1
|
Madár I, Szabó A, Vleskó G, Hegyi P, Ács N, Fehérvári P, Kói T, Kálovics E, Szabó G. Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for the Detection of Myometrial Infiltration in Endometrial Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:907. [PMID: 38473269 DOI: 10.3390/cancers16050907] [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: 01/15/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
In endometrial cancer (EC), deep myometrial invasion (DMI) is a prognostic factor that can be evaluated by various imaging methods; however, the best method of choice is uncertain. We aimed to compare the diagnostic performance of two-dimensional transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the preoperative detection of DMI in patients with EC. Pubmed, Embase and Cochrane Library were systematically searched in May 2023. We included original articles that compared TVS to MRI on the same cohort of patients, with final histopathological confirmation of DMI as reference standard. Several subgroup analyses were performed. Eighteen studies comprising 1548 patients were included. Pooled sensitivity and specificity were 76.6% (95% confidence interval (CI), 70.9-81.4%) and 87.4% (95% CI, 80.6-92%) for TVS. The corresponding values for MRI were 81.1% (95% CI, 74.9-85.9%) and 83.8% (95% CI, 79.2-87.5%). No significant difference was observed (sensitivity: p = 0.116, specificity: p = 0.707). A non-significant difference between TVS and MRI was observed when no-myometrium infiltration vs. myometrium infiltration was considered. However, when only low-grade EC patients were evaluated, the specificity of MRI was significantly better (p = 0.044). Both TVS and MRI demonstrated comparable sensitivity and specificity. Further studies are needed to assess the presence of myometrium infiltration in patients with fertility-sparing wishes.
Collapse
Affiliation(s)
- István Madár
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, 1088 Budapest, Hungary
| | - Anett Szabó
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Department of Urology, Semmelweis University, 1082 Budapest, Hungary
| | - Gábor Vleskó
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, 1088 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
| | - Nándor Ács
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, 1088 Budapest, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Stochastics Department, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Emma Kálovics
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
| | - Gábor Szabó
- Centre for Translational Medicine, Semmelweis University, 1088 Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, 1088 Budapest, Hungary
| |
Collapse
|
2
|
López‐González E, Rodríguez‐Jiménez A, Rojas‐Luna JA, Daza‐Manzano C, Gómez‐Salgado J. Values of tumor volume on magnetic resonance imaging for a surgical approach to endometrial cancer. Cancer Med 2023; 12:17671-17678. [PMID: 37602828 PMCID: PMC10523938 DOI: 10.1002/cam4.6384] [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: 03/15/2023] [Revised: 06/10/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE To analyze the relationship between tumor volume in Endometrial Cancer (EC) on Magnetic Resonance Imaging (MRI) and lymph node metastasis to establish which patients benefit from omitting the lymphadenectomy. METHODS A retrospective observational study with 194 patients with EC identified between 2016 and 2021 at the Juan Ramón Jiménez University Hospital, Huelva (Spain) was carried out. Preoperative MRI of 127 patients was assessed. The tumor volume was analyzed on MRI by the ellipsoid formula and another alternative method with a manual ROI in different sections. Risk factors for node metastases were analyzed to understand its relationship and to identify an optimum criterion for the tailored surgery. RESULTS Univariate analysis showed risk factors for lymph node metastases were histological grade (p = 0.001), tumor with a volume greater than >25 cm3 (p < 0.001), lymphovascular space invaded (p = 0.007), and preoperative Ca 125 serum >28 (p < 0.001). Multivariate analysis indicated that tumor volume index >25 cm3 was an independent risk factor for lymph node metastases. The patients without significant proposed risk factors (volume index >25 cm3 [OR = 0.64], Ca 125 > 28 [OR = 0.32], and high histological grade [OR = 2.6]) did not present lymph node metastases, independent of myometrial invasion. CONCLUSIONS Lymphadenectomy can be omitted in patients with Endometrioid carcinoma that do not have any of the following risk factors: high-grade tumor, elevated Ca 125 (>28), and tumor volume on MRI greater than 25 cm3 . Tumor volume might predict the state of lymph nodes in EC and it could give information regarding surgical management.
Collapse
Affiliation(s)
- Elga López‐González
- Gynecological Oncology Unit, Department of Obstetrics and GynecologyHospital Universitario Juan Ramón JiménezHuelvaSpain
| | | | - José Antonio Rojas‐Luna
- Gynecological Oncology Unit, Department of Obstetrics and GynecologyHospital Universitario Juan Ramón JiménezHuelvaSpain
| | - Cinta Daza‐Manzano
- Gynecological Oncology Unit, Department of Obstetrics and GynecologyHospital Universitario Juan Ramón JiménezHuelvaSpain
| | - Juan Gómez‐Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labor SciencesUniversity of HuelvaHuelvaSpain
- Safety and Health Postgraduate ProgramUniversidad Espíritu SantoGuayaquilEcuador
| |
Collapse
|
3
|
Wang Y, Chen Z, Liu C, Chu R, Li X, Li M, Yu D, Qiao X, Kong B, Song K. Radiomics-based fertility-sparing treatment in endometrial carcinoma: a review. Insights Imaging 2023; 14:127. [PMID: 37466860 DOI: 10.1186/s13244-023-01473-y] [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] [Received: 01/10/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
In recent years, with the increasing incidence of endometrial carcinoma in women of child-bearing age, to decision of whether to preserve patients' fertility during treatment has become increasingly complex, presenting a formidable challenge for both physicians and patients. Non-fertility-sparing treatment can remove lesions more thoroughly than fertility-sparing treatment. However, patients will permanently lose their fertility. In contrast, fertility-sparing treatment can treat tumors without impairing fertility, but the risk of disease progression is high as compared with non-fertility-sparing treatment. Therefore, it is extremely important to accurately identify patients who are suitable for fertility-sparing treatments. The evaluation of prognostic factors, including myometrial invasion, the presence of lymph node metastases, and histopathological type, is vital for determining whether a patient can receive fertility-sparing treatment. As a non-invasive and quantitative approach, radiomics has the potential to assist radiologists and other clinicians in determining more precise judgments with regard to the above factors by extracting imaging features and establishing predictive models. In this review, we summarized currently available fertility-sparing strategies and reviewed the performance of radiomics in predicting risk factors associated with fertility-sparing treatment. This review aims to assist clinicians in identifying patients suitable for fertility-sparing treatment more accurately and comprehensively and informs more appropriate and rigorous treatment decisions for endometrial cancer patients of child-bearing age.Critical relevance statement: Radiomics is a promising tool that may assist clinicians identify risk factors about fertility-sparing more accurately and comprehensively.
Collapse
Affiliation(s)
- Yuanjian Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China
| | - Zhongshao Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China
| | - Chang Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China
- Gynecology Oncology Key Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China
- Gynecology Oncology Key Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiao Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China.
- Gynecology Oncology Key Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Mingbao Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China.
- Gynecology Oncology Key Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xu Qiao
- School of Control Science and Engineering, Shandong University, Jinan, Shandong, China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China
- Gynecology Oncology Key Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kun Song
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong Province, China.
