Strategies for managing postmenopausal bleeding: a clinician's perspective

Postmenopausal bleeding (PMB) poses a diagnostic challenge due to the varied presentation of endometrial pathologies ranging from benign endometrial atrophy to the possibility of endometrial carcinoma. Although the incidence varies with patient characteristics, it warrants thorough evaluation. Risk factors such as obesity and hormone use should guide assessment. Bleeding may originate from various gynecological and non-gynecological sites, demanding meticulous history-taking and examination. Transvaginal sonography (TVS) is typically the initial step, yet its accuracy in excluding carcinoma remains debated. Invasive procedures like hysteroscopy and endometrial sampling offer higher accuracy but are more intrusive. The optimal diagnostic strategy remains uncertain, necessitating focused research for enhanced accuracy. TVS-guided assessment with an endometrial thickness (ET) threshold of >4 mm prompts evaluation and endometrial sampling. Progestogen therapy mitigates endometrial cancer risk associated with estrogen use, with atypia-hyperplasia necessitating vigilant monitoring and possible hysterectomy. Patient counselling on treatment options is crucial. In summary, PMB warrants a systematic approach integrating imaging, histological assessment, and tailored therapy guided by risk factors, final diagnosis and patient preferences.

Perfil molecular de cáncer de endometrio en mujeres de Bogotá DC, Colombia / Molecular profile of endometrial cancer in women from Bogota DC, Colombia

Introducción: El cáncer de endometrio ocupa el sexto lugar en incidencia del cáncer en mujeres. La caracterización molecular de este cáncer permite optimizar la estratificación de riesgo para mejorar el tratamiento de las pacientes. Objetivo: Determinar el perfil molecular TCGA de pacientes con cáncer de endometrio en Bogotá, D.C., Colombia. Método: Estudio descriptivo en una cohorte de pacientes con cáncer de endometrio. Las mutaciones en los exones 9 a 14 del gen POLE fueron identificadas mediante amplificación por reacción en cadena de la polimerasa, seguida de secuenciación Sanger y análisis bioinformático. La expresión de las proteínas MMR y p53 se identificó mediante inmunohistoquímica. Resultados: Se incluyeron 40 pacientes con una mediana de edad de 66 años. El 15% presentaron mutaciones en el dominio exonucleasa de POLE. El 32% de las pacientes que no presentaron mutaciones manifestaron deficiencia en el sistema MMR. El 43,47% de las pacientes sin mutaciones en POLE ni alteración del sistema MMR presentaron alteración de la proteína p53. Conclusiones: La población de cáncer de endometrio analizada presenta un perfil molecular TCGA similar a lo reportado para otras poblaciones.

Introduction: Endometrial cancer ranks sixth in cancer incidence among women. Its molecular characterization allows for a more precise risk stratification with the aim of improving patient treatment. Objective: To determine the TCGA molecular profile of patients with endometrial cancer in Bogota, Colombia. Method: A descriptive study of a cohort of patients with endometrial cancer. The expression of MMR proteins and p53 was identified through immunohistochemistry. Mutations in exons 9 to 14 of the POLE gene were identified through polymerase chain reaction amplification, followed by Sanger sequencing and bioinformatic analysis. Results: Forty patients were included in the study, with a median age of 66 years, 15% of them exhibited mutations in the exonuclease domain of POLE, while 32% of patients without mutations showed deficiency in the MMR system. Forty three percent of patients without mutations in POLE or MMR alterations showed aberrant p53 protein expression. Conclusions: The analyzed population of endometrial cancer presents a TCGA molecular profile similar to that reported for other populations.

Sentinel lymph node biopsy in early-stage endometrium cancer using methylene blue dye

Background: The nodal evaluation of early-stage carcinoma endometrium has evolved rapidly, with various methods and dyes explored for sentinel lymph node biopsy (SLNB). Our study specifically aims to investigate the utilization of 1% methylene blue in SLNB for carcinoma endometrium at our center.Methods: In our prospective study of 105 patients with early-stage CA endometrium in our center between June 2021 and August 2022, we used 1% methyl blue dye for SLNB identification. We followed each patient for a minimum of 6 months. We documented demographic characteristics, SLNB features, and postoperative outcomes.Results: Out of 105 patients,94 patients (93%) of the study population belong to clinical FIGO stage IA disease.82 patients (81%) had biopsy specimens that showed endometrioid variant grade 1, followed by grade 2 in 13 patients (12.9%). 82 patients (81.2%) had unilateral SLNB visualisation 48 patients( 47.5%) had bilateral visualization of nodes. 19 patients (18.8%) of the study population had negative visualization of nodes on both sides. The average number of sentinel nodes retrieved was 2 nodes in 48 patients (45.5%), with a false negative rate of 4%.Conclusion: In our study, using a 1% methylene blue dye for an SLNB in Ca endometrium showed less than 50% success in visualizing both sides. Therefore, we do not recommend using it as a standard method. However, in resource-limited settings where indocyanine green (ICG) and radiocolloid are not available, considering methylene blue as an alternative is a viable option provided the SLNB algorithm is followed.

