Lesions In Postmenopausal Women Research Articles

Preoperative Haematologic Markers for the Differentiation of Endometrial Cancer from Benign Endometrial Lesions in Postmenopausal Patients with Endometrial Masses.

The diagnostic value of preoperative hematological changes in endometrial cancer (EC) remains unclear. This study aimed to assess the role of preoperative hematologic parameters in differentiating EC from benign endometrial lesions in postmenopausal women with endometrial masses. Preoperative laboratory variables were retrospectively reviewed in patients with malignant or benign endometrial lesions, and the significance of intergroup differences was assessed. Receiver operating characteristic curves were used to analyze the optimal cut-off values for each variable. Logistic regression analysis was used to identify the variables predicting the presence of endometrial malignancy. Preoperative laboratory variables of 176 patients (84 EC and 92 benign lesions) with endometrial masses were analyzed. Significant differences were observed between malignant and benign lesions in terms of WBC count, ANC, MCV, MPV, PDW, CA125, NLR, PMR, LMR, and SII (P < 0.05). Multivariate analyses showed that a high WBC count, high ANC, low MCV, low MPV, low PDW, high CA125, high NLR, high PMR, high LMR, and high SII independently predicted the presence of endometrial malignancy. The combination markers, MPV+PDW+NLR, had good discriminatory power for the presence of malignancy (AUC 0.797). Our results suggest that hematologic markers could be useful for the differentiation of malignant and benign endometrial lesions.

Performance of p16/Ki67 Immunostaining for Triage of Elderly Women with Atypical Squamous Cells of Undetermined Significance.

The p16/Ki67 technique has been poorly studied in postmenopausal women with ASC-US cytology. The objective of this study was to compare the accuracy of p16/Ki67 staining, HPV testing and HPV 16 genotyping for the identification of CIN2 + lesions in postmenopausal women with ASC-US cytology. A total of 324 postmenopausal women with positive ASC-US were included. The women underwent HPV test, colposcopy, and biopsy. The slides were discolored and then stained with the CINtec Plus Kit for p16/Ki67. The HPV test results were classified as HPV16 +, hrHPV+ (other hrHPV genotypes), or HPV negative. The p16/Ki67 sensitivity for CIN2+ was 94.5%, the specificity 86.6%, PPV of 59% and NPV of 95.9%. The HPV test showed a sensitivity of 96.4% for CIN2+, a specificity of 62.8%, a PPV of 35% and a NPV of 98.8%. In postmenopausal women, the prevalence of genotype 16 decreases in favor of the other high-risk genotypes. Given the low sensitivity of cytology and the low percentage of HPV16-positive cancers among elderly women, triage via cytology and genotyping is not the best strategy; double staining cytology shows high profiles of sensibility and specificity for CIN2+ in ASCUS postmenopausal women.