- Gynecology Oncology Key Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| |
Collapse
|
4
|
Rei M, Costa-Santos C, Bernardes J, Costa A. Preoperative staging of uterine cancer: can transvaginal ultrasonography play a role? Front Oncol 2023; 13:1089105. [PMID: 37404747 PMCID: PMC10315648 DOI: 10.3389/fonc.2023.1089105] [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: 11/03/2022] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Preoperative staging of uterine cancer has recently been implied as an important contribution to an accurate selection of low-risk cases, ultimately avoiding unnecessary lymph node debulking. The aim of this study was to evaluate the validity of transvaginal ultrasonography (TVS) in preoperative staging of uterine cancer in comparison to pelvic magnetic resonance imaging (MRI) and permanent section. Methods We conducted a prospective longitudinal multicenter trial between 2017 and 2018. Inclusion criteria comprised cases of endometrial neoplasia histologically confirmed or strong imaging suspicion, candidates for elective surgery as primary treatment. Proportions of Agreement (PA), kappa statistic (K), sensitivity, specificity and accuracy were calculated with 95% confidence intervals (95%CI). Results Eighty-two patients were eligible for the study, presenting a mean age of 68 years (standard deviation 11). In what concerns the TVS evaluation of myometrial invasion, the subjective and objective methods of Gordon and Karlsson presented a sensitivity of 79%, 79% and 67% [95%CI 63-91; 63-91; 50-81], a specificity of 65%, 58% and 79% [95%CI 49-79; 42-73; 64-89] and an overall accuracy of 72%, 68% and 73% [95%CI 61-81; 57-78; 63-82]. MRI presented respectively a sensitivity, specificity and overall accuracy of 92%, 70% and 82% [95%CI 77-98; 52-85; 71-90]. Regarding cervical involvement, the sensitivity was respectively 31%, 50% and 67% [95%CI 9-61; 21-79; 35-90] for the subjective method, objective TVS and MRI, and the specificity was 98%, 90% and 100% [95%CI 92-100; 77-97; 94;100]. Agreement between TVS and MRI was superior in the assessment of cervical invasion, with PA ranging from 0.82 to 0.93 and K from 0.45 to 0.58, in comparison to myometrial invasion with PA ranging from 0.68 to 0.73 and K from 0.31 to 0.50. Considering the assessment of cervical involvement, as MRI showed a specificity of 100% it is not possible to increase the specificity. However, it was possible to increase the sensitivity, considering the combination of TVS with objective approach and MRI. Conclusion TVS may have a promising role as a tool for preoperative staging of endometrial carcinoma, presenting a performance that approximates to MRI, with a higher agreement in the assessment of cervical invasion.
Collapse
Affiliation(s)
- Mariana Rei
- Department of Gynecology, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
- Department of Obstetrics, Gynecology and Pediatrics, Medical School, University of Porto, Porto, Portugal
| | - Cristina Costa-Santos
- Department of Health Informatics and Decision Sciences, Medical School, University of Porto, Porto, Portugal
- Centre for Research in Health Information Systems and Technologies, CINTESIS, University of Porto, Porto, Portugal
| | - João Bernardes
- Department of Obstetrics, Gynecology and Pediatrics, Medical School, University of Porto, Porto, Portugal
- Centre for Research in Health Information Systems and Technologies, CINTESIS, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics, Gynecology and Pediatrics, Medical School, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| |
Collapse
|
5
|
Learning Curve for Ultrasound Assessment of Myometrial Infiltration in Endometrial Cancer Visualizing Videoclips: Potential Implications for Training. Diagnostics (Basel) 2023; 13:diagnostics13030425. [PMID: 36766530 PMCID: PMC9914064 DOI: 10.3390/diagnostics13030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Diagnostic accuracy for estimating myometrial infiltration by ultrasound in endometrial cancer requires experience. The objective of this study is to determine the learning curve (LC) for assessing myometrial infiltration in cases of endometrial cancer using transvaginal ultrasound (TVS). METHODS Five trainees (one staff radiologist and four fourth-year OB/GYN residents) participated in this study. All trainees had experience in performing TVS, but none of them had specific training on the assessment of myometrial infiltration. Trainees were given one specific lecture about the topic, and then they observed videoclips from 10 cases explained by the trainer. After this, all trainees visualized 45 videoclips of uterine ultrasound scans of endometrial cancer cases. The assessment of myometrial infiltration was based on the subjective impression. Definitive histology was used as a reference standard. Trainees stated whether myometrial infiltration was ≥50% or <50%. LC-CUSUM and standard CUSUM graphics were plotted to determine how many cases were needed to reach competence, allowing a mistake rate of 15%. RESULTS All trainees completed the study. LC-CUSUM graphics showed that three trainees reached competence at the 33rd, 35th and 36th case, respectively. All three of them kept the process under control after reaching competence. One trainee reached competence but did not maintain it in the cumulative analysis. One trainee did not reach competence. CONCLUSION Our study suggests that 30-40 cases would be needed to be trained for assessing myometrial infiltration by TVS by visual interpretation of videoclips by most trainees.
Collapse
|
6
|
Incorporation of Tumor-Free Distance and Other Alternative Ultrasound Biomarkers into a Myometrial Invasion-Based Model Better Predicts Lymph Node Metastasis in Endometrial Cancer: Evidence and Future Prospects. Diagnostics (Basel) 2022; 12:diagnostics12112604. [PMID: 36359447 PMCID: PMC9689828 DOI: 10.3390/diagnostics12112604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 12/02/2022] Open
Abstract
Myometrial invasion (MI) is a parameter currently used in transvaginal ultrasound (TVS) in endometrial cancer (EC) to determine local staging; however, without molecular diagnostics, it is insufficient for the selection of high-risk cases, i.e., those with a high risk of lymph node metastases (LNM). The study’s objective was to answer the question of which TVS markers, or their combination, reflecting the molecular changes in EC, can improve the prediction of LNM. Methods: The TVS examination was performed on 116 consecutive EC patients included in this prospective study. The results from the final histopathology were a reference standard. Univariate and multivariate logistic models of analyzed TVS biomarkers (tumor [T] size, T area [AREA], T volume [SPE-VOL], MI, T-free distance to serosa [TFD], endo-myometrial irregularity, [EMIR], cervical stromal involvement, CSI) were evaluated to assess the relative accuracy of the possible LNM predictors., Spline functions were applied to avoid a potential bias in assuming linear relations between LNM and continuous predictors. Calculations were made in R using libraries splines, glmulti, and pROC. Results: LNM was found in 20 out of the 116 (17%) patients. In univariate analysis, only uMI, EMIR, uCSI and uTFD were significant predictors of LNM. The accuracy was 0.707 (AUC 0.684, 95% CI 0.568−0.801) for uMI (p < 0.01), 0.672 (AUC 0.664, 95% CI 0.547−0.781) for EMIR (p < 0.01), 0.776 (AUC 0.647, 95% CI 0.529−0.765) for uCSI (p < 0.01), and 0.638 (AUC 0.683, 95% CI 0.563−0.803) for uTFD (p < 0.05). The cut-off value for uTFD was 5.2 mm. However, AREA and VOL revealed a significant relationship by nonlinear analysis as well. Among all possible multivariate models, the one comprising interactions of splines of uTFD with uMI and splines of SPE-VOL with uCSI showed the most usefulness. Accuracy was 0.802 (AUC 0.791, 95% CI 0.673−0.91) Conclusions: A combination of uTFD for patients with uMI > 50%, and SPE-VOL for patients with uCSI, allows for the most accurate prediction of LNM in EC, rather than uMI alone.
Collapse
|
7
|
Akbari Sene A, Farzaneh F, Mehrnami A, Faizei AM, Alizadeh A, Saadat Mostafavi SR, Ghaffari E. Diagnostic value and agreement of transrectal in comparison with transvaginal sonography among women with abnormal uterine bleeding. J Ultrasound 2022; 25:687-697. [PMID: 35032024 PMCID: PMC9402856 DOI: 10.1007/s40477-021-00647-y] [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: 06/02/2021] [Accepted: 12/02/2021] [Indexed: 11/25/2022] Open
Abstract
AIMS Transvaginal sonography (TVS) is not applicable for evaluating the endometrium in some cases with abnormal uterine bleeding (AUB) such as virgin women. The aim of the present study was to investigate the diagnostic value of transrectal sonography (TRS), as a non-invasive alternative for TVS, among women with AUB. METHODS In this cross-sectional study, 40 women over 40 years of age with AUB first underwent TRS and then TVS. Endometrial biopsy was also performed as a gold standard method to evaluate endometrial pathologies. The findings of the two endometrial ultrasound methods were compared with the biopsy results. Also, the findings of the two methods were compared in terms of the agreement on other uterine markers and adnexal findings. RESULTS There was a high agreement between the findings of TVS and TRS for uterine size, endometrial thickness and homogeneity, endomyometrial junction, myometrial homogeneity, uterine lesions, uterine lesions size, ovarian size and ovarian echogenicity. When comparing the results of these two methods with biopsy findings, sensitivity, specificity as well as positive and negative predictive values of both methods were similar (82%, 100%, 100%, and 0%, respectively). CONCLUSION When it is not possible to use TVS in women with AUB, TRS is a suitable, non-invasive and inexpensive alternative method for evaluating the endometrium and other genital organs.