The utility of colposcopy in detecting relapse after treatment of gynaecological malignancies

Background: Vaginal bleeding is the most common symptom of vault relapse in gynecological cancers. This symptom may be overlooked or attributed to other causes, such as atrophy, infection, or post-radiation changes. Colposcopy allows direct magnified visualization of vaginal mucosa and abnormal vasculature though its role in detecting relapse is unclear.Methods: It is a retrospective observational study of 31 patients who were referred for colposcopy and biopsy with complaints of abnormal vaginal bleeding during follow up of endometrial or cervical cancer.Results: Among 31 patients, 19 patients were diagnosed to have primary cervical cancer and 12 endometrial cancers. Primary treatment was surgery alone (n=10, 32.2%), chemo-radiation alone (n=4, 12.9%) and both (n=17, 54.8%). Abnormal colposcopic findings were atropic features (n=21, 67.7%), radiation changes (n=8, 25.8%), erosion (n=9, 29.0%), acetowhite areas (n=9, 29.0%), abnormal vessels (n=8, 25.8%) and iodine staining abnormality (n=16, 51.6%). According to Swede scoring system, 77.1% (n=24) were normal or low grade lesions, 22.6% (n=7) were high grade lesions. Total of 6 recurrence cases identified out of which 5 cases had high grade (Swede score >7) and one had low grade (Swede score 5-7) colposcopic features. On taking Swede score cut off of 5 or more, the sensitivity of colposcopy in detecting vault recurrence is 100%, specificity 96%, positive likelihood ratio of 25%and negative likelihood ratio of 0%. Overall the accuracy of colposcopy in detecting relapse was 96.8%.Conclusions: In our experience colposcopy is worth in detecting the cause of abnormal vaginal bleeding after treatment for endometrial and cervical cancer. Swede score is a good measure to decide on taking biopsy among these patients. Furthermore, larger studies are needed for better clarification.

Agreement level of preoperative histology with post-surgical histology in atypical hyperplasia and endometrial cancer patients

Background: Endometrial cancer significantly contributes to gynecological cancers. The aim of the study was to assess the concordance between the preoperative endometrial biopsy and histology of hysterectomy specimens in patients surgically treated for endometrial hyperplasia and endometrial cancer. Concurrent malignancy was also assessed in cases of endometrial hyperplasia with atypia.Methods: This study is a retrospective analysis of patients surgically treated for atypical hyperplasia (47 patients) and cancer (210 patients) at HHFT from January 2014 to March 2020. The preoperative histology was compared to the histological findings of hysterectomy. In cases of endometrial cancer, its histological type and grade were also assessed.Results: In the endometrial cancer group, the majority were endometrioid adenocarcinoma (204 patients) and only 6 had a non-endometrioid type. In the endometrioid and non-endometrioid group, preoperative diagnosis was confirmed in 88.7% and 100% patients respectively in postoperative specimens. Tumor grade was reported in 193 patients. The present study shows the highest accuracy in grade 3 patients (88%) followed by grade 1 (82.8%) and grade 2 (62.5%). Out of these 47 patients who underwent surgical management for atypical hyperplasia, preoperative diagnosis was confirmed in 46.8% (22 patients). Importantly, concurrent endometrial cancer in hysterectomy specimens was found in 34% patients in atypical hyperplasia group.Conclusions: High level of concordance was noticed in histology and grade in endometrial cancer patients. Only half of the patients in atypical hyperplasia group showed concordance as one-third of patients were found to have concurrent malignancy.

