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Plekhanov AA, Grechkanev GO, Avetisyan EA, Loginova MM, Kiseleva EB, Shepeleva AA, Moiseev AA, Sovetsky AA, Gubarkova EV, Anina AA, Shutova AM, Gamayunov SV, Gelikonov GV, Zaitsev VY, Sirotkina MA, Gladkova ND. Quantitative Assessment of Polarization and Elastic Properties of Endometrial Tissue for Precancer/Cancer Diagnostics Using Multimodal Optical Coherence Tomography. Diagnostics (Basel) 2024; 14:2131. [PMID: 39410535 PMCID: PMC11475316 DOI: 10.3390/diagnostics14192131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 10/20/2024] Open
Abstract
Objectives: The most important phase in the endometrial pathologies diagnostics is the histological examination of tissue biopsies obtained under visual hysteroscopic control. However, the unclear visual diagnostics characteristics of subtle focal endometrial pathologies often lead to selection errors regarding suspicious endometrial lesions and to a subsequent false pathological diagnosis/underestimation of precancer or early-stage cancer. Methods: In this study, we investigate the potential of Multimodal Optical Coherence Tomography (MM OCT) to verify suspicious endometrial lesion regions before biopsy collection. We study the polarization (by cross-polarization OCT, CP OCT) and elastic (by compression OCT-elastography, C-OCE) properties of ex vivo endometrial tissue samples in normal conditions (proliferative and secretory phases to the menstrual cycle, atrophic endometrium) with endometrial hyperplasia (non-atypical and endometrial intraepithelial neoplasia) and endometrial cancer subtypes (low-grade, high-grade, clear cell and serous). Results: To the best of our knowledge, this is the first quantitative assessment of relevant OCT parameters (depth-resolved attenuation coefficient in co-[Att(co) values] and cross-[(Att(cross) values] polarizations and Young's elastic modulus [stiffness values]) for the selection of the most objective criteria to identify the clinically significant endometrial pathologies: endometrial intraepithelial neoplasia and endometrial cancer. The study demonstrates the possibility of detecting endometrial pathologies and establishing optimal threshold values of MM OCT criteria for the identification of endometrial cancer using CP OCT (by Att(co) values = 3.69 mm-1, Sensitivity (Se) = 86.1%, Specificity (Sp) = 92.6%; by Att(cross) values = 2.27 mm-1, Se = 86.8%, Sp = 87.0%) and C-OCE (by stiffness values = 122 kPa, Se = 93.2%, Sp = 91.1%). The study also differentiates endometrial intraepithelial neoplasia from non-atypical endometrial hyperplasia and normal endometrium using C-OCE (by stiffness values = 95 kPa, Se = 87.2%, Sp = 90.1%). Conclusions: The results are indicative of the efficacy and potential of clinical implementation of in vivo hysteroscopic-like MM OCT in the diagnosis of endometrial pathologies.
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Affiliation(s)
- Anton A. Plekhanov
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
| | - Gennady O. Grechkanev
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
| | - Elena A. Avetisyan
- Nizhny Novgorod Regional Oncological Hospital, 11/1 Delovaya St., 603093 Nizhny Novgorod, Russia; (E.A.A.); (A.A.S.); (S.V.G.)
| | - Maria M. Loginova
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
| | - Elena B. Kiseleva
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
| | - Anastasia A. Shepeleva
- Nizhny Novgorod Regional Oncological Hospital, 11/1 Delovaya St., 603093 Nizhny Novgorod, Russia; (E.A.A.); (A.A.S.); (S.V.G.)
| | - Alexander A. Moiseev
- A.V. Gaponov-Grekhov Institute of Applied Physics The Russian Academy of Sciences, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (A.A.M.); (A.A.S.); (G.V.G.); (V.Y.Z.)
| | - Alexander A. Sovetsky
- A.V. Gaponov-Grekhov Institute of Applied Physics The Russian Academy of Sciences, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (A.A.M.); (A.A.S.); (G.V.G.); (V.Y.Z.)
| | - Ekaterina V. Gubarkova
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
| | - Anastasia A. Anina
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
- Lobachevsky University, 23 Gagarin Av., 603022 Nizhny Novgorod, Russia
| | - Angelina M. Shutova
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
| | - Sergey V. Gamayunov
- Nizhny Novgorod Regional Oncological Hospital, 11/1 Delovaya St., 603093 Nizhny Novgorod, Russia; (E.A.A.); (A.A.S.); (S.V.G.)
| | - Grigory V. Gelikonov
- A.V. Gaponov-Grekhov Institute of Applied Physics The Russian Academy of Sciences, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (A.A.M.); (A.A.S.); (G.V.G.); (V.Y.Z.)
| | - Vladimir Y. Zaitsev
- A.V. Gaponov-Grekhov Institute of Applied Physics The Russian Academy of Sciences, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (A.A.M.); (A.A.S.); (G.V.G.); (V.Y.Z.)
| | - Marina A. Sirotkina
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
| | - Natalia D. Gladkova
- Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia; (G.O.G.); (M.M.L.); (E.B.K.); (E.V.G.); (A.A.A.); (A.M.S.); (M.A.S.); (N.D.G.)
