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Marcus D, Phelps DL, Savage A, Balog J, Kudo H, Dina R, Bodai Z, Rosini F, Ip J, Amgheib A, Abda J, Manoli E, McKenzie J, Yazbek J, Takats Z, Ghaem-Maghami S. Point-of-Care Diagnosis of Endometrial Cancer Using the Surgical Intelligent Knife (iKnife)-A Prospective Pilot Study of Diagnostic Accuracy. Cancers (Basel) 2022; 14:5892. [PMID: 36497372 PMCID: PMC9736036 DOI: 10.3390/cancers14235892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: Delays in the diagnosis and treatment of endometrial cancer negatively impact patient survival. The aim of this study was to establish whether rapid evaporative ionisation mass spectrometry using the iKnife can accurately distinguish between normal and malignant endometrial biopsy tissue samples in real time, enabling point-of-care (POC) diagnoses. Methods: Pipelle biopsy samples were obtained from consecutive women needing biopsies for clinical reasons. A Waters G2-XS Xevo Q-Tof mass spectrometer was used in conjunction with a modified handheld diathermy (collectively called the 'iKnife'). Each tissue sample was processed with diathermy, and the resultant surgical aerosol containing ionic lipid species was then analysed, producing spectra. Principal component analyses and linear discriminant analyses were performed to determine variance in spectral signatures. Leave-one-patient-out cross-validation was used to test the diagnostic accuracy. Results: One hundred and fifty patients provided Pipelle biopsy samples (85 normal, 59 malignant, 4 hyperplasia and 2 insufficient), yielding 453 spectra. The iKnife differentiated between normal and malignant endometrial tissues on the basis of differential phospholipid spectra. Cross-validation revealed a diagnostic accuracy of 89% with sensitivity, specificity, positive predictive value and negative predictive value of 85%, 93%, 94% and 85%, respectively. Conclusions: This study is the first to use the iKnife to identify cancer in endometrial Pipelle biopsy samples. These results are highly encouraging and suggest that the iKnife could be used in the clinic to provide a POC diagnosis.
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Affiliation(s)
- Diana Marcus
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - David L. Phelps
- Department of Gynaecological Oncology, University Hospital Southampton, Coxford Road, Southampton SO16 5YA, UK
| | - Adele Savage
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Julia Balog
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Hiromi Kudo
- Centre for Pathology, Imperial College London, 4th Floor Clarence Wing, St Mary’s Hospital, London W2 1NY, UK
| | - Roberto Dina
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Zsolt Bodai
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Francesca Rosini
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Jacey Ip
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Ala Amgheib
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Julia Abda
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Eftychios Manoli
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - James McKenzie
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Joseph Yazbek
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Zoltan Takats
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London W12 0NN, UK
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Terzic M, Aimagambetova G, Bapayeva G, Ukybassova T, Kenbayeva K, Kaiyrlykyzy A, Ibrayimov B, Lyasova A, Terzic S, Alkatout I, Gitas G, Hortu İ, Garzon S, Laganà AS. Pipelle endometrial sampling success rates in Kazakhstani settings: results from a prospective cohort analysis. J OBSTET GYNAECOL 2021; 42:1255-1260. [PMID: 34592892 DOI: 10.1080/01443615.2021.1953452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this study was to evaluate the feasibility of Pipelle endometrial sampling and to explore factors influencing Pipelle success rate in the clinical settings of Kazakhstan. This prospective analysis included 87 patients who had undergone Pipelle biopsy due to medical indications for endometrial sampling. We analysed physician and patient-related factors potentially influencing the success rate of this method. Pipelle endometrial biopsy overall success rate was 82.76%. The indications for the procedure and patients' age were key factors influencing Pipelle sampling success (p < .001). The success rate was the highest in the group with abnormal uterine bleeding as a biopsy indication in the reproductive age group (93.19%; p < .001).Pipelle biopsy was found to be an acceptable option for endometrial sampling in our clinical setting; at the same time, physicians should consider the potential influencing factors on its success rate like indications for the procedure, BMI and patients' age as well as their menopausal status. In order to provide precise future directions, there is a need to study a larger number of patients.IMPACT STATEMENTWhat is already known on this subject? Compared to dilation and curettage sampling conducted in the operation room, Pipelle endometrial sampling is relatively inexpensive, associated with less morbidity, safe, accurate, and can be performed in an office setting.What do the results of this study add? This is the first prospective data analysis about Pipelle endometrial sampling in Kazakhstani population.What are the implications of these findings for clinical practice and/or further research? Enabling the timely diagnosis of current endometrial pathology, Pipelle endometrial sampling approach may have an important impact on healthcare safety and efficiency, and improve overall treatment outcomes and the quality of life of Kazakhstani population if used consistently.
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Affiliation(s)
- Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan.,Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Talshyn Ukybassova
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Kamila Kenbayeva
- Clinical Academic Department of Women's Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Aiym Kaiyrlykyzy
- National Laboratory of Astana, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Bakytkali Ibrayimov
- Department of Pathological Anatomy, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Alla Lyasova
- Pathology Bureau of Nur-Sultan City Administration, Nur-Sultan, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Lübeck, Germany
| | - İsmet Hortu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ege University, İzmir, Turkey.,Department of Stem Cell, Institute of Health Sciences, Ege University, İzmir, Turkey
| | - Simone Garzon
- lDepartment of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Narvekar SA, Gupta N, Shetty N, Kottur A, Srinivas M, Rao KA. Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study. J Hum Reprod Sci 2011; 3:15-9. [PMID: 20607003 PMCID: PMC2890904 DOI: 10.4103/0974-1208.63116] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/03/2009] [Accepted: 12/31/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Management of repeated implantation failure despite transfer of good-quality embryos still remains a dilemma for ART specialists. Scrapping of endometrium in the nontransfer cycle has been shown to improve the pregnancy rate in the subsequent IVF/ET cycle in recent studies. AIM: The objective of this randomized controlled trial (RCT) was to determine whether endometrial injury caused by Pipelle sampling in the nontransfer cycle could improve the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome. SETTING: Tertiary assisted conception center. DESIGN: Randomized controlled study. MATERIALS AND METHODS: 100 eligible patients with previous failed IVF despite transfer of good-quality embryos were randomly allocated to the intervention group and control groups. In the intervention group, Pipelle endometrial sampling was done twice: One in the follicular phase and again in the luteal phase in the cycle preceding the embryo transfer cycle. OUTCOME MEASURE: The primary outcome measure was live birth rate. The secondary outcome measures were implantation and clinical pregnancy rates. RESULTS: The live birth rate was significantly higher in the intervention group compared to control group (22.4% and 9.8% P = 0.04). The clinical pregnancy rate in the intervention group was 32.7%, while that in the control group was 13.7%, which was also statistically significant (P = 0.01). The implantation rate was significantly higher in the intervention group as compared to controls (13.07% vs 7.1% P = 0.04). CONCLUSIONS: Endometrial injury in nontransfer cycle improves the live birth rate, clinical pregnancy and implantation rates in the subsequent IVF-ET cycle in patients with previous unsuccessful IVF cycles.
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Affiliation(s)
- Sachin A Narvekar
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, #6/7 Kumara Krupa, High Grounds, Bangalore - 560001, India
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