Collapse
Affiliation(s)
- Azadeh Akbari Sene
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Farah Farzaneh
- Preventive Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Mehrnami
- Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Faizei
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahad Alizadeh
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyed Reza Saadat Mostafavi
- Radiology Department of Radiology, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elnaz Ghaffari
- Preventive Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
8
|
Ziogas A, Xydias E, Kalantzi S, Papageorgouli D, Liasidi PN, Lamari I, Daponte A. The diagnostic accuracy of 3D ultrasound compared to 2D ultrasound and MRI in the assessment of deep myometrial invasion in endometrial cancer patients: A systematic review. Taiwan J Obstet Gynecol 2022; 61:746-754. [PMID: 36088040 DOI: 10.1016/j.tjog.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Endometrial cancer is a common malignancy in women worldwide, with myometrial invasion (MI) being an important prognostic factor, usually assessed via imaging techniques. The aim of this review is to compare the diagnostic accuracy of 3D transvaginal ultrasound (3D-TVUS), a relatively new imaging modality, to that of 2D transvaginal ultrasound (2D-TVUS) and MRI in the prediction of deep myometrial invasion. Relevant articles were sought on MEDLINE/PubMed, Scopus, Web of Science and Wiley Online Library databases. Articles were included if they were primary studies comparing 3D-TVUS to 2D-TVUS and/or MRI in adult endometrial cancer patients, with histopathological confirmation of MI as a reference standard. Ultimately, 7 studies were included, with 714 participants, 242 with deep MI and a mean age of approximately 60 years. 3D-TVUS, 2D-TVUS, MRI and 3D-TVUS-MRI co-evaluation had a pooled sensitivity of 80.4%, 77.6%, 80.7% and 94.6% respectively and a specificity range of 82.8%, 81.6%, 87% and 69.1% respectively. Overall, no statistically significant differences were found in sensitivity and specificity among 3D-TVUS and the other methods, except for a significant increase in sensitivity (p = 0.038) when combined with MRI. This shows that 3D-TVUS is comparable to MRI as far as diagnostic accuracy is concerned, however remains cheaper, less time-consuming and more tolerable, while offering some advantages over 2D-TVUS as well. Therefore 3D-TVUS application in MI assessment seems promising, although more research is required to further assess this finding and ascertain 3D-TVUS's place in endometrial cancer MI assessment.
Collapse
Affiliation(s)
- Apostolos Ziogas
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Greece.
| | - Emmanouil Xydias
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Greece
| | - Sofia Kalantzi
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Greece
| | | | | | - Ioanna Lamari
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Greece
| | - Alexandros Daponte
- University of Thessaly, School of Health Sciences, Faculty of Medicine, Greece; University of Thessaly, Department of Obstetrics and Gynaecology, Greece
| |
Collapse
|
9
|
Wong M, Amin T, Thanatsis N, Foo X, Jurkovic D. Efficacy of transrectal ultrasound in assessing endometrium of postmenopausal women with axial uterus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:414-419. [PMID: 34919769 DOI: 10.1002/uog.24835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the acceptance and efficacy of transrectal ultrasound (TRS) in assessing the endometrium in postmenopausal women with an axial uterus. METHODS This was a prospective cross-sectional study conducted between October 2015 and October 2018 of consecutive postmenopausal women with an axial uterus on transvaginal ultrasound (TVS). Women with a known diagnosis of gynecological malignancy were excluded. TRS was offered immediately after TVS without prior bowel preparation. A single operator determined subjectively whether the endometrium was visualized satisfactorily on TVS and TRS. In women with postmenopausal bleeding (PMB), endometrial thickness (ET) was measured and endometrial morphology was categorized as atrophic, uniformly thickened, benign endometrial polyp or endometrial cancer, based on subjective pattern recognition. All women with PMB and a non-atrophic endometrium underwent outpatient endometrial biopsy, hysteroscopy or hysterectomy. The success rate of TRS in assessing satisfactorily the endometrium was compared with that of TVS. In patients with PMB, ET measurements and subjective diagnosis of endometrial cancer on TVS vs TRS were compared. RESULTS Of the 1553 women who underwent TVS examination, 103 (6.6%) had an axial uterus, of whom 76 (73.8%) presented with PMB. TRS was accepted by 66/103 (64.1%) women with an axial uterus. TRS assessed satisfactorily a significantly higher proportion of endometria compared with TVS (90.9% vs 62.1%; χ2 = 14.1, P < 0.001). In 50 women with PMB and an axial uterus who underwent both TVS and TRS, TVS failed to visualize the endometrium satisfactorily in 15 (30.0%) women, whilst TRS provided satisfactory images in all cases. Among the 35 women with PMB and a satisfactory endometrial assessment on TVS and TRS, measurements of ET on TRS were significantly lower compared to those on TVS (median difference, -1.2 (interquartile range, -3.0 to -0.4) mm). The overall agreement of TVS and TRS on the presence or absence of endometrial cancer using subjective pattern recognition was 30/35 (85.7%; 95% CI, 74.1-97.3%). While all seven cases of histologically confirmed endometrial cancer were diagnosed correctly on TRS, four were misdiagnosed on TVS as benign polyps or uniformly thickened endometrium. CONCLUSIONS TRS is an acceptable and effective way to assess the endometrium in postmenopausal women with an axial uterus. Among women presenting additionally with PMB, TRS is associated with a higher proportion of satisfactory endometrial assessments and fewer misdiagnoses of endometrial cancer by subjective pattern recognition compared with TVS. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- M Wong
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - T Amin
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - N Thanatsis
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - X Foo
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - D Jurkovic
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Gastón B, Muruzábal JC, Lapeña S, Modroño A, Guarch R, García de Eulate I, Alcázar JL. Transvaginal Ultrasound Versus Magnetic Resonance Imaging for Assessing Myometrial Infiltration in Endometrioid Low Grade Endometrial Cancer: A Prospective Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:335-342. [PMID: 33780025 DOI: 10.1002/jum.15708] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for assessing myometrial infiltration (MI) in patients with low grade endometrioid endometrial cancer. METHODS Observational prospective study performed at a single tertiary care center from 2016 to 2020, comprising 156 consecutive patients diagnosed by endometrial sampling as having an endometrioid grade 1/grade 2 endometrial cancer. TVS and MRI were performed prior to surgical staging for assessing MI, which was estimated using subjective examiner's impression and Karlsson's method for both TVS and MRI. During surgery, intraoperative assessment of MI was also performed. Definitive pathological study considered as reference standard. Diagnostic accuracy for ultrasound, MRI, and intraoperative biopsy was estimated and compared. RESULTS Sensitivity and specificity of TVS for detecting deep MI were 75 and 73.5% for subjective impression and 65 and 70% for Karlsson method, respectively (P = .54). Sensitivity and specificity of MRI for detecting deep MI were 80 and 87% for subjective impression and 70 and 71.3% for Karlsson method. MRI subjective impression showed a significant better specificity than MRI Karlsson method (P = .03). MRI showed better specificity than TVS when subjective impression was considered (P <.05), but not for Karlsson method. Sensitivity and specificity of intraoperative were 75 and 97%, respectively. Intraoperative biopsy showed better specificity than ultrasound and MRI either using examiner's impression or Karlsson method (P <.05). CONCLUSIONS MRI revealed a significant higher specificity than TVS when assessing deep myometrial infiltration. However, the intraoperative biopsy offers a significant better diagnostic accuracy than preoperative imaging techniques.
