patients who were diagnosed with endometrial hyperplasia and had hysterectomy, determination of the incidence of endometrial cancer accompanying postoperatively and clinical parameters associated with cancer are aimed. MATERIALS AND METHODS Endometrial biopsies were taken from patients for various reasons and among them 158 patients diagnosed with endometrial hyperplasia from pathologic examination results were retrospectively evaluated. All of the patient's age, parity, weight, transvaginal ultrasound measured by endometrial thickness, concomitant systemic disease (diabetes, hypertension, hypothyroidism), tamoxifen use, hormone use and whether in reproductive age or menopause were all questioned. Patients who applied with endometrial cancer, their cervical stromal involvement, lymph node involvement, cytology positivity and omental metastases were examined. Patients were classified according to their stage and grade. Patients who had intraoperative frozen were re-evaluated. RESULTS Fifteen cases with preoperative endometrial hyperplasia diagnosed with endometrial cancer postoperatively, 2 cases had complex hyperplasia without atypia and 13 cases had complex atypical hyperplasia. The rate of preoperative hyperplasia with postoperative endometrial cancer was found to be 10.8% where by 15 cases of patients diagnosed with endometrial cancer postoperatively 11 cases were in postmenopausal period. In patients diagnosed with endometrial cancer according to their histologic types 14 cases had endometrioid adenocarcinoma while one patient with preoperative complex hyperplasia without atypia was diagnosed with serous papillary carcinoma postoperatively. Evaluation of stages in patients diagnosed with cancer, 7 cases of patients had stage IA, 7 cases of patients had stage IB, and 7 cases cases of patients with serous papillary carcinoma were evaluated as stage 3C. CONCLUSION The risk of endometrial cancer in patients diagnosed with endometrial hyperplasia especially endometrial hyperplasia ranges between 15% to 45% and among them 7.9%-51% are found to have myometrial inversion. Therefore, preoperative ultrasound and magnetic resonance imaging should be perfomed in patients diagnosed with complex atypical hyperplasia. Even intraoperative frozen section examination can provide useful information in selected cases.
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Affiliation(s)
- Pinar Kadirogullari
- Faculty, Department of Obstetrics and Gynecology, Istanbul Kanuni Sultan Suleyman Research and Education Hospital , Istanbul, Turkey
| | - Cemal Resat Atalay
- Faculty, Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital , Ankara, Turkey
| | - Ozhan Ozdemir
- Faculty, Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital , Ankara, Turkey
| | - Mustafa Erkan Sari
- Faculty, Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital , Ankara, Turkey
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Management of Endometrial Hyperplasia: A Survey of Members of the Korean Gynecologic Oncology Group. Int J Gynecol Cancer 2015; 25:1277-84. [PMID: 26067858 DOI: 10.1097/igc.0000000000000483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the current management of endometrial hyperplasia (EH) in Korea. MATERIALS AND METHODS This was an electronic survey, which included 40 questions, that was distributed to the members of the Korean Gynecologic Oncology Group in 2014. RESULTS In total, 50 (69%) of 72 members responded to the survey. The oral progestogens were the most popular choices for managing EH without atypia (simple hyperplasia(SH), 64%; complex hyperplasia (CH), 52%). In the case of CH with atypia, most of the gynecologist respondents would perform hysterectomy (95.9%). For fertility preservation, the oral progestogens were the most popular choices (SH, 75.5%; CH, 56.3%), followed by the levonorgestrel-releasing intrauterine system (LNG-IUS). More than 70% of the respondents reported use of dilatation and curettage as a follow-up method. CONCLUSIONS Our survey results show that most of Korean gynecologic oncologists still prefer oral progestogens for conservative management of EH, notwithstanding the many successful reports on the LNG-IUS. As a follow-up evaluation method, dilatation and curettage is mostly used. To identify the optimum therapy, a randomized controlled trial comparing the LNG-IUS with continuous oral progestogens is required. Furthermore, a large-scale prospective study to confirm the most reliable technique for follow-up evaluation is necessary.
