Early Diagnosis Of Endometrial Cancer Research Articles

Discovery of the potential biomarkers for early diagnosis of endometrial cancer via integrating metabolomics and transcriptomics

Endometrial cancer (EC) is one of the most common malignant tumors in women, and the increasing incidence and mortality pose a serious threat to the public health. Early diagnosis of EC could prolong the survival period and optimize the survivorship, greatly alleviating patients’ suffering and social medical pressure. In this study, we collected urine and serum samples from the recruited patients, analyzed the samples using LC-MS approach, and identified the differential metabolites through metabolomic analysis. Then, the differentially expressed genes were identified through the systematic transcriptomic analysis of EC-related dataset from Gene Expression Omnibus (GEO), followed by network profiling of metabolic-reaction-enzyme-gene. In this experiment, a total of 83 differential metabolites and 19 hub genes were discovered, of which 10 different metabolites and 3 hub genes were further evaluated as more potential biomarkers based on network analysis. According to the KEGG enrichment analysis, the potential biomarkers and gene-encoded proteins were found to be involved in the arginine and proline metabolism, histidine metabolism, and pyrimidine metabolism, which was of significance for the early diagnosis of EC. In particular, the combination of metabolites (histamine, 1-methylhistamine, and methylimidazole acetaldehyde) as well as the combination of RRM2, TYMS and TK1 exerted more accurate discrimination abilities between EC and healthy groups, providing more criteria for the early diagnosis of EC.

Recent Advances in Endometrial Cancer Prevention, Early Diagnosis and Treatment.

Endometrial cancer is the sixth commonest cancer in women worldwide, with over 417,000 diagnoses in 2020. The disease incidence has increased by 132% over the last 30 years and is set to continue to rise in response to an ageing population and increasing global rates of obesity and diabetes. A greater understanding of the mechanisms driving endometrial carcinogenesis has led to the identification of potential strategies for primary disease prevention, although prospective evaluation of their efficacy within clinical trials is still awaited. The early diagnosis of endometrial cancer is associated with improved survival, but has historically relied on invasive endometrial sampling. New, minimally invasive tests using protein and DNA biomarkers and cytology have the potential to transform diagnostic pathways and to allow for the surveillance of high-risk populations. The molecular classification of endometrial cancers has been shown to not only have a prognostic impact, but also to have therapeutic value and is increasingly used to guide adjuvant treatment decisions. Advanced and recurrent disease management has also been revolutionised by increasing the use of debulking surgery and targeted treatments, particularly immunotherapy. This review summarises the recent advances in the prevention, diagnosis and treatment of endometrial cancer and seeks to identify areas for future research.

Analysis of clinical data of different endometrial pathological types in perimenopausal women with abnormal uterine bleeding.

Early detection and diagnosis are important for improving the therapeutic effect and quality of life in patients with endometrial cancer (EC). This study aimed to analyze the clinical data of different endometrial pathological types in perimenopausal women with abnormal uterine bleeding (AUB) in order to provide evidence for the prevention and early diagnosis of EC. A total of 462 perimenopausal women with AUB were enrolled in this prospective observational study. Endometrial biopsy was performed in patients with suspected endometrial lesions. According to the pathological examination results, the patients were divided into endometrial polyp group (EP) (n = 71), endometrial hyperplasia without atypia group (EH) (n = 59), atypical endometrial hyperplasia (AEH) (n = 36), and EC group (n = 27). The history risk factors and ultrasonic imaging characteristics of endometrium among the four groups were compared. Twenty-seven women were diagnosed with EC (5.84%). The prevalence rate of AEH and EC in the group of 51- to 55-year-old women was significantly higher than that in the groups of 40- to 45-year-old women and of 46- to 50-year-old women (P < 0.05). The age, body mass index, and history of diabetes gradually increased with the development of endometrial pathological types. In addition, the correlation index of endometrial blood flow increased gradually, and the proportion of uneven endometrial echo, unclear endometrial-myometrial junction (EMJ), and ovarian cyst also increased gradually. However, no statistically significant difference was found when comparing endometrial thickness (ET) and endometrial volume (EV) among endometrial pathological groups (P > 0.05). The ET, EV, endometrial vascularization index, endometrial flow index, and vascularization flow index in the ovarian cyst group were significantly higher (P < 0.05), and the proportion of uneven endometrium echo and unclear EMJ were significantly higher compared with that in the non-ovarian cyst group (P < 0.05). The most common cause of perimenopausal women with AUB was benign endometrial lesions. However, women aged 51-55 years old with endometrial high risk factors and ovarian cyst should be alert to AEH and EC. Endometrial biopsy needs to be performed to determine endometrial malignancy in necessity.