Collapse
Affiliation(s)
- Begoña Gastón
- Division of Benign Gynecologic Pathology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Juan C Muruzábal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Sonia Lapeña
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Ana Modroño
- Division of Ultrasound, Department of Obstetrics and Gynecology, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Rosa Guarch
- Department of Pathological Anatomy, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | | | - Juan L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| |
Collapse
|
11
|
Concin N, Planchamp F, Abu-Rustum NR, Ataseven B, Cibula D, Fagotti A, Fotopoulou C, Knapp P, Marth C, Morice P, Querleu D, Sehouli J, Stepanyan A, Taskiran C, Vergote I, Wimberger P, Zapardiel I, Persson J. European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma. Int J Gynecol Cancer 2021; 31:1508-1529. [PMID: 34795020 DOI: 10.1136/ijgc-2021-003178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care. OBJECTIVE In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma. METHODS QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs. RESULTS Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.
Collapse
Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria .,Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | | | - Nadeem R Abu-Rustum
- Department of Obstetrics and Gynecology, Memorial Sloann Kettering Cancer Center, New York, New York, USA
| | - Beyhan Ataseven
- Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynaecology, University Hospital Munich (LMU), Munich, Germany
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pawel Knapp
- Department of Gynaecology and Gynaecologic Oncology, University Oncology Center of Bialystok, Medical University of Bialystok, Bialystok, Poland
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Artem Stepanyan
- Department of Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Ankara, Turkey.,Department of Gynecologic Oncology, VKV American Hospital, Istambul, Turkey
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
| |
Collapse
|
12
|
Cubo-Abert M, Díaz-Feijoo B, Bradbury M, Rodríguez-Mías NL, Vera M, Pérez-Hoyos S, Gómez-Cabeza JJ, Gil-Moreno A. Diagnostic performance of transvaginal ultrasound and magnetic resonance imaging for preoperative evaluation of low-grade endometrioid endometrial carcinoma: prospective comparative study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:469-475. [PMID: 33533532 DOI: 10.1002/uog.23607] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To compare the diagnostic performance of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the prediction of deep myometrial invasion (DMI) and cervical stromal invasion (CSI) in patients with low-grade (Grade 1 or 2) endometrioid endometrial cancer (EEC). METHODS This was a prospective study including all patients with low-grade EEC diagnosed between October 2013 and July 2018 at the Vall d'Hebron Hospital in Barcelona, Spain. Preoperative staging was performed using TVS and MRI, followed by surgical staging. Final histology was considered as the reference standard. Sensitivity, specificity, likelihood ratios and diagnostic accuracy were calculated for both imaging techniques in the prediction of DMI and CSI, and the agreement index was calculated for both techniques. The STARD 2015 guidelines were followed. RESULTS A total of 131 patients with low-grade EEC were included consecutively. Sensitivity was higher for TVS than for MRI both for the prediction of DMI (69% (95% CI, 53-82%) vs 51% (95% CI, 36-66%), respectively) and CSI (43% (95% CI, 27-61%) vs 24% (95% CI, 12-41%), respectively). Specificity was similar for TVS and MRI in the prediction of DMI (87% (95% CI, 78-93%) vs 91% (95% CI, 82-96%)) and equal in the prediction of CSI (97% (95% CI, 91-99%) for both). The agreement index between TVS and MRI was 0.84 (95% CI, 0.76-0.90) for DMI and 0.92 (95% CI, 0.85-0.96) for CSI. CONCLUSIONS The diagnostic performance of TVS is similar to that of MRI for the prediction of DMI and CSI in low-grade EEC, and TVS can play a role as a first-line imaging technique in the preoperative evaluation of low-grade EEC. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- M Cubo-Abert
- Gynecology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - B Díaz-Feijoo
- Gynecology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Bradbury
- Gynecology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - N-L Rodríguez-Mías
- Gynecology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Vera
- Radiology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Pérez-Hoyos
- Statistics and Bioinformatics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - J-J Gómez-Cabeza
- Gynecology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Gil-Moreno
- Gynecology Service, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- CIBERONC, Barcelona, Spain
| |
Collapse
|
13
|
Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, Fotopoulou C, Martin AG, Lax S, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell D, Querleu D, Raspollini MR, Sehouli J, Sturdza A, Taylor A, Westermann A, Wimberger P, Colombo N, Planchamp F, Creutzberg CL. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Radiother Oncol 2021; 154:327-353. [PMID: 33712263 DOI: 10.1016/j.radonc.2020.11.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
Collapse
Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Austria; Evangelische Kliniken Essen-Mitte, Germany.
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain; Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, UK
| | | | - Sigurd Lax
- Department of Pathology, Hospital Graz II, Austria; School of Medicine, Johannes Kepler University Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | | | - Anneke Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Noord-Holland, Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Italy
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden Netherlands
| |
Collapse
|
14
|
Concin N, Creutzberg CL, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann JA, Bosse T, Chargari C, Fagotti A, Fotopoulou C, González-Martín A, Lax SF, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell DE, Querleu D, Raspollini MR, Sehouli J, Sturdza AE, Taylor A, Westermann AM, Wimberger P, Colombo N, Planchamp F, Matias-Guiu X. ESGO/ESTRO/ESP Guidelines for the management of patients with endometrial carcinoma. Virchows Arch 2021; 478:153-190. [PMID: 33604759 DOI: 10.1007/s00428-020-03007-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
Collapse
Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria. .,Evangelische Kliniken Essen-Mitte, Essen, Germany.
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | | | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alina E Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Anneke M Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Milan, Italy
| | | | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
| |
Collapse
|
15
|
Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, Fotopoulou C, Gonzalez Martin A, Lax S, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell D, Querleu D, Raspollini MR, Sehouli J, Sturdza A, Taylor A, Westermann A, Wimberger P, Colombo N, Planchamp F, Creutzberg CL. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2020; 31:12-39. [PMID: 33397713 DOI: 10.1136/ijgc-2020-002230] [Citation(s) in RCA: 826] [Impact Index Per Article: 206.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multi-disciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.