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Han X, Kang J, Zhang J, Xiu J, Huang Z, Yang C, Sun X, Fu C, Liu Q. Can the signal-to-noise ratio of choline in magnetic resonance spectroscopy reflect the aggressiveness of endometrial cancer? Acad Radiol 2015; 22:453-9. [PMID: 25641318 DOI: 10.1016/j.acra.2014.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 09/11/2014] [Accepted: 12/09/2014] [Indexed: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES To differentiate endometrial cancer (ECa) from benign lesions in endometrial or in submucosa (BLs-ESm), and investigate whether the signal-to-noise ratio (SNR) of choline-containing compounds (Cho) obtained from three-dimensional (1)H magnetic resonance spectroscopy (MRS) is associated with the aggressiveness of ECa. MATERIALS AND METHODS Thirty-three patients with ECa and 15 patients with BLs-ESm underwent preoperative multivoxel (1)H MRS at 3 T MR. The amplitude of Cho peak of each voxel was recorded, and the corresponding SNR of Cho peak (ChoSNR) was calculated. The maximum ChoSNR (max ChoSNR) for each lesion was identified. The max ChoSNR of ECa and BLs-ESm, as well as type I ECa and type II ECa, was compared. The relationship between max ChoSNR and pathologic characteristics of tumors, including tumor grade, stage, type, and tumor size, was analyzed. RESULTS The mean max ChoSNR (±standard deviation [SD]) was 30.93 ± 16.89 for ECa and 10.40 ± 3.07 for BLs-ESm (P < .001). The mean max ChoSNR for type II ECa (48.54 ± 21.46) was higher than that for type I ECa (26.19 ± 12.02, P = .001). There were no significant differences among different grades (P = .449). The Spearman coefficient between max ChoSNR and stage was 0.423 (P = .014); the difference existed only between Ia and III ECa (P = .048). The Pearson coefficient between ChoSNR and tumor size was 0.515 (P = .002). CONCLUSIONS The max ChoSNR obtained from MRS can differentiate ECa from BLs and type I ECa and type II ECa, but cannot differentiate between each grade ECa and each International Federation of Gynecology and Obstetrics stage ECa. However, max ChoSNR increased with the increase in International Federation of Gynecology and Obstetrics stage and size of ECa.
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Affiliation(s)
- Xue Han
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Jingxia Kang
- Department of Radiology, Linyi People's Hospital, Linyi, PR China
| | - Jie Zhang
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Jianjun Xiu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Zhaoqin Huang
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China
| | - Chunrun Yang
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Xichao Sun
- Department of Pathology, Provincial Hospital Affiliated to Shandong University, Jinan, PR China
| | - Caixia Fu
- Siemens MRI Center, Shenzhen, PR China
| | - Qingwei Liu
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, 324#, Jingwu Weiqi Road, Jinan, PR China.
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Gungorduk K, Ozdemir A, Ertas IE, Sahbaz A, Asicioglu O, Gokcu M, Solmaz U, Harma M, Uzuncakmak C, Dogan A, Sanci M. A Novel Preoperative Scoring System for Predicting Endometrial Cancer in Patients with Complex Atypical Endometrial Hyperplasia and Accuracy of Frozen Section Pathological Examination in This Context: A Multicenter Study. Gynecol Obstet Invest 2014; 79:50-6. [DOI: 10.1159/000365086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/04/2014] [Indexed: 11/19/2022]
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Can magnetic resonance spectroscopy differentiate endometrial cancer? Eur Radiol 2014; 24:2552-60. [DOI: 10.1007/s00330-014-3237-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/28/2014] [Accepted: 05/13/2014] [Indexed: 12/15/2022]
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Abu Hashim H, Zayed A, Ghayaty E, El Rakhawy M. LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women: a randomized controlled trial. J Gynecol Oncol 2013; 24:128-34. [PMID: 23653829 PMCID: PMC3644688 DOI: 10.3802/jgo.2013.24.2.128] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/04/2012] [Accepted: 12/20/2012] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To compare the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) and oral norethisterone acetate (NET) for treatment of non-atypical endometrial hyperplasia in perimenopausal women. METHODS One hundred and twenty perimenopausal women with non-atypical endometrial hyperplasia were selected in this randomized controlled trial. Patients received LNG-IUS (n=59) or NET (n=61; 15 mg/day for 3 weeks/cycle) for 3-6 months. Outpatient follow-up with endometrial biopsies were undertaken at 3, 6, and 12 months intervals after treatment. Outcome measures were; the regression rate, the time to regression and hysterectomy rate. RESULTS A significantly higher regression rate was noted in the LNG-IUS group than in NET group at the 3rd, 6th and 12th month follow-up visits using intention-to-treat analysis (67.8% vs. 47.5%, relative risk [RR], 1.42; 79.7% vs. 60.7%, RR, 1.31; and 88.1% vs. 55.7%, RR, 1.58, respectively). However, no significant difference was found regarding the median time to regression (3 months). The hysterectomy rate during the follow-up period was significantly higher in the NET group (57.4% vs.22%, p<0.001). CONCLUSION LNG-IUS treatment of non-atypical endometrial hyperplasia in perimenopausal women is more effective than NET for achieving disease regression for the majority within 1 year. Moreover, it can reduce the number of hysterectomies performed.
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Affiliation(s)
- Hatem Abu Hashim
- Department of Obstetrics and Gynecology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
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