V07-12 FULGURATION FOR PANCYSTITIS CYSTICA (STAGE 4) IN WOMEN WITH RECURRENT URINARY TRACT INFECTIONS

You have accessJournal of UrologyCME1 Apr 2023V07-12 FULGURATION FOR PANCYSTITIS CYSTICA (STAGE 4) IN WOMEN WITH RECURRENT URINARY TRACT INFECTIONS Philippe E. Zimmern, Colby P. Souders, Jessie Chen, and Ramy Goueli Philippe E. ZimmernPhilippe E. Zimmern More articles by this author , Colby P. SoudersColby P. Souders More articles by this author , Jessie ChenJessie Chen More articles by this author , and Ramy GoueliRamy Goueli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This movie describes our experience with recurrent urinary tract infections in postmenopausal women who have very extensive lesions of cystitis cystica in their bladder. METHODS: As shown in this diagram of the bladder, a simple staging system was devised to account for the visual extent of cystitis lesions noted on cystoscopy. Stage 1 is just for lesions covering the trigone or trigonitis. Stage 2 includes stage 1 and extension of these lesions to the bladder base. Stage 3 involves stage 2 as well as lesions lateral to the ureteric orifices on one or both sides, and finally Stage 4 is for a complete bladder involvement with stage 3 lesions also extending to the posterior wall, dome, anterior area. This condition is sometimes referred as pancystitis. RESULTS: Here are typical lesions of cystitis cystica noted over the trigone and bladder base, and extending laterally and anteriorly in a patient with antibiotic-recalcitrant recurrent urinary tract infections. We used a small tip bugbee electrode on a low setting under anesthesia on an outpatient basis. We started the procedure by marking around the ureteric orifices to easily recognize their location and protect them. Then we focus on lesions at the dome and anteriorly. One can see here the white pods representing the bacterial infection niches beneath the fulgurated surface mucosa. Fulguration can literally explode or “pop” these niches and drain out these pod collections. Here is a survey of a bladder with pancystitis following extensive fulguration. The ureteric orifices are identified and are still effluxing urine well. On this second patient, a similar pattern of extensive pancystitis can be observed. Due to recurrent infections, that same patient underwent a second fulguration one year later. At that time, healed areas from the first fulguration were noted with a shallow, white or light pink, appearance, and few areas of cystitis cystica were seen interspersed in between and targeted during this repeat fulguration procedure. CONCLUSIONS: Women with antibiotic-recalcitrant symptomatic and uncomplicated recurrent urinary tract infections with stage 4 or pancystitis, who have very few options left for therapy short of undergoing a cystectomy, can benefit at times from fulguration even though the procedure is longer than in an earlier stage, can take longer to recover from, and may not be as successful than in an early stage with lesions just confined to the trigone and/or bladder base. Therefore, our experience invites considering early cystoscopy in the evaluation of women suffering from recurrent urinary tract infections to detect these lesions at a low volume of surface disease. Ma R, Chavez JA, Christie AL, Zimmern PE. Electro-fulguration for extensive inflammatory bladder lesions in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections. Int Urogynecol J. 2022 Sep 27. doi: 10.1007/s00192-022-05360-w. Epub ahead of print. PMID: 36166061. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e599 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philippe E. Zimmern More articles by this author Colby P. Souders More articles by this author Jessie Chen More articles by this author Ramy Goueli More articles by this author Expand All Advertisement PDF downloadLoading ...

A risk prediction nomogram of endometrial carcinoma and precancerous lesions in postmenopausal women: A retrospective study

This study aimed to develop a risk prediction nomogram for endometrial carcinoma and precancerous lesions in postmenopausal women to provide postmenopausal patients with more information on disease probability, work out personalized medical plans, and reduce unnecessary invasive clinical examinations. We enrolled 340 patients who underwent hysteroscopy at Beijing Maternity Hospital between March 2016 and July 2018. The patients were divided into the low-risk (275 patients) and high-risk (65 patients) groups, according to the results of the pathological examinations. Binary logistic analysis was performed to evaluate the 20 potential risk factors for endometrial cancer and precancerous lesions in postmenopausal women and to screen for certain risk factors using the Statistical Package for the Social Sciences version 26.0. Using R 4.0.3, we built a prediction nomogram that incorporated the selected factors. The discrimination, calibration, and clinical usefulness of the prediction model were assessed using the concordance (C)-index, calibration plot, and decision curve analysis. Internal validation was assessed using bootstrapping validation. Predictors included in the prediction nomogram included obesity, vaginal bleeding, family history of gynecological malignancies, endometrial thickness ≥ 1.15 cm, and color Doppler flow imaging blood flow. The model displayed good discrimination, with a C-index of 0.853, and good calibration. Decision curve analysis showed that the model was clinically useful, with a benefit range of 2% to 93%. A high C-index value of 0.844 could still be reached in the interval validation. Obesity, vaginal bleeding, family history of gynecological malignancies, endometrial thickness ≥ 1.15 cm, and color Doppler flow imaging blood flow were independent risk factors for endometrial cancer and precancerous lesions. Thus, the prediction nomogram can be conveniently used to facilitate individual risk prediction in patients with endometrial cancer and precancerous lesions.