Collapse
Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria .,Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | | | - Sigurd Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Anneke Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Milan, Italy
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
16
|
Reinhold C, Ueno Y, Akin EA, Bhosale PR, Dudiak KM, Jhingran A, Kang SK, Kilcoyne A, Lakhman Y, Nicola R, Pandharipande PV, Paspulati R, Shinagare AB, Small W, Vargas HA, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer. J Am Coll Radiol 2020; 17:S472-S486. [PMID: 33153558 DOI: 10.1016/j.jacr.2020.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
Abstract
To date, there is little consensus on the role of pelvic imaging in assessing local disease extent during initial staging in patients with endometrial carcinoma, with practices differing widely across centers. However, when pretreatment assessment of local tumor extent is indicated, MRI is the preferred imaging modality. Preoperative imaging of endometrial carcinoma can define the extent of disease and indicate the need for subspecialist referral in the presence of deep myometrial invasion, cervical extension, or suspected lymphadenopathy. If distant metastatic disease is clinically suspected, preoperative assessment with cross-sectional imaging or PET/CT may be performed. However, most patients with low-grade disease are at low risk of lymph node and distant metastases. Thus, this group may not require a routine pretreatment evaluation for distant metastases. Recurrence rates in patients with endometrial carcinoma are infrequent. Therefore, radiologic evaluation is typically used only to investigate suspicion of recurrent disease due to symptoms or physical examination and not for routine surveillance after treatment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Yoshiko Ueno
- Research Author, Kobe University Graduate School of Medicine, Kobe, Japan, McGill University, Montreal, Quebec, Canada
| | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | | | | | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stella K Kang
- New York University Medical Center, New York, New York
| | | | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, Buffalo, New York
| | | | - Rajmohan Paspulati
- University Hospitals Medical Group Radiology, Cleveland, Ohio, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Atul B Shinagare
- Brigham & Women's Hospital Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut; Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Linton JK, Heller MC, Bender SJ, Stefanovski D, Fecteau ME. Neoplasia of the tubular genital tract in 42 goats. J Am Vet Med Assoc 2020; 256:808-813. [PMID: 32176579 DOI: 10.2460/javma.256.7.808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the prevalence of tubular genital tract neoplasia in does evaluated at 2 veterinary teaching hospitals; describe the main clinical, surgical, and histopathologic or necropsy findings in affected does; and assess factors potentially associated with short-term prognosis in these animals. ANIMALS 42 does. PROCEDURES Medical records of 2 veterinary teaching hospitals were searched to identify does with neoplasia of the tubular genital tract. Signalment; history; physical and diagnostic imaging results; biopsy, surgery, and necropsy findings; and short-term outcome were recorded. Age and breed frequencies for the sample were compared with those of the overall hospital population, and variables of interest were tested for associations with a diagnosis of adenocarcinoma and with short-term outcome by statistical methods. RESULTS Median age at hospital admission (10 years) was greater for the study sample than for the general hospital population (2 years). Pygmy goats were overrepresented (22/42 [52%]). Common reasons for evaluation were bloody vaginal discharge or hematuria and abdominal straining. Adenocarcinoma (13/42 [31%]), leiomyoma (13 [31%]), and leiomyosarcoma (11 [26%]) were the most common tumors. Does with distant metastasis had greater odds of a diagnosis of adenocarcinoma (OR, 40.5) than does without distant metastasis. In the analysis adjusted for hemorrhagic discharge, odds of euthanasia for does with straining were 13 times those for does without straining. In the analysis adjusted for straining status, does with hemorrhagic discharge had almost 7 times the odds of euthanasia for does without this finding. The survival-to-discharge rate was low (13/42 [31%]). CONCLUSIONS AND CLINICAL RELEVANCE The frequency of adenocarcinomas in the study sample was unexpectedly high. Further research is needed to confirm the study findings.
Collapse
|
18
|
Green RW, Epstein E. Dynamic contrast-enhanced ultrasound improves diagnostic performance in endometrial cancer staging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:96-105. [PMID: 31647145 DOI: 10.1002/uog.21885] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To compare the sensitivity and specificity of conventional two-dimensional transvaginal ultrasound/power Doppler (2D-TVU/PD) alone and 2D-TVU/PD combined with dynamic contrast-enhanced ultrasound (DCE-US) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) in women with endometrial cancer (EC), and to assess the association of DCE-US semiquantitative and qualitative variables with International Federation of Gynecology and Obstetrics (FIGO) Stage ≥ IB and 'high-risk' cancer. METHODS This was a prospective study of 101 consecutive women with biopsy-confirmed EC, undergoing expert ultrasound examination at Karolinska University Hospital, a tertiary referral center. All consenting women underwent DCE-US using a 1.5-2.5-mL intravenous bolus of SonoVue contrast agent, as well as conventional 2D-TVU/PD examination. DCE-US videoclips were analyzed with regard to filling (global or focal), wash-in (prior, simultaneous or after) and wash-out (global or focal) patterns of the contrast agent in the tumor compared with the surrounding tissue, as well as semiquantitative DCE-US parameters (wash-in slope, time-to-peak, peak intensity and area under the time-intensity curve (TIC)) obtained from a TIC. The study cohort was compared with a control cohort of women with EC examined at our center according to the International Endometrial Tumor Analysis protocol using 2D-TVU/PD only, matched at a ratio of 3:1 for FIGO stage and grade. The sensitivity and specificity of 2D-TVU/PD alone in the control cohort and in combination with DCE-US in the study cohort in the diagnosis of deep MI, CSI and high-risk cancer (defined as FIGO Stage ≥ IB and/or Grade 3 endometrioid and/or non-endometrioid histology) were compared, using pathological evaluation after hysterectomy as the 'gold standard'. RESULTS After exclusions, 93 women were included in the study cohort and were matched to 279 women in the control cohort. The prevalence of FIGO Stage IA, Grade 1-2 EC was 52% in both cohorts. The sensitivity of 2D-TVU/PD with DCE-US in the study cohort was higher than that of 2D-TVU/PD alone in the control cohort in diagnosing both deep MI (0.74 vs 0.62; P = 0.036) and CSI (0.75 vs 0.51; P < 0.001), whereas the specificity was not significantly different (0.87 vs 0.85 and 0.96 vs 0.95, respectively). Compared with 2D-TVU/PD alone, the specificity of 2D-TVU/PD with DCE-US was higher in detecting high-risk cancer (0.94 vs 0.85; P = 0.024) but the sensitivity did not differ (0.73 vs 0.71). High-risk cancer and FIGO Stage ≥ IB were characterized by a 'focal' filling pattern, with a 'prior' wash-in pattern and a 'focal' wash-out pattern on subjective assessment of DCE-US videoclips. All semiquantitative DCE-US parameters were significantly predictive of FIGO Stage ≥ IB but not of high-risk cancer, despite a clear trend. CONCLUSIONS Compared with 2D-TVU/PD alone, combining 2D-TVU/PD with DCE-US can significantly improve the detection of deep MI and CSI in women with EC, without increasing the false-positive rate. It can also improve the correct classification of high-risk disease, mainly by increasing specificity, thereby possibly reducing the number of unnecessarily extensive surgeries by almost 10%. Semiquantitative DCE-US parameters, as well as a 'focal' filling pattern, endometrial wash-in prior to the myometrium and a 'focal' wash-out pattern, are all associated with more advanced disease. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- R W Green
- Karolinska Institute, Department of Women's and Children's Health, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institute and Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
19
|