Association of postmenopausal bleeding with endometrial cancer

Background: Uterine cancer, also clinically referred to as endometrial cancer, stands out as the most prevalent cancer within the reproductive system of women. Notably, approximately 80% of women experiencing postmenopausal bleeding (PMB) with an endometrial thickness of ?4 mm exhibit localized pathological lesions in the uterine cavity. This study aimed to assess the association of PMB with endometrial cancer.Methods: This prospective study was conducted at the department of obstetrics and gynecology, delta medical college and hospital, Dhaka, Bangladesh from July 2018 to June 2019. The study comprised 1000 patients selected through purposive sampling, adhering to specific inclusion and exclusion criteria. Microsoft office tools were employed for data processing and analysis. The analytical approach employed was descriptive in nature.Results: The study revealed that the highest percentage of patients (20.20%) exhibited abnormal endometrial hyperplasia, followed by carcinoma cervix (19.2%) and endometrial cancer (16.7%). Additionally, a significant portion of the participants, constituting 40.30%, had co-existing hypertension, while 38.1% had diabetes mellitus, and 34.0% had dyslipidemia. Notably, 65.9% of patients diagnosed with endometrial carcinoma displayed an endometrial thickness exceeding 4 mm.Conclusions: PMB is not statistically significant for endometrial cancer, but prompt evaluation is essential to exclude malignancy. Transvaginal ultrasonography (TVUS) is a reasonable first-line approach, and invasive sampling is recommended when the endometrial thickness exceeds 4 mm.

The rehabilitation effect of universal and individualized dual-track nursing on patients with endometrial cancer after laparoscopic surgery / 沈阳医学院学报

Objective:To investigate the effects of universal and individualized dual-track nursing on the recovery process,bladder function,self-care ability and complications of patients with endometrial cancer(EC)after laparoscopic surgery.Methods:A total of 164 EC patients admitted to our hospital from Aug 2019 to Jan 2022 were collected and randomly divided into conventional nursing group and dual-track nursing group,82 patients in each group.All patients in 2 groups received laparoscopic surgery,the conventional nursing group received routine nursing intervention,and the dual-track nursing group received universal and individual dual-track nursing intervention on the basis of conventional nursing.The recovery process(time of first ambulation,first exhaust and hospitalization),self-care ability,postoperative bladder function,incidence of complications,quality of life,and recurrence rate of 1-year follow-up were compared between the two groups.Results:The first ambulation time,first exhaust time and hospitalization time in dual-track nursing group were shorter than those in conventional nursing group(P＜0.05).At 3 days after operation,the recovery rate of bladder function in the dual-track nursing group was significantly higher in dual-track nursing group than that in conventional nursing group(P＜0.05).After 3 months of nursing,the scores of health knowledge,self-care responsibility,nursing skills and self-concept in dual-track nursing group were higher than those in conventional nursing group,while the scores of PWB,SWB,EWB and FWB were lower than those in conventional nursing group(P＜0.05).During the nursing period,the incidence of complications in the dual-track nursing group was lower than that in the conventional nursing group(P＜0.05).After 1 year of follow-up,the recurrence rate of dual-track nursing group was slightly lower than that of conventional nursing group,but the difference was not statistically significant(P＞0.05).Conclusion:The application of universal and individualized dual-track nursing in EC patients after laparoscopic surgery can improve patients'self-care ability and quality of life,enhance bladder function,reduce complications and recurrence,and promote patients'rapid recovery after surgery.

Study on the dosimetry effect of rotational errors of a multi-channel cylinder applicator of vagina / 中国医学装备

Objective:To investigate the dosimetry effect of rotational errors of multi-channel cylinder vaginal applicator of intravaginal irradiation after surgery of endometrial cancer.Methods:A total of 18 patients who underwent surgery of endometrial cancer at Peking Union Medical College Hospital from June to December 2022 were selected.The plans of patients who adopted the treatment of multi-channel cylinder applicator of vagina were retrospectively analyzed,which maintained the same retained mode with clinical plan.The applicator was rotated clockwise by 22.5? and 45.0?,respectively,simulating the rotational errors that occurred in placing the applicator among clinical inter-fractions.And then,the changes of dosimetry of target area and organs at risk(OAR)under two kinds of rotation amplitudes were further analyzed.Results:When the applicator was rotated as 22.5?,the minimum doses to 90%volumes of CTV by 2.03%than that of clinical plan,which was significantly different(t=5.86,P<0.05),and the maximal doses to 2cc of OARs of bladder and rectum respectively increased 2.35%and 2.71%,and the differences of them were statistically significant(t=-3.49,-2.40,P<0.05),respectively.When the applicator was rotated as 45?,the D90 of the target area decreased by 5.75%than that of clinical plan,which was statistically significant(t=14.07,P<0.05).The D2cc values of the bladder and rectum increased respectively by 6.50%and 9.49%than that of clinical plan,which were statistically significant(t=-7.72,-6.9,P<0.05).The differences of the exposed doses of sigmoid colon and small intestine after the applicator was rotated by 22.5? and 45.0? between the plan and original plan were respectively less,which were not statistical significance.Conclusion:The multi-channel cylinder applicator can provide individualized dose distribution in intravaginal irradiation.However,attention should be paid to the placement of the applicator when patients undergo inter-fractional treatment,in order to avoid deviations in the angular alignment from the original plan.This can impact the dosages of the target area and OARs.