COLPOSCOPIC EVALUATION OF POST-MENOPAUSAL WOMEN WITH NORMAL CERVICAL CYTOLOGY

1. Introduction The most common genital cancer seen in Indian women is Carcinomacervix Its incidence is approximately 1 in 53 Indian women during their lifetime compared to 1 in 100 in developed countries. In women ≥ 50 years where the lifetime risk of cervix cancer is estimated as 3.5%, which can be reduced to 0.8% with screening. Pap smear evaluation alone is inadequate for predicting the precancerous lesions in postmenopausal women due to hypoestrogenic changes of menopause which makes it difcult to differentiate atrophic cellular changes from other pathologic conditions, giving more false negative results which can be reduced if combines with colposcopy examination and guided biopsy wherever needed 2. Aim &amp; Objective To diagnose intraepithelial lesions in postmenopausal patients with normal cytological ndings and to assess the usefulness of cytological screening, colposcopy, and colposcopy-directed biopsy in these patients. 3. Material And Method- A retrospective study was carried out from 1st January 2018 to 31 October 2022 at a colposcopy clinic, in district Shivpuri M.P. on 104 post-menopausal females of age group 45-68 years. After detailed history and examination, a pap smear in all 104 patients was taken. All patients with negative cytology reports for Intra epithelial lesions with persistent symptoms and suspicious signs were subjected to colposcopy. 23 Patients with positive Colposcopic ndings were subjected to Colposcopic guided biopsy. histopathological evaluation was done. 4. Result This study analyzed 104 postmenopausal patients who had Pap smear reports with NILM (Negative for intraepithelial Lesion or Malignancy). 58% of the patients were referred by other Doctors. The most common post-menopausal age group nd in this study was between 45-55 (52.88%), Most of the patients were of a low socioeconomic group (54.81%), Multipara (3-5 parity 66.35%). with a history of menopause of 5-10 years (49.04%) duration. Only 5.77% of patients had 3 Pap smear reports with them, and a history of smoking was present in 6.73% of cases. The most common presenting symptom was discharge PV (47.11%) followed by Foul smelling bloody discharge (14.42%). Post-coital bleeding (12.5%), Post-menopausal bleeding (8.65%), and dyspareunia (4.80%). On colposcopy, (77.89%) of cases had normal Colposcopic ndings while (22.11%) had abnormal Colposcopy ndings. In 17.30% of cases, LSIL was suspected, in 4.80% of cases HSIL was suspected on colposcopy Colposcopy-guided biopsy was done in 23 (22.11%) patients with suspected CIN. On histopathology 9.61% of cases were positive for intraepithelial lesions, CIN1 was found in 7.69%, and CIN2 in 1.92%. Carcinoma in situ and Invasive carcinoma were not found in any case. 10(9.61%) out of 104 patients had cervical intraepithelial neoplasia diagnosed on colposcopy-guided biopsy and histopathology report. 5. Conclusion- In our study, despite the Pap smear report as NILM (Negative for intraepithelial lesion or malignancy). ,10(9.61%) out of 104patients had cervical intraepithelial neoplasia diagnosed on colposcopy guided biopsy, thus we recommend, the combined use of cervix cytology, colposcopy, and histopathology in postmenopausal cervix cancer screening evaluation to improve the diagnosis of the cervical intraepithelial lesion.

Cytological characteristics of premalignant cervical epithelial lesions in postmenopausal women based on endocrine indices and parakeratosis.

To identify useful cytological findings for detecting premalignant lesions in postmenopausal women, cervicovaginal smear samples were analyzed and compared between women with or without premalignant lesions based on endocrine indices and presence of parakeratosis (PK). The cervicovaginal smear samples of postmenopausal women with premalignant lesions (n = 94) and those who were without (n = 344), who were diagnosed between 2012 and 2014 were retrieved and analyzed. Women cytologically diagnosed with malignancy or those with suspicion of malignancy were excluded from this study. Cytological endocrine indices, such as the maturation index (MI) and eosinophilic index (EI) and the prevalence of PK were compared between the groups and analyzed using the 2 × 2 χ2 test. The association of endocrine indices combined with the presence of PK and histological findings was also evaluated. Postmenopausal women with premalignant lesions had higher endocrine indices (EI of ≥11%; 65% vs. 43%, P < 0.01, f = 0.18) and a higher prevalence of PK positivity (PK ≥ 1; 46% vs. 7%, P < 0.01, f = 0.44) than those without lesions. Further analysis indicated that the combination of high EI and the presence of PK in postmenopausal women with cytological premalignant cases was highly associated with histological squamous intraepithelial lesions (SIL) (86% in women with premalignant lesions vs. 53% in those without; P = 0.01, f = 0.34). Our research demonstrated that high EI and PK positivity were correlated with SIL in postmenopausal women. These cytological findings could provide potential diagnostic clues for detecting dysplasia.

Electro-fulguration for extensive inflammatory bladder lesions in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections.