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Yao Y, Xu S, Wang T, Jiang R. Efficacy of drugs treatment in patients with endometrial hyperplasia with or without atypia: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e39619. [PMID: 39312359 PMCID: PMC11419537 DOI: 10.1097/md.0000000000039619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/16/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Endometrial hyperplasia (EH) is a hyperplastic endometrial lesion with irregular gland size, increased glands, and increased glandular interstitial ratio. During follow-up, some EH progressed further to endometrial cancer. It is crucial to provide timely treatment for EH and improve the overall prognosis of EH patients. METHODS We searched the PubMed, ClinicalTrials.gov., and Embase databases for studies published from their inception to March 31, 2023. The methodological quality of each study was evaluated in accordance with the Cochrane Collaboration's tool for assessing the risk of bias. The RevMan5.3 software provided by the Cochrane Collaboration was used for direct meta-analysis statistical analysis; and the relative risk and 95% confidence interval along with the mean difference and 95% confidence interval, were used as evaluation indexes. RESULTS We included 21 randomized controlled trials involving a total of 2276 women with EH, 6 studies were of high quality, and 15 were of moderate quality. The blinding of subjects and intervention providers was identified as the main source of potential bias. Six interventions were addressed in the network meta-analysis: medroxyprogesterone acetate (MPA), plus metformin, norethisterone (NET), levonorgestrel-releasing intrauterine system (LNG-IUD), megestrol acetate, and other drugs. In the direct meta-analysis, we found the probability of endometrial complete regression (CR) in the LNG-IUD group to be significantly higher than those in the NET. In the network meta-analysis, we found the probability of CR in the NET group to be significantly lower than those in the MPA and plus metformin groups, the probability of CR in the LNG-IUD group to be significantly higher than those in the NET, the probability of CR in the other drugs group to be significantly higher than those in the LNG-IUD. The NET group had the lowest incidences of endometrial complete regression, plus metformin could have a better outcome. CONCLUSION According to the 21 randomized controlled trials included in this study, MPA is the most effective for EH endometrial outcome when applied as a single agent, while the combination of metformin can achieve a more significant effect.
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Affiliation(s)
- Yingsha Yao
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Shuhang Xu
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ting Wang
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ruoan Jiang
- Department of Obstetrics and Gynecology, Women’s Hospital Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China
- Traditional Chinese Medicine for Reproductive Health Key Laboratory of Zhejiang Province, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Matsumoto Y, Yamaguchi K, Maruyama M, Sone K, Mori-Uchino M, Hirota Y, Wada-Hiraike O, Osuga Y. Characteristic hysteroscopy appearance considerations for detecting uterine endometrial malignancies. J Obstet Gynaecol Res 2024; 50:566-571. [PMID: 38214188 DOI: 10.1111/jog.15879] [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: 06/29/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
AIM The effectiveness of hysteroscopy in diagnosing endometrial lesions has been demonstrated, showing high diagnostic accuracy for malignant endometrial lesions. Although the characteristic appearances of atypical and malignant endometria have been reported, they are not definitive and sometimes complicated. This study aimed to identify a small number of characteristic features to detect endometrial abnormalities using a simple judgment system and analyze the diagnostic characteristics and their accuracy in endometrial malignancy diagnosis. METHODS We performed a retrospective analysis of hysteroscopy video data of 250 patients, of which we selected for analysis based on pathology examination 152 cases with benign changes, 16 with atypical endometrium, and 18 with carcinoma in situ or endometrial cancer. Endometrial characteristics assessed included protrusion, desquamation, extended vessel, atypical vessel, and white/yellow lesion. RESULTS Multivariable analysis revealed that desquamation (p = 0.001, odds ratio [OR] 5.28), atypical vessels (p < 0.001, OR 8.50), and white/yellow lesions (p = 0.011, OR 1.37) were significant predictors for endometrial malignancy. From their contribution status, scoring points of 4, 6, and 1 were settled according to the odds ratio proportions. When scores ≥5 (at least both desquamation and white/yellow lesions or only atypical vessels) were used to define endometrial malignancy, sensitivity and specificity were 100% and 92%, respectively. When detecting cancer, atypical, and benign cases, sensitivity and specificity were 88% and 90%, respectively. CONCLUSION Our characteristics hysteroscopic findings showed a higher predictive ability in detecting endometrial malignancies. However, further examination with more cases would be needed to accurately diagnose endometrial malignancy by hysteroscopy.
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Affiliation(s)
- Yoko Matsumoto
- Department of Obstetrics and Gynecology, Kanto Rosai Hospital, Kawasaki-shi, Kanagawa, Japan
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Yamaguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masanori Maruyama
- Department of Obstetrics and Gynecology, Maruyama Memorial General Hospital, Saitama, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayuyo Mori-Uchino
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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