Progesterone Challenge Test in Screening of Endometrial Pathologic Lesions in High-Risk Post-Menopausal Women

The aim of this study was to determine the value of the progesterone challenge test (PCT) in screening for the endometrial pathology of asymptomatic postmenopausal women receiving tamoxifen (TMX). A prospective and preliminary study was conducted on 89 postmenopausal women who had been receiving adjuvant treatment for breast cancer with TMX (20 mg/d) for at least 2 years and who had not presented with any episode of postmenopausal metrorrhagia. Transvaginal ultrasound (TVUS), PCT, diagnostic hysteroscopy, and sampling of histologic material were performed on all the women. The validity of the PCT was compared with that of TVUS in screening these women for endometrial pathology, using hysteroscopic biopsy as the gold standard for comparisons. The study protocol was completed in 82 (92.13%) women. The PCT was negative in 69.5% and positive in 30.4% of the cases. The sensitivity of the PCT for detecting the absence of pathology (atrophic endometrium) in the women was 100% versus 91.6% for TVUS; the positive predictive value for endometrial pathology was 100% versus 85.7% for TVUS; and the negative predictive value for hyperplasic pathology was 100% versus 98.1% for TVUS. In asymptomatic postmenopausal women receiving TMX, the PCT presents high sensitivity (100% in our series) and high positive predictive value (100%) in the diagnosis of endometrial pathology and a high negative predictive value (100%) for hyperplasic pathology. Its predictive performance is superior even to that of TVUS. Therefore, although this a preliminary study, we consider that the inexpensive PCT could be an efficient method of screening in these women during or before initiation of TMX therapy.

Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women

The data of 174 postmenopausal patients with abnormal uterine bleeding admitted were assessed to determine associated risk factors and develop and validate a prediction model to evaluate the risk of endometrial cancer in these patients. The patients were divided into a study group and a control group, among which 62 patients were diagnosed with endometrial cancer. A binary logistic regression analysis model using multifactorial regression analysis was established, and a column line graph of the prediction model was created using the R software. The model’s goodness-of-fit test was performed using the Hosmer-Lemeshow test, and SPSS (version 27, International Business Machines Corporation, Armonk, NY, USA) was used to plot the receiver operating characteristic (ROC) curve to evaluate the model’s predictive value. Binary logistic multifactorial regression analysis revealed that elevated body mass index (BMI), human epididymal protein 4 (HE4), cancer antigen 125 (CA125), combined fibroids and thickened endometrial cancer were risk factors for endometrial cancer in patients with abnormal postmenopausal uterine bleeding, based on which a probability model for predicting the risk of developing endometrial cancer in patients with abnormal postmenopausal uterine bleeding was constructed, and represented as P = 1/[1 + exp (4.227 − 4.594X1 − 2.029X5 − 1.165X6 − 1.817X7 − 2.080X8)]. In addition, the goodness-of-fit test, assessed using Hosmer and Lemeshow, yielded an χ2 value of 14.253 and a p-value of 0.075. Furthermore, the ROC curve analysis demonstrated an area under the curve (AUC) of 0.993 (95% confidence interval (CI), 0.892–0.974; p < 0.05). In conclusion, elevated BMI, HE4 and CA125, along with the presence of combined fibroids and thickened endometrial lining, were identified as significant risk factors for endometrial cancer in postmenopausal patients with abnormal uterine bleeding. The risk prediction model developed in this study provides a scientifically sound approach to assess the risk of endometrial cancer in these patients.

Role of hysteroscopy with endometrial biopsy to rule out endometrial cancer in postmenopausal women with abnormal uterine bleeding

Aim The objective of this study was to assess the adequacy of the sample aspirated in order to make a definite diagnosis of endometrial disease in abnormal uterine bleeding (AUB) and to draw comparisons between the histopathological findings of Pipelle endometrial aspiration biopsy and dilatation and curettage (D&C). Materials and methods Pipelle endometrial biopsy and D&C samples were collected from 100 patients with AUB in the Department of the Obstetrics and Gynecology and sent to the Department of Pathology of a tertiary care hospital for adequacy of the sample and for histopathological analysis. Results The Pipelle sample was adequate in 73% of the cases and inadequate in 27% compared with D&C, which showed 85% and 15%, respectively. About 53% of cases were comparable between D&C and Pipelle and 37% were discordant. For endometrial hyperplasia using Pipelle aspirator, the sensitivity was 58.8%, specificity was 91.6%, positive predictive value (PPV) was 58.8%, negative predictive value (NPV) was 91.6%, and concordance was 86%. For detection of endometrial carcinoma using Pipelle, the sensitivity was 50%, specificity was 99%, PPV was 50%, NPV was 99%, and concordance rate was 98%. Conclusion It is more convenient and cost-effective for patients to undergo pipelle biopsy to confirm normalcy and rule out endometrial hyperplasia rather than undergoing D&C initially. Out of the 27% of inadequate samples, 14.8% had fibroids and 11.1% had polyps, thus showing that tumors localized to a polyp or a small area of endometrium went undetected with Pipelle. Clinical significance Due to the high specificity and NPV and low sensitivity and PPV in diagnosing endometrial lesions and carcinomas, pipelle is suitable for women with a low risk of cancer. In cases where the diagnosis is hyperplasia on Pipelle, the patients are advised to undergo hysteroscopic-guided D&C following pipelle to confirm the diagnosis. This is also applicable for cases of polyps and fibroids. How to cite this article Chandrashekar N, Jyothi GS, Shetty P. Pipelle Endometrial Biopsy vs Dilatation and Curettage to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2017;5(2):123-128.

Objective: This study aimed to evaluate the role of plasma cytokine detection in endometrial cancer screening and tumor progression assessment in patients with abnormal uterine bleeding. Methods: In this multicenter retrospective cohort study of 287 patients with abnormal uterine bleeding, comprehensive clinical information and laboratory assessments, including cytokines, routine blood tests, and tumor markers, were performed. Associations between the clinical indicators and endometrial carcinogenesis/progression were evaluated. The independent risk factors for endometrial cancer and endometrial cancer with deep myometrial invasion were analyzed using multivariate binary logistic regression. Additionally, a diagnostic model was used to evaluate the predictive efficacy of these identified risk factors. Results: In patients with abnormal uterine bleeding, low IL-4 and high IL-8 levels were independent risk factors for endometrial cancer (p < 0.05). Combining IL-4, IL-8, CA125, and menopausal status improved the accuracy of assessing endometrial cancer risk. The area under curve of the model is 0.816. High IL-6 and IL-8 levels were independent risk factors for deep myometrial invasion in patients with endometrial cancer (p < 0.05). Similarly, combining IL-6, IL-8, and Monocyte counts enhanced the accuracy of assessing endometrial cancer risk with deep myometrial invasion. The area under curve of the model is 0.753. Conclusions: Cytokines such as IL-4, IL-8, and IL-6 can serve as markers for monitoring endometrial cancer and its progression in women with abnormal uterine bleeding.

Validation of hysteroscopic view in cases of endometrial hyperplasia and cancer in patients with abnormal uterine bleeding

Objective To evaluate the value of hysteroscopy in elder women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. Methods Fifty-three cases in the AUB group and seventy-eight cases in the endometrial hyperplasia group underwent hysteroscopy examination and hysteroscopy-guided biopsy, then the hysteroscopic and histopathological results were compared between the two groups. Results Of the 131 cases, the normal endometrium accounted for 29.8% (n=39), endometrial polyp for 49.6% (n=65), submucous myomas for 4.6% (n=6), hyperplasia endometrii for 6.1%(n=8) and endometrial carcinoma for 9.9% (n=13). Both the AUB group and the endometrial hyperplasia group had 8 cases of endometrial carcinoma (15.1%, 6.4%, respectively). For the diagnosis of normal endometrium with hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 88%, 97%, 94% and 95%, respectively, in the AUB group, versus 82%, 95%, 86% and 93%, respectively, in the endometrial hyperplasia group. For the endometrial polyps, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 100%, 79%, 74%, 100%, respectively, in the AUB group and 98%, 88%, 92%, 97%, respectively, in the endometrial hyperplasia group. For the endometrial cancer, hysteroscopy had a sensitivity, specificity, PPV and NPV of 75%, 100%, 100% and 96%, respectively, in the AUB group; while in the endometrial hyperplasia group, the sensitivity was 80%, the specificity and PPV were 100%, and the NPV was 99%. Conclusions In elder females, hysteroscopy allows for an accurate diagnosis in endometrial disease, and hysteroscopically directed sampling is mandatory, even if the uterine cavity appears normal at hysteroscopy, to rule out endometrial neoplasms. Key words: Hysteroscopy; Endometrial; Uterine hemorrhage

Abnormal uterine bleeding is one of the most common gynecologic complaints, generating one-fifth of all visits to the gynecologist and accounting for up to one-fourth of hysterectomies performed in the United States each year. A careful evaluation of this condition is important because endometrial cancer is diagnosed in 10% of postmenopausal women with abnormal bleeding and is a plausible possibility in premenopausal women who present with this symptom. The authors have developed a cost-efficient, risk-based clinical pathway for evaluation of abnormal uterine bleeding. This article is a report of 1000 patients with abnormal uterine bleeding who were seen at the Women's Care Clinic in Denver over a 3-year period and who were managed using this protocol. The women were grouped according to menopausal status (570 premenopausal and 430 postmenopausal) and the presence of risk factors for endometrial cancer, including obesity (43%), nulligravidity (12%), history of anovulation (27%), diabetes (14%), hypertension (15%), or tamoxifen therapy. Patients with one or more of these characteristics were considered high-risk for endometrial cancer and underwent endometrial biopsy. The clinical pathways followed for premenopausal and postmenopausal women are presented in Figures 1 and 2. Four hundred thirty women (44%) were successfully treated medically and did not require endometrial biopsy. The remaining 530 women had endometrial biopsy performed, and 250 of these (90 premenopausal and 160 postmenopausal) were also evaluated with ultrasonography. Biopsy results revealed 40 women with simple hyperplasia, 5 with atypical hyperplasia, and 5 with endometrial cancer. Overall, endometrial biopsy was avoided in nearly 50% of the patients. Physician compliance with the protocols was greater with high-risk patients (77% overall and 88% in postmenopausal patients) than with low-risk patients (42%).

Knowledge of endometrial cancer risk factors and symptoms at the Minnesota State Fair (393)

ObjectiveThe aim of our study was to explore the value of DNA (CDO1m/CELF4m) methylation detection in exfoliated cervical cells collected for screening endometrial cancer in premenopausal women with abnormal uterine...

Abnormal uterine bleeding in premenopausal women and the role of body mass index

Objective: In women with abnormal uterine bleeding, the appropriate age for endometrial biopsy remains controversial. In this study, we aimed to evaluate the importance of endometrial biopsy in premenopausal women aged 40-49 years who presented with menorrhagia but did not have risk factors for endometrial cancer. Material And Methods: The records of patients who underwent endometrial biopsy for diagnostic purposes at the gynecology and obstetrics clinic of our hospital between January 1, 2017 and October 31, 2021 were retrospectively reviewed. Among these patients, premenopausal women aged 40-49 years with menorrhagia who had endometrial biopsy results were included in the sample. Patients with risk factors were excluded from the study. Results: A total of 176 premenopausal patients with menorrhagia were included in the study. According to the biopsy results of these patients without risk factors, no malignancy was detected. Endometrial hyperplasia was present in six patients (3.4%), of whom (0.6%) had hyperplasia with atypia and five (2.8%) had hyperplasia without atypia. Conclusion: We found a minimal risk of neoplastic and preneoplastic disease in premenopausal women aged 40-49 years with menorrhagia but no risk factors for endometrial cancer. Endometrial biopsy indications should be reviewed in this patient group.

Introduction: More than 47,000 women will be diagnosed with endometrial cancer in 2012, making it the most common gynecologic cancer among women in the United States. Data from the SEER registry from 1975-2009 report the incidence rate of endometrial cancer is lower among black women than white women (19.2 and 27.5 cases per 100,000 women, respectively). Tumor histology also varies by racial group, with a larger proportion of black women diagnosed with non-endometrioid tumors compared to their white counterparts. It is possible that risk factors for endometrial cancer may differ between black and white women; the small number of black women in individual studies has precluded these analyses. The aim of this study was to investigate risk factors for endometrial cancer in blacks using a pooled analysis. For comparison, we pooled data on risk factors among non-Hispanic white women in the same studies. Methods: We have data from eleven studies that included &amp;gt;10 black cases and &amp;gt;10 black controls (7 cohort studies and 4 case-control studies). The following information was collected from each study: age at diagnosis/study entry, education, body mass index (BMI), smoking status, reproductive variables, hormone use, and self-reported diabetes and hypertension. Unconditional logistic regression was used to estimate odds ratios and 95% confidence intervals for each risk factor in blacks and whites separately. Estimates for endometrioid tumors will also be presented. Results: Data were pooled for 2,011 black women (516 cases and 1,495 controls) and 19,297 white women (5,693 cases and 13,604 controls). In univariate analyses, the following variables were associated with endometrial cancer in both black and white women: BMI, smoking, oral contraceptive use for 10 years or more, and diabetes. In models adjusted for these variables, along with age and study site, obesity (BMI ≥ 30) was associated with an approximate 3-fold increase in risk for both black and white women (OR=2.80, 95% CI: 2.00, 3.92 and OR=3.26, 95% CI: 2.96, 3.59, respectively). Diabetes was also associated with a 30-40% increase in risk among both groups. Cigarette smoking was associated with reduced risk of endometrial cancer among both blacks and whites (OR=0.66, 95%CI: 0.47, 0.94 and OR=0.62, 95% CI: 0.54, 0.71, respectively). Increasing parity was more strongly associated with decreased risk in whites (p-trend &amp;lt;0.001) than blacks (p-trend = 0.09). Similarly, age at first birth was also more protective in whites (p-trend&amp;lt;0.001) than blacks (p-trend=0.76). Conclusions: Overall, risk factors for endometrial cancer are similar in black and white women, with the exception of some of the reproductive factors, which do not appear to afford protection in blacks to the same extent as in whites. Citation Format: Michele L. Cote, Tala Alhajj, Julie J. Ruterbusch, Louise A. Brinton, William J. Blot, Chu Chen, Brian E. Henderson, Pamela L. Horn-Ross, Laurence N. Kolonel, Timothy R. Rebbeck, Veronica W. Setiawan, Lisa B. Signorello, Michael S. Simon, Noel S. Weiss, Nico Wentzensen, Hannah P. Yang, Sara H. Olson. Risk factors for endometrial cancer in black and white women: A pooled analysis from the Epidemiology of Endometrial Cancer Consortium (E2C2). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2285. doi:10.1158/1538-7445.AM2013-2285

A case control study of 143 Japanese women with uterine endometrial cancer and 143 individually age‐matched controls was conducted to assess the risk factors for endometrial cancers in Japan. Among the characteristics studied, the following factors were significantly greater in the cases than in the controls: nulliparity (odds ratio for parity 1–3 and ≥4 versus nullipara are 0.40 and 0.02, respectively), obesity (odds ratio: 2.73), hypertension (odds ratio: 2.4), diabetes mellitus (odds ratio: 6.30), and a personal medical history of cancer (odds ratio: 3.06). The present study showed that Japanese women have the same risk factors for endometrial cancer as those reported in Western countries. The recent increase in the incidence of endometrial cancer in Japan may be largely attributed to the decrease in parity.