Effectiveness of the artificial intelligence image recognition system in diagnosing endometrial cytopathology / 西安交通大学学报(医学版)

【Objective】 To explore the effectiveness of an image recognition system based on artificial intelligence (AI) in diagnosing benign and malignant endometrial cell clumps. 【Methods】 We selected endometrial cytological specimens from The First Affiliated Hospital of Xi’an Jiaotong University and Xi’an Daxing Hospital from August 2021 to February 2023; histopathology was used as the gold standard. We compared and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, accuracy and diagnostic time of AI image recognition system (AI diagnosis) and professional pathologists’ manual diagnosis (manual diagnosis) of benign and malignant endometrial cell clumps. 【Results】 Among the 126 patients included in the analysis, the overall coincidence rate of AI diagnosis and histological diagnosis was 92.1% (116/126), which was highly consistent with histopathological results (Kappa=0.841). The overall coincidence rate of manual diagnosis and histological diagnosis was 94.4% (119/126), which was highly consistent with histopathological results (Kappa=0.889). There was no statistically significant difference between AI diagnosis and manual diagnosis methods (χ2=0.568, P=0.451). The sensitivity, specificity, positive predictive value, and negative predictive value of AI diagnosis were 91.8%, 92.3%, 91.8%, and 92.3%, respectively. There were 126 cytology sections, each of which required 6.67 minutes for manual diagnosis and 5.00 minutes for AI diagnosis. 【Conclusion】 The AI image recognition system has high diagnostic accuracy, sensitivity and specificity, which is equivalent to the manual diagnosis level of professional pathologists. Therefore, this system has application value in the diagnosis of benign and malignant endometrial cell clumps.

Association between endometrial cancer and breast cancer: a bidirectional Mendelian randomization study / 预防医学

Objective@#To examine the causal relationship between endometrial cancer and breast cancer using bidirectional two-sample Mendelian randomization (MR) approach.@*Methods@#Genetic association data of endometrial cancer were collected through a meta analysis, including 54 884 participants and 9 464 330 single nucleotide polymorphisms (SNPs), and genetic association data of breast cancer were collected through the Breast Cancer Society Consortium, with 228 951 participants and 10 680 257 SNPs. A forward MR analysis was performed using the inverse variance weighted (IVW) method with 8 endometrial cancer-associated SNPs as instrumental variables and breast cancer as the study outcome, and a reverse MR analysis was performed with 112 breast cancer-associated SNPs as instrumental variables and endometrial cancer as the study outcome. The heterogeneity was assessed using the Cochran's Q test, the horizontal pleiotropy was assessed using the MR-PRESSO test and MR-Egger regression, and the robustness of the results was verified with the leave-one-out.@*Results@#Forward MR analysis results showed that patients with genetically predicted endometrial cancer had an increased risk of breast cancer compared to those without endometrial cancer (OR=1.083, 95%CI: 1.037-1.132). Reverse MR analysis showed that patients with genetically predicted breast cancer had an increased risk of endometrial cancer compared to those without breast cancer (OR=1.070, 95%CI: 1.010-1.134). Cochran's Q test detected no heterogeneity (P>0.05), and neither the MR-PRESSO test nor the MR-Egger regression revealed horizontal pleiotropy of instrumental variables (both P>0.05). Leave-one-out analysis showed robustness of the MR analysis results.@*Conclusion@#There are bidirectional causal relationship between endometrial cancer and breast cancer.

Knockdown of BMI1 Enhances The Sensitivity of Cervical and Endometrial Cancer Cells to Paclitaxel / 生物化学与生物物理进展