Verbakel JY, Mascilini F, Wynants L, Fischerova D, Testa AC, Franchi D, Frühauf F, Cibula D, Lindqvist PG, Fruscio R, Haak LA, Opolskiene G, Alcazar JL, Mais V, Carlson JW, Sladkevicius P, Timmerman D, Valentin L, Bosch TVD, Epstein E. Validation of ultrasound strategies to assess tumor extension and to predict high-risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)-4 cohort. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:115-124. [PMID: 31225683 DOI: 10.1002/uog.20374] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/28/2019] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To compare the performance of ultrasound measurements and subjective ultrasound assessment (SA) in detecting deep myometrial invasion (MI) and cervical stromal invasion (CSI) in women with endometrial cancer, overall and according to whether they had low- or high-grade disease separately, and to validate published measurement cut-offs and prediction models to identify MI, CSI and high-risk disease (Grade-3 endometrioid or non-endometrioid cancer and/or deep MI and/or CSI). METHODS The study comprised 1538 patients with endometrial cancer from the International Endometrial Tumor Analysis (IETA)-4 prospective multicenter study, who underwent standardized expert transvaginal ultrasound examination. SA and ultrasound measurements were used to predict deep MI and CSI. We assessed the diagnostic accuracy of the tumor/uterine anteroposterior (AP) diameter ratio for detecting deep MI and that of the distance from the lower margin of the tumor to the outer cervical os (Dist-OCO) for detecting CSI. We also validated two two-step strategies for the prediction of high-risk cancer; in the first step, biopsy-confirmed Grade-3 endometrioid or mucinous or non-endometrioid cancers were classified as high-risk cancer, while the second step encompassed the application of a mathematical model to classify the remaining tumors. The 'subjective prediction model' included biopsy grade (Grade 1 vs Grade 2) and subjective assessment of deep MI or CSI (presence or absence) as variables, while the 'objective prediction model' included biopsy grade (Grade 1 vs Grade 2) and minimal tumor-free margin. The predictive performance of the two two-step strategies was compared with that of simply classifying patients as high risk if either deep MI or CSI was suspected based on SA or if biopsy showed Grade-3 endometrioid or mucinous or non-endometrioid histotype (i.e. combining SA with biopsy grade). Histological assessment from hysterectomy was considered the reference standard. RESULTS In 1275 patients with measurable lesions, the sensitivity and specificity of SA for detecting deep MI was 70% and 80%, respectively, in patients with a Grade-1 or -2 endometrioid or mucinous tumor vs 76% and 64% in patients with a Grade-3 endometrioid or mucinous or a non-endometrioid tumor. The corresponding values for the detection of CSI were 51% and 94% vs 50% and 91%. Tumor AP diameter and tumor/uterine AP diameter ratio showed the best performance for predicting deep MI (area under the receiver-operating characteristics curve (AUC) of 0.76 and 0.77, respectively), and Dist-OCO had the best performance for predicting CSI (AUC, 0.72). The proportion of patients classified correctly as having high-risk cancer was 80% when simply combining SA with biopsy grade vs 80% and 74% when using the subjective and objective two-step strategies, respectively. The subjective and objective models had an AUC of 0.76 and 0.75, respectively, when applied to Grade-1 and -2 endometrioid tumors. CONCLUSIONS In the hands of experienced ultrasound examiners, SA was superior to ultrasound measurements for the prediction of deep MI and CSI of endometrial cancer, especially in patients with a Grade-1 or -2 tumor. The mathematical models for the prediction of high-risk cancer performed as expected. The best strategies for predicting high-risk endometrial cancer were combining SA with biopsy grade and the subjective two-step strategy, both having an accuracy of 80%. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- J Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F Mascilini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli-IRCSS, Rome, Italy
| | - L Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - A C Testa
- Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Division of Gynecologic Oncology, Rome, Italy
| | - D Franchi
- Department of Gynecological Oncology, Milan, Italy
| | - F Frühauf
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - P G Lindqvist
- Department of Clinical Science and Education, Karolinska Institutet, and Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy
| | - L A Haak
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - G Opolskiene
- Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius University, Lithuania
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - V Mais
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J W Carlson
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - T Van Den Bosch
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, and Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
20
|
Rei M, Rodrigues I, Condeço P, Igreja F, Veríssimo C, Mendinhos G. Endometrial cancer: Preoperative versus intraoperative staging. J Gynecol Obstet Hum Reprod 2019; 49:101647. [PMID: 31760175 DOI: 10.1016/j.jogoh.2019.101647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/09/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the accuracy of transvaginal ultrasonography (TVS) and pelvic magnetic resonance imaging (MRI) in preoperative staging of endometrial cancer in comparison to frozen section (FS) for the assessment of myometrial invasion, considering permanent section as the gold standard. METHODS A retrospective longitudinal study of all endometrial carcinomas diagnosed in our institution between March 2012 and October 2018 was conducted. Women with histologically confirmed endometrial malignancy, planned for surgery as primary treatment and submitted either to TVS, MRI and/or intraoperative FS followed by comprehensive surgical staging were eligible. RESULTS From a total of 187 endometrial carcinomas, 156 were eligible for the study. The most frequent histology was endometrioid carcinoma (n=115), followed by serous carcinoma (n=25); the majority presented a FIGO stage IA (n=85) or IB (n=21). TVS, MRI and FS presented a sensitivity 56 %, 71 % and 67 % [95 %CI 0.35-0.75; 0.49-0.87; 0.45-0.84] and a specificity of 90 %, 78 % and 94 % [95 %CI 0.79-0.97; 0.58-0.91; 0.84-0.98], respectively. FS was the method with the lowest overestimation rate (6.5 %, 95 %CI 0.02-0.16), whereas MRI showed the lowest underestimation rate (29.2 %, 95 %CI 0.13-0.51). Agreement was superior between MRI and FS (Pa=0.79, K=0.56) and secondly between MRI and TVS (Pa=0.78, K=0.47). CONCLUSIONS Intraoperative FS presents the higher specificity and the lowest overestimation rate, while MRI seems to be the exam with the highest sensitivity in the evaluation of myometrial invasion. Agreement between the different methods is reasonable, suggesting that the best alternative will be highly dependent on the availability and experience of each institution.
Collapse
Affiliation(s)
- Mariana Rei
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Loures, Portugal; Department of Obstetrics and Gynaecology, Centro Hospitalar Universitário de São João, EPE Porto, Portugal; Porto Medical School, University of Porto, Portugal.
| | - Inês Rodrigues
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Pedro Condeço
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Fernando Igreja
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Carlos Veríssimo
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gustavo Mendinhos
- Department of Obstetrics and Gynaecology, Hospital Beatriz Ângelo, Loures, Portugal
| |
Collapse
|
21
|
Moro F, Leombroni M, Pasciuto T, Trivellizzi IN, Mascilini F, Ciccarone F, Zannoni GF, Fanfani F, Scambia G, Testa AC. Synchronous primary cancers of endometrium and ovary vs endometrial cancer with ovarian metastasis: an observational study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:827-835. [PMID: 30620432 DOI: 10.1002/uog.20213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare the ultrasound characteristics of patients with synchronous primary cancers of the endometrium and ovary vs those of patients with endometrial cancer with ovarian metastasis. METHODS This was a single-institution retrospective observational study of patients with a histological diagnosis of endometrial cancer and an ovarian malignant mass, who had undergone preoperative ultrasound examination at our unit. Based on the histological diagnosis, patients were classified into two groups: those with synchronous primary cancers of the endometrium and ovary (synchronous group) and patients with endometrial cancer with ovarian metastasis (metastasis group). We compared the ultrasound features of ovarian malignant masses and of endometrial cancers between the two groups. Student's t-test, Mann-Whitney U-test, χ2 test or Fisher's exact test were used for comparisons of variables between the two histological groups, as appropriate. RESULTS We identified 131 patients, of whom 51 had synchronous primary cancers of the endometrium and ovary (synchronous group) and 80 had endometrial cancer with ovarian metastasis (metastasis group). On ultrasound examination, ovarian masses in the synchronous group were more often multilocular-solid and less often bilateral than those in the metastasis group. With respect to the ultrasound features of the endometrial lesions, the median largest diameter was 29 (range, 11-118) mm in the synchronous group in comparison with 51.5 (range, 6-150) mm in the metastasis group (P < 0.0001). Endometrial lesions in the synchronous group presented more often with no myometrial infiltration and less often with a multiple-vessel pattern on color Doppler compared with the endometrial lesions in the metastasis group. CONCLUSIONS Synchronous primary cancers of the endometrium and ovary have significantly different sonomorphological patterns compared with endometrial cancer with ovarian metastasis. Ovarian masses in women with synchronous primary cancers of the endometrium and ovary appeared as unilateral multilocular-solid or solid masses, whereas ovarian masses in women with endometrial cancer with ovarian metastasis were mostly bilateral solid masses. The different sonomorphology of these two cancers may facilitate their preoperative identification, helping the surgeon to determine optimum management for the patient. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- F Moro
