1
|
Peremiquel-Trillas P, Gómez D, Martínez JM, Fernández-González S, Frias-Gomez J, Paytubi S, Pelegrina B, Pineda M, Brunet J, Ponce J, Matias-Guiu X, Bosch X, de Sanjosé S, Bruni L, Alemany L, Costas L, Díaz M. Cost-effectiveness analysis of molecular testing in minimally invasive samples to detect endometrial cancer in women with postmenopausal bleeding. Br J Cancer 2023; 129:325-334. [PMID: 37165201 PMCID: PMC10338433 DOI: 10.1038/s41416-023-02291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION New approaches are being developed to early detect endometrial cancer using molecular biomarkers. These approaches offer high sensitivities and specificities, representing a promising horizon to develop early detection strategies. OBJECTIVE To evaluate the effectiveness and cost-effectiveness of introducing molecular testing to detect endometrial cancer in women with postmenopausal bleeding compared to the current strategy using the national healthcare service perspective. METHODS A Markov model was developed to assess the two early detection strategies. The model predicts the number of hysterectomies, lifetime expectancy, quality-adjusted life-years, endometrial cancer prevalence and incidence, mortality from endometrial cancer and the lifetime cost of screening, diagnosis, and treatment. Strategies were compared using the incremental cost-effectiveness ratio. RESULTS The molecular strategy reduces 1.9% of the overall number of hysterectomies and the number of undetected cancer cases by 65%. Assuming a molecular test cost of 310€, the molecular strategy has an incremental cost of -32,952€ per QALY gained, being more effective and less expensive than the current strategy. CONCLUSIONS The introduction of molecular testing to diagnose endometrial cancer in women presenting postmenopausal bleeding provides more health benefit at a lower cost, and therefore has the potential to be cost-effective.
Collapse
Affiliation(s)
- Paula Peremiquel-Trillas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - David Gómez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Manuel Martínez
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Fernández-González
- Department of Gynecology and Obstetrics, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Frias-Gomez
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Barcelona. C/ Casanova, 143, 08036, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Sonia Paytubi
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Pelegrina
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Pineda
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Joan Brunet
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Medical Oncology Department. Catalan Institute of Oncology, Doctor Josep Trueta Girona University Hospital. Av. França-Sant Ponç s/n, 17007, Girona, Spain
| | - Jordi Ponce
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Hereditary Cancer Program, IDIBELL. Catalan Institute of Oncology. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Matias-Guiu
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Cancer-CIBERONC. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL. Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Bosch
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Health Sciences, UOC - Open University of Barcelona, Barcelona, Spain
| | - Silvia de Sanjosé
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Consultant National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laia Bruni
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Laura Costas
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain
| | - Mireia Díaz
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP. Carlos III Institute of Health. Av. De Monforte de Lemos 5, 28029, Madrid, Spain.
| |
Collapse
|
2
|
Yang B, Guo H, Shen G. Screening of Endometrial Cancer Related to Lynch Syndrome in China by Suction Curettage-Based Cytology and Histology: A Retrospective Study. J Cytol 2023; 40:99-104. [PMID: 37388402 PMCID: PMC10305898 DOI: 10.4103/joc.joc_39_22] [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: 02/21/2022] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 07/01/2023] Open
Abstract
Objective To explore the feasibility of sampling Chinese patients by suction curettage for cytological and histological screening of endometrial cancer related to Lynch syndrome. Methods This retrospective study enrolled patients who underwent endometrial biopsy at our hospital between May 2018 and January 2019. Endometrial sampling (cytological and micro-histological specimens) was conducted by suction curettage. The gold standard for diagnosis was traditional sharp dilation and curettage (D&C). The sensitivity, specificity, and diagnostic accuracy of cytology, micro-histology, and the combination of cytology and micro-histology were calculated. Additionally, receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficiency of three screening methods. Mismatch repair proteins were further detected using immunohistochemistry (IHC) in endometrial cancer. Results This retrospective finally enrolled 100 patients, which satisfactory samples were obtained from 96 patients for liquid-based cytology and 93 patients for microtissue histology. The concordance rates with D&C, sensitivity, and specificity were 94.8%, 76.9%, and 97.5% for liquid-based cytology, 96.8%, 84.6%, and 98.8% for microtissue histology, and 99.0%, 92.3%, and 100.0% for liquid-based cytology and microtissue histology combined, respectively. The AUC of ROC curves in liquid-based cytology, microtissue histology, and the combined methods for diagnostic ability were 0.873, 0.917, and 0.962, respectively. Absence rates of MLHl, MSH2, MSH6, and PMS2 proteins were 15.3% (2/13), 0% (0/13), 7.7% (1/13), and 15.3% (2/13) in the 13 endometrial cancer samples. Conclusion Liquid-based cytology and microtissue histology samples from suction curettage combined IHC are useful for endometrial cancer screening.