ObjectiveTo study the effects of BMI1 on the proliferation and drug resistance of cervical cancer (CC) and endometrial cancer (EC) cells. In addition, the mechanism of paclitaxel (PTX) resistance induced by BMI1 was explored. MethodsIn this study, we utilized the GTEx, Cbioportal, TCGA, and CPTAC databases to comprehensively analyze the mutation rate as well as mRNA and protein expression profiles of BMI1 in CC and EC. Subsequently, immunohistochemistry (IHC) analysis was employed to evaluate the protein expression levels of BMI1 in 40 pairs of CC and 40 pairs of EC tissue samples. Western blot was conducted to investigate alterations in downstream factor protein levels upon BMI1 knockdown in CC and EC cells. Furthermore, functional experiments were performed to elucidate the role of BMI1 in CC and EC cells. Finally, we assessed the synergistic anti-growth effect by combining BMI1 knockdown with paclitaxel treatment in vitro. ResultsThe Cbioportal database revealed that BMI1 amplification, misinterpretation, and splicing occurred in 1.5% of CC patients and 1.9% of EC patients. Mining the data from TCGA and CPTAC databases, high mRNA levels of BMI1 were associated with the pathological type of CC and lower overall survival, and high protein levels of BMI1 were related to EC’s pathological type and tumor grade. Furthermore, the BMI1 protein level is overexpressed in cancer tissues of CC and EC compared with normal tissues, as detected by IHC analysis. Besides, drug sensitivity experiments showed that overexpression of BMI1 resulted in decreased sensitivity of HeLa and HEC-1-A cells to a variety of anticancer drugs, including paclitaxel. In order to further analyze the relationship between BMI1 and paclitaxel resistance, Western blot was used to detect the changes in the protein levels of downstream factors of BMI1 in HeLa and HEC-1-A cells after BMI1 knockdown. The results showed that the level of anti-apoptotic factor Bcl-2 protein decreased, while that of pro-apoptotic factor BAX increased with BMI1 knockdown. Additionally, we showed that high expression of BMI1 promoted the proliferation and migration of CC and EC cells in vitro. Moreover, CC and EC cells with low BMI1 expression were more sensitive to the paclitaxel. ConclusionThe expression of BMI1 is significantly upregulated in tumor tissues from patients with cervical and endometrial cancer, and silencing BMI1 makes CC and EC cells more sensitive to paclitaxel via enhancing pro-apoptotic regulation.

Role of clinical characteristics in preoperative diagnosis of adenomyosis with endometrial cancer / 安徽医科大学学报

Objective @#To analyze the clinical characteristics of patients with adenomyosis (AM) and endometrial cancer (EC) and their role in preoperative diagnosis.@*Methods @#A total of 142 patients with AM complicated with EC or endometrial atypical hyperplasia (EAH) and AM with abnormal uterine bleeding ( AUB) during the same period were collected from this hospital. They were divided into AM with EC or EAH group (71 cases) and control group (71 cases) according to whether they were complicated with EC or EAH. The clinical data of the patients were retrospectively analyzed , and the clinical characteristics and treatment strategies of the patients with adenomyosis complicated with endometrial cancer were discussed. @*Results @#Univariate analysis showed that age , increased proportion of CA125 and CA125 , uterine volume , proportion of hypertension and abnormal endometrial ultrasonography in patients with AM with EC or EAH were significantly higher than those in the control group , and the proportion of dysmenorrhea was significantly lower than that in the control group , and the difference was statistically significant (P < 0. 05) . Multivariate Logistic regression analysis showed that endometrial thickening , endometrial echogenicity , and endometrial thickening combined with echogenicity were independent risk factors for AM with EC or EAH.@*Conclusion @#In clinical practice , the patients with AM with endometrial thickening or uneven echo - echo of ultrasound should be treated by hysteroscopy and curettage before further operation plan is formulated , so as to achieve the purpose of early diagnosis and treatment of EC.

Research advance in progesterone therapy for endometrial cancer / 中国临床药理学与治疗学

Endometrial cancer originates from the endometrium and is one of the common gynecologic malignancies, with its incidence and mortality rate increasing year by year. Although endometrial cancer is more prevalent in the peri- and postmenopausal female population, it has been an evident trend in recent years towards younger patients. For young patients who have not yet given birth but intend to do so, the application of progestins in endometrial cancer treatment has made significant progress in clinical practice. Considering the existence of large individual differences and unclear mechanisms of action in the clinical application of progestins, this paper aims to provide an overview of the current clinical application status, efficacy, hormone resistance, and its mechanisms in the context of hormone therapy.

Effect of 3D laparoscopy versus traditional laparotomy on serum tumor markers and coagulation function in patients with early-stage endometrial cancer