Combination of serum CST1 and HE4 for early diagnosis of endometrial cancer

Purpose Optimal serological biomarkers have been absent for the early diagnosis of endometrial cancer, to date. In this study, we aimed to define the diagnostic performances of individual and combined detection of serum cysteine protease inhibitor 1 (CST1) with traditional tumor markers, including glycated antigen 125 (CA125) and human epididymis protein 4 (HE4), in patients with early-stage endometrial cancer (EC). Methods The performances of individual and combined detection of serum CST1, HE4, and CA125 were evaluated by enzyme-linked immunosorbent assay (ELISA) and chemiluminescent immunoassay, respectively. A training data set of 67 patients with early EC, 67 patients with endometrial benign lesion (EBL), and 67 healthy controls (HC) was used to develop a predictive model for early EC diagnosis, which was validated by an independent validation data set. Results In the training data set, serum CST1 and HE4 levels in the early EC group were significantly higher than in EBL/HC groups (P &lt; 0.05), while there was no significant difference of serum CA125 level between the early EC and EBL/HC groups (P &gt; 0.05). Serum CST1 and HE4 exhibited areas under the curve (AUC) of 0.715 with 31.3% sensitivity at 90.3% specificity, and 0.706 with 23.9% sensitivity at 95.5% specificity, respectively. Combined detection of serum CST1 and HE4 exhibited an AUC of 0.788 with 49.3% sensitivity at 92.5% specificity. The combination of serum CST1 and HE4 showed promise in diagnosis. Conclusion CST1 is a prospective serological biomarker for early EC diagnosis, and the combination of CST1 and HE4 contributes to the further improvement in the diagnosis of patients with early-stage EC.

New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know?

Transvaginal ultrasound (TVUS) represents an accurate and noninvasive technique to investigate endometrial thickness (ET) in the early diagnosis of endometrial cancer (EC). In the literature, for maximum ET there is no consensus on the cutoff value for normal ET in postmenopause for either symptomatic or asymptomatic women. Most patients with EC present with postmenopausal bleeding (PMB) and in these patients is necessary to perform TVUS to evaluate ET as an indicator for endometrial biopsy. On the contrary, if ET is incidentally detected in postmenopausal patients without bleeding, endometrial sampling for a postmenopausal woman without bleeding should not be routinely performed, although it is estimated that up to 15% of EC occurs in women without vaginal bleeding. The aim of our review was to give clinicians necessary and useful knowledge on the role of TVUS and ET for early detection of EC in their daily routine practice. Based on the most important studies in the literature, we summarized that in premenopausal woman with abnormal uterine bleeding, an optimal cutoff for ET has not yet been established. For postmenopausal women with PMB, at low risk, and ET <4 mm, a follow-up scan could be offered, and for women with ET ≥4 mm, office hysteroscopy–guided endometrial sampling is recommended independently of ET results. On the other hand, in postmenopausal women with PMB and at high risk of EC, office hysteroscopy–guided endometrial sampling is necessary. In postmenopausal women without PMB and ET ≥4 mm, arbitrary endometrial sampling is not recommended, but evaluated case by case based on risk factors. In conclusion, there is broad consensus on the importance of TVUS and the need for further investigation based on risk factors of EC.

Diagnostic value of different color ultrasound diagnostic method in endometrial lesions

BACKGROUNDEndometrial lesions include endometrial cancer and inferior fibroids. Among them, endometrial cancer as a malignant tumor seriously endangers the life and health of patients. Ultrasonography is an important means of diagnosing female reproductive system diseases, and it is of critical value for the early diagnosis of endometrial cancer. However, different ultrasound inspection programs have achieved different results. It is of great significance to choose a suitable inspection program.AIMTo explore the diagnostic efficacy of different ultrasonic examination methods in clinical endometrial lesions.METHODSThe 140 patients with endometrial lesions who were treated in our hospital from April 2018 to October 2019 were used as the research subjects. All patients underwent transvaginal color ultrasound and transabdominal color ultrasound. We compared the diagnostic coincidence and image display effects of the two different examination methods, and the endometrial thickness, blood flow, uterine effusion and resistance index of different diseases were observed by transvaginal color ultrasound.RESULTSThe diagnostic coincidence rate of all types of diseases of transvaginal color ultrasound was significantly higher than that of transabdominal color ultrasound (P = 0.001, 0.005, 0.001 and 0.001). In addition, the excellent and good rate of image display of transvaginal color ultrasound was higher than that of transabdominal color ultrasound (P = 0.001). There were significant differences in endometrial thickness in patients with different types of endometrial lesions through the transvaginal color examination (P = 0.001). The incidence rate of uterine effusion in patients with endometrial carcinoma was significantly higher than that in patients with other types of endometrial lesions (P = 0.001), and the rate of the blood flow was the highest (P = 0.001). The comparison of blood flow resistance index indicated that the blood flow resistance index in endometrial cancer patients was the lowest, which shows that the difference was statistically significant (P = 0.001).CONCLUSIONThe overall diagnostic efficacy of transvaginal color ultrasound in the clinical diagnosis of endometrial lesions is better than that of transabdominal color ultrasound, which held higher diagnostic coincidence rate and image display effect. There were significant differences in the thickness of the endometrium and the blood flow in different types of lesions.

Current role of Pipelle endometrial sampling in early diagnosis of endometrial cancer.

Endometrial cancer is the most common gynecologic cancer in developed countries. The most prevalent, however not pathognomonic symptom of the disease is abnormal uterine bleeding. The diagnosis of endometrial cancer is based on the histologic results of endometrial sampling. Endometrial biopsy could be obtained using different modalities: hysteroscopy-directed endometrial biopsy, uterine curettage or office endometrial biopsy. Outpatient endometrial biopsy using different devices for the evaluation of abnormal uterine bleeding is gaining popularity. The most popular office-based device for endometrial sampling procedure is the Pipelle device. Currently, Pipelle endometrial sampling is widely used to diagnose endometrial cancer in women with abnormal uterine bleeding and/or postmenopausal bleeding. The method became very useful due to easiness and simplicity of the procedure, availability of a device, as well as high sensitivity in detecting endometrial cancer. Many studies compared the validity and accuracy of Pipelle biopsy with dilation and curettage in the detection of various endometrial pathologies. Published results state that Pipelle biopsy and uterine curettage are almost equally reliable in the evaluation of endometrial pathologies. Moreover, Pipelle biopsy appears more beneficial as it does not require hospital admission and anaesthesia. However, it is proven the Pipelle technique has a limited capacity to identify endometrial polyps, and some authors, based on their study, claim that dilation and curettage is a more reliable method in terms of correlation with the final histological results. In addition, there are many factors affecting the efficiency of the endometrial biopsy. Failure to get samples that are adequate for histological examination is one of the problems associated with Pipelle sampling. The above mentioned contradictory conclusions by different researchers and lack of guidance to avoid inadequate sampling present the demand for further studies on the comparison of Pipelle biopsy and uterine curettage efficiency and accuracy.

Image enhancement of photoacoustic imaging for early endometrial cancer detection by employing a filtered delay multiply and sum beamforming algorithm

In endometrial cancer, patients in early stages have a 91% 5-year survival chance. By contrast, patients in advanced stages have only 20% survival chance. Therefore, early diagnosis of endometrial cancer is very important. Photoacoustic imaging is able to distinguish benign from malignant tumors. However, the images acquired through photoacoustic imaging contain inherent artifacts, caused by imperfect reconstruction algorithms. In this paper, to improve the said images, a filtered delay-multiply-and-sum (F-DMAS) algorithm, which was proven to have an increased dynamic range and better quality of B-mode images was employed in the reconstruction process. First, the images of two blood vessel phantom experiments, acquired through photoacoustic imaging, were reconstructed by employing the F-DMAS algorithm. The results show the lateral resolutions of the system improving from 2.22 mm (with traditional photoacoustic imaging reconstruction algorithms) to 1.47 mm. Next, images of a pig uterus, filled with intralipid-20% emulsion, were also reconstructed by employing the F-DMAS algorithm. The average signal-to-noise ratio increased from 11.14 dB (with traditional photoacoustic imaging reconstruction algorithms) to 64.90 dB. In order to improve the continuity of the 3D PA image, F-DMAS with an adaptive coefficient was discussed to find the best balance between the signal-to-noise ratio and continuity. In conclusion, this paper demonstrates that the use of F-DMAS algorithms in the reconstruction of the images acquired through photoacoustic imaging in clinical investigations would improve the detection rate of early endometrial cancer.

Diagnostic Accuracy of DW MRI in Early Detection of Endometrial Carcinoma

AbstractIntroduction: Endometrial carcinoma is the most common gynecological malignancy and the sixth most common neo-plasm worldwide. The role of MRI in patients with histolog-ically proven endometrial cancer is to evaluate the depth of myometrial and cervical invasion and detect pelvic lymph node involvement pre-operatively thereby helping to determine the need for lymph node dissection. DW-MRI provides im-portant new information noninvasively. This unique modality is helpful in initial staging of known malignancies, differen-tiating benign from malignant lesions, as a biomarker for treatment response and determining the presence of disease recurrence.Aim of Study: The aim of this study is to assess the diagnostic accuracy of diffusion weighted imaging and ADC value in early diagnosis of endometrial cancer in high risk patients decreasing the need for surgical interventions for diagnosis.Patients and Methods: This study included 33 patients, 21 patients had pathologically proven endometrial cancer, and 12 patients had endometrial hyperplasia with control group of 36 patients referred to the Radiology Department from Surgical Department to assess the endometrium. Pelvic DCE-MR was done and DWI was obtained with 3 b-values including 0, 300 and 600mm/sec.Results: There is statistically significant difference between the benign and malignant group with p-value=0.001 in which Sensitivity=90.0% Specificity=83.3% Accuracy=85.2%. The ADC value of benign group ranged from (0.8 to 2), the ADC value of malignant group ranged from (0.5 to 1.3). There was significant overlap between benign and malignant group as regards the ADC value however if we use cut off value of 0.6 for malignant lesions and 1.6 for benign lesions, the specificity will be 77.1% for benign and 100% for hyperplasia. Our results revealed that the inclusion of CE MRI resulted in statistically insignificant improvement of the diagnostic accuracy and sensitivity in differentiation between benign and malignant group (p 0.06) in which Sensitivity=30.4% Specificity=38.5% Accuracy=33.3%.Conclusion: Our results revealed that the inclusion of CE MRI resulted in statistically insignificant improvement of the diagnostic accuracy and sensitivity in differentiation between benign and malignant group. The diffusion weighted imaging ADC value improve the efficacy and diagnostic accuracy in early diagnosis of endometrial cancer in high risk patients decrease the need for surgical interventions for diagnosis.

SPAG9 May Be a Potential Prognostic Marker of Endometrial Hyperplasia and Grade 1 Endometrioid Adenocarcinoma Treated with Progestin

Background: Sperm-associated antigen 9 (SPAG9), a recently characterized oncogene, may serve as a marker for the early diagnosis of endometrial cancer. However, whether SPAG9 can be a prognostic marker of complex atypical endometrial hyperplasia (CAEH) or grade 1 endometrioid adenocarcinoma (EA) treated with progestin is still unknown. Methods: Progestin therapy was performed in 27 women diagnosed with CAEH (19/27, CAEH group) or grade 1 EA (8/27, EA group). The expression of SPAG9 was measured in pre and post progestin-treated endometrial specimens by immunohistochemistry. The expression of SPAG9 was also examined by real-time polymerase chain reaction (PCR) and Western blot in Ishikawa cells and ECC-1 cells with or without progestin treatment. Results: (1) CAEH showed a significantly better therapeutic efficacy than EA. (2) The expression of SPAG9 was lower in CAEH than in EA. (3) SPAG9 expression significantly declined in the endometrial tissues of women responding to progestin. (4) Significant downregulations of SPAG9 were validated by reverse transcription PCR (RT-PCR) and Western blot both in Ishikawa cells and ECC-1 cells treated with progestin. Conclusion: SPAG9 may be associated with the efficacy of progestin treatment in CAEH and grade 1 EA. It may help to distinguish CAEH from grade 1 EA and serve as a new prognostic marker of CAEH or grade 1 EA treated with progestin.

Sperm-Associated Antigen 9 is a Promising marker for Early Diagnosis of Endometrial Cancer

Sperm-associated antigen 9 (SPAG9) has been recently proposed as a novel biomarker for early diagnosis of several human tumors, including ovarian, cervical and breast cancers. Its clinical value remains to be clarified for endometrial cancer (EC). In this study, we investigated the utility of serum SPAG9 levels in diagnosis of EC and its association with important clinicopathological parameters. This cross-sectional study was performed at a tertiary women's referral center in Ankara, Turkey. Preoperative serum samples were collected from patients surgically treated for endometrial cancer between June 2012-April 2013. Similar aged women with a biopsy proven benign endometrium were used as controls. Serum SPAG9 levels were measured with an enzyme-linked immunosorbent assay (ELISA) method and assessed for links with clinicopathological factors. Receiver operating characteristic (ROC) curve analysis was performed to assess power of SPAG9 levels for EC prediction. P values less than 0.05 were considered statistically significant. A total of 63 women with EC and 27 with benign endometrium were included in the study. Mean age in the EC group was 58.7±1.1. Median SPAG9 levels in the EC and control groups were 18.3 (range, 12.7-53.8) and 14.1 (range, 4.3-65.3), respectively (p<0.001). A cut-off value of 17 ng/ml for SPAG9 predicted presence of malignant endometrium with 74% sensitivity and 83% specificity [Area under curve (AUC)=0.82, p<0.001]. SPAG9 levels did not demonstrate any significant association with histological type, FIGO stage, tumor grade, size, myometrial invasion, lymphovascular space invasion, cervical involvement, adnexal involvement, peritoneal cytology or lymph node status (all p>0.05). Testing for SPAG9 may be useful for early detection of EC in asymptomatic high-risk women. Its role in post-treatment follow-up and early detection of recurrence should be assessed in future trials.

The Value of Tumor Markers in Endometrial Carcinoma: Review of Literature

Endometrial cancer is the most common gynecologic malignancy in more developed countries. Most endometrial carcinomas cases are diagnosed at an early stage with a tumor confined to the uterine corpus. Although most patients are cured by surgery alone, about 15% - 20% with no signs of locally advanced or metastatic disease at primary treatment recurs, with limited responsiveness to systemic therapy. Although it has a comparatively low mortality rate compared with other gynaecological cancers, it is capable of aggressive behaviour. Diagnosis at an early stage is the most important determinant of survival. Discovery of new diagnostic biomarkers/panels for early diagnosis of endometrial cancer is one of the main challenges of modern medicine. For endometrial cancers, there are no established serum markers. We will review the present knowledge regarding tumor markers, assessing how such markers could be applied to address in screening, diagnosis and monitoring of endometrial carcinoma.

Features of postmenopausal uterine haemorrhage.

ABSTRACTIntroduction:Postmenopausal uterine bleeding is a „cancer until proven otherwise”. Endometrial cancer is a typical disease among postmenopause woman, because every bleeding in this age etiology associated with endometrial cancer (10-30%). The lifespan of women today has been extended and post menopause today last one third of a woman’s life. Early diagnosis of endometrial cancer has a very high cure rate. Screening for this cancer has limits in practice and is necessary given the definition of high-risk groups would be subject to primary and secondary prevention.Goal:Primary to evaluate the leading causes of postmenopausal uterine bleeding among patients at risk for endometrial cancer (diabetes, obesity, nulliparity, late menopause (after 55 years) and compared them with the causes of postmenopausal uterine bleeding patients without this risk.Material and methods:A retrospective, descriptive study with a targeted sample of 50 consecutive patients who had registered postmenopausal uterine bleeding in high-risk groups (cohorts) and the same number of patients with postmenopausal uterine bleeding that does not belong to the risk group (control group). Each patient underwent clinical examination, then fractionated curettements and its histopathological verification and assessment of treated clinical stage of disease with PH analysis of the resected specimens.Results:The patients of the studied risk group were significantly affected by endometrial cancer compared with the control group (RR=2.45, 95% CI 1.2 4.6, p=0.005). Endocervical pathology did not differ between groups. Clinical forms of bleeding: for those that are profuse bleeding cancer was present in 54.6% of cases. With intermittent bleeding cancer is verified in the 33.3% of patients. Risk patient groups with cancer frequently suffer from clinically more advanced stages of histologically aggressive endometrial cancer (serous adenocarcinoma–type II, low differentiated cancer).

Diffusion weighted imaging and contrast-enhanced magnetic resonance imaging in the evaluation of early stage endometrial cancer.

To assess the values of diffusion weighted imaging and contrast-enhanced magnetic resonance imaging (MRI) in the evaluation of early endometrial cancer. We retrospectively analyzed the imaging data of 27 patients with pathologically confirmed stage 1-2 endometrial cancer. These patients received pelvic magnetic resonance imaging, diffusion weighted imaging with apparent diffusion coefficient-T2 weighted imaging fusion images(ADC-T2WI), and T1 weighted imaging (T1WI) of contrast-enhanced scan sequence. The accuracies of these image modes were analyzed and compared. The accuracy of routine pelvic MRI scan, diffusion weighted imaging with ADC-T2WI fusion images, and T1WI of contrast-enhanced scan for the early diagnosis of endometrial cancer was 66.7%, 85.2%, and 92.5%, respectively. The sensitivity, specificity and diagnostic accuracy of diffusion weighted imaging with ADC-T2WI fusion images in the diagnosis of lesions with a 1/2 depth of muscle were 82.3%, 75%, and 85.2%. Routine pelvic MRI scan sequence has certain errors for the early diagnosis of endometrial cancer. On the contrary, the diffusion weighted imaging with ADC-T2WI image fusion has remarkably increased diagnostic accuracy. The T1WI of contrast-enhanced scan can clearly display most of the lesions by identifying the muscular infiltrations, and therefore can provide the most accurate information for the staging of early endometrial cancer.

Retrospective Study about the Prevalence of Neoplastic Pathology in Symptomatic and Asymptomatic Endometrial Polyps in Postmenopausal Women

Study Objective: Polypectomy of symptomatic polyps in atrophic endometrium has both a therapeutical and diagnostic function, because it solves the symptoms such as abnormal uterine bleeding and it allows an early diagnosis of endometrial cancer through histological examination. The study objective is to estimate the prevalence of cancer or pre-cancer lesions in symptomatic and asymptomatic polyps in atrophic endometrium in post-menopause removed through operative hysteroscopy and to define a right management for these two groups.

Significance of CD44v6 expression in gynecologic malignancies

Variants of CD44 have been proposed to be important in cancer invasion and metastasis. The purpose of this study was to evaluate the diagnostic and prognostic value of CD44v6 expression in gynecologic malignancies. Immunohistochemistry was used to determine the expression of CD44v6 in samples from a series of 65 cases of early cervical cancer, 76 cases of endometrial samples and 57 cases of serous epithelial ovarian tumors. We analyzed the expression of CD44v6 and correlated the findings with clinicopathological factors. In the cervical series, CD44v6 was detected in 60 cases of cervical cancer (92.3%). The immunoreactivity was decreased when stromal invasion reached a depth of more than 5 mm (P < 0.05). However, it was not correlated with other clinicopathological factors. In the endometrial series, CD44v6 was detected in one endometrial hyperplasia (6.7%) and in 24 endometrial cancers (100%), while it was not detected in the proliferative endometrium (P < 0.05). Immunoreactivity was decreased in grade 2 and 3 endometrial cancers compared with grade 1 (P < 0.05). In the ovarian series, CD44v6 was not detected in the benign tumors, but it was detected in four borderline malignancies (27%) and 12 carcinomas (40%). Immunoreactivity was not correlated with clinicopathological factors of ovarian cancer. CD44v6 may be involved in stromal invasion of early squamous cervical carcinomas and in the cellular differentiation of endometrial cancer. In addition, it may be useful for early diagnosis of endometrial cancer.

Early detection of endometrial cancer by combined use of vaginal ultrasound and endometrial vacuum sampling.

With increasing lifespan and decreased incidence of uterine cervical cancer, the importance of the proper and early diagnosis of endometrial cancer has become a demand to gynecology. The objective of the present study is to evaluate the effectiveness of gynecologic diagnostic tools in detection of endometrial cancer in early stage. The patients (72) involved in the study, after giving their informed consent, were investigated by transvaginal ultrasound and subsequent vacuum endometrial sampling in office settings. Whenever the histology examination of endometrial vacuum sampling showed hyperplasia or carcinoma, it was reassured by sampling with dilatation and curettage. The analysis of sonography and histology results showed that in 4 cases (5.6%) endometrial hyperplasia and in two cases (2.8%) endometrial adenocarcinoma were present. Also analyzed were sensitivity, specificity, positive and negative predictive values for histology results and for sonographic findings. These results show that transvaginal ultrasound is a reliable method for screening for endometrial carcinoma. Moreover, in the case of pathologic endometrial change suspected by ultrasound, the combination of vacuum endometrial sampling with ultrasound examination can yield firm diagnosis in office settings, saving cost and time in early diagnosis of endometrial cancer.

Early detection of endometrial cancer by combined use of vaginal ultrasound and endometrial vacuum sampling

Abstract.Patai K, Szentmariay IF, Jakab ZS, Szilagyi G. Early detection of endometrial cancer by combined use of vaginal ultrasound and endometrial vacuum sampling.With increasing lifespan and decreased incidence of uterine cervical cancer, the importance of the proper and early diagnosis of endometrial cancer has become a demand to gynecology. The objective of the present study is to evaluate the effectiveness of gynecologic diagnostic tools in detection of endometrial cancer in early stage. The patients (72) involved in the study, after giving their informed consent, were investigated by transvaginal ultrasound and subsequent vacuum endometrial sampling in office settings. Whenever the histology examination of endometrial vacuum sampling showed hyperplasia or carcinoma, it was reassured by sampling with dilatation and curettage. The analysis of sonography and histology results showed that in 4 cases (5.6%) endometrial hyperplasia and in two cases (2.8%) endometrial adenocarcinoma were present. Also analyzed were sensitivity, specificity, positive and negative predictive values for histology results and for sonographic findings. These results show that transvaginal ultrasound is a reliable method for screening for endometrial carcinoma. Moreover, in the case of pathologic endometrial change suspected by ultrasound, the combination of vacuum endometrial sampling with ultrasound examination can yield firm diagnosis in office settings, saving cost and time in early diagnosis of endometrial cancer.

A Significant Correlation between Melatonin Deficiency and Endometrial Cancer

Endometrial cancer is the most common pelvic genital cancer in women. Its incidence is increasing. Unlike the successful screening method for cervical cancer, there is no such equivalent procedure for the early diagnosis of endometrial cancer. Screening procedures currently being tested are too insensitive and nonspecific while diagnostics are either too complex or invasive. In Austria, a multicenter study was begun to search for parameters appropriate for a screening program. 138 women were selected based on anamnestic, serologic and cytologic risk factors. 68 women were diagnosed with endometrial cancer, 70 patients had abnormal bleeding. There were no significant differences in age and menopausal status. Secondary diseases including diabetes mellitus, hypertonia and adipositas were evenly distributed in both groups. In addition to the routine hormone analyses, we tested the patients’ plasma for differences in melatonin levels. We found a significant correlation (p < 0.001) between melatonin plasma levels and the presence of endometrial cancer. The mean plasma melatonin value was 6.1 pg/ml in the cancer-positive group and 33.2 pg/ml in the cancer-negative control group resulting in a 6-fold difference between the two groups. We conclude that decreasing melatonin plasma levels may be an indicator of endometrial cancer and that this may therefore be used as a reliable screening parameter.

Endometrial carcinoma and vaginal ultrasound: studies of the diagnostic validity

Up to now, there has been no effective diagnostic procedure for early diagnosis of endometrial cancer. During recent years, however, study results on transvaginal sonography (TVS) of the endometrium have been published recommending TVS as a screening method for early diagnosis of endometrial cancer in postmenopausal women. The purpose of this study was to determine the sensitivity and specificity of TVS in measuring endometrial thickness and the resulting performance under screening conditions. Patients with postmenopausal bleeding were included in a prospective blind diagnostic study. Endometrial thickness was measured with TVS before D&C. The histological findings of D&C were used as a control. Sensitivity and specificity were calculated after combining the separately and blindly determined findings. The study comprised 195 patients. Endometrial cancer was diagnosed in 29 of these patients, a prevalence of 15%. The median endometrial thickness was 5.5 mm (0-10 mm) in women with endometrial cancer and 4 mm (0-15 mm) in women without cancer (p > 0.05 Mann-Whitney U-test). For a cut-off > or = 4 mm, the sensitivity is 62% and the specificity is 50%. The sensitivities and specificities for all cut-offs are displayed in a receiver operating characteristic (ROC) curve. The relationship between the positive predictive values and the different prevalences is demonstrated in another curve. Using the results of this and other comparable studies, only very low positive predictive values can be calculated (0.03-1.9%) with prevalences expected under screening conditions (0.02-0.12%). Transvaginal sonography is not a useful method in early diagnosis of endometrial cancer.