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Ma X, Xu L, Ma F, Zhang J, Zhang G, Qiang J. Whole-tumor apparent diffusion coefficient histogram analysis for preoperative risk stratification in endometrial endometrioid adenocarcinoma. Int J Gynaecol Obstet 2024; 164:1174-1183. [PMID: 37925611 DOI: 10.1002/ijgo.15226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To investigate the application of whole-tumor apparent diffusion coefficient (ADC) histogram metrics for preoperative risk stratification in endometrial endometrioid adenocarcinoma (EEA). METHODS Preoperative MRI of 502 EEA patients were retrospectively analyzed. Whole tumor ADC histogram analysis was performed with regions of interest drawn on all tumor slices of diffusion-weighted imaging scans. Risk stratification was based on ESMO-ESTRO-ESP guidelines: low-, intermediate-, high-intermediate-, and high-risk. Univariable analysis was used to compare ADC histogram metrics (tumor volume, minADC, maxADC, and meanADC; 10th, 25th, 50th, 75th, and 90th percentiles of ADC [recorded as P10, P25, P50, P75, and P90 ADC, respectively]; skewness; and kurtosis) between different risk EEAs, and multivariable logistic regression analysis to determine the optimal metric or combined model for risk stratifications. Receiver operating characteristic curve analysis with the area under the curve (AUC) was used for diagnostic performance evaluation. RESULTS A decreasing tendency in multiple ADC values was observed from the low- to high-intermediate-risk EEAs. The (low + intermediate)-risk EEAs and low-risk EEAs had significantly smaller tumor volumes and higher minADCs, meanADCs, P10, P25, P50, P75, and P90 ADCs than the (high-intermediate + high)-risk EEAs and non-low-risk EEAs (all P < 0.05), respectively. The combined models of the (meanADC + volume) and the (P75 ADC + volume) yielded the largest AUCs of 0.775 and 0.780 in identifying the (low + intermediate)- and the low-risk EEAs from the other EEAs, respectively. CONCLUSION Whole-tumor ADC histogram metrics might be helpful for preoperatively identifying low- and (low + intermediate)-risk EEAs, facilitating personalized therapeutic planning.
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Affiliation(s)
- Xiaoliang Ma
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Limin Xu
- Department of Ultrasound, Lishui People's Hospital, Zhejiang Province, Lishui, People's Republic of China
| | - Fenghua Ma
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jialiang Zhang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Guofu Zhang
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, People's Republic of China
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Chen X, Guo Q, Chen X, Zheng W, Kang Y, Cao D. Clinical and multiparametric MRI features for differentiating uterine carcinosarcoma from endometrioid adenocarcinoma. BMC Med Imaging 2024; 24:48. [PMID: 38373912 PMCID: PMC10877902 DOI: 10.1186/s12880-024-01225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION The purpose of our study was to differentiate uterine carcinosarcoma (UCS) from endometrioid adenocarcinoma (EAC) by the multiparametric magnetic resonance imaging (MRI) features. METHODS We retrospectively evaluated clinical and MRI findings in 17 patients with UCS and 34 patients with EAC proven by histologically. The following clinical and pathological features were evaluated: post- or pre-menopausal, clinical presentation, invasion depth, FIGO stage, lymphaticmetastasis. The following MRI features were evaluated: tumor dimension, cystic degeneration or necrosis, hemorrhage, signal intensity (SI) on T2-weighted images (T2WI), relative SI of lesion to myometrium on T2WI, T1WI, DWI, ADCmax, ADCmin, ADCmean (RSI-T2, RSI-T1, RSI-DWI, RSI-ADCmax, RSI-ADCmin, RSI-ADCmean), ADCmax, ADCmin, ADCmean, the maximum, minimum and mean relative enhancement (RE) of lesion to myometrium on the arterial and venous phases (REAmax, REAmin, REAmean, REVmax, REVmin, REVmean). Receiver operating characteristic (ROC) analysis and the area under the curve (AUC) were used to evaluate prediction ability. RESULTS The mean age of UCS was higher than EAC. UCS occurred more often in the postmenopausal patients. UCS and EAC did not significantly differ in depth of myometrial invasion, FIGO stage and lymphatic metastasis. The anterior-posterior and transverse dimensions were significantly larger in UCS than EAC. Cystic degeneration or necrosis and hemorrhage were more likely occurred in UCS. The SI of tumor on T2WI was more heterogeneous in UCS. The RSI-T2, ADCmax, ADCmean, RSI-ADCmax and RSI-ADCmean of UCS were significantly higher than EAC. The REAmax, REAmin, REAmean, REVmax, REVmin and REVmean of UCS were all higher than EAC. The AUCs were 0.72, 0.71, 0.86, 0.96, 0.89, 0.84, 0.73, 0.97, 0.88, 0.94, 0.91, 0.69 and 0.80 for the anterior-posterior dimension, transverse dimension, RSI-T2, ADCmax, ADCmean, RSI-ADCmax, RSI-ADCmean, REAmax, REAmin, REAmean, REVmax, REVmin and REVmean, respectively. The AUC was 0.997 of the combined of ADCmax, REAmax and REVmax. Our study showed that ADCmax threshold value of 789.05 (10-3mm2/s) can differentiate UCS from EAC with 100% sensitivity, 76.5% specificity, and 0.76 AUC, REAmax threshold value of 0.45 can differentiate UCS from EAC with 88.2% sensitivity, 100% specificity, and 0.88 AUC. CONCLUSION Multiparametric MRI features may be utilized as a biomarker to distinguish UCS from EAC.
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Affiliation(s)
- Xiaodan Chen
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, P.R. China
| | - Qingyong Guo
- Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Xiaorong Chen
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, P.R. China
| | - Wanjing Zheng
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, P.R. China
| | - Yaqing Kang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, P.R. China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, P.R. China.
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, P.R. China.
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, P.R. China.
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López-González E, Rodriguez-Jiménez A, Gómez-Salgado J, Daza-Manzano C, Rojas-Luna JA, Alvarez RM. Role of tumor volume in endometrial cancer: An imaging analysis and prognosis significance. Int J Gynaecol Obstet 2023; 163:840-846. [PMID: 37350418 DOI: 10.1002/ijgo.14954] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To evaluate the prognostic value of tumor volume on preoperative MRI in endometrial cancer (EC) patients and its association with adverse prognostic factors and survival. METHODS A retrospective observational study with 127 consecutive patients with endometrioid EC was carried out between 2016 and 2021 at Juan Ramón Jiménez University Hospital, Huelva (Spain). All patients underwent preoperative magnetic resonance imaging (MRI) for local staging. The tumor volume was analyzed on MRI by two different methods: by measuring the three maximum diameters of the tumor according to an ellipse formula and by manual region of interest in different sections; the ratio between tumor volume and uterus volume was also calculated as a third tool. The relationships between volume, prognostic factors, and survival were analyzed. RESULTS A total of 127 patients with endometroid EC underwent preoperative MRI and were included in the study. Tumor volume was significantly higher for deep myometrial invasion, cervical stromal involvement, infiltrated serosa, lymph node metastases, high-grade EC, and lymphovascular space involvement, advanced FIGO stage, and High Recurrence Risk Group (P < 0.001). ROC curves showed that tumor volume greater than 25 cm3 predicts lymph node metastases. Volume index greater than 17 cm3 was associated with reduced disease-free survival (P < 0.001) and overall survival (P < 0.003). Multivariate analysis showed that the greatest tumor volume had an independent impact on recurrence (odds ratio [OR]1.019, 95% confidence interval [CI] 1.005-1.032) and survival (OR 1.027, 95% CI 1.009-1.046). CONCLUSIONS This study shows an important correlation between tumor volume on MRI and poor prognostic factors. Preoperative tumor volume on MRI is a valuable biomarker to be considered for management of EC.
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Affiliation(s)
- Elga López-González
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labor Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Cinta Daza-Manzano
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - José Antonio Rojas-Luna
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Rosa María Alvarez
- Gynecological Oncology and Breast Cancer Unit, Department of Obstetrics and Gynecology, Hospital Universitario Santa Cristina, Madrid, Spain
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Yan B, Zhao T, Li Z, Ren J, Zhang Y. An MR-based radiomics nomogram including information from the peritumoral region to predict deep myometrial invasion in stage I endometrioid adenocarcinoma: a preliminary study. Br J Radiol 2023; 96:20230026. [PMID: 37751166 PMCID: PMC10607389 DOI: 10.1259/bjr.20230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE To develop and validate an MR-based radiomics nomogram combining different imaging sequences (ADC mapping and T2 weighted imaging (T2WI)), different tumor regions (combined intra- and peritumoral regions), and different parameters (clinical features, tumor morphological features, and radiomics features) while considering different MR field strengths in predicting deep myometrial invasion (MI) in Stage I endometrioid adenocarcinoma (EEA). METHODS A total of 202 patients were retrospectively analyzed and divided into two cohorts (training cohort, 1.5 T MR, n = 131; validation cohort, 3.0 T MR, n = 71). Axial ADC mapping and T2WI were conducted. Radiomics features were extracted from intra- and peritumoral regions. Least absolute shrinkage and selection operator regression, univariate analysis, and multivariate logistic regression were used to select radiomics features and tumor morphological and clinical parameters. The area under the receiver operator characteristic curve (AUC) was calculated to evaluate the performance of the prediction model and radiomics nomogram. RESULTS Ten radiomics features, 4 morphological parameters and 1 clinical characteristic were selected. The radiomics nomogram achieved good discrimination between the superficial and deep MI cohorts. The AUC was 0.927 (95% confidence interval [CI]: 0.865, 0.967) in the training cohort and 0.921 (95% CI: 0.872, 0.948) in the validation cohort. The specificity and sensitivity were 92.0 and 78.9% in the training cohort and 83.0 and 77.8% in the validation cohort, respectively. CONCLUSION The radiomics nomogram showed good performance in predicting the depth of MI in Stage I EEA before surgery and might be useful for surgical patient management. ADVANCES IN KNOWLEDGE An MR-based radiomics nomogram was useful for predicting deep MI in Stage I EEA patients (AUCtrain = 0.927, AUCvalidation = 0.921). The intra- and peritumoral radiomics features complemented each other. The nomogram was developed and validated with different MR field strengths, suggesting that the model demonstrates good generalizability.