Abstract Objectives To investigate the impact of Three-Dimensional (3D) laparoscopy compared to traditional laparotomy on serum tumor markers and coagulation function in patients diagnosed with early-stage Endometrial Cancer (EC). Method The authors retrospectively analyzed the clinical data of 75 patients diagnosed with early-stage EC and categorized them into two groups based on the surgical techniques employed. The 3D group consisted of 36 patients who underwent 3D laparoscopic surgery, while the Laparotomy group comprised 39 patients who underwent traditional laparotomy. The authors then compared the alterations in serum tumor markers and coagulation function between the two groups. Results Postoperatively, serum levels of CA125, CA199, and HE4 were notably reduced in both groups on the third day, with the levels being more diminished in the 3D group than in the Laparotomy Group (p < 0.05). Conversely, FIB levels escalated significantly in both groups on the third-day post-surgery, with a more pronounced increase in the 3D group. Additionally, PT and APTT durations were reduced and were more so in the 3D group than in the laparotomy group (p < 0.05). Conclusions When juxtaposed with traditional laparotomy, 3D laparoscopic surgery for early-stage EC appears to be more efficacious, characterized by reduced complications, and expedited recovery. It can effectively mitigate serum tumor marker levels, attenuate the inflammatory response and damage to immune function, foster urinary function recovery, and enhance the quality of life. However, it exerts a more significant influence on the patient's coagulation parameters, necessitating meticulous prevention and treatment strategies for thromboembolic events in clinical settings.

Preoperative cancer antigen-125 levels as a predictor of recurrence in early-stage endometrial cancer

SUMMARY OBJECTIVE: Endometrial cancer is the most common gynecological cancer in developed countries, with a majority of cases being low-grade endometrioid endometrial cancer. Identifying risk factors for disease recurrence and poor prognosis is critical. This study aimed to assess the correlation between preoperative cancer antigen-125 levels and disease recurrence in early-stage endometrioid endometrial cancer patients. METHODS: The study was a retrospective analysis of 217 patients diagnosed with endometrioid endometrial cancer who underwent surgical treatment at a university-affiliated tertiary hospital between 2016 and 2022. Patients were divided into two groups based on their preoperative cancer antigen-125 levels and compared with clinicopathological findings and disease recurrence. Disease-free survival rates were calculated, and logistic regression analysis was performed to determine independent factors affecting disease-free survival. RESULTS: The mean age of patients was 61.59±0.75 years, and the mean follow-up time was 36.95±1.18 months. The mean cancer antigen-125 level was 27.80±37.81 IU/mL. The recurrence rate was significantly higher in the group with elevated cancer antigen-125 levels (p=0.025). Disease-free survival was lower in patients with elevated cancer antigen-125 compared with those with normal levels (p=0.005). Logistic regression analysis revealed that elevated cancer antigen-125 levels were associated with disease recurrence (OR: 3.43, 95%CI 1.13-10.37, p=0.029). CONCLUSION: The findings of this study suggest that preoperative cancer antigen-125 levels can be used as a predictor of disease recurrence in early-stage endometrioid endometrial cancer patients. cancer antigen-125 levels may be a useful tool for risk stratification and patient management in endometrial cancer.

Validación de técnica de ganglio centinela en cáncer de endometrio en el Hospital de Talca / Validation of sentinel lymph node technique in endometrial cancer at the Hospital de Talca

Objetivo: Validar la técnica de ganglio centinela utilizando verde de indocianina en la estadificación del cáncer de endometrio. Método: Realizamos un estudio prospectivo entre enero y diciembre de 2021. Se incluyeron todas las pacientes portadoras de cáncer de endometrio clínicamente en etapa 1, de todos los grados de diferenciación e histologías. Todas las pacientes fueron sometidas a una estadificación laparoscópica. Se inició el procedimiento con identificación de ganglio centinela utilizando verde de indocianina. Posteriormente, se completó la cirugía de estadiaje estándar en todas las pacientes. Los ganglios centinelas fueron procesados con técnica de ultraestadiaje. Resultados: Se incluyeron 33 pacientes. El 81% presentaron histología endometrioide. El 100% fueron sometida además a una linfadenectomía pelviana estándar y el 20% a una linfadenectomía paraaórtica simultáneamente. Se detectó al menos un ganglio centinela en el 100% de los casos. La detección bilateral ocurrió en el 90,9%. La localización más frecuente fue la fosa obturatriz y la arteria hipogástrica. Obtuvimos una sensibilidad del 90% para detectar enfermedad ganglionar y un valor predictivo negativo del 95,8%. Conclusiones: La técnica de ganglio centinela utilizando verde de indocianina es replicable. Los resultados de nuestra serie nos permiten realizar procedimientos menos agresivos al estadificar el cáncer de endometrio.

Objective: To validate sentinel node mapping using indocyanine green in endometrial cancer staging. Method: A prospective study was conducted between January and December 2021. All patients with clinically stage 1 endometrial cancer, of all grades and histologies were included. All patients underwent laparoscopic staging. The procedure began with identification of the sentinel node using indocyanine green. Subsequently, standard staging surgery was completed in all patients. Sentinel nodes were processed using ultrastaging technique. Results: Thirty-three patients were enrolled. 81% of cases had endometrioid histology. All patients also underwent a standard pelvic lymphadenectomy and in 20% of cases a para-aortic lymphadenectomy. At least one sentinel node was detected in 100% of the cases. Bilateral detection occurred in 90.9%. The most frequent location was obturator fossa and hypogastric artery. Sensitivity to detect lymph node disease was 90% and negative predictive value 95.8%. Conclusions: Sentinel lymph node mapping using indocyanine green is a replicable technique. Our results allows us to perform less aggressive procedures in endometrial cancer staging.

Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil / Características clínicas e desfechos de uma coorte de câncer endometrial de alto grau tratada no Instituto Nacional de Câncer, Brasil

Abstract Objective To analyze the outcomes of a cohort of patients with high-risk histologies of endometrial cancer (EC) treated at Instituto Nacional de Câncer (National Cancer Institute, INCA, in Portuguese), in Brazil. Materials and Methods We reviewed the medical records of patients with high-risk histologies of EC in any stage registered at INCA between 2010 and 2016 to perform a clinical and demographic descriptive analysis and to evaluate the outcomes in terms of recurrence and survival. Results From 2010 to 2016, 2,145 EC patients were registered and treated at INCA, and 466 had high-grade histologies that met the inclusion criteria. The mean age of the patients was 65 years, 44.6% were Caucasian, and 90% had a performance status of 0 or 1. The most common histology was high-grade endometrioid (31.1%), followed by serous carcinoma (25.3%), mixed (20.0%), carcinosarcoma (13.5%), and clear cell carcinoma (9.4%). Considering the 2018 Fédération Internationale de Gynécologie et d'Obstétrique (International Federation of Gynecology and Obstetrics, FIGO, in French) staging system, 44.8%, 12.4%, 29.8%, and 12.9% of the patient were in stages I, II, III or IV respectively. Age (> 60 years), more than 50% of myoinvasion, higher stage, poor performance status, serous and carcinosarcoma histologies, and adjuvant treatment were independent factors associated with recurrence-free survival (RFS) and overall survival (OS) in the multivariate analysis. Conclusion The current findings reinforced the international data showing poor outcomes of these tumors, especially for serous and carcinosarcomas and tumors with advanced stages, with shorter survival and high recurrence rates in distant sites, independently of the FIGO stage. Adjuvant therapy was associated with better survival.

Resumo Objetivo Analisar os desfechos de uma coorte de pacientes com câncer de endométrio (CE) e histologias de alto risco atendida no Instituto Nacional do Câncer (INCA) entre 2010 e 2016. Materiais e Métodos Foram revisados prontuários de pacientes com histologias de alto risco de CE em qualquer estágio cadastradas no INCA entre 2010 e 2016 para realizar uma análise descritiva clínica e demográfica e avaliar os resultados em termos de recorrência e sobrevida. Resultados De 2010 a 2016, 2.145 pacientes com CE foram cadastradas e atendidas no INCA, e 466 tinham histologias de alto grau e atendiam aos critérios de inclusão. A média de idade das pacientes foi de 65 anos, 44,6% eram brancas, e 90% tinham performance status de 0 ou 1. A histologia mais comum foi endometrioide de alto grau (31,1%), seguida de carcinoma seroso (25,3%), misto (20,0%), carcinossarcoma (13,5%) e carcinoma de células claras (9,4%). Considerando o estadiamento da Fédération Internationale de Gynécologie et d'Obstétrique (Federação Internacional de Ginecologia e Obstetrícia, FIGO, em francês) de 2018, 44,8%, 12,4%, 29,8% e 12,9% apresentaram estágios I, II, III ou IV, respectivamente. Idade (> 60 anos), mais de 50% de mioinvasão, estágio avançado, performance status ruim, histologias serosas e carcinossarcoma, e tratamento adjuvante foram fatores independentes associados à sobrevida livre de recorrência e sobrevida global na análise multivariada. Conclusão Os achados atuais reforçam os dados internacionais que demonstram o prognóstico ruim desses tumores, principalmente para as histologias serosas e carcinossarcomas e para estágios avançados, com menor sobrevida e altas taxas de recorrência à distância, independentemente do estágio da FIGO. A terapia adjuvante foi associada a melhor sobrevida.