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - M Leombroni
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio, Chieti-Pescara, Italy
| | - T Pasciuto
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - I N Trivellizzi
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Ciccarone
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G F Zannoni
- Instituto di Istopatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Fanfani
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio, Chieti-Pescara, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A C Testa
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
22
|
Weinberger V, Bednarikova M, Hausnerova J, Ovesna P, Vinklerova P, Minar L, Felsinger M, Jandakova E, Cihalova M, Zikan M. A Novel Approach to Preoperative Risk Stratification in Endometrial Cancer: The Added Value of Immunohistochemical Markers. Front Oncol 2019; 9:265. [PMID: 31032226 PMCID: PMC6473394 DOI: 10.3389/fonc.2019.00265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
Abstract
Background: The current model used to preoperatively stratify endometrial cancer (EC) patients into low- and high-risk groups is based on histotype, grade, and imaging method and is not optimal. Our study aims to prove whether a new model incorporating immunohistochemical markers, L1CAM, ER, PR, p53, obtained from preoperative biopsy could help refine stratification and thus the choice of adequate surgical extent and appropriate adjuvant treatment. Materials and Methods: The following data were prospectively collected from patients operated for EC from January 2016 through August 2018: age, pre- and post-operative histology, grade, lymphovascular space invasion, L1CAM, ER, PR, p53, imaging parameters obtained from ultrasound, CT chest/abdomen, final FIGO stage, and current decision model (based on histology, grade, imaging method). Results: In total, 132 patients were enrolled. The current model revealed 48% sensitivity and 89% specificity for high-risk group determination. In myometrial invasion >50%, lower levels of ER (p = 0.024), PR (0.048), and higher levels of L1CAM (p = 0.001) were observed; in cervical involvement a higher expression of L1CAM (p = 0.001), lower PR (p = 0.014); in tumors with positive LVSI, higher L1CAM (p = 0.014); in cases with positive LN, lower expression of ER/PR (p < 0.001), higher L1CAM (p = 0.002) and frequent mutation of p53 (p = 0.008). Cut-offs for determination of high-risk tumors were established: ER <78% (p = 0.001), PR <88% (p = 0.008), and L1CAM ≥4% (p < 0.001). The positive predictive values (PPV) for ER, PR, and L1CAM were 87% (60.8–96.5%), 63% (52.1–72.8%), 83% (70.5–90.8%); the negative predictive values (NPV) for each marker were as follows: 59% (54.5–63.4%), 65% (55.6–74.0%), and 77% (67.3–84.2%). Mutation of p53 revealed PPV 94% (67.4–99.1%) and NPV 61% (56.1–66.3%). When immunohistochemical markers were included into the current diagnostic model, sensitivity improved (48.4 vs. 75.8%, p < 0.001). PPV was similar for both methods, while NPV (i.e., the probability of extremely low risk in negative test cases) was improved (66 vs. 78.9%, p < 0.001). Conclusion: We proved superiority of new proposed model using immunohistochemical markers over standard clinical practice and that new proposed model increases accuracy of prognosis prediction. We propose wider implementation and validation of the proposed model.
Collapse
Affiliation(s)
- Vit Weinberger
- Department of Gynecology and Obstetrics, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Marketa Bednarikova
- Department of Internal Medicine - Hematology and Oncology, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Jitka Hausnerova
- Department of Pathology, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Petra Ovesna
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czechia
| | - Petra Vinklerova
- Department of Gynecology and Obstetrics, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Lubos Minar
- Department of Gynecology and Obstetrics, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Michal Felsinger
- Department of Gynecology and Obstetrics, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Eva Jandakova
- Department of Pathology, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Marta Cihalova
- Department of Pathology, University Hospital in Brno and Masaryk University, Brno, Czechia
| | - Michal Zikan
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| |
Collapse
|
23
|
Green RW, Valentin L, Alcazar JL, Chiappa V, Erdodi B, Franchi D, Frühauf F, Fruscio R, Guerriero S, Graupera B, Jakab A, di Legge A, Ludovisi M, Mascilini F, Pascual MA, van den Bosch T, Epstein E. Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy. Gynecol Oncol 2018; 150:438-445. [DOI: 10.1016/j.ygyno.2018.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/30/2018] [Accepted: 06/24/2018] [Indexed: 12/14/2022]
|
24
|
Anastasi E, Gigli S, Ballesio L, Angeloni A, Manganaro L. The Complementary Role of Imaging and Tumor Biomarkers
in Gynecological Cancers: An Update of the Literature. Asian Pac J Cancer Prev 2018; 19:309-317. [PMID: 29479951 PMCID: PMC5980913 DOI: 10.22034/apjcp.2018.19.2.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Gynecological tumors, including endometrial, cervical and ovarian cancer, have increased in incidence over time. The widespread introduction of screening programs and advances in diagnostic imaging methods has lead to a progressive increase in gynecological cancer detection. Accurate diagnosis and proper monitoring of disease remain the primary target for a successful treatment. In the last years, knowledge about cancer biomarkers has considerably increased providing great opportunities for improving cancer detection and treatment. In addition, in the last few years there has been an important development of imaging techniques. Nowadays, a multimodal approach including the evaluation of serum tumor biomarkers combined with imaging techniques, seems to be the best strategy for assessing tumor presence, spread, recurrence, and/or the response to treatment in female cancer patients In this review we provide an overview of the application of biomarkers combined with novel imaging methods and highlight their roles in female cancer diagnosis and follow-up.
Collapse
Affiliation(s)
- Emanuela Anastasi
- Department of Molecular Medicine, Sapienza University, Viale Regina Elena 324, 00161 Roma, Italy.
| | | | | | | | | |
Collapse
|
25
|
Abstract
Pelvic ultrasound examination is the primary imaging modality for evaluating a wide range of female pelvic symptomatology, and is often the first imaging test to detect a gynecologic malignancy. Ultrasound imaging is particularly useful for evaluating the thickness and appearance of the endometrium in patients with abnormal bleeding, and in detecting and characterizing ovarian lesions. This article reviews the ultrasound appearance of gynecologic neoplasms grouped by anatomic site of origin, the ultrasound appearance of select benign pelvic pathology not to be misinterpreted as malignancy, as well as available ultrasound imaging-based guidelines for managing potential gynecologic neoplasms.
Collapse
|
26
|
An Y, Wang H, Jie J, Tang Y, Zhang W, Ji S, Guo X. Identification of distinct molecular subtypes of uterine carcinosarcoma. Oncotarget 2017; 8:15878-15886. [PMID: 28178664 PMCID: PMC5362530 DOI: 10.18632/oncotarget.15032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/06/2017] [Indexed: 12/14/2022] Open
Abstract
Uterine carcinosarcoma (UCS) is a rare but lethal neoplasm with high metastasis and recurrence rate, and to date, no molecular classification of UCS has been defined to achieve targeted therapies. In this study, we identified two distinct molecular subtypes of UCS with distinct gene expression patterns and clinicopathologic characteristics. Subtype I UCS recapitulates low-grade UCS, in contrast subtype II UCS represents high-grade UCS with higher tumor invasion rate and tumor weight. Interestingly, subtype I UCS is characterized by cell adhesion and apoptosis pathways, whereas genes over-expressed in subtype II UCS are more involved in myogenesis/muscle development. We also proposed certain potential subtype specific therapeutic targets, such as SYK (spleen tyrosine kinase) for subtype I and cell-cycle proteins for subtype II. Our findings provide a better recognition of UCS molecular subtypes and subtype specific oncogenesis mechanisms, and can help develop more specific targeted treatment options for these tumors.