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Affiliation(s)
| | - Tingting Zhao
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | | | | | - Yuchen Zhang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
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Yan B, Jia Y, Li Z, Ding C, Lu J, Liu J, Zhang Y. Preoperative prediction of lymphovascular space invasion in endometrioid adenocarcinoma: an MRI-based radiomics nomogram with consideration of the peritumoral region. Acta Radiol 2023; 64:2636-2645. [PMID: 37312525 DOI: 10.1177/02841851231181681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lymphovascular space invasion (LVSI) of endometrial cancer (EC) is a postoperative histological index, which is associated with lymph node metastases. A preoperative acknowledgement of LVSI status might aid in treatment decision-making. PURPOSE To explore the utility of multiparameter magnetic resonance imaging (MRI) and radiomic features obtained from intratumoral and peritumoral regions for predicting LVSI in endometrioid adenocarcinoma (EEA). MATERIAL AND METHODS A total of 334 EEA tumors were retrospectively analyzed. Axial T2-weighted (T2W) imaging and apparent diffusion coefficient (ADC) mapping were conducted. Intratumoral and peritumoral regions were manually annotated as the volumes of interest (VOIs). A support vector machine was applied to train the prediction models. Multivariate logistic regression analysis was used to develop a nomogram based on clinical and tumor morphological parameters and the radiomics score (RadScore). The predictive performance of the nomogram was assessed by the area under the receiver operator characteristic curve (AUC) in the training and validation cohorts. RESULTS Among the features obtained from different imaging modalities (T2W imaging and ADC mapping) and VOIs, the RadScore had the best performance in predicting LVSI classification (AUCtrain = 0.919, and AUCvalidation = 0.902). The nomogram based on age, CA125, maximum anteroposterior tumor diameter on sagittal T2W images, tumor area ratio, and RadScore was established to predict LVSI had AUC values in the training and validation cohorts of 0.962 (sensitivity 94.0%, specificity 86.0%) and 0.965 (sensitivity 90.0%, specificity 85.3%), respectively. CONCLUSION The intratumoral and peritumoral imaging features were complementary, and the MRI-based radiomics nomogram might serve as a non-invasive biomarker to preoperatively predict LVSI in patients with EEA.
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Affiliation(s)
- Bin Yan
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, PR China
- Department of Radiology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Yuxia Jia
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, PR China
| | - Zhihao Li
- GE Healthcare China, Xi'an, Shaanxi, PR China
| | - Caixia Ding
- Department of Pathology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Jianrong Lu
- Department of Pathology, Shaanxi Provincial Tumor Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, PR China
| | - Yuchen Zhang
- Department of Nuclear Medicine, First Affiliated Hospital of Xi'an Jiaotong University, PR China
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Yue XN, He XY, Wu JJ, Fan W, Zhang HJ, Wang CW. Endometrioid adenocarcinoma: combined multiparametric MRI and tumour marker HE4 to evaluate tumour grade and lymphovascular space invasion. Clin Radiol 2023; 78:e574-e581. [PMID: 37183140 DOI: 10.1016/j.crad.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/06/2022] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
AIM To assess the value of semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and quantitative diffusion-weighted imaging parameters combined with human epididymis protein 4 (HE4) in predicting the pathological grade and lymphovascular space invasion (LVSI) of endometrioid adenocarcinoma (EAC). MATERIALS AND METHODS Between October 2018 and December 2021, 60 women (mean age, 55 [range, 32-77] years) with EAC underwent preoperative pelvic MRI and HE4 level measurements. The positive enhancement integral (PEI), time to peak, maximum slope of increase (MSI), and maximum slope of decrease were measured by manually drawing a region of interest on the neoplastic tissue. The receiver operating characteristic curve was used to calculate the diagnostic efficiency of the single parameter and combined factors. RESULTS Lower apparent diffusion coefficients (ADCs) were observed in high-grade tumours (G3) than in low-grade tumours (G1/G2). PEI, MSI, and HE4 levels were higher in the high-grade tumours than in the low-grade tumours (p<0.05). The area under the curve (AUC) for G3 diagnosis using multiparametric MRI combined with HE4 was 0.929. ADC values were significantly lower in the EAC with LVSI than in those without LVSI. Tumours with LVSI showed higher PEI and HE4 levels than those without LVSI (p<0.05). The AUC for LVSI-positive diagnosis using multiparametric MRI combined with HE4 was 0.814. CONCLUSION Semi-quantitative DCE-MRI, ADC values, and serum HE4 levels can be used to predict tumour grade and LVSI, and the prediction efficiency of multiparametric MRI combined with serum HE4 is better than that of any single factor.
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Affiliation(s)
- X N Yue
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - X Y He
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - J J Wu
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - W Fan
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - H J Zhang
- Department of Pathology, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - C W Wang
- Department of CT/MRI, First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, 832000, China.
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Mu Q, Wang C, Liu H, Xu Y, Luan S, Xia B. Endometrioid adenocarcinoma of the rectovaginal septum: A case report. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:941-946. [PMID: 37587081 PMCID: PMC10930444 DOI: 10.11817/j.issn.1672-7347.2023.220614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Indexed: 08/18/2023]
Abstract
Primary endometrioid adenocarcinoma of the rectovaginal septum is rare. Its pathogenesis is not clear and there is no standard treatment. One patient with endometrioid adenocarcinoma of the rectovaginal septum arising from deep infiltrative endometriosis was admitted to Qingdao Municipal Hospital. The patient presented with incessant menstruation and abdominal distension. She had bilateral ovarian endometriotic cystectomy 6 years ago. Imaging findings suggested a pelvic mass which might invade the rectovaginal septum. Pathological results of primary surgery confirmed endometrioid carcinoma of the pelvic mass arising from the rectovaginal septum. Then she had a comprehensive staged surgery. Postoperative chemotherapy was given 6 times. No recurrence or metastasis was found during the 2-year follow-up. The possibility of deep infiltrating endometriosis and its malignant transformation should be considered in the differential diagnosis of a new extragonadal pelvic lesion in a patient with a history of endometriosis, which would avoid misdiagnosis and missed diagnosis.
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Affiliation(s)
- Qingling Mu
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000.
| | - Chun Wang
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000
| | - Hongyun Liu
- Department of Pathology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000, China
| | - Youzheng Xu
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000
| | - Shaohong Luan
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000
| | - Baoguo Xia
- Department of Gynecology, Qingdao Municipal Hospital (Group), Qingdao Shandong 266000.
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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. J Ultrasound Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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 Obstet Gynecol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Lubrano A, Benito V, Pinar B, Molano F, Leon L. Efficacy of Endometrial Cancer Follow-up Protocols: Time to Change? Rev Bras Ginecol Obstet 2021; 43:41-45. [PMID: 33513635 PMCID: PMC10183951 DOI: 10.1055/s-0040-1721352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/28/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy. METHODS Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014. RESULTS Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serum marker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse. CONCLUSION Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.
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MESH Headings
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Clinical Protocols/standards
- Disease-Free Survival
- Endometrial Neoplasms/diagnostic imaging
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Outcome Assessment, Health Care
- Retrospective Studies
- Spain
- Tomography, X-Ray Computed
- Women's Health Services
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Affiliation(s)
- Amina Lubrano
- Department of Gynecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Virginia Benito
- Department of Gynecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Beatriz Pinar
- Depatment of Radiotherapy, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Fernando Molano
- Department of Medical Oncology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Laureano Leon
- Department of Pathology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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11
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Eriksson LSE, Epstein E, Testa AC, Fischerova D, Valentin L, Sladkevicius P, Franchi D, Frühauf F, Fruscio R, Haak LA, Opolskiene G, Mascilini F, Alcazar JL, Van Holsbeke C, Chiappa V, Bourne T, Lindqvist PG, Van Calster B, Timmerman D, Verbakel JY, Van den Bosch T, Wynants L. Ultrasound-based risk model for preoperative prediction of lymph-node metastases in women with endometrial cancer: model-development study. Ultrasound Obstet Gynecol 2020; 56:443-452. [PMID: 31840873 DOI: 10.1002/uog.21950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To develop a preoperative risk model, using endometrial biopsy results and clinical and ultrasound variables, to predict the individual risk of lymph-node metastases in women with endometrial cancer. METHODS A mixed-effects logistic regression model for prediction of lymph-node metastases was developed in 1501 prospectively included women with endometrial cancer undergoing transvaginal ultrasound examination before surgery, from 16 European centers. Missing data, including missing lymph-node status, were imputed. Discrimination, calibration and clinical utility of the model were evaluated using leave-center-out cross validation. The predictive performance of the model was compared with that of risk classification from endometrial biopsy alone (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread). RESULTS Lymphadenectomy was performed in 691 women, of whom 127 had lymph-node metastases. The model for prediction of lymph-node metastases included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and undefined tumor with an unmeasurable endometrium. The model's area under the curve was 0.73 (95% CI, 0.68-0.78), the calibration slope was 1.06 (95% CI, 0.79-1.34) and the calibration intercept was 0.06 (95% CI, -0.15 to 0.27). Using a risk threshold for lymph-node metastases of 5% compared with 20%, the model had, respectively, a sensitivity of 98% vs 48% and specificity of 11% vs 80%. The model had higher sensitivity and specificity than did classification as high-risk, according to endometrial biopsy alone (50% vs 35% and 80% vs 77%, respectively) or combined endometrial biopsy and ultrasound (80% vs 75% and 53% vs 52%, respectively). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold. CONCLUSIONS Based on endometrial biopsy results and clinical and ultrasound characteristics, the individual risk of lymph-node metastases in women with endometrial cancer can be estimated reliably before surgery. The model is superior to risk classification by endometrial biopsy alone or in combination with ultrasound. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L S E Eriksson
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - A C Testa
- Department of Gynecological Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - D Franchi
- Department of Gynecological Oncology, European Institute of Oncology, Milan, Italy
| | - F Frühauf
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - 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, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - G Opolskiene
- Center of Obstetrics and Gynecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - F Mascilini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - C Van Holsbeke
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - V Chiappa
- Department of Obstetrics and Gynecology, National Cancer Institute, Milan, Italy
| | - T Bourne
- Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - P G Lindqvist
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - 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
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium
| | - 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
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12
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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 Obstet Gynecol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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13
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Narazaki T, Nakashima Y, Tsukamoto Y, Tsuda M, Masuda T, Kimura D, Takamatsu A, Ohshima K, Shiratsuchi M, Ogawa Y. Transformation of follicular lymphoma to double-hit lymphoma during adjuvant chemotherapy for concurrent ovarian carcinoma. Int J Hematol 2019; 110:375-380. [PMID: 31104212 DOI: 10.1007/s12185-019-02656-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022]
Abstract
The frequency of multiple primary malignant neoplasms (MPMN) is increasing due to population aging. Since consensus guidelines for the treatment of MPMN are lacking, treatment strategies are determined by disease status on a per-patient basis. In this report, we describe a case of MPMN with follicular lymphoma (FL) grade 1 that transformed to double-hit lymphoma during adjuvant chemotherapy for concurrent ovarian carcinoma. A 64-year-old woman was diagnosed with MPMN of FL and endometrioid carcinoma by staging laparotomy and lymph node biopsy. She received four cycles of adjuvant chemotherapy (carboplatin and paclitaxel) for endometrioid carcinoma, but during chemotherapy, the FL grade 1 transformed to double-hit lymphoma. We speculate that adjuvant chemotherapy for endometrioid carcinoma may have triggered the transformation of FL in the present case.
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Affiliation(s)
- Taisuke Narazaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhiro Nakashima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhiro Tsukamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Mariko Tsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toru Masuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisaku Kimura
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akiko Takamatsu
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Motoaki Shiratsuchi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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14
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Dueholm M, Hjorth IMD, Dahl K, Pedersen LK, Ørtoft G. Identification of endometrial cancers and atypical hyperplasia: Development and validation of a simplified system for ultrasound scoring of endometrial pattern. Maturitas 2019; 123:15-24. [PMID: 31027672 DOI: 10.1016/j.maturitas.2019.01.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/02/2019] [Accepted: 01/31/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To derive and validate a practical scoring system for identification of endometrial cancer (EC) or atypical hyperplasia (AH) using transvaginal ultrasonography (TVS) and gel infusion sonography (GIS) in women with postmenopausal bleeding (PMB). STUDY DESIGN Endometrial pattern was correlated with endometrial pathology in consecutive women with PMB in both a derivation study (N = 164) and a validation study (N = 711). Logistic regression was used to derive and validate two scoring systems (A and B) for prediction of EC/AH: scoring system A was Doppler score + interrupted endo-myometrial junction (IEJ) (2 points); and scoring system B was Doppler score + IEJ (1 point) + Irregular Endometrial Outline (IESO) by GIS (1 point); the Doppler score was based on the presence of more than one single or double vessel (1 point) + multiple vessels (1 point) + large vessels (1 point). OUTCOME MEASURES Diagnostic performance and calibration curves for identification of EC/AH. RESULTS Both scoring systems had good observer agreement. VALIDATION DATA Scoring was most effective with endometrial thickness (ET) ≥ 8 mm. Both scoring systems were well calibrated and performed satisfactorily in women with ET ≥ 8 mm. The sensitivity and specificity of a score of ≥ 2 points in system A were 92% and 84%; the respective values were 89% and 88% in system B. CONCLUSIONS Scoring was highly efficient in identifying EC/AH. Four risk groups of EC/AH may guide the management of women with PMB: very low (ET < 4 mm), low (ET 4-7.9 mm), intermediate (ET ≥ 8 mm and score < 2 points) and high risk (ET ≥ 8 mm and score ≥ 2 points).
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MESH Headings
- Aged
- Carcinoma, Endometrioid/complications
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/pathology
- Carcinosarcoma/complications
- Carcinosarcoma/diagnostic imaging
- Carcinosarcoma/pathology
- Endometrial Hyperplasia/complications
- Endometrial Hyperplasia/diagnostic imaging
- Endometrial Hyperplasia/pathology
- Endometrial Neoplasms/complications
- Endometrial Neoplasms/diagnostic imaging
- Endometrial Neoplasms/pathology
- Endometrium/diagnostic imaging
- Female
- Humans
- Hysteroscopy
- Logistic Models
- Middle Aged
- Myometrium/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/complications
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Postmenopause
- Sensitivity and Specificity
- Ultrasonography
- Ultrasonography, Doppler
- Uterine Hemorrhage/etiology
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Affiliation(s)
- M Dueholm
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark.
| | - I M D Hjorth
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | - K Dahl
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus N, Denmark
| | - L K Pedersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - G Ørtoft
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, City, Copenhagen, Denmark
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15
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Abstract
The levonorgestrel-releasing intrauterine system (LNG-IUS) is widely used and recommended as a reliable contraceptive. It also acts by opposing the effects of estrogen on the endometrium, thereby preventing development of endometrial hyperplasia and its possible malignant transformation. This case describes a 52-year-old multiparous amenorrhoeic patient who was seen in the gynecology outpatient department for a routine control 46 months after the insertion LNG-IUS as contraception. Hysteroscopy with a target biopsy following suspicious ultrasound scan confirmed well-differentiated endometrioid adenocarcinoma. Ultrasound scan prior to inserting LNG-IUS revealed normal 5 mm thin endometrium with the sharp edges. Uterine bleeding before the LNG-IUS insertion was regular and not excessive and the woman has remained amenorrhoeic after the LNG-IUS insertion. We present a case of the growth of a polyp-shaped endometrial carcinoma in a LNG-IUS asymptomatic user.
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Affiliation(s)
- David Kuzel
- a Department of Obstetrics and Gynecology , First Medical Faculty of Charles University and General Faculty Hospital , Praha , Czech Republic
| | - Michal Mara
- a Department of Obstetrics and Gynecology , First Medical Faculty of Charles University and General Faculty Hospital , Praha , Czech Republic
| | - Zdenek Zizka
- a Department of Obstetrics and Gynecology , First Medical Faculty of Charles University and General Faculty Hospital , Praha , Czech Republic
| | - Peter Koliba
- a Department of Obstetrics and Gynecology , First Medical Faculty of Charles University and General Faculty Hospital , Praha , Czech Republic
| | - Pavel Dundr
- b Institute of Pathology , First Medical Faculty of Charles University and General Faculty Hospital , Praha , Czech Republic
| | - Michael Fanta
- a Department of Obstetrics and Gynecology , First Medical Faculty of Charles University and General Faculty Hospital , Praha , Czech Republic
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16
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Moro F, Magoga G, Pasciuto T, Mascilini F, Moruzzi MC, Fischerova D, Savelli L, Giunchi S, Mancari R, Franchi D, Czekierdowski A, Froyman W, Verri D, Epstein E, Chiappa V, Guerriero S, Zannoni GF, Timmerman D, Scambia G, Valentin L, Testa AC. Imaging in gynecological disease (13): clinical and ultrasound characteristics of endometrioid ovarian cancer. Ultrasound Obstet Gynecol 2018; 52:535-543. [PMID: 29418038 DOI: 10.1002/uog.19026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/17/2018] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of ovarian pure endometrioid carcinomas. METHODS This was a retrospective multicenter study of patients with a histological diagnosis of pure endometrioid carcinoma. We identified 161 patients from the International Ovarian Tumor Analysis (IOTA) database who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016, and another 78 patients from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. In addition, one author reviewed all available ultrasound images and described them using pattern recognition. RESULTS Median age of the 239 patients was 55 years (range, 19-88 years). On ultrasound examination, two (0.8%) endometrioid carcinomas were described as unilocular cysts, three (1.3%) as multilocular cysts, 37 (15.5%) as unilocular-solid cysts, 115 (48.1%) as multilocular-solid cysts and 82 (34.3%) as solid masses. Median largest tumor diameter was 102.5 mm (range, 20-300 mm) and median largest diameter of the largest solid component was 63 mm (range, 9-300 mm). Papillary projections were present in 70 (29.3%) masses. Most cancers (188 (78.7%)) were unilateral. In 49 (20.5%) cases, the cancer was judged by the pathologist to develop from endometriosis. These cancers, compared with those without evidence of tumor developing from endometriosis, more often manifested papillary projections on ultrasound (46.9% (23/49) vs 24.7% (47/190)), were less often bilateral (8.2% (4/49) vs 24.7% (47/190)) and less often associated with ascites (6.1% (3/49) vs 28.4% (54/190)) and fluid in the pouch of Douglas (24.5% (12/49) vs 48.9% (93/190)). Retrospective analysis of available ultrasound images using pattern recognition revealed that many tumors without evidence of tumor developing from endometriosis (36.3% (41/113)) had a large central solid component entrapped within locules, giving the tumor a cockade-like appearance. CONCLUSIONS Endometrioid cancers are usually large, unilateral, multilocular-solid or solid tumors. The ultrasound characteristics of endometrioid carcinomas developing from endometriosis differ from those without evidence of tumor developing from endometriosis, the former being more often unilateral cysts with papillary projections and no ascites. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Moro
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Magoga
- Instituo di Ginecologia e Obstetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Pasciuto
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Mascilini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - M C Moruzzi
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - L Savelli
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - S Giunchi
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - R Mancari
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - A Czekierdowski
- First Department of Gynecological Oncology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - D Verri
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - E Epstein
- Department of Clinical Science and Education, Södersjukhuset and Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - V Chiappa
- Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - G F Zannoni
- Institute of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - G Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - L Valentin
- Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - A C Testa
- Instituo di Ginecologia e Obstetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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Bellati F, Papadia A, Gasparri ML, Scanagatta P, Carriero F, Beneditti Panici P, Raspagliesi F. Tertiary cytoreduction for recurrent endometrial cancer. EUR J GYNAECOL ONCOL 2017; 38:132-134. [PMID: 29767882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper reviews the surgical approach experiences in endometrial cancer recurrence and presents for the first time data on the surgical management of endometrial cancer patients at the time of their second recurrence. Surgery could represent a pivotal role in selected cases of recurrent endometrial cancer, offering long-term complete remissions and a survival advantage.
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Bikou O, Delides A, Drougou A, Nonni A, Patsouris E, Pavlakis K. Fractal Dimension as a Diagnostic Tool of Complex Endometrial Hyperplasia and Well-differentiated Endometrioid Carcinoma. In Vivo 2016; 30:681-690. [PMID: 27566091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Fractal dimension (FD) is widely used in medicine and biology as a tool for defining features of structure. This study aimed to compare pathological endometrium (simple-complex hyperplasia and endometrial carcinoma), as well as the endometrial changes, during the phases of the menstrual cycle. The main goal was the objective measurement of fractal dimension and to refrain from subjective evaluation. MATERIALS AND METHODS Two thousand cases of endometrial tissue from patients who underwent dilatation and curettage (D&C) were reviewed. Out of these, 137 cases were eligible for the study. In each case, immunohistochemistry with cytokeratin Ae1/AE3 was performed in order to simplify the evaluation of the FD. RESULTS Endometria with carcinoma, simple or complex hyperplasia showed significant differences only in the immunohistochemically stained fractal dimensions. As expected, significant differences were also found between atrophic and secretory endometrium and carcinoma. CONCLUSION FD is an objective, rapid and simple procedure for the differential diagnosis between complex hyperplasia and endometrial adenocarcinoma.
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Affiliation(s)
- Olga Bikou
- "IASO" Maternity Hospital, Maroussi, Athens, Greece
| | - Alexander Delides
- 2ndOtolaryngology Department, "Attikon" University Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | | | - Afroditi Nonni
- Pathology Department, The National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Patsouris
- Pathology Department, The National and Kapodistrian University of Athens, Athens, Greece
| | - Kitty Pavlakis
- Pathology Department, The National and Kapodistrian University of Athens, Athens, Greece
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Karpathiou G, Da Cruz V, Casteillo F, Corsini T, Paul S, Peyron R, Forest F, Peoc'h M. Paraneoplastic cerebellar degeneration and endometrial cancer: a rare occurrence. Pathology 2016; 48:275-8. [PMID: 27020505 DOI: 10.1016/j.pathol.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | - Roland Peyron
- Department of Neurology, North Hospital, University Hospital of St-Etienne, France
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20
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Pineda L, Alcázar JL, Caparrós M, Mínguez JA, Idoate MA, Quiceno H, Solórzano JL, Jurado M. Agreement between preoperative transvaginal ultrasound and intraoperative macroscopic examination for assessing myometrial infiltration in low-risk endometrioid carcinoma. Ultrasound Obstet Gynecol 2016; 47:369-373. [PMID: 26033260 DOI: 10.1002/uog.14909] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To compare diagnostic performance of preoperative transvaginal ultrasound (TVS) and intraoperative macroscopic examination for determining myometrial infiltration in women with low-risk endometrial cancer, and to estimate the agreement between the two methods. METHODS This was a single-center observational study comprising women with preoperative diagnosis of well- or moderately differentiated endometrioid carcinoma of the endometrium. All women underwent preoperative TVS by a single examiner. According to the examiner's subjective impression, myometrial infiltration was stated as ≥ 50% or < 50%. Surgical staging was performed in all cases. Intraoperative macroscopic examination of the removed uterus was performed by pathologists who were unaware of the ultrasound findings, and myometrial infiltration was stated as ≥ 50% or < 50%. Definitive histological diagnosis of myometrial infiltration was made by frozen section analysis and was used as the gold standard. Sensitivity and specificity with 95% CIs were calculated for TVS and intraoperative macroscopic inspection and compared using McNemar's test. Agreement between TVS and intraoperative macroscopic inspection was estimated using Cohen's kappa index (κ) and percentage of agreement. RESULTS Of 209 eligible women, 152 were ultimately included. Mean (± SD) age was 60.9 ± 10.2 years, with a range of 32-91 years. Definitive histological diagnosis revealed that myometrial infiltration was < 50% in 114 women and ≥ 50% in 38 women. Sensitivity and specificity of TVS for detecting deep myometrial infiltration were 81.6% and 89.5%, respectively, whereas the respective values for intraoperative macroscopic examination were 78.9% and 90.4% (McNemar's test, P > 0.05 when comparing TVS and intraoperative macroscopic examination). Agreement between methods was moderate with κ = 0.54 (95% CI, 0.39-0.69) and percentage of agreement of 82%. CONCLUSIONS Although the agreement between preoperative TVS and intraoperative macroscopic examination for detecting deep myometrial infiltration was only moderate, both methods had similar accuracy when compared with frozen section histology. Preoperative TVS might reasonably be proposed as a method for assessing myometrial infiltration as an alternative to intraoperative macroscopic examination, especially when performed by an experienced examiner and image quality is not poor. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L Pineda
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Caparrós
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J A Mínguez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M A Idoate
- Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - H Quiceno
- Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J L Solórzano
- Department of Pathology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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21
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Alcázar JL, Pineda L, Caparrós M, Utrilla-Layna J, Juez L, Mínguez JA, Jurado M. Transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well- or moderately differentiated endometrioid carcinoma. Ultrasound Obstet Gynecol 2016; 47:374-379. [PMID: 26033568 DOI: 10.1002/uog.14912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high-risk cases among women with well-differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium. METHODS This was a single-center prospective observational cohort study comprising a consecutive series of women with a preoperative diagnosis of G1/G2 endometrioid carcinoma of the endometrium. All women underwent transvaginal or transrectal ultrasound examination by a single examiner. According to the examiner's subjective impression, patients were considered high risk if myometrial infiltration was ≥ 50% and/or involvement of the cervix and/or adnexa was suspected. FIGO surgical staging was performed in all cases. According to definitive histological data regarding myometrial infiltration, cervical involvement and adnexal involvement, women were classified as low risk (no myometrial infiltration, no cervical involvement and no adnexal involvement) or high risk (myometrial infiltration ≥ 50% and/or cervical involvement and/or adnexal involvement). Sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios, with 95% CIs, of transvaginal/transrectal ultrasound for detecting stage ≥ IB were calculated. Agreement between risk determined by transvaginal/transrectal ultrasound and postoperative definitive histology was calculated. RESULTS Of 209 eligible women, 169 were included in the study. Mean (± SD) age of the study cohort was 60.7 ± 10.3 years, with a range of 32-91 years. Sensitivity, specificity, LR+ and LR- of transvaginal/transrectal ultrasound identifying high-risk cases according to myometrial infiltration, cervical involvement and adnexal involvement were 78.0% (95% CI, 63.7-88.0%), 89.1% (95% CI, 81.7-93.8%), 7.14 (95% CI, 4.19-12.18) and 0.25 (95% CI, 0.15-0.42), respectively. CONCLUSIONS Preoperative transvaginal/transrectal ultrasound may play a significant role in identifying high-risk cases among those with G1/G2 endometrioid carcinoma of the endometrium according to preoperative biopsy, and could be a useful test in this clinical setting. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - L Pineda
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Caparrós
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - L Juez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J A Mínguez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Berceanu C, Stepan AE, MehedinŢu C, Cîrstoiu MM, Ciortea R, Berceanu S, Gheonea IA, Brătilă E. Morphological, imaging and surgical aspects in endometrial endometrioid adenocarcinoma. Rom J Morphol Embryol 2016; 57:995-1002. [PMID: 28002515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Endometrioid endometrial adenocarcinomas (EECs) are frequent genital tumors for which the clinical, imaging and histopathological integrated analysis is the basis of differential diagnosis and therapeutic attitude. This research represents a tertiary multicenter study including 58 cases examined histopathologically and immunohistochemically, surgically treated, on a five years period. The main characteristics of the patients in the study group are represented by the average age of 66 years, associated with obesity, hypertension, diabetes, history of infertility, early menopause, nulliparity or long-time oral contraception. The most important clinical sign was the menopausal or postmenopausal vaginal bleeding. The golden standard in the diagnosis of endometrial carcinoma is the dilation and curettage of the uterine cavity, followed by histopathological assessment. The association between transvaginal ultrasonography (TVUS) and endometrial biopsy increases to 100% the diagnostic sensitivity. The use of an antibodies panel that includes CK, ER, PR, vimentin can guide the diagnosis to EEC and the analysis of Ki67, p16, p53 and CEA immunoreactions can be useful both for EEC differential diagnosis and to assess the tumor aggressiveness. The interrelation between the accurate histopathological diagnosis and the adequate surgical staging is the cornerstone of curative therapy in the EEC.
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Affiliation(s)
- Costin Berceanu
- Department of Pathology, University of Medicine and Pharmacy of Craiova, Romania;
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Abstract
Endometrial carcinoma is the most common malignancy of the upper female genital tract but is rare in teenagers. Here, we report the case of a 15-year-old, nulliparous, morbidly obese female with complaints of asthenia and menometrorrhagia lasting for six months. On examination, the patient had an enlarged uterus approximately 14 gestational weeks in size, and ultrasound revealed an intrauterine mass and polycystic ovaries. An endometrial biopsy performed during hysteroscopy revealed endometrioid adenocarcinoma, and magnetic resonance imaging showed myometrial invasion. The patient underwent a laparotomy involving total abdominal hysterectomy, right salpingo-oophorectomy, wedge-shape dissection of the left ovary, and pelvic and para-aortic lymphadenectomy. We analyze the pathogenesis of endometrial carcinoma in this case and discuss the risk factors for endometrial carcinoma, especially in young women. Gynecologists should be vigilant for persistent abnormal uterine bleeding and other signs of endometrial carcinoma in young women, especially those who have risk factors for the disease.
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Affiliation(s)
- Guoyan Liu
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital , Tianjin , China
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Seki T, Yanaihara N, Hirata Y, Fukunaga M, Tanaka T, Okamoto A. Uterine endometrial carcinoma with trophoblastic differentiation: a case report with literature review. EUR J GYNAECOL ONCOL 2014; 35:461-464. [PMID: 25118494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Choriocarcinoma is categorized as either gestational or nongestational depending on its origin. Nongestational choriocarcinoma originated in the trophoblastic differentiation is a rare but an aggressive tumor. This article reports a nongestational case of a uterine endometrial carcinoma with trophoblastic differentiation. A 54-year-old woman with a history of atypical genital bleeding that underwent semi-radical hysterectomy, bilateral salpingo-oophrectomy, and pelvic lymph nodes dissection. Pathological investigation showed that the tumor had endometrioid adenocarcinoma and choriocarcinomatous components. Although a series of multimodality treatments including craniotomy were performed, she died of aggressive lung and brain metastases one year after the primary surgery.
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MESH Headings
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Choriocarcinoma, Non-gestational/diagnostic imaging
- Choriocarcinoma, Non-gestational/pathology
- Choriocarcinoma, Non-gestational/surgery
- Endometrial Neoplasms/diagnostic imaging
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Humans
- Hysterectomy
- Middle Aged
- Mixed Tumor, Malignant/diagnostic imaging
- Mixed Tumor, Malignant/pathology
- Mixed Tumor, Malignant/surgery
- Ovariectomy
- Salpingectomy
- Tomography, X-Ray Computed
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25
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Rossi A, Forzano L, Romanello I, Ambrosini G, Iuri V, Marchesoni D. Comparison of pelvic masses score (PMS) and Risk of Malignancy Index (RMI 3) in the evaluation of pelvic masses. EUR J GYNAECOL ONCOL 2014; 35:421-424. [PMID: 25118484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Ovarian cancer is the fourth cause of death from cancer in women worldwide and the majority of its diagnoses is made in an advanced stage of the disease. Several sonographic scoring systems have been created for a better preoperative discrimination between benign and malignant pelvic masses. The aim of this study was to evaluate the performances of the Risk of the Malignancy Index 3 (RMI 3) and the Pelvic Masses Score (PMS). MATERIALS AND METHODS This retrospective study was performed in 55 women admitted to the department of Obstetrics and Gynecology of University of Udine for surgical exploration of pelvic masses between 2009 and 2012. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both the scores. RESULTS PMS showed a sensitivity of 100%, a specificity of 93.8%, a PPV of 70%, and a NPV of 100%, while RMI 3 yielded a sensitivity of 85%, a specificity of 91%, a PPV of 60%, and a NPV of 97.8%. CONCLUSION The authors found that, in discriminating between benign and malignant pelvic disease, the PMS method was more reliable than RMI3. PMS is a simple scoring system which can be used in clinical practice.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- CA-125 Antigen/blood
- Carcinoma, Endometrioid/blood
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/pathology
- Cystadenocarcinoma, Serous/blood
- Cystadenocarcinoma, Serous/diagnostic imaging
- Cystadenocarcinoma, Serous/pathology
- Cystadenoma, Mucinous/blood
- Cystadenoma, Mucinous/diagnostic imaging
- Cystadenoma, Mucinous/pathology
- Cystadenoma, Serous/blood
- Cystadenoma, Serous/diagnostic imaging
- Cystadenoma, Serous/pathology
- Female
- Humans
- Membrane Proteins/blood
- Middle Aged
- Ovarian Cysts/blood
- Ovarian Cysts/diagnostic imaging
- Ovarian Cysts/pathology
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/pathology
- Predictive Value of Tests
- ROC Curve
- Retrospective Studies
- Risk Assessment
- Sensitivity and Specificity
- Teratoma/blood
- Teratoma/diagnostic imaging
- Teratoma/pathology
- Ultrasonography
- Young Adult
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Sawicki S, Kobierski J, Cytawa W, Wydra D. Sentinel lymph node detection with the use of SPECT-CT in endometrial cancer--analysis of two cases. Ginekol Pol 2012; 83:703-707. [PMID: 23342901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
On the basis of two cases we discuss the important issues regarding the sentinel lymph node detection biopsy (SLNB) in endometrial cancer with combined cervical administration of the radiocolloid and the subserosal blue dye injection. The first patient (endometrioid adenocarcinoma G2, invasion > 50% myometrium) had 4 SLNs detected. Three were both hot and blue (detected on SPECT-CT). The fourth, paraaortic SLN was blue only. None of the lymph nodes contained metatstases. The second patient (endometrioid adenocarcinoma G1, invasion > 50% myometrium) had 4 SLNs detected. Three were blue (but two of them had also very low radioactivity). The fourth SLN was hot only. Blue only node contained macrometastasis. In the past patients underwent cervical amputation. Diverse distribution of each tracer confirms the advantages of the combined tracers administration in SLNB. The radiotracer is the crucial component--uptake was present in 6 of 8 SLNs. Although the blue dye is more a complimentary method, its suberosal injection significantly increases the safety of the SLNB procedure. In the first case we have detected blue only SLN in paraaortic region which otherwise would be missed using the cervical approach only. More importantly in the second case the tracer uptake was very limited due to the previous surgery and the blue dye administration allowed correct SLNs detection (including the metastatic node). Presented clinical cases confirms that the combined cervical and subserosal tracers administration together with preoperative SPECT-CT constitute an optimal SLN detection method and correctly provides information about the regional lymph node status.
