Role of acoustic radiation force-based elasticity imaging in endometrium pathologies.

BACKROUND: Ultrasonography is difficult to distinguish between endometrial pathologies and often requires curettage. ARFI (Acoustic Radiation Force-Based Elasticity Imaging) is a new ultrasonography elastography method. Using ARFI, it is possible to obtain information about the likelihood of the tissue benign or malignant. AIM: The aim of this study is to evaluate the contribution of ARFI to differentiate endometrial pathologies in hysterectomy specimens. SUBJECTS AND METHODS: Our study was prospectively, January-May 2017, performed in randomly 45 cases of 41-91 years of age (mean 58.3 years) who have decided to have hysterectomy. Hysterectomy was performed for uterine prolapse and endometrial hyperplasia in elderly patients and menorrhagia in young patients. Pathology results were compared with ARFI values and endometrial thickness. ANNOVA test was used for the comparison of ARFI values. RESULTS: Pathology revealed 14 cases of endometrial atrophy, 11 cases of proliferative phase, 10 cases of polyp, 6 cases of endometrial hyperplasia, and 4 cases of endometrium cancer. There is a statistically significant difference between mean ARFI values of endometrium, subendometrium, and myometrium of the groups (P < 0.05). There was a statistically significant difference between the mean endometrial thickness of the groups (P < 0.05). CONCLUSION: Endometrium ARFI contributes to the differential diagnosis of endometrial pathologies. Subendometrial and myometrial ARFI values decrease in polyps and increase in hyperplasia. Our study shows that the addition of subendometrium ARFI to gray-scale sonography before deciding on invasive procedures in endometrial pathologies may improve diagnostic accuracy. We concluded that further in vivo studies will establish the usefulness of this technique for preoperative diagnostic measures.

Adjuvant therapy for Stage IA uterine clear cell carcinoma with no myometrial invasion: a critical review of literature.

Uterine clear cell carcinoma (UCC) is an aggressive variant of endometrial cancer. Comprehensive surgical staging is strongly recommended for these patients as an upstaging to Stage 3-4 occur in 35-50% of patients. Stage 1A (no myometrial invasion) according to FIGO 1988 staging system are seen very rarely in patients. In most of the studies, regarding adjuvant treatment, clear cell carcinoma were all evaluated with papillary serous carcinoma (PSC). Studies on clear cell histology are low in number and also a limited number of patients were included. Proportion of patients with complete surgical staging, number of lymph nodes excised, and rate of omentectomy were all heterogenous and were not presented uniformly in studies. There is no concensus regarding adjuvant treatment for Stage 1A patients. Some authors suggest only close observation. Vaginal brachytherapy is also strongly recommended in some studies of this review. Multi-institutional studies with homogenous patient characteristics with homogeneous surgery is warranted.

First trimester maternal serum PAPP-A levels and associated pregnancy complications in intrahepatic cholestasis of pregnancy.

PURPOSE: To investigate first trimester maternal serum pregnancy associated plasma protein A (PAPP-A) multiple of the median (MoM) in cases with intrahepatic cholestasis of pregnancy (ICP). Obstetric complications and relation with PAPP-A MoM were also evaluated. MATERIALS AND METHODS: This was a retrospective case-control study. After exclusions, for each ICP case, two controls with uncomplicated singleton pregnancies were randomly selected. PAPP-A MoM of ICP cases with and without obstetric complications, and the control group were compared with each other. RESULTS: Total incidence of ICP was 0.99 % (138/13988). The study included 113 singleton pregnant women. Rates of gestational diabetes mellitus (GDM), preeclampsia (PE), fetal growth restriction (FGR), preterm labor (PTL), and hypothyroidism in cases with ICP were 21.2%, 7.9%, 10.6%, 18.6%, and 5.3%, respectively. Median PAPP-A MoM were 0.93 in ICP group and 1.10 in control group (p > 0.05). PAPP-A MoM levels were not significantly different either between the ICP group with complicated pregnancies and the control group or between the ICP group without complicated pregnancies and the control group (p >0.05). CONCLUSION: ICP incidence was similar to other European countries. Rates of obstetric complications expecially GDM were higher than expected in general pregnant population. ICP is not considered as pregnancy complications that have low PAPP-A MoM levels.