Hematologic parameters as a predictor of myometrial and cervical invasion in endometrial cancer.

BACKGROUND: Despite significant improvements in molecular biology for uterine cancer, we did not have specific peripheral blood biomarkers for clinical usage such as prognostic or predictive outcomes of disease in the last decade. METHODS: A retrospective endometrial cancer database was collected from a tertiary gynecologic cancer center. The cohort included only endometrioid type uterine cancer. Subsequently, we investigated the relationship between preoperative hematologic parameters and pathologic findings. RESULTS: In this study, 191 non-metastatic endometrial cancer (median age was 61 years, ranging from 41 to 86 years) were analyzed. Lymphocyte-to-monocyte ratio (LMR) was significantly different between the FIGO stage I and II (4.48 vs. 3.88, P=0.004). Platelet-to-lymphocyte (PLR) was significantly higher in FIGO stage III than stage I, and LMR was significantly decreased by each FIGO stage. LMR values significantly decreased with a depth of myometrial invasion. PLR and eosinophil-to-lymphocyte ratio (ELR) values were significantly higher in patients with cervical invasion compared to those without invasion, 287 vs. 144, P=0.005, 10.3 vs. 6, P=0.022, respectively. CONCLUSIONS: This study revealed that low-LMR levels and high-PLR with ELR levels correlated with myometrial and cervical invasion, respectively. These findings can explain why hematologic parameters have an impact on oncologic outcomes.

The efficacy, cost and patient satisfaction of classic versus office hysteroscopy in cases with suspected intrauterine space occupying lesions with 3-dimension ultrasound and abnormal uterine bleeding.

OBJECTIVE: The aim of this study is to compare the diagnostic efficacy, treatment effectiveness and cost of office hysteroscopy procedure with classic hysteroscopy in women suspected of having an intrauterine space occupying lesion, after being examined for abnormal uterine bleeding. MATERIAL AND METHODS: Among 544 cases admitted to our outpatient clinic due to abnormal uterine bleeding, 123 cases suspected of having an intrauterine space occupying lesion on 3D transvaginal ultrasound were included in the study. Patients were informed about classic and office hysteroscopy and asked to choose one of them. Fifty-seven cases preferred classic hysteroscopy and 66 cases preferred office hysteroscopy. The Visual analog scale was used to measure pain in office hysteroscopy cases while the Likert scale was used for patient satisfaction and cost was calculated in Turkish Lira. RESULTS: According to the histopathological examination, 65.9% of the cases (n=81) were diagnosed as polyp and 7.3% of the cases (n=9) were diagnosed as submucous leiomyoma. Mean operation time was 11±5.6 min. for office hysteroscopy and 42.6±18.4 min. for classic hysteroscopy (p<0.001). The level of pain before the operation was 0.3±0.1 (0-1), during the operation 2.8±2.5 (0-10) and after the operation 1.5±1.6 (0-8) in Office hysteroscopy cases. Among the Office hysteroscopy cases, 89.3% were very satisfied and 86.3% will advise other patients to have the procedure. Patients were evaluated at sixth month after the procedures and 92.4% of office hysteroscopy group and 96.4% of classic hysteroscopy group were symptom free. At sixth month of the office hysteroscopy procedure 83.3% of the cases were satisfied with the procedure and 81.8% would advice other patients to have the procedure. The mean cost of classic hysteroscopy was 3.6 times higher than the office procedure. CONCLUSION: Office hysteroscopy is a safe and satisfactory procedure for the patient and provides a fast "see and treat" option at a low cost as an out patient procedure without need for general anesthesia. It should be utilized as a first line diagnosis and treatment option.