Endometrial volume as predictor of malignancy in women with postmenopausal bleeding.

OBJECTIVE: To assess endometrial volume as a predictor of endometrial malignancy in women with postmenopausal bleeding. METHODS: Endometrial volume was measured by virtual organ computer-aided analysis in 170 women with postmenopausal bleeding, and histopathologic results of endometrial biopsies were obtained for all. A group of 100 women without postmenopausal bleeding was used for control. RESULTS: There were 90 cases of benign disease, 53 cases of atypia, and 27 cases of endometrial cancers in the study group. Whereas endometrial thickness was 9.61+/-5.12 mm (range, 5-20 mm) and endometrial volume was 3+/-1.1 mL (range, 1.8-5.4 mL) in women with atypia or cancer, they were 4.87+/-3.43 mm (range, 2-8 mm) and 1.52+/-0.82 (range, 0.6-2.2 mL), respectively, in women with benign disease. In the control group, endometrial volume was 1.15+/-0.14 mL (range, 0.6-1.3 mL). Volume was more sensitive than thickness for predicting malignancy, and a cutoff value of 1.35 mL was found to provide the best sensitivity. CONCLUSION: An endometrial volume of 1.35 mL or greater may predict malignancy in women with postmenopausal bleeding.

Evolution of treatment of high-risk metastatic gestational trophoblastic tumors: Ain Shams University experience.

The aim of the current study is to evaluate the different treatment modalities used in the management of high-risk metastatic gestational trophoblastic tumors (GTT) between June 1992 and December 2004 at the Gynecologic Oncology Unit, Ain Shams University. Out of 261 patients diagnosed and treated for GTT, 70 (26.8%) were high risk metastatic patients based on the National Institutes of Health clinical classification. The mean age was 29.39 +/- 9.38 years (16-55 years), with six patients (8.6%) being older than 39 years, and the mean duration of follow-up was 79.74 +/- 40.44 months (6-157 months). Forty patients (57.14%) were diagnosed after molar pregnancy, 22 (31.43%) after abortion, and 8 (11.43%) after term pregnancy. Forty-two patients (60%) were diagnosed within 4 months of the occurrence of the disease, and 28 (40%) were diagnosed after more than 4 months. Sixty-seven patients were treated using different regimens according to the protocol of treatment at that time. The MAC regimen was used initially but has been subsequently abandoned in favor of EMA-CO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine [Oncovin]) regimen, which was later modified by omitting the CO arm to decrease its toxicity. If resistance developed, platinum-based therapy was given in the form of EMA-EP. Recently, our unit incorporated paclitaxel in the third-line treatment. Surgical intervention was used selectively. Fifty-seven (81.4%) patients could be cured; 43 by initial chemotherapy, with a mean of 7 +/- 0.46 courses (6-15), and 14 were salvaged by second- or third-line chemotherapy. Fourteen patients (20%) died during the study period; one was unrelated to GTT, while three died of acute respiratory distress syndrome before instituting proper therapy and two died of treatment complications. Using univariate and multivariate Cox regression analyses, the presence of brain and/or liver metastases was found to be the worst prognostic variable affecting the survival, followed by resistance to combination chemotherapy and then the type of antecedent pregnancy. The projected 5-year survival as estimated by Kaplan-Meier method was 78%.

Preoperative breast ultrasound and Doppler velocimetric findings in patients with breast cancer.

PURPOSE: To evaluate the role of ultrasound and Doppler velocimetry in the diagnosis of breast cancer. METHODS: Thirty breast cancer patients, diagnosed by clinical examination, mammography and fine needle aspiration, or trucut biopsy were assessed by breast ultrasound including Doppler velocimetry to evaluate blood flow in the axillary and lateral thoracic arteries. Postoperative histopathological examination proved malignancy in all cases. This cohort was compared to another group of 30 patients with proven benign breast disease and a cross-matched control group of 30 asymptomatic women with no breast disease. RESULTS: In the 30 cancer patients, the size of masses ranged from 1-4 cm (2.51 +/- 1.13), the mean axillary artery resistance index (RI) ranged from 0.8-0.88 (0.84 +/- 0.03), and the lateral thoracic artery RI ranged from 0.45-0.59 (0.55 +/- 0.106). However, power Doppler did not detect any increased perfusion. In the benign group, the lateral thoracic artery RI ranged from 0.78-0.86 (0.85 +/- 0.8) and the axillary artery RI ranged from 0.81-0.89 (0.81 +/- 0.05), while in the control group, the mean lateral thoracic artery RI ranged from 0.85 to 0.89 (0.87 +/- 0.082), and the axillary artery RI ranged from 0.84-0.9 (0.88 +/- 0.16). Statistical analysis revealed only a high statistical significance (p < 0.01) for the lateral thoracic artery indices between the malignant group as compared to the benign and normal groups. There was no statistical significant difference in the axillary artery RI between the three groups. CONCLUSION: It is suggested that a marked decrease in the lateral thoracic artery RI with a cut-off value less than 0.6 is highly suggestive of malignancy. Taking the pilot nature of the results, further studies with much larger numbers are needed to corroborate such findings.

Expression of matrix metalloproteinase-2 in preinvasive and invasive carcinoma of the uterine cervix.

PURPOSE: To study the immunohistochemical expression of matrix metalloproteinase-2 (MMP-2) in preinvasive and invasive carcinoma of the uterine cervix so as to demonstrate whether the expression of MMP-2 is an early or late event in the process of dedifferentiation and cancer progression. METHODS: A total number of 50 samples of cervical tissue were studied for MMP-2 immunoreactivity. The cases were selected to include ten normal cases used as a control group, 20 CIN cases and 20 cervical carcinoma cases. The CIN group was subdivided into CIN1 (n = 7), CIN2 (n = 6) and CIN3 (n = 7), while the carcinoma group was represented by squamous cell carcinoma (n = 16) and adenocarcinoma (n = 4). RESULTS: MMP-2 expression was totally absent in control cervices and low-grade squamous intraepithelial lesions, while high-grade squamous intraepithelial neoplasia and invasive carcinoma showed up-regulation of MMP-2 expression with no significant difference concerning the type of carcinoma. This overexpression of MMP-2 points to the possibility that it is an early marker of tumor progression in cervical carcinoma. CONCLUSIONS: MMP-2 has a key role in extracellular matrix degradation and invasion in carcinoma of the uterine cervix. Its expression in high-grade squamous intraepithelial lesions may denote a potential risk for invasion and metastasis.