Collapse
Affiliation(s)
- Yang An
- Department of Biochemistry and Molecular Biology, Medical School, Henan University, Kaifeng 475004, China.,Cell Signal Transduction Laboratory, Henan University, Kaifeng 475004, China
| | - Haojie Wang
- Department of Biochemistry and Molecular Biology, Medical School, Henan University, Kaifeng 475004, China.,Cell Signal Transduction Laboratory, Henan University, Kaifeng 475004, China
| | - Jingyao Jie
- Department of Biochemistry and Molecular Biology, Medical School, Henan University, Kaifeng 475004, China.,Cell Signal Transduction Laboratory, Henan University, Kaifeng 475004, China
| | - Yitai Tang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Weijuan Zhang
- Department of Biochemistry and Molecular Biology, Medical School, Henan University, Kaifeng 475004, China.,Cell Signal Transduction Laboratory, Henan University, Kaifeng 475004, China
| | - Shaoping Ji
- Department of Biochemistry and Molecular Biology, Medical School, Henan University, Kaifeng 475004, China.,Cell Signal Transduction Laboratory, Henan University, Kaifeng 475004, China.,Department of Oncology, The First Affiliated Hospital of Henan University, Kaifeng, 475001, China
| | - Xiangqian Guo
- Department of Biochemistry and Molecular Biology, Medical School, Henan University, Kaifeng 475004, China.,Cell Signal Transduction Laboratory, Henan University, Kaifeng 475004, China.,Department of Preventive Medicine, Medical School, Henan University, Kaifeng 475004, China.,Department of Burn and Plastic Surgery, The Affiliated Nanshi Hospital of Henan University, Nanyang, 473003, China
| |
Collapse
|
27
|
The Diagnostic Accuracy of Ultrasound in Assessment of Myometrial Invasion in Endometrial Cancer: Subjective Assessment versus Objective Techniques. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1318203. [PMID: 28812010 PMCID: PMC5546069 DOI: 10.1155/2017/1318203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/02/2017] [Accepted: 05/23/2017] [Indexed: 01/02/2023]
Abstract
The aim of this study was to assess the diagnostic accuracy of subjective ultrasound evaluation of myometrial invasion of endometrial cancer and to compare its accuracy to objective methods. All consecutive patients with histologically proven endometrial cancer, who underwent ultrasound evaluation followed by surgical staging between January 2009 and December 2011, were prospectively enrolled. Myometrial invasion was evaluated by subjective assessment using ultrasound (<50% or ≥50%) and calculated as deepest invasion/normal myometrium ratio (Gordon's ratio) and as tumor/uterine anteroposterior diameter ratio (Karlsson's ratio). Histological assessment from hysterectomy was considered the gold standard. Altogether 210 patients were prospectively included. Subjective assessment and two objective ratios were found to be statistically significant predictors of the myometrial invasion (AUC = 0.65, p value < 0.001). Subjective assessment was confirmed as the most reliable method to assess myometrial invasion (79.3% sensitivity, 73.2% specificity, and 75.7% overall accuracy). Deepest invasion/normal myometrium (Gordon's) ratio (cut-off 0.5) reached 69.6% sensitivity, 65.9% specificity, and 67.3% overall accuracy. Tumor/uterine anteroposterior diameter (Karlsson's) ratio with the same cut-off reached 56.3% sensitivity, 76.4% specificity, and 68.1% overall accuracy. The subjective ultrasound evaluation of myometrial invasion performed better than objective methods in nearly all measures but showed statistically significantly better outcomes only in case of sensitivity.
Collapse
|
28
|
Cymbaluk-Płoska A, Chudecka-Głaz A, Pius-Sadowska E, Sompolska-Rzechuła A, Machaliński B, Surowiec A, Menkiszak J. Clinical importance of serum HE4 and MMP2 levels in endometrial cancer patients. Onco Targets Ther 2017; 10:3169-3175. [PMID: 28721066 PMCID: PMC5499930 DOI: 10.2147/ott.s136750] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Endometrial cancer is the one of the most common cancers of the genital organ. HE4 and MMP2 are both proteins whose serum levels increase in endometrial cancer. Aim To explore the diagnostic potential of the serum levels of HE4 and MMP2 in patients with endometrial cancer and benign endometrial diseases. To assess the relationship between the serum levels of HE4 and MMP2 and the typical prognostic factors in patients with endometrial cancer. Materials and methods Included in the study was a group of 112 patients presenting with bleeding abnormalities at the Pomeranian Medical University in years 2012–2016. Serum HE4 concentrations were measured using the Elecsys Electrochemiluminescence Immunoassay (ECLIA). MMP2 concentrations were quantified in the serum using multiplex immunoassays. Results We observed statistically significant differences in mean serum levels of HE4 and MMP2 between the group of endometrial cancer patients and the group of patients with no changes in the endometrium (P=0.002/0.003). The diagnostic potential of HE4 and MMP2 in differentiation of high (International Federation of Gynecology and Obstetrics [FIGO] III and IV) vs low (FIGO I and II) clinical stage of tumor and prediction of cellular differentiation grade (G1 vs G3) on the basis of the analysis of the area under the curve is, respectively, 0.86 and 0.82 for HE4 and 0.82 and 0.74 for MMP2. The HE4 marker was significantly more specific than MMP2 in every study group and amounted to 93% vs 86% in all patients included in the analysis, 94% vs 84% in pre-menopausal patients and 84% vs 79% in post-menopausal patients. Conclusion HE4 and MMP2 are characterized by high specificity and may be useful as biomarkers in the diagnostics of endometrial cancer. When determined preoperatively, HE4 is correlated with the prognostic factors of endometrial cancer and may be helpful in the planning of individual treatment of endometrial cancer patients.
Collapse
Affiliation(s)
- Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents
| | - Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents
| | | | | | | | - Anna Surowiec
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents
| | - Janusz Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents
| |
Collapse
|
29
|
Kim TH, Kim HS, Park JW, Lim OK, Park KD, Lee JK. Falsely Elevated Postvoid Residual Urine Volume in Uterine Myoma. Ann Rehabil Med 2017; 41:332-336. [PMID: 28503470 PMCID: PMC5426254 DOI: 10.5535/arm.2017.41.2.332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022] Open
Abstract
Precise measurement of postvoid residual (PVR) urine volume is a key factor in assessing patients with voiding dysfunction, including those with lower urinary tract problems. The safe and noninvasive ultrasound bladder scan is the preferred mode to measure PVR volume. However, this procedure has a false-positive rate up to 9%, in the presence of ovarian cysts, renal cysts, ascites, or uterine myoma with cystic degeneration. Until now, cystic lesions are known to cause false positivity in ultrasound bladder scanner. However, we encountered falsely-elevated PVR in two cases of non-cystic uterine myomas. We present these cases with detailed radiologic images and volume measurement data.
Collapse
Affiliation(s)
- Tae Hee Kim
- Department of Rehabilitation Medcine, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyo Sang Kim
- Department of Rehabilitation Medcine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jung Wook Park
- Department of Rehabilitation Medcine, Gachon University Gil Medical Center, Incheon, Korea
| | - Oh Kyung Lim
- Department of Rehabilitation Medcine, Gachon University College of Medicine, Incheon, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medcine, Gachon University College of Medicine, Incheon, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medcine, Gachon University College of Medicine, Incheon, Korea
| |
Collapse
|
30
|
Abstract
Although endometrial cancer is surgicopathologically staged, preoperative imaging is recommended for diagnostic work-up to tailor surgery and adjuvant treatment. For preoperative staging, imaging by transvaginal ultrasound (TVU) and/or magnetic resonance imaging (MRI) is valuable to assess local tumor extent, and positron emission tomography-CT (PET-CT) and/or computed tomography (CT) to assess lymph node metastases and distant spread. Preoperative imaging may identify deep myometrial invasion, cervical stromal involvement, pelvic and/or paraaortic lymph node metastases, and distant spread, however, with reported limitations in accuracies and reproducibility. Novel structural and functional imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for improving risk stratification. In this review, we summarize the reported staging performances of conventional and novel preoperative imaging methods and provide an overview of promising novel imaging methods relevant for endometrial cancer care.
Collapse
Affiliation(s)
- Ingfrid S Haldorsen
- Department of Radiology, Haukeland University Hospital, Jonas Liesvei 65, Postbox 7800, 5021, Bergen, Norway.
- Section for Radiology, Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
| | - Helga B Salvesen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, 5020, Bergen, Norway
- Department of Clinical Science, University of Bergen, 5020, Bergen, Norway
| |
Collapse
|
31
|
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.
Collapse
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)
| |
Collapse
|