Collapse
Affiliation(s)
- Bo Yang
- Departments of Pathology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Huiqin Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Guqun Shen
- Departments of Gynecology, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| |
Collapse
|
3
|
Gupta M, Gupta P, Yadav P. A randomized comparative study to compare Karman's cannula and pipelle biopsy for evaluation of abnormal uterine bleeding. J Midlife Health 2022; 13:67-73. [PMID: 35707309 PMCID: PMC9190963 DOI: 10.4103/jmh.jmh_292_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/12/2021] [Accepted: 01/25/2022] [Indexed: 11/04/2022] Open
|
4
|
Terzic M, Aimagambetova G, Bapayeva G, Ukybassova T, Kenbayeva K, Kaiyrlykyzy A, Ibrayimov B, Lyasova A, Terzic S, Alkatout I, Gitas G, Hortu İ, Garzon S, Laganà AS. Pipelle endometrial sampling success rates in Kazakhstani settings: results from a prospective cohort analysis. J OBSTET GYNAECOL 2021; 42:1255-1260. [PMID: 34592892 DOI: 10.1080/01443615.2021.1953452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the feasibility of Pipelle endometrial sampling and to explore factors influencing Pipelle success rate in the clinical settings of Kazakhstan. This prospective analysis included 87 patients who had undergone Pipelle biopsy due to medical indications for endometrial sampling. We analysed physician and patient-related factors potentially influencing the success rate of this method. Pipelle endometrial biopsy overall success rate was 82.76%. The indications for the procedure and patients' age were key factors influencing Pipelle sampling success (p < .001). The success rate was the highest in the group with abnormal uterine bleeding as a biopsy indication in the reproductive age group (93.19%; p < .001).Pipelle biopsy was found to be an acceptable option for endometrial sampling in our clinical setting; at the same time, physicians should consider the potential influencing factors on its success rate like indications for the procedure, BMI and patients' age as well as their menopausal status. In order to provide precise future directions, there is a need to study a larger number of patients.IMPACT STATEMENTWhat is already known on this subject? Compared to dilation and curettage sampling conducted in the operation room, Pipelle endometrial sampling is relatively inexpensive, associated with less morbidity, safe, accurate, and can be performed in an office setting.What do the results of this study add? This is the first prospective data analysis about Pipelle endometrial sampling in Kazakhstani population.What are the implications of these findings for clinical practice and/or further research? Enabling the timely diagnosis of current endometrial pathology, Pipelle endometrial sampling approach may have an important impact on healthcare safety and efficiency, and improve overall treatment outcomes and the quality of life of Kazakhstani population if used consistently.
Collapse
Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan.,Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Kamila Kenbayeva
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Aiym Kaiyrlykyzy
- National Laboratory of Astana, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Bakytkali Ibrayimov
- Department of Pathological Anatomy, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Alla Lyasova
- Pathology Bureau of Nur-Sultan City Administration, Nur-Sultan, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - İsmet Hortu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ege University, İzmir, Turkey.,Department of Stem Cell, Institute of Health Sciences, Ege University, İzmir, Turkey
| | - Simone Garzon
- lDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| |
Collapse
|
5
|
Behnamfar F, Arshad E. Diagnostic Values of Pipelle and Standard Curettage Compared to Hysterectomy Pathology in Postmenopausal Bleeding: A Comparative Study. Adv Biomed Res 2020; 9:58. [PMID: 33457341 PMCID: PMC7792876 DOI: 10.4103/abr.abr_28_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/30/2020] [Accepted: 07/05/2020] [Indexed: 11/04/2022] Open
Abstract
Background Postmenopausal bleeding might occur due to many benign and malignant underlying diseases. Differentiating between these diseases poses a great importance. This study was designed to compare the diagnostic value of pipelle endometrial sampling and curettage in patients with postmenopausal bleeding. Further, the results were compared with hysterectomy if performed. Materials and Methods Eighty-seven patients with postmenopausal bleeding were included. Pipelle sampling endometrial biopsy was performed for patients in office, and then, patients were transferred to the operation room for dilatation and curettage. Pathology results of pipelle sampling were compared with curettage method. If hysterectomy was performed due to any reason, it was compared as well. Results The pipelle sampling biopsy diagnosed 94.1% of malignant tumors, and curettage sampling biopsy diagnosed 100% of malignant tumors. The sensitivity and specificity of pipelle compared to curettage were 94.12% and 100%, respectively, for the diagnosis of malignant tumors. Based on the Kappa test, the agreement between pipelle and curettage sampling biopsy was statistically significant (P < 0.001). Conclusion The endometrial sampling with pipelle is safe and cost-effective in patients referred with postmenopausal bleeding. This might avoid the need for general anesthesia for the detection of endometrial hyperplasia and endometrial malignancy.
Collapse
Affiliation(s)
- Fariba Behnamfar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Arshad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
6
|
Thakur M, Maharjan M, Tuladhar H, Dwa Y, Bhandari S, Maskey S, Bajracharya M. Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding in a Tertiary Care Hospital: A Descriptive Cross-sectional Study. ACTA ACUST UNITED AC 2020; 58:333-337. [PMID: 32538929 PMCID: PMC7654461 DOI: 10.31729/jnma.5033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Introduction: Abnormal uterine bleeding is a common gynecological presentation, accounting for at least 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may have profound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with a variety of changes, including delayed onset of puberty, anovulatory cycles, and abnormally high fetal wastage. Hence, this study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. Methods: A descriptive cross-sectional study was conducted in all the patients with abnormal uterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearance was received from the institutional review committee of KIST Medical College. Convenient sampling was done. Data was collected using a questionnaire which includes patients profile, the pattern of abnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Package for the Social Sciences version 23. Results: Out of 79 patients, it was found that 67 (84.8%) were euthyroid, 11 (13.9%) were hypothyroid, and 1 (1.2%) was hyperthyroidism. The most common type of abnormal uterine bleeding was menorrhagia 34 (43%), followed by polymenorrhoea 23 (29%), oligomenorrhoea 13 (16.5%), menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), and hypomenorrhea 1 (1.3%). The maximum number of patients was between 20-25 years with the mean age of 31 years. Among hypothyroid, 7 (8.8%) had subclinical hypothyroidism and 4 (5%) had frank hypothyroidism. Conclusions: Most females with abnormal uterine bleeding were euthyroid. Menorrhagia was the most common pattern of abnormal uterine bleeding.
Collapse
Affiliation(s)
- Minaxi Thakur
- Department of Obstetrics and Gynecology, KIST Medical College, Imadol, Nepal
| | - Meenu Maharjan
- Department of Obstetrics and Gynecology, KIST Medical College, Imadol, Nepal
| | - Heera Tuladhar
- Department of Obstetrics and Gynecology, KIST Medical College, Imadol, Nepal
| | - Yam Dwa
- Department of Obstetrics and Gynecology, KIST Medical College, Imadol, Nepal
| | - Sunita Bhandari
- Department of Obstetrics and Gynecology, KIST Medical College, Imadol, Nepal
| | - Smrity Maskey
- Department of Obstetrics and Gynecology, KIST Medical College, Imadol, Nepal
| | - Manisha Bajracharya
- Department of Obstetrics and Gynecology, KIST Medical College, Imadol, Nepal
| |
Collapse
|
7
|
Comparison of aspirating pipettes and hysteroscopy with curettage. Arch Gynecol Obstet 2020; 301:1485-1492. [PMID: 32350598 DOI: 10.1007/s00404-020-05551-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE In this prospective study, endometrial biopsy by pipette was compared with hysteroscopy with curettage in patients with an abnormal uterine bleeding (ABU) (hypermenorrhea, intermediate bleeding, continuous bleeding, postmenopausal bleeding) and patients with a sonographically abnormal endometrium. METHODS 176 patients were included. The pipette samples were taken during the usual planned procedure under general anaesthesia. Thereafter, the planned hysteroscopy with curettage was completed. The study was performed as a double-blind study. The obtained histologies (of pipelle and curettage) were sent separately to the same pathologist. The pipelle material was encoded by a specific number without any patient data. RESULTS In 97% of the cases using the biopsy with pipette were obtained an adequate sample. The biopsy with pipette had a sensitivity and specificity of 100% in the diagnosis of endometrial carcinoma and atypical hyperplasia. Pipette showed a significantly lower accuracy with a sensitivity of 28% in the diagnosis of endometrial hyperplasia without atypia. Pipette showed the lowest sensitivity for polyps, myomas and atrophic endometrium. CONCLUSION The study shows that pipette sampling is a safe, accurate, low-cost ambulatory procedure with high sensitivity for the detection of atypical endometrial hyperplasia and endometrial carcinoma. In the case of sonographically definable findings (polyp, myoma), hysteroscopy with curettage is preferred.
Collapse
|
8
|
Du G, Zhang W, Zhang Z, Zeng M, Wang Y. HTLV-1-associated genes as potential biomarkers for endometrial cancer. Oncol Lett 2019; 18:699-705. [PMID: 31289544 PMCID: PMC6546975 DOI: 10.3892/ol.2019.10389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/05/2019] [Indexed: 01/15/2023] Open
Abstract
Endometrial carcinoma (EC) is a malignant neoplasm of the endometrial epithelium, which may be diagnosed by pathological investigations. The aim of the current study was to identify new markers for the diagnosis of EC using machine learning. The association between human T cell lymphotropic virus type 1 (HTLV-1) infection and endometrial cancer risk have not been widely reported. It remains ambiguous whether HTLV-1 infection is associated with several types of cancer. The present study investigated the association between HTLV-1 infection-associated genes and EC risk. RNA sequencing uterine cancer expression data were downloaded from The Cancer Genome Atlas (TCGA) database. Differentially expressed genes (DEGs) were identified between normal and matched tumor samples. A total of 41 genes were selected by an overlap between HTLV-1 infection pathway-associated genes and the DEGs. Two-way hierarchical clustering analysis (HCA) and a support vector machine (SVM) classifier were constructed using the 41 genes. The accuracy of the candidate genes in risk-stratifying the samples was 100%. The accuracy of the proposed SVM model was 100%. In addition, the classification power of the SVM model was validated using a merged dataset (TCGA and the Genotype-Tissue Expression project). This predictive feature achieved reliable outcomes with risk-stratifying samples of almost 99% in two-way HCA, and an accuracy yield of 98% of the SVM classifier. In conclusion, the 41 genes identified in the current study may be implicated in the development of EC and may be of prognostic value for the disease. The results obtained the current study suggest that HTLV-1 may be potentially associated with EC and highlight potential disease mechanisms.
Collapse
Affiliation(s)
- Gang Du
- Department of Laboratory Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Wenqian Zhang
- Department of Reproductive Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510000, P.R. China
| | - Zhen Zhang
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou, Guangdong 510080, P.R. China
| | - Meizhai Zeng
- Department of Bioinformatics, Guangzhou GenCoding Lab, Guangzhou, Guangdong 510670, P.R. China
| | - Yuxia Wang
- Department of Reproductive Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510000, P.R. China
| |
Collapse
|
9
|
Tuo X, Zhao L, Wang Q, Han L, Wang Y, Ma S, Feng X, Li Q, Sun C, Wang Q, Shi G, Hou H, Zhang G, Li Q. Validation of Molecular Typing for Endometrial Screening Test That Predicts Benign and Malignant Lesions. Front Oncol 2019; 9:561. [PMID: 31338322 PMCID: PMC6629861 DOI: 10.3389/fonc.2019.00561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/10/2019] [Indexed: 12/24/2022] Open
Abstract
The aim of this study is to examine the immunocytochemical expression of p53, Ki-67, and CA125 in endometrial brush samples for endometrial cancer. Forty-four patients were recruited with liquid-based cytology preparations during a 5-month period. Both the histological and cytological samples were assessed by histology based on hematoxylin and eosin (H&E), and the expression of p53, CA125, and Ki-67 in endometrial cells was examined by immunocytochemistry. The percentage and intensity of endometrial cells were scored on a scale of 0-3. The final score was calculated by the addition of all partial scores, and then Probit model was used to predict the possibility for malignant lesions. The mean immunoreactivity score of the three immunocytochemical biomarkers (p53, CA125, and Ki-67) in the positive group (including atypical hyperplastic cells and malignant cells) was significantly higher than in the negative group (benign cells and non-atypical hyperplastic cells). The possibility value of the positive group was also significantly higher than the negative group (P < 0.05). The cutoff value of the possibility value was 0.754, the sensitivity and specificity of which were 86.4 and 95.5%. The assessment of p53, CA125, and Ki-67 combined with the prediction model is valuable for the detection of endometrial cancer and atypical hyperplasia in endometrial cytology.
Collapse
Affiliation(s)
- Xiaoqian Tuo
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lanbo Zhao
- Guipei 77, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Qi Wang
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lu Han
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yiran Wang
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Sijia Ma
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xue Feng
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qing Li
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Chao Sun
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qing Wang
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Guizhi Shi
- Aviation General Hospital of Beijing, Medical University and Beijing Institute of Translational Medicine, University of Chinese Academy of Sciences, Beijing, China
| | - Huilian Hou
- Department of Pathology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Guanjun Zhang
- Department of Pathology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qiling Li
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
10
|
Narice BF, Delaney B, Dickson JM. Endometrial sampling in low-risk patients with abnormal uterine bleeding: a systematic review and meta-synthesis. BMC FAMILY PRACTICE 2018; 19:135. [PMID: 30060741 PMCID: PMC6066914 DOI: 10.1186/s12875-018-0817-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 07/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND One million women per year seek medical advice for abnormal uterine bleeding (AUB) in the United Kingdom. Many low-risk patients who could be managed exclusively in primary care are referred to hospital based gynaecology services. Performing endometrial sampling (ES) in the community may improve care, reduce the rate of referrals and minimise costs. We aimed to search and synthesise the literature on the effectiveness of ES (Pipelle versus other devices) in managing AUB in low-risk patients. METHODS We undertook an electronic literature search in MEDLINE via OvidSP, Scopus, and Web of Science for relevant English-language articles from 1984 to 2016 using a combination of MeSH and keywords. Two reviewers independently pre-selected 317 articles and agreed on 60 articles reporting data from over 7300 patients. Five themes were identified: sample adequacy, test performance, pain and discomfort, cost-effectiveness, and barriers and complications of office ES. RESULTS Pipelle seems to perform as well as dilation and curettage and, as well or better than other ES devices in terms of sampling adequacy and sensitivity. It also seems to be better regarding pain/discomfort and costs. However, Pipelle can disrupt the sonographic appearance of the endometrium and may be limited by cervical stenosis, pelvic organ prolapse and endometrial atrophy. CONCLUSIONS The current evidence supports the use of Pipelle in the management of low-risk women presenting in the outpatient setting with symptomatic AUB when combined with clinical assessment and ultrasound scanning. However, the implications of its widespread use in primary care are uncertain and more research is required.
Collapse
Affiliation(s)
- Brenda F. Narice
- Clinical Research Fellow in Obstetrics & Gynaecology; Academic Unit of Reproductive and Developmental Unit, University of Sheffield, Sheffield, S10 2SF UK
| | - Brigitte Delaney
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, S5 7AU UK
| | - Jon M. Dickson
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, S5 7AU UK
| |
Collapse
|
11
|
Pennant ME, Mehta R, Moody P, Hackett G, Prentice A, Sharp SJ, Lakshman R. Premenopausal abnormal uterine bleeding and risk of endometrial cancer. BJOG 2017; 124:404-411. [PMID: 27766759 PMCID: PMC5297977 DOI: 10.1111/1471-0528.14385] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endometrial biopsies are undertaken in premenopausal women with abnormal uterine bleeding but the risk of endometrial cancer or atypical hyperplasia is unclear. OBJECTIVES To conduct a systematic literature review to establish the risk of endometrial cancer and atypical hyperplasia in premenopausal women with abnormal uterine bleeding. SEARCH STRATEGY Search of PubMed, Embase and the Cochrane Library from database inception to August 2015. SELECTION CRITERIA Studies reporting rates of endometrial cancer and/or atypical hyperplasia in women with premenopausal abnormal uterine bleeding. DATA COLLECTION AND ANALYSIS Data were independently extracted by two reviewers and cross-checked. For each outcome, the risk and a 95% CI were estimated using logistic regression with robust standard errors to account for clustering by study. MAIN RESULTS Sixty-five articles contributed to the analysis. Risk of endometrial cancer was 0.33% (95% CI 0.23-0.48%, n = 29 059; 97 cases) and risk of endometrial cancer or atypical hyperplasia was 1.31% (95% CI 0.96-1.80, n = 15 772; 207 cases). Risk of endometrial cancer was lower in women with heavy menstrual bleeding (HMB) (0.11%, 95% CI 0.04-0.32%, n = 8352; 9 cases) compared with inter-menstrual bleeding (IMB) (0.52%, 95% CI 0.23-1.16%, n = 3109; 14 cases). Of five studies reporting the rate of atypical hyperplasia in women with HMB, none identified any cases. CONCLUSIONS The risk of endometrial cancer or atypical hyperplasia in premenopausal women with abnormal uterine bleeding is low. Premenopausal women with abnormal uterine bleeding should first undergo conventional medical management. Where this fails, the presence of IMB and older age may be indicators for further investigation. Further research into the risks associated with age and the cumulative risk of co-morbidities is needed. TWEETABLE ABSTRACT Contrary to practice, premenopausal women with heavy periods or inter-menstrual bleeding rarely require biopsy.
Collapse
Affiliation(s)
- ME Pennant
- Public Health DirectorateCambridgeshire County CouncilCambridgeUK
| | - R Mehta
- Cambridge University Hospitals NHS Foundation trustCambridgeUK
| | - P Moody
- Cambridge University Hospitals NHS Foundation trustCambridgeUK
| | - G Hackett
- Cambridge University Hospitals NHS Foundation trustCambridgeUK
| | - A Prentice
- Cambridge University Hospitals NHS Foundation trustCambridgeUK
- Department of Obstetrics & GynaecologyUniversity of CambridgeCambridgeUK
| | - SJ Sharp
- Medical Research Council Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - R Lakshman
- Public Health DirectorateCambridgeshire County CouncilCambridgeUK
- Medical Research Council Epidemiology UnitUniversity of CambridgeCambridgeUK
| |
Collapse
|
12
|
Du J, Li Y, Lv S, Wang Q, Sun C, Dong X, He M, Ulain Q, Yuan Y, Tuo X, Batchu N, Song Q, Li Q. Endometrial sampling devices for early diagnosis of endometrial lesions. J Cancer Res Clin Oncol 2016; 142:2515-2522. [PMID: 27515060 PMCID: PMC5095161 DOI: 10.1007/s00432-016-2215-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/03/2016] [Indexed: 11/25/2022]
Abstract
Purpose Endometrial carcinoma is the most common gynecologic malignancy in both developed and some developing countries. Unlike cervical cancer, for which there is routine screening, only patients symptomatic for endometrial carcinoma typically seek medical help for its diagnosis and treatment. Dilatation and curettage (D&C) has been the standard procedure for evaluating suspicious endometrial lesions.
The discomfort and injury caused by the D&C procedure, however, restrict its use as a screening method for early diagnosis of endometrial lesions. High-risk endometrial cancer patients would benefit from an effective and low-cost screening test. In recent years, several endometrial devices have been developed and proposed as screening tools. Methods We have reviewed and evaluated the literature relating to the endometrial sampling devices in clinical use or clinical trials, with the goal of comparing devices and identifying the most appropriate ones for screening for endometrial lesions. Eligible literature was identified from systematic PubMed searches, and the relevant data were extracted. Comments, letters, unpublished data, conference proceedings, and case reports were excluded from our search. Seventy-four articles on endometrial sampling devices were obtained for this review. Results The main screening devices for endometrial carcinoma are aspiration devices (such as the Vabra aspirator), Pipelle, Tao Brush, and SAP-1 device. Among these devices, the Tao Brush is the most promising endometrial sampler for screening for endometrial lesions. However, its sampling insufficiency, cost, and unsuccessful insertion rate (20 % in nulliparous and 8 % in parous women) are problematic. Conclusions A more accurate and low-cost endometrial sampler, with improved specimen sufficiency and higher sensitivity for endometrial lesions, needs tobe developed and clinically verified.
Collapse
Affiliation(s)
- Jiang Du
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yaling Li
- Gongzhuling Health Workers High School, Gongzhuling, 136100, Jilin, China
| | - Shulan Lv
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Qing Wang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Chao Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xin Dong
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Ming He
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Qurat Ulain
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yongxing Yuan
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiaoqian Tuo
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Nasra Batchu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Qing Song
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, 30310, USA.,Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Center of Big Data and Bioinformatics, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| |
Collapse
|
13
|
Khan R, Sherwani RK, Rana S, Hakim S, S Jairajpuri Z. Clinco-Pathological Patterns in Women with Dysfunctional Uterine Bleeding. IRANIAN JOURNAL OF PATHOLOGY 2016; 11:20-6. [PMID: 26870139 PMCID: PMC4749191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/08/2015] [Indexed: 10/27/2022]
Abstract
BACKGROUND The term dysfunctional uterine bleeding (DUB) refers to any abnormal bleeding from the uterus, unassociated with tumour, inflammation and pregnancy. The histological diagnosis of DUB is very essential for adequate management especially in perimenopausal and postmenopausal females. The present study was undertaken with the aim of evaluating DUB in various age groups, carry out histopathological study of the endometrium and analyze its clinic-pathological patterns. METHODS The study included 500 cases of atypical uterine bleeding, out of which 120 cases of DUB were included based on clinical features and detailed investigations. Study was conducted in Jawaharlal Nehru Medical College, Aligarh Muslim University, between March 2003 to December 2004 Endometrial tissue was collected by D&C procedure and the samples were sent for histopathological evaluation by pathologist. RESULT Hyperplasia was the commonest endometrial pathology (20.5%) followed by luteal phase insufficiency (15.6%) and secretory endometrium (13.7%). Endometritis including tubercular endometritis (12.7%), post abortal (5.8%), proliferative (6.8%), polyp (3.9%), atrophic (3.9%), exogenous hormone changes (2.9%) and anovulatory cycles (6.8%) made up for the remaining lesions. CONCLUSION DUB occurs secondary to a wide variety of functional and structural abnormalities, warranting a thorough evaluation especially in perimenoupausal females. Menorrhagia is a common symptom and the most likely etiology relates to the patient's age. Significant number of endometrial samples revealed pathology rendering endometrial curetting and biopsy an important procedure. Cervical cytology is a valuable adjunct however histopathology remains the gold standard in diagnosis.
Collapse
Affiliation(s)
- Rehana Khan
- Dept. of Obstetrics and Gynaecology, JN Medical College, AMU, Aligarh, India
| | - Rana K Sherwani
- Dept. of Pathology, JN Medical College, AMU, Aligarh, , India
| | - Safia Rana
- Dept. of Pathology,Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| | - Seema Hakim
- Dept. of Obstetrics and Gynaecology, JN Medical College, AMU, Aligarh, India
| | - Zeeba S Jairajpuri
- Dept. of Pathology,Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi, India
| |
Collapse
|
14
|
Lilford RJ, Burn SL, Diaconu KD, Lilford P, Chilton PJ, Bion V, Cummins C, Manaseki-Holland S. An approach to prioritization of medical devices in low-income countries: an example based on the Republic of South Sudan. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:2. [PMID: 25606027 PMCID: PMC4298960 DOI: 10.1186/s12962-014-0027-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Efficient and evidence-based medical device and equipment prioritization is of particular importance in low-income countries due to constraints in financing capacity, physical infrastructure and human resource capabilities. Methods This paper outlines a medical device prioritization method developed in first instance for the Republic of South Sudan. The simple algorithm offered here is a starting point for procurement and selection of medical devices and can be regarded as a screening test for those that require more labour intensive health economic modelling. Conclusions A heuristic method, such as the one presented here, is appropriate for reaching many medical device prioritization decisions in low-income settings. Further investment and purchasing decisions that cannot be reached so simply require more complex health economic modelling approaches. Electronic supplementary material The online version of this article (doi:10.1186/s12962-014-0027-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Richard J Lilford
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Dental and Medical Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT UK ; Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, CV4 7AL UK
| | - Samantha L Burn
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Dental and Medical Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT UK
| | - Karin D Diaconu
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Dental and Medical Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT UK
| | - Peter Lilford
- Ministry of Finance, Government of South Sudan, Juba, South Sudan
| | - Peter J Chilton
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Dental and Medical Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT UK
| | - Victoria Bion
- School of Medicine, University of Southampton, Southampton, SO17 1BJ UK
| | - Carole Cummins
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Dental and Medical Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT UK
| | - Semira Manaseki-Holland
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, College of Dental and Medical Sciences, University of Birmingham, Edgbaston, West Midlands, B15 2TT UK
| |
Collapse
|
15
|
Abdelazim IA, Aboelezz A, Abdulkareem AF. Pipelle endometrial sampling versus conventional dilatation & curettage in patients with abnormal uterine bleeding. J Turk Ger Gynecol Assoc 2013; 14:1-5. [PMID: 24592061 DOI: 10.5152/jtgga.2013.01] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study was designed to compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. MATERIAL AND METHODS One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; where endometrial sampling was carried out before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the dilatation & curettage sample and the dilatation & curettage reports were considered as the gold standard. RESULTS 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by the Pipelle device were adequate for histopathological examination. The histolopathological examination of 140 samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium. Also, it had 88.9% sensitivity, and 99.2% negative predictive value (NPV) and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. CONCLUSION The endometrial sampling using Pipelle is a safe, accurate, cost effective outpatient procedure, which avoids general anesthesia and has a high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy.
Collapse
Affiliation(s)
- Ibrahim Anwar Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt ; Department of Obstetrics and Gynecology, Ahmadi Hospital, Ahmadi, Kuwait
| | - Amro Aboelezz
- Department of Obstetrics and Gynecology, Al-azhar University Maternity Hospital, Faculty of Medicine, Al-azhar University, Cairo, Egypt ; Department of Obstetrics and Gynecology, Ahmadi Hospital, Ahmadi, Kuwait
| | - Amr Fathy Abdulkareem
- Department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt ; Department of Obstetrics and Gynecology, Ahmadi Hospital, Ahmadi, Kuwait
| |
Collapse
|