Cáncer endometrial: hallazgos en la citología cervical. Un caso clínico / Endometrial cancer: findings on cervical cytology. A clinical case

El cáncer endometrial representa la neoplasia ginecológica más frecuente en países desarrollados y la segunda en los países en vía de desarrollo, luego del cáncer cervical. Se ha establecido claramente la sensibilidad y la utilidad de la citología cervical para la detección de cáncer y lesiones precursoras del cuello uterino, especialmente para aquellas de origen escamoso, pero la utilidad de este muestreo para detectar lesiones a nivel de cavidad uterina es limitada debido a la dificultad del muestreo y otros factores de interpretabilidad. Es por eso que se presenta el siguiente caso clínico en el cual se logró establecer una orientación clara y certera de adenocarcinoma endometrial en una muestra tomada de cuello uterino en una paciente posmenopáusica, tras presentar un sangrado vaginal anormal(AU)

Endometrial cancer represents the most common gynecological neoplasm in developed countries and the second in developing countries after cervical cancer. The sensitivity and usefulness of cervical cytology for the detection of cervical cancer and precursor lesions, especially those of squamous origin, has been clearly established, but the usefulness of this sampling to detect lesions at the level of the uterine cavity is limited due to the difficulty of sampling and other interpretability factors. That is why the following clinical case is presented in which a clear and accurate orientation of endometrial adenocarcinoma was established in a sample taken from the cervix in a post-menopausal patient after presenting an abnormal vaginal bleeding(AU)

ENDOMETRIAL CARCINOMA: NARRATIVE REVIEW

Endometrial cancer is the most common gynecological malignancy in developed countries and its incidence has been increasing over recent years. Symptoms include postmenopausal bleeding, abnormal vaginal bleeding, pelvic pain, and dyspareunia. Risk factors include obesity, unopposed estrogen exposure, family history of endometrial or ovarian cancer, and Lynch syndrome. Diagnosis is con?rmed through endometrial biopsy, hysteroscopy, or dilation and curettage. Treatment options depend on the stage and grade of the cancer and may include surgery, radiation therapy, chemotherapy, or a combination. This review article summarizes the current state of knowledge on endometrial cancer, including its epidemiology, risk factors, clinical presentation, diagnostic methods, and treatment options. Recent advancements in the ?eld, including emerging biomarkers and targeted therapies, are highlighted. The authors conducted a systematic search of the literature on endometrial cancer, and the results were synthesized and presented using a narrative synthesis approach. The epidemiology of endometrial cancer underscores the importance of preventive measures, including regular gynecological checkups and lifestyle modi?cations to reduce obesity and improve reproductive health

Comparison of ZOOMit-DWI sequence and conventional DWI sequence in endometrial cancer / 中南大学学报(医学版)

OBJECTIVES@#Magnetic resonance diffusion-weighted imaging (DWI) has important clinical value in diagnosis and curative effect evaluation on endometrial carcinoma. How to improve the detection rate of endometrial small lesions by DWI is the research focus of MRI technology. This study aims to analyze the image quality of small field MRI ZOOMit-DWI sequence and conventional single-shot echo-planar imaging (SS-EPI) DWI sequence in the scanning of endometrial carcinoma, and to explore the clinical value of ZOOMit-DWI sequence.@*METHODS@#A total of 37 patients with endometrial carcinoma diagnosed by operation and pathology in the Second Xiangya Hospital of Central South University from July 2019 to May 2021 were collected. All patients were scanned with MRI ZOOMit-DWI sequence and SS-EPI DWI sequence before operation. Two radiologists subjectively evaluated the anatomical details, artifacts, geometric deformation and focus definition of the 2 groups of DWI images. At the same time, the signal intensity were measured and the signal-to-noise ratio (SNR), contrast to noise ratio (CNR), and apparent diffusion coefficient (ADC) of the 2 DWI sequences were calculated for objective evaluation. The differences of subjective score, objective score and ADC value of the 2 DWI sequences were analyzed.@*RESULTS@#The SNR of the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (301.96±141.85 vs 94.66±41.26), and the CNR of the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (185.05±105.45 vs 57.91±31.54, P<0.05). There was no significant difference in noise standard deviation between the ZOOMit-DWI group and the SS-EPI DWI group (P>0.05). The subjective score of anatomical detail and focus definition in the ZOOMit-DWI group was significantly higher than that of the SS-EPI DWI group (both P<0.05). The subjective score of artifacts and geometric deformation of ZOOMit-DWI group was significantly lower than that of the SS-EPI DWI group (both P<0.05). ADC had no significant difference between the ZOOMit-DWI group and the SS-EPI DWI group (P>0.05).@*CONCLUSIONS@#The image quality of ZOOMit-DWI is significantly higher than that of conventional SS-EPI DWI. In the MRI DWI examination of endometrial carcinoma, ZOOMit-DWI can effectively reduce the geometric deformation and artifacts of the image, which is more conducive to clinical diagnosis and treatment.