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Affiliation(s)
- Sambor Sawicki
- Department of Gynecology, Oncologic Gynecology and Gynecologic Endocrinology, Medical University of Gdańsk, Poland.
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Richards A, Boogert T, Livingstone M, Dalrymple C. Endometrioid ovarian carcinoma in a woman with a history of infertility and multiple in-vitro fertilization treatment cycles. Ultrasound Obstet Gynecol 2012; 40:112-114. [PMID: 21674660 DOI: 10.1002/uog.9077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2011] [Indexed: 05/30/2023]
Abstract
Ovarian cancer is rarely diagnosed during assisted reproduction. Several case-control and cohort studies have described its incidence within the infertile population well after the assisted reproductive process. We present a case of endometrioid adenocarcinoma that developed during the ovarian stimulation process and show corresponding ultrasound images of its development.
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Affiliation(s)
- A Richards
- Department of Gynaecology Oncology, Sydney Cancer Centre, Camperdown, NSW, Australia
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Andrei S, Preda C, Andrei A, Becheanu G, Herlea V, Lupescu I, Popescu I. Isolated splenic metastasis of endometrial adenocarcinoma--a case report. Chirurgia (Bucur) 2011; 106:833-837. [PMID: 22308925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The spleen in rarely the place for solid, non-haematological tumors, isolated splenic metastases from adenocarcinomas being extremely rare findings, regardless of the origin and the histological type of the primary tumor. We present the case of a female patient with isolated splenic metastasis diagnosed by abdominal computer tomography at only 20 months after curative surgery for endometrial adenocarcinoma, in which the final diagnosis has been established by histological and immunohistochemical examination of the splenectomy piece. The haematogenous dissemination of the endometrial cancer occurs most commonly in the lungs, liver or bones, the spleen being rarely affected. In the medical literature there are cited up to date only 12 cases of solitary splenic metastasis from endometrial adenocarcinoma. The particularity of the case presented by us is the early appearance of an isolated splenic metastasis, at less than two years after curative surgery (compared to an average of 4-5 years cited in the literature), from an endometrial cancer which was classified histologicaly in the group with low-risk for relapse (well differentiated endometrioid adenocarcinoma). In conclusion, although solitary splenic secondary determinations are very rare, the incidence of the reported cases in the medical literature is increasing, their late appearance (a few years after the primary tumor's resection) and the lack of symptoms until the tumor reaches appreciable size or it complicates with necrosis, justifies the periodic abdominal imaging examination, on long-term, for postoperative monitorisation after the initial curative surgery. Their treatment of choice is open, classical splenectomy that must be followed by chemotherapy in order to prevent the development of other possible micrometastases.
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Affiliation(s)
- S Andrei
- "Dan Setlacec" Center for General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
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Ohkubo Y, Kato S, Kiyohara H, Tsuruoka I, Tamaki T, Noda SE, Ohno T, Nakano T. Dose volume analysis of radiotherapy for inoperable patients with stage I-II endometrial carcinoma. J Radiat Res 2011; 52:666-673. [PMID: 21857147 DOI: 10.1269/jrr.11024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study aims to assess the efficacy and toxicity of definitive radiotherapy for early-stage endometrial carcinoma. The correlation between CT-based dosimetric parameters and clinical outcomes is also evaluated. Between 2002 and 2006, 10 medically inoperable patients with T1-2 endometrial carcinoma were treated with radiotherapy alone. A combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) was used for 9 patients, and one was treated with HDR-ICBT alone. Dose prescription of HDR-ICBT was determined in reference to CT images at brachytherapy, and a total dose of 22-24 Gy in 4 fractions was delivered to the outer perimeter of the uterine corpus. Dose-volume parameters of the gross tumor volume (GTV), clinical target volume (CTV), and organs at risk were assessed retrospectively using the dose-volume histograms derived from the CT image-based treatment planning system. After a median follow-up of 55 months, 9 patients were alive without evidence of recurrence. One patient died from liver cirrhosis 17 months after radiotherapy. Severe acute and late toxicities were not observed in any of the patients. Average minimum dose to 90% of GTV and CTV (D90) was 88.0 and 45.9 Gy(EQD2), respectively. The minimum dose delivered to 2 cc of the most irradiated volumes of the rectum and sigmoid colon (D(2cc)) was 78.9 and 65.9 Gy(EQD2), respectively. These patients developed Grade 1 late complications. In this study, stage I-II endometrial carcinoma was well-controlled locally with minimum late toxicity by radiotherapy alone with HDR-ICBT. 3D image-based brachytherapy may potentially deliver a sufficiently high dose to the whole tumor without significant increase in dose to surrounding normal tissues.
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Affiliation(s)
- Yu Ohkubo
- Hidaka Hospital, Gunma 370-0001, Japan
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30
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Testa AC, Timmerman D, Van Holsbeke C, Zannoni GF, Fransis S, Moerman P, Vellone V, Mascilini F, Licameli A, Ludovisi M, Di Legge A, Scambia G, Ferrandina G. Ovarian cancer arising in endometrioid cysts: ultrasound findings. Ultrasound Obstet Gynecol 2011; 38:99-106. [PMID: 21351179 DOI: 10.1002/uog.8970] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To describe sonographic characteristics of malignant transformation in endometrioid cysts. METHODS Women with a histological diagnosis of ovarian endometrioid cysts, borderline tumors arising in endometrioid cysts and carcinoma arising in endometrioid cysts, preoperatively examined sonographically, were included in this retrospective study. Gray-scale and Doppler ultrasound characteristics of the endometrioid cysts were compared with those of the borderline tumors and primary cancers arising in endometrioid cysts. The performance of an experienced examiner in classifying the masses was also assessed. RESULTS Of 324 cases collected for the study, 309 (95.3%) lesions were classified as endometrioid cysts, four (1.2%) as borderline tumors arising in endometrioid cysts and 11 (3.4%) as carcinoma arising in endometrioid cysts. Women with malignant findings (borderline ovarian tumors and cancers) were older (median age 52 (range, 28-79) years) than those with benign endometrioid cysts (median age 34 (range, 18-76) years) (P<0.0001), and the prevalence of postmenopausal status was significantly higher in malignant cases. All (15/15) malignant tumors vs. 16% (50/309) of benign tumors were characterized by the presence of solid tissue (P<0.0001). The prevalence of solid tissue with positive Doppler signals was higher in malignant tumors (100%) than in benign cysts (7.8%) (P<0.0001). Papillary projections were a more frequent sonographic feature among malignant lesions (86.7%) than among benign endometrioid cysts (11.3%) (P<0.0001); power Doppler signals were detected within the projections in 92.3% and 37.1% of malignant and benign lesions, respectively. The examiner correctly diagnosed 94.8% (293/309) of benign lesions as benign and 93.3% (14/15) of malignant lesions as malignant. The risk estimation of the examiner was 'uncertain' in three (20%) and 'probably/certainly malignant' in 12 (80%) of 15 malignant cases. CONCLUSION Borderline tumors and carcinomas arising in endometrioid cysts show a vascularized solid component at ultrasound examination.
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Affiliation(s)
- A C Testa
- Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
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Tsili AC, Argyropoulou MI, Koliopoulos G, Paraskevaidis E, Tsampoulas K. Malignant transformation of an endometriotic cyst: MDCT and MR findings. J Radiol Case Rep 2011; 5:9-17. [PMID: 22470759 DOI: 10.3941/jrcr.v5i1.435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Malignant transformation is a rare complication of endometriosis. MR criteria for diagnosis include the presence of soft-tissue components, enhancement after contrast material administration in an endometriotic cyst. We present the multidetector CT and MR imaging findings in a case of an incidentally found endometrioid adenocarcinoma in a left-sided ovarian endometrioma, occurring in a 30-year old woman. MR imaging enabled the correct preoperative characterization of the lesion, by depicting a soft-tissue element, with strong and early enhancement after gadolinium administration. The same area had high signal intensity on diffusion-weighted images and low apparent diffusion coefficient values due to restricted diffusion, findings also strongly suggestive of malignancy.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, University Hospital of Ioannina, Pl. Pargis 2, Ioannina, Greece.
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MESH Headings
- Aged
- CA-125 Antigen/blood
- Carcinoma, Endometrioid/blood
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/pathology
- Diagnosis, Differential
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/diagnostic imaging
- Endometrial Neoplasms/pathology
- Female
- Humans
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/pathology
- Tissue Adhesions/blood
- Tissue Adhesions/diagnosis
- Tissue Adhesions/diagnostic imaging
- Tissue Adhesions/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- W A A Tjalma
- Department of Gynaecology and Gynaecological Oncology, University Hospital Antwerp, Antwerp, Belgium.
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Min'ko BA, Stoliarova IV, Tarkova AB, Vinokurov VL, Sirazitdinov BR. [New ultrasonic techniques in the diagnosis and monitoring of endometrial cancer]. Vopr Onkol 2009; 55:103-108. [PMID: 19435210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Sixty-six peri- or postmenopausal patients with endometrial pathology were treated and followed-up. Ultrasound, color Doppler examination and energy mapping of uterine intra-tumor vessels were used. Endometrial carcinoma was diagnosed in 52 (78.8%), mean age 65.4 +/- 7.0. Ultrasound angiography is instrumental in such diagnosis as it registers peculiarities of intra-organ and tumor-related features. It contributes to improvement of diagnosis and to efficacy of antitumor therapy monitoring.
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Berretta R, Merisio C, Piantelli G, Rolla M, Giordano G, Melpignano M, Nardelli GB. Preoperative transvaginal ultrasonography and intraoperative gross examination for assessing myometrial invasion by endometrial cancer. J Ultrasound Med 2008; 27:349-355. [PMID: 18314512 DOI: 10.7863/jum.2008.27.3.349] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Endometrial cancer is the most common gynecologic malignancy. The cornerstone of treatment remains surgery according to International Federation of Gynecology and Obstetrics staging. The aim of this study was to evaluate the concordance between myometrial infiltration detected by ultrasonography and gross examination with respect to definitive histologic examination and to select a population in which lymphadenectomy could be excluded. We also evaluated the concordance for the degree of tumor differentiation between diagnostic biopsy and final histologic results. METHODS Our study included 75 patients with International Federation of Gynecology and Obstetrics stage I endometrial cancer. We evaluated preoperative and definitive grading and myometrial infiltration detected by ultrasonography and gross examination. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the procedures under study were determined with the Bayes theorem. To determine the predictive value of preoperative transvaginal ultrasonography and intraoperative gross examination for myometrial invasion, we used a multiple logistic regression model with a statistical software package. RESULTS Our study showed 60% concordance between biopsy and histologic results. In 80% of the cases with discordant results, the tumor was undergraded. Ultrasonography had diagnostic accuracy of 73%, whereas gross examination correctly determined myometrial invasion in 82.6% of the patients, with sensitivity of 62% and specificity of 79%. CONCLUSIONS Preoperative transvaginal ultrasonography and macroscopic gross examination appear to be simple, fast, and reliable methods to predict in myometrial invasion in patients with a low risk for lymph node metastasis, for which lymphadenectomy can reasonably be avoided.
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Affiliation(s)
- Roberto Berretta
- Department of Obstetrics and Gynecology, University of Parma, Via A. Gramsci 14, 43100 Parma, Italy.
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Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol 2008; 108:486-92. [PMID: 18201753 DOI: 10.1016/j.ygyno.2007.11.044] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 11/24/2007] [Accepted: 11/29/2007] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare positron emission tomography/computed tomography (PET/CT) with magnetic resonance imaging (MRI) in the preoperative detection of primary lesions and lymph node (LN) and distant metastases in patients with uterine corpus cancer. METHODS The patient cohort consisted of 53 women with uterine corpus cancer who underwent preoperative workup, including both MRI and PET/CT scans, and underwent surgical staging, including pelvic and/or paraaortic LN dissection, between October 2004 and June 2007 at Asan Medical Center, Seoul, Korea. Pathologic data from surgical staging were compared with the preoperative MRI and PET/CT results. For area specific analysis, LNs were divided into paraaortic, right pelvic and left pelvic areas. RESULTS In detecting primary lesions, MRI and PET/CT showed no differences in sensitivity (91.5% vs. 89.4%), specificity (33.3% vs. 50.5%), accuracy (84.9% vs. 84.9%), positive predictive value (PPV) (91.5% vs. 93.3%) and negative predictive value (NPV) (33.3% vs. 37.5%). With MRI, the sensitivity, specificity, accuracy, PPV and NPV for detecting metastatic LNs on LN area-by-area analysis were 46.2%, 87.9%, 83.9%, 28.6% and 94.0%, respectively; With PET/CT, those were 69.2%, 90.3%, 88.3%, 42.9%, and 96.6%, respectively. PET/CT showed higher sensitivity, but it did not reach statistical significance (p=0.250). There were also no differences in specificity, accuracy, PPV and NPV. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV and NPV of PET/CT were 100%, 93.8%, 92.5%, 62.5% and 100%, respectively. CONCLUSION In patients with uterine corpus cancer, PET/CT had moderate sensitivity, specificity and accuracy in detecting primary lesions and LN metastases, indicating that this method cannot replace surgical staging. The primary benefit of PET/CT is its sensitivity in detecting distant metastases. Because of its high NPV in predicting LN metastasis, PET/CT may also have advantages in selected patients who are poor candidates for surgical staging.
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Affiliation(s)
- Jeong-Yeol Park
- Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, #388-1 Poongnap-dong, Songpa-Ku, Seoul, 138-736, South Korea
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36
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Balbi G, Visconti S, Monteverde A, Manganaro MA, Cardone A. Liposomal doxorubicin: a phase II trial. Acta Biomed 2007; 78:210-213. [PMID: 18330081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND AIM OF THE WORK In patients with disseminated endometrial carcinoma, doxorubicin is used as a single agent or in combination therapy. We have carried out a phase II clinical trial of liposomal doxorubicin in first-line therapy of women with disseminated endometrial carcinoma. METHODS Between September 2001 and May 2003, 22 patients with histologically confirmed disseminated endometrial carcinoma, were enrolled in this study. Eleven patients had been previously treated with radiation, none of them had been treated with chemotherapy. Liposomal doxorubicin (40 mg/m2) was intravenously administered at 4 week intervals until toxicity or progression. RESULTS The most common adverse events were fatigue, anemia, pain, and dermatologic toxicity (EPP). Eight patients (36%) achieved a tumor regression (Complete response, CR 3; Partial response, PR 5), ten (46%) maintained stable disease, and four (18%) experienced increasing disease. CONCLUSION Liposomal doxorubicin has a lower cardiologic toxicity than doxorubicin with a similar response rate in patients with disseminated endometrial carcinoma.
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MESH Headings
- Adult
- Aged
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/adverse effects
- Antibiotics, Antineoplastic/therapeutic use
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/radiotherapy
- Combined Modality Therapy
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/diagnostic imaging
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/radiotherapy
- Endometrium/pathology
- Female
- Humans
- Injections, Intravenous
- Magnetic Resonance Imaging
- Middle Aged
- Monitoring, Physiologic
- Neoplasm Staging
- Radiotherapy Dosage
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Giancarlo Balbi
- Department Obstetrics and Gynecology, Second University of Study of Naples, Naples, Italy.
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Takac I. Transvaginal ultrasonography with and without saline infusion in assessment of myometrial invasion of endometrial cancer. J Ultrasound Med 2007; 26:949-55; quiz 956-7. [PMID: 17592058 DOI: 10.7863/jum.2007.26.7.949] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the diagnostic accuracy of saline infusion ultrasonography (SIUS) compared with transvaginal ultrasonography (TVUS) in the assessment of myometrial invasion of endometrial cancer. METHODS A total of 53 patients with endometrial cancer were examined preoperatively with TVUS and SIUS with respect to myometrial invasion. All patients were postmenopausal. Ultrasonographic findings were compared with histopathologic findings of the surgical specimens. RESULTS The median age of the patients +/- SD was 64 +/- 7 years (range, 51-77 years). In all patients, the procedure was well tolerated. The median thickness of malignant endometria was 17 +/- 9 mm (range, 2-51 mm). The specimens consisted of 40 endometrioid adenocarcinomas, 2 serous papillary carcinomas, 5 clear cell adenocarcinomas, 2 adenosquamous carcinomas, 3 mixed types, and 1 undifferentiated carcinoma. There were 18 grade G1, 24 G2, and 11 G3 cases. On histopathologic examination, superficial myometrial invasion (<or=50% of the myometrium) was present in 25 specimens (47.2%), and deep myometrial invasion (>50% of the myometrium) was present in 28 (52.8%). For superficial myometrial invasion, evaluation by TVUS was accurate in 19 (76.0%) of 25 cases, and evaluation by SIUS was accurate in 18 (72.0%) of 25. For deep myometrial invasion, evaluation by TVUS was accurate in 24 (85.7%) of 28 cases, and evaluation by SIUS was accurate in 27 (96.4%) of 28. CONCLUSIONS Transvaginal ultrasonography is a reliable method for assessing myometrial invasion of endometrial cancer. Saline infusion ultrasonography showed slightly better accuracy in the assessment of myometrial invasion than TVUS, but the differences were not statistically significant.
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Affiliation(s)
- Iztok Takac
- Gynecology and Perinatology Service, Maribor Teaching Hospital, Ljubljanska 5, 2000 Maribor, Slovenia.
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Chen CY, Wu YC, Yen MS, Hung JH, Yuan CC, Chao KC. The power Doppler velocity index, pulsatility index, and resistive index can assist in making a differential diagnosis of primary ovarian carcinoma and Krukenberg tumors: a preliminary study. J Ultrasound Med 2007; 26:921-6; quiz 927-9. [PMID: 17592055 DOI: 10.7863/jum.2007.26.7.921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of transvaginal power Doppler sonography with spectral Doppler analysis as an aid in preoperatively distinguishing primary ovarian carcinoma and metastatic carcinoma to the ovary (Krukenberg tumors). METHODS Fifty women with ovarian disease were preoperatively examined with transvaginal power Doppler sonography. Six basic parameters were measured, including intratumoral peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, pulsatility index (PI), resistive index (RI), and velocity index (VeI). Blood flow analyses were detectable in all patients. Twelve patients with metastatic carcinoma to the ovary were classified as group 1; 38 patients with primary ovarian carcinoma were classified as group 2. Comparison of intratumoral blood flow analyses between the two groups was performed. RESULTS The PI, RI, and VeI were significantly lower in patients with metastatic carcinoma to the ovary than those with primary ovarian carcinoma (P < .05). There were no significant differences in the peak systolic velocity (P = .871), end-diastolic velocity (P = .508), and time-averaged maximum velocity (P = .850) between the two groups. CONCLUSIONS Transvaginal power Doppler sonography with spectral Doppler analysis is an effective method in evaluating intratumoral blood flow of Krukenberg tumors. Low impedance (PI, RI, and VeI) might assist us in making differential diagnoses between primary ovarian carcinoma and Krukenberg tumors according to our preliminary results.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/physiopathology
- Adult
- Aged
- Blood Flow Velocity/physiology
- Carcinoma/diagnostic imaging
- Carcinoma/physiopathology
- Carcinoma/secondary
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/physiopathology
- Cystadenocarcinoma, Papillary/diagnostic imaging
- Cystadenocarcinoma, Papillary/physiopathology
- Cystadenocarcinoma, Serous/diagnostic imaging
- Cystadenocarcinoma, Serous/physiopathology
- Diagnosis, Differential
- Female
- Humans
- Krukenberg Tumor/diagnostic imaging
- Krukenberg Tumor/physiopathology
- Middle Aged
- Neoplasms, Germ Cell and Embryonal/diagnostic imaging
- Neoplasms, Germ Cell and Embryonal/physiopathology
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/physiopathology
- Prospective Studies
- Pulsatile Flow/physiology
- Regional Blood Flow/physiology
- Sex Cord-Gonadal Stromal Tumors/diagnostic imaging
- Sex Cord-Gonadal Stromal Tumors/physiopathology
- Ultrasonography, Doppler
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Pulsed
- Vascular Resistance/physiology
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Affiliation(s)
- Chih-Yao Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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De Smet F, De Brabanter J, Van den Bosch T, Pochet N, Amant F, Van Holsbeke C, Moerman P, De Moor B, Vergote I, Timmerman D. New models to predict depth of infiltration in endometrial carcinoma based on transvaginal sonography. Ultrasound Obstet Gynecol 2006; 27:664-71. [PMID: 16715466 DOI: 10.1002/uog.2806] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Preoperative knowledge of the depth of myometrial infiltration is important in patients with endometrial carcinoma. This study aimed at assessing the value of histopathological parameters obtained from an endometrial biopsy (Pipelle de Cornier; results available preoperatively) and ultrasound measurements obtained after transvaginal sonography with color Doppler imaging in the preoperative prediction of the depth of myometrial invasion, as determined by the final histopathological examination of the hysterectomy specimen (the gold standard). METHODS We first collected ultrasound and histopathological data from 97 consecutive women with endometrial carcinoma and divided them into two groups according to surgical stage (Stages Ia and Ib vs. Stages Ic and higher). The areas (AUC) under the receiver-operating characteristics curves of the subjective assessment of depth of invasion by an experienced gynecologist and of the individual ultrasound parameters were calculated. Subsequently, we used these variables to train a logistic regression model and least squares support vector machines (LS-SVM) with linear and RBF (radial basis function) kernels. Finally, these models were validated prospectively on data from 76 new patients in order to make a preoperative prediction of the depth of invasion. RESULTS Of all ultrasound parameters, the ratio of the endometrial and uterine volumes had the largest AUC (78%), while that of the subjective assessment was 79%. The AUCs of the blood flow indices were low (range, 51-64%). Stepwise logistic regression selected the degree of differentiation, the number of fibroids, the endometrial thickness and the volume of the tumor. Compared with the AUC of the subjective assessment (72%), prospective evaluation of the mathematical models resulted in a higher AUC for the LS-SVM model with an RBF kernel (77%), but this difference was not significant. CONCLUSIONS Single morphological parameters do not improve the predictive power when compared with the subjective assessment of depth of myometrial invasion of endometrial cancer, and blood flow indices do not contribute to the prediction of stage. In this study an LS-SVM model with an RBF kernel gave the best prediction; while this might be more reliable than subjective assessment, confirmation by larger prospective studies is required.
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Affiliation(s)
- F De Smet
- Department of Electrical Engineering ESAT-SCD, Katholieke Universiteit Leuven, Leuven, Belgium
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Martín-Ondarza C, Gil-Moreno A, Torres-Cuesta L, García A, Eyzaguirre F, Díaz-Feijoo B, Xercavins J. Endometrial cancer in polyps: a clinical study of 27 cases. EUR J GYNAECOL ONCOL 2005; 26:55-8. [PMID: 15755002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE OF INVESTIGATION To review risk factors, clinical presentation, diagnostic methods, and histopathologic findings in 27 cases of endometrial cancer in polyps. METHODS A descriptive, retrospective study of 204 consecutive patients with endometrial carcinoma who were diagnosed at our institution between June 1998 to June 2001. Endometrial cancer arising in polyps occurred in 27 patients (13.2%) and accounted for 1.8% of 1492 endometrial polyps diagnosed during this period. RESULTS Patients had a mean age of 62 years. All except one woman were postmenopausal. Three breast cancer patients were currently given tamoxifen. Metrorrhagia was the presenting symptom in 74% of cases, although 22% of patients were asymptomatic at the time of diagnosis. Ultrasonography performed in 22 patients showed images compatible with an endometrial polyp in 50% of cases, myoma in 5%, and inconclusive findings in 45%. The median endometrial thickness was 11 mm (range 4-33 mm). Diagnosis was made by aspiration-biopsy in 13 patients and by hysteroscopic endometrial sampling in 13 (in one patient endometrial carcinoma was incidentally found in the surgical specimen). All patients were in FIGO Stage IA. Endometrioid carcinoma was found in 81.5% of cases. Retroperitoneal metastases were not found in 25 patients undergoing pelvic lymphadenectomy, nor neoplastic growth in the specimens of six polypeptomies performed during hysteroscopy. All patients are free of relapse after a mean follow-up of 30 months. CONCLUSIONS Postmenopausal women with endometrial polyps diagnosed by ultrasonography should undergo directed biopsies under hysteroscopic vision. The present series confirms the good prognosis of endometrial cancer in polyps.
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MESH Headings
- Adenocarcinoma, Papillary/diagnostic imaging
- Adenocarcinoma, Papillary/epidemiology
- Adenocarcinoma, Papillary/etiology
- Adenocarcinoma, Papillary/pathology
- Aged
- Aged, 80 and over
- Carcinoma, Adenosquamous/diagnostic imaging
- Carcinoma, Adenosquamous/epidemiology
- Carcinoma, Adenosquamous/etiology
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/epidemiology
- Carcinoma, Endometrioid/etiology
- Carcinoma, Endometrioid/pathology
- Endometrial Neoplasms/diagnostic imaging
- Endometrial Neoplasms/epidemiology
- Endometrial Neoplasms/etiology
- Endometrial Neoplasms/pathology
- Female
- Humans
- Medical Records
- Middle Aged
- Polyps/diagnostic imaging
- Polyps/epidemiology
- Polyps/etiology
- Polyps/pathology
- Prevalence
- Retrospective Studies
- Risk Factors
- Spain/epidemiology
- Ultrasonography
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Affiliation(s)
- C Martín-Ondarza
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-infantil Vall d'Hebron, Barcelona, Spain
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Dunder I, Berker B, Atabekoglu C, Bilgin T. Preliminary experience with salvage weekly paclitaxel in women with advanced recurrent ovarian carcinoma. EUR J GYNAECOL ONCOL 2005; 26:79-82. [PMID: 15755007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE OF INVESTIGATION To assess the role of palliative chemotherapy with weekly paclitaxel in patients with recurrent ovarian cancer. METHODS Thirty-two patients with paclitaxel- and platinum-resistant ovarian cancer were treated with weekly paclitaxel at 80 mg/m2 as a 1-hour intravenous infusion weekly for six weeks every eight weeks (1 cycle). This schedule was considered to be given for three cycles. Evaluation of radiographically measurable disease was used in the assessment of response. CA-125 was used to classify responses only in the absence of a measurable lesion. RESULTS Thirty-two patients were all assessable for response. Of these, nine patients (28.1%) achieved a partial response and one patient achieved a complete response, leading to an overall response rate of 31.2%. Stable disease occurred in six patients (18.8%), and 16 patients (50%) had progressive disease. Nine patients died of progressive disease while on treatment. The median survival for the entire group was 10.5 months (range 2.5-22 months). Grade 3 or 4 leukopenia and neutropenia occurred in eight and six patients, respectively. Four of these patients developed febrile neutropenia without infection. Grade 1 and 2 peripheral neuropathies were observed in 50% of the patients without causing any premature drop out. Severe (grade 3 or 4) peripheral neuropathy was not observed. There were 11 patients with grade 1 or 2 myalgias. CONCLUSION Weekly paclitaxel regimen is well tolerated with acceptable toxicity. The favorable toxicity profile and the encouraging antitumor activity observed in this study makes this regimen an option for the salvage treatment of patients with recurrent ovarian cancer.
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MESH Headings
- Adenocarcinoma, Clear Cell/blood
- Adenocarcinoma, Clear Cell/diagnostic imaging
- Adenocarcinoma, Clear Cell/drug therapy
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/blood
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Papillary/blood
- Adenocarcinoma, Papillary/diagnostic imaging
- Adenocarcinoma, Papillary/drug therapy
- Adenocarcinoma, Papillary/mortality
- Adenocarcinoma, Papillary/pathology
- Adult
- Aged
- Antineoplastic Agents, Phytogenic/administration & dosage
- Antineoplastic Agents, Phytogenic/adverse effects
- CA-125 Antigen/blood
- Carcinoma, Endometrioid/blood
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/drug therapy
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Drug Administration Schedule
- Female
- Humans
- Infusions, Intravenous
- Middle Aged
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/pathology
- Paclitaxel/administration & dosage
- Paclitaxel/adverse effects
- Radiography
- Salvage Therapy
- Survival Analysis
- Treatment Outcome
- Turkey
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Affiliation(s)
- I Dunder
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
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Kurokawa T, Yoshida Y, Kawahara K, Tsuchida T, Okazawa H, Fujibayashi Y, Yonekura Y, Kotsuji F. Expression of GLUT-1 glucose transfer, cellular proliferation activity and grade of tumor correlate with [F-18]-fluorodeoxyglucose uptake by positron emission tomography in epithelial tumors of the ovary. Int J Cancer 2004; 109:926-32. [PMID: 15027127 DOI: 10.1002/ijc.20057] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We evaluated whether tracer FDG uptake, quantified as an SUV by PET in ovarian epithelial tumors, correlates with clinical stage, tumor grade, cell proliferation and glucose metabolism, all of which are biomarkers for response to chemotherapy, prognosis and overall survival in ovarian cancer patients. Seventeen patients suspected of having ovarian cancer by physical examination, tumor marker analysis and anatomic imaging (such as sonography, CT and/or MRI) underwent whole-body FDG-PET within the 2 weeks prior to surgery. Seventeen epithelial ovarian tumor specimens (13 malignant tumors, 5 at stage I, 2 at stage II, 6 at stage III; 2 borderline tumors; and 2 benign lesions) were available for pathologic evaluation. They were graded histopathologically, and immunohistochemistry for MIB-1 (proliferation index marker) and GLUT-1 was performed. Correlation between FDG uptake and clinical stage, GLUT-1 expression, MIB-1 LI and histologic grading score was determined. No positive correlation was observed between FDG uptake and clinical stage (p=0.14). Intensity of GLUT-1 expression (r=0.76, p=0.001), MIB-1 LI (r=0.457, p=0.014) and histologic grading score (r=0.692, p=0.005) showed statistically significant positive correlations with FDG uptake. Stepwise logistic regression analysis revealed that expression of GLUT-1 transporters was the strongest parameter (r=0.760, p=0.0004) by which to predict positive FDG uptake. Therefore, glucose consumption, as determined by analysis of SUVs in FDG-PET, may be a noninvasive biomarker for ovarian epithelial tumors.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/metabolism
- Adenocarcinoma, Mucinous/pathology
- Biomarkers, Tumor
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/metabolism
- Carcinoma, Endometrioid/pathology
- Cell Division
- Cystadenocarcinoma, Serous/diagnostic imaging
- Cystadenocarcinoma, Serous/metabolism
- Cystadenocarcinoma, Serous/pathology
- Female
- Fluorodeoxyglucose F18/pharmacokinetics
- Glucose/metabolism
- Glucose Transporter Type 1
- Humans
- Ki-67 Antigen/metabolism
- Monosaccharide Transport Proteins/metabolism
- Neoplasm Staging
- Neoplasms, Glandular and Epithelial/diagnostic imaging
- Neoplasms, Glandular and Epithelial/metabolism
- Neoplasms, Glandular and Epithelial/pathology
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/pathology
- Radiopharmaceuticals/pharmacokinetics
- Tomography, Emission-Computed
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Affiliation(s)
- Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, Fukui Medical University, Fukui-ken, Japan
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43
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Tohya T, Shimajiri S, Onoda C, Yoshimura T. Complete remission of ovarian endometrioid adenocarcinoma associated with hyperamylasemia and liver metastasis treated by paclitaxel and carboplatin chemotherapy: a case report. Int J Gynecol Cancer 2004; 14:378-80. [PMID: 15086742 DOI: 10.1111/j.1048-891x.2004.014225.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Complete remission in the case of a 45-year-old woman with ovarian endometrioid adenocarcinoma associated with hyperamylasemia and liver metastasis is described. Ultrasound examination and CT scan revealed several large solid and cystic intra-abdominal tumors and a metastatic liver tumor. The serum amylase was 600 micro/l (normal value: 60-200 micro/l), and electrophoresis identified isoamylases of the salivary type. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed for invasive carcinoma of the left ovary. The histology of the left ovary showed endometrioid adenocarcinoma. Immunohistochemically, the adenocarcinoma cells were diffusely and strongly positive for amylase. The patient received six courses of paclitaxel and carboplatin combination chemotherapy. Two years later, the patient is alive and well, without evidence of disease. The prognosis of patients with ovarian cancer metastatic to the liver is uniformly poor. This represents the first report of complete remission of such a patient in the literature.
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Affiliation(s)
- T Tohya
- Department of Obstetrics and Gynecology, Kumamoto Rosai Hospital, Yatsushiro, Kumamoto 866-8533, Japan.
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44
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Ruangvutilert P, Sutantawibul A, Sunsaneevithayakul P, Boriboonhirunsarn D, Chuenchom T. Accuracy of transvaginal ultrasound for the evaluation of myometrial invasion in endometrial carcinoma. J Med Assoc Thai 2004; 87:47-52. [PMID: 14971534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To evaluate the accuracy of transvaginal ultrasound for the evaluation of myometrial invasion in endometrial carcinoma in comparison with standard paraffin section. METHOD A total of 111 patients with endometrial carcinoma diagnosed from fractional curettage underwent pre-operative transvaginal ultrasonography to assess myometrial invasion. Operation for surgical staging was subsequently performed and the hysterectomy specimen was evaluated for depth of myometrial invasion by standard paraffin section blinded from transvaginal ultrasound results. Final histopathologic diagnosis and depth of myometrial invasion were obtained from standard paraffin section. Ultrasonographic assessment was compared with the histopathological results. RESULTS In evaluation of myometrial invasion, transvaginal ultrasound yielded the sensitivity of 69.4 per cent, specificity of 70.6 per cent, positive predictive value of 53.2 per cent, negative predictive value of 82.8 per cent, and accuracy of 70.3 per cent. The accuracy, sensitivity, specificity, negative predictive value, false positive and negative rates were comparable between grade 3 and grade 1 and 2 tumors. However, the positive predictive value was significantly higher among grade 3 than grade 1 and 2 tumors. The Kappa coefficients were 0.57 and 0.22 for grade 3 and grade 1 and 2 tumors respectively. CONCLUSION Transvaginal ultrasound for assessment of depth of myometrial invasion in endometrial carcinoma provided acceptable accuracy compared with standard paraffin section. This technique might be of value for the decision making in the intra-operative management of endometrial carcinoma.
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Affiliation(s)
- Pornpimol Ruangvutilert
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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45
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Fersis N, Gruber I, Relakis K, Friedrich M, Becker S, Wallwiener D, Wagner U. Sentinel node identification and intraoperative lymphatic mapping. First results of a pilot study in patients with endometrial cancer. EUR J GYNAECOL ONCOL 2004; 25:339-42. [PMID: 15171314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION To minimize the surgical morbidity after lymphadenectomy, sentinel node biopsy (SLNB) has become fundamental in the management of different malignancies. We decided to evaluate sentinel lymph node (SNL) biopsies also in patients with endometrial cancer undergoing hysterectomy with lymphadenectomy. METHODS In the setting of a prospective study we developed a technique for sentinel node biopsy of ten patients with histologically confirmed endometrial cancer. Prior to surgery 99m Tc Nanocol was injected in the peritumoral region by hysteroscopy. Six hours later lymphoscintigraphy was performed to identify the draining lymph nodes. During surgery we first detected the sentinel lymph node by a hand-held gamma tracer and then removed it. Surgery was completed by the standard therapy of total hysterectomy, bilateral salpingo-oophorectomy and pelvic and/or para-aortic lymphadenectomy. RESULTS Scintigraphic identification was possible in eight out of ten patients. Intraoperative identification of sentinel lymph nodes was possible in seven out of eight patients. In five patients we found the sentinel lymph nodes in the pelvic region while the other two patients had bilateral sentinel nodes in the pelvic and para-aortic region. Histologically confirmed microscopic tumor metastases of the SLNs and para-aortic lymph nodes were only found in one case. The sentinel lymph nodes from the other six patients were free of tumor and accurately reflected the pathological status. CONCLUSION The identification of sentinel lymph nodes in endometrial cancer is a practical and safe method. In order to improve this technique as a standard procedure for staging of endometrial cancer further studies with a larger number of patients have to be done.
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Affiliation(s)
- N Fersis
- Department of Gynaecology, University of Tuebingen, Tuebingen, Germany
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Affiliation(s)
- Vanita Jain
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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47
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Akhan SE, Işikoglu M, Salihoglu Y, Bengisu E, Berkman S. Brain metastasis of ovarian cancer after negative second-look laparotomy. EUR J GYNAECOL ONCOL 2003; 23:330-2. [PMID: 12214736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
We present a case of ovarian carcinoma that had brain metastasis seven months after having a negative second-look laparotomy and 13 months after the onset of diagnosis. Despite intense multidisciplinary treatment with surgery, chemotherapy and radiotherapy, the patient died seven months after second-look laparotomy.
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Affiliation(s)
- S E Akhan
- University of Istanbul, Istanbul Medical Faculty, Gynecology and Obstetrics Department, Turkey
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48
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Abstract
OBJECTIVE To correlate the color Doppler sonographic features of endometrial masses with histologic characteristics and microvessel density. METHODS We performed a retrospective analysis of 10 postmenopausal and 5 premenopausal women with abnormal bleeding who had color Doppler sonography and histologic studies of endometrial masses. RESULTS Endometrial masses that contained multiple branches on color Doppler sonography were more likely carcinomas, even though both polyps and carcinomas were vascular on color Doppler sonography and their microvessel densities were similar. On color Doppler sonography, polyps averaged 1.2 detectable vessels versus 3.4 for carcinomas. CONCLUSIONS Color Doppler sonography may be useful in distinguishing carcinomas from polyps in women with thickened endometria.
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Affiliation(s)
- Arthur C Fleischer
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675, USA
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49
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Abstract
Our objective was a retrospective study reporting on ovarian cancer screening in a high-risk female population using both CA-125 and ultrasound over a 7-year period. We used risk estimates of carrying a BRCA mutation that were based on family history. Subjects were screened with CA-125 and ultrasound every 6 months. Each of 311 high-risk subjects had between 1 and 17 screening visits. Overall, 33 of 1209 (2.7%) CA-125 results were abnormal (>35 U/ml); 226 of 1342 (17%) ultrasounds were abnormal, with abnormalities ranging from benign appearing cystic changes to more ominous patterns. Since entry into the program, 29 subjects (9%) have undergone surgery. In 20 of these, the preoperative screening was normal; in six, only the ultrasound was abnormal, and in two, only the CA-125 was abnormal (46-91 U/ml). In only one subject undergoing surgery were both serial CA-125 levels (52-91 U/ml) and ultrasound abnormal. In 7 years of screening, one patient (0.3%) has been diagnosed with ovarian cancer (stage IA, grade 1 endometrioid adenocarcinoma). Overall, 31 (10%) subjects have completed BRCA testing. We conclude that despite screening results comparable to other studies, the detection of only one ovarian cancer over 7 years is lower than expected. Explanations for this observation are discussed. Despite the limitations of CA-125 and ultrasound, we continue to recommend these screening modalities for high-risk women. At the present time, they offer the best opportunity to detect ovarian cancers early. With increasing knowledge of BRCA testing, more women may benefit from this testing in assessing their personal risk.
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Affiliation(s)
- Stéphane Laframboise
- Division of Gynecology Oncology, Princess Margaret Hospital, 610 University Avenue, M-716, Toronto, Ontario, Canada M5G 2M9.
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50
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Rose PG, Faulhaber P, Miraldi F, Abdul-Karim FW. Positive emission tomography for evaluating a complete clinical response in patients with ovarian or peritoneal carcinoma: correlation with second-look laparotomy. Gynecol Oncol 2001; 82:17-21. [PMID: 11426956 DOI: 10.1006/gyno.2001.6246] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Positive emission tomography (PET) provides a novel means of imaging malignancies. The following study was undertaken to evaluate the predictive value of PET in determining a pathologic complete response in patients with advanced ovarian or peritoneal carcinoma who had a complete clinical response following primary chemotherapy. METHODS Twenty-two patients with advanced-stage ovarian (N = 17) or peritoneal (N = 5) carcinoma who had achieved complete clinical and radiologic remission and normal CA-125 level after six cycles of chemotherapy and who had consented to a second look laparotomy procedure were studied. All patients received platinum based therapy and all but one patient, treated elsewhere, received paclitaxel in combination with platinum. Following IV administration of 20 mCi [(18)F]fluorodeoxyglucose (FDG), the entire abdomen and pelvis were scanned. Various technical modifications including bladder activity dilution, intravenous hydration with diuretic therapy, and mechanical bowel preparations, were used to reduce background activity. Second-look laparotomy findings were classified as negative, macroscopically positive if a biopsy of a suspicious area was histologically positive, or microscopically positive if only a nonsuspicious area was histologically positive. The effect of patient preparation prior to PET imaging was evaluated. RESULTS Persistent disease was found in 13 of the 22 patients (59%). Only one of nine sites with macroscopic and none of four with microscopic disease were accurately predicted. The sensitivity was only 10% and the specificity 42%. Intravenous hydration, diuretic therapy, and bowel preparation did not improve the results. CONCLUSIONS These results suggest that despite technical modifications the sensitivity of PET before second-look laparotomy for small-volume persistent disease is low.
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Affiliation(s)
- P G Rose
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Cleveland, Ohio, 44106, USA
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