To evaluate how women with uncomplicated antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) and extensive inflammatory bladder lesions on office cystoscopy responded to electro-fulguration (EF) to eliminate these chronic bladder sites. After IRB approval, a retrospective study of non-neurogenic women with RUTIs, inflammatory lesions on cystoscopy, and who underwent EF was performed. Lesions were classified through a simplified staging system based on the extent of bladder wall involvement. Only those with extensive bladder wall involvement (stages 3 and 4) at the time of EF were analyzed in this report. Six months after EF, an office cystoscopy was performed, with endoscopic success defined as no lesions seen. The primary clinical outcome was number of symptomatic UTIs after EF, defined as cure (0/year), improvement (1-2/year), and failure (≥3/year). From 2007 to 2019, a total of 57 women met the study criteria, 30 stage 3 and 27 stage 4. Nineteen (63%) were endoscopically successful in stage 3 and 11 (41%) in stage 4. Mean follow-up was 2.9 years (stage 3) and 3.1 years (stage 4). All had at least a 6-month UTI follow-up after the 6 months of office cystoscopy, with 15 patients cured, 37 improved, and 5 failed (all stage 4). Although EF only resulted in 63% complete endoscopic resolution, the majority experienced a decrease in the frequency of UTIs, suggesting that EF can be durably effective even in women with very extensive cystitis lesions.

The relationship between endometrial thickening and endometrial lesions in postmenopausal women.

The study aims to investigate the relationship between endometrial thickening and endometrial lesions in postmenopausal women. Totally 390 postmenopausal patients with endometrial thickening ≥ 5mm were enrolled from June 2016 to April 2020, among whom 188 patients were asymptomatic and 202 patients were symptomatic. There were 50 cases with endometrial cancer and precancerous lesions and 150 cases with benign lesions in the symptomatic group, significantly higher than that in the asymptomatic group. The most common pathological type in the asymptomatic group was endometrial polyp. In the asymptomatic group, statistically significant differences were found in endometrial thickness between patients with endometrial cancer and precancerous lesion (group B) and those with benign lesions and non-organic lesions (group A). Statistically significant differences were also found in age, endometrial thickness, hypertension, full-term delivery time and miscarriage times between group A and group B. Regression analysis indicated that hypertension and endometrial thickness were independent risk factors for endometrial cancer and precancerous lesions in the symptomatic group. ROC analysis showed that 10.5mm was the optimal threshold for predicting endometrial cancer and precancerous lesions in the asymptomatic group, with sensitivity of 100% and specificity of 78.3%. The incidence of endometrial cancer and precancerous lesions in postmenopausal women with endometrial thickening and vaginal bleeding is higher than that of asymptomatic women. The endometrial thickening in postmenopausal asymptomatic women is mainly benign, and the threshold for predicting endometrial cancer and precancerous lesions is 10.5mm.

Ovarian Fibroma Mimicking Malignant Tumor on F-18 FDG PET/CT

Benign ovarian tumors like fibroma rarely shows mild or moderate F-18 FDG uptake. FDG-avid adnexial lesions in postmenopausal women should be as considered primarily malignant. A 69 years old female who had diagnosis with both colon adenocarcinoma and lung carcinoma, was referred to F-18 FDG PET/CT imaging for follow up. A mass lesion showing moderate F-18 FDG uptake at right adnexial region was detected. She was operated after gynaecological evaluation. Her histopathology examination was reported as ovarian fibroma.

Application and accuracy analysis of three-dimensional transvaginal ultrasound in the diagnosis of endometrial lesions in postmenopausal women.

Objectives:To evaluate the value of three-dimensional transvaginal ultrasound (3D-TVS) for endometrial lesions in postmenopausal women, so as to improve the accuracy of clinical diagnosis of endometrial lesions in postmenopausal women.Methods:A total of 170 female patients admitted to Tianjin Central Hospital of Gynecology and Obstetrics from April 2018 to April 2020 were included in this study. Among them, 110 patients with pathologically confirmed postmenopausal endometrial lesions were divided into the study group (65 patients with benign lesions, 45 patients with malignant lesions), while 60 healthy postmenopausal women were divided into the volunteer group. PASS software was used to calculate the sample size. 3D-TVS was performed in both groups, and the results of the different groups were compared and analyzed.Results:The pathological results were invoked as the gold standard for detection, and the accuracy, sensitivity and specificity of 3D-TVS were 97.27%, 77.78% and 80% respectively. Patients in the study group had higher endometrial thickness and endometrial volume than those in the volunteer group (p<0.05). The results of ultrasound parameters in the benign lesion group were lower than those in the malignant lesion group (p<0.05), while the vascular index and micro-vessel density in the malignant lesion group were significantly higher than those in the benign lesion group (p<0.05).Conclusion:3D-TVS has obvious clinical value in the diagnosis of endometrial lesions in postmenopausal women, boasting a variety of advantages, such as high accuracy, sensitivity and specificity, effectively reflecting the blood flow of patients with endometrial lesions, and further determining the degree of benign and malignant lesions in patients.

Long-term use of glucocorticoid exacerbates bone lesions in postmenopausal women with rheumatoid arthritis

Glucocorticoid-induced osteoporosis is osteoporosis arising due to long-term use of glucocorticoids. Despite decades of intense research, the effects of long-term use of glucocorticoids in humans on bone cells and bone structural changes remain unclear. We performed post-mortem histomorphometric analysis of bone from two female patients with rheumatoid arthritis aged 64 and 85years. Our two patients had been treated with glucocorticoids for 19 and 14 years, respectively. In Case 1, all markers of cancellous bone volume were markedly decreased compared with the age-matched reference range. Connectivity of cancellous bone trabecula was absent. Only a few island bones were noted. There was prominent thinning of the cortical bone and extension of the bone marrow cavity into the cortical bone with prominent cortical porosis. Cortical nodes between the endocortical surface and the trabecula disappeared due to endocortical resorption. Stoppage of lamellar structure was observed because the bone resorption by osteoclasts surpassed bone formation by osteoblasts. Empty lacunae characterised by disappearance of osteocytes were visible. In Case 2, all volume markers of cancellous bone were decreased to the same extent as Case 1. However, cortical porosis was more prominent than Case 1. These two cases suggest that use of glucocorticoid therapy >10years can induce severe osteoporosis in elderly rheumatoid arthritis women with higher disease activity and that the disappearance of cancellous bone is the common characteristic. The 85-year-old woman was characterised by cortical porosis.

Analysis of clinical features of cervical precancerous lesions in postmenopausal women

Objective: To analyze the characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in postmenopausal women. Methods: A retrospective study was performed on 2 013 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by cervical conization at the First Affiliated Hospital of Zhengzhou University from June 2017 to November 2018, to compare the difference of patients' clinical features, HPV test, liquid-based thin-layer cytology (TCT), performance of colposcopy and biopsy pathology, pathology after cervical conization between 439 postmenopausal patients and 1 574 pre-menopausal patients. Results: (1) Clinical features: the proportion of contact bleeding showed no significant difference between postmenopausal patients and pre-menopausal patients [4.3% (19/439) vs 6.4% (101/1 574); χ²=2.672, P=0.102]. Among the patients with contact bleeding, the proportion of cervical cancer after cervical cone resection was significantly higher in postmenopausal patients compared with pre-menopausal patients [10/19 vs 22.8% (23/101); χ²=7.157, P=0.007]. Among the patients found by routine screening, the proportion of cervical cancer after cervical cone resection was significantly higher in postmenopausal patients compared with pre-menopausal patients [9.0% (38/420) vs 4.3% (63/1 473); χ²=14.726, P<0.01]. The proportion of smooth cervix was higher in postmenopausal patients compared with pre-menopausal patients [63.6% (279/439) vs 35.5% (558/1 574); χ²=111.601, P<0.01]. (2) High-risk HPV infection: there was no significant difference in the high-risk HPV positive rate between the postmenopausal group and the pre-menopausal group [92.0% (404/439) vs 94.4% (1 486/1 574); χ²=3.394, P=0.065]; the HPV 16 infection was the most common type, but there was no significant difference in the HPV 16 infection rate between the two groups [65.8% (289/439) vs 68.0% (1 070/1 574); χ²=0.722, P=0.395]. (3) TCT test: TCT test results included negative for intraepithelial lesion and malignancy (NILM), atypical squamous cell of undetermined signification (ASCUS), atypical squamous cells cannot exclude high-grade lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), HSIL, compared with the different results of TCT examination, there were not statistically significant difference between postmenopausal and pre-menopausal patients (all P>0.05). (4) The performance of colposcopy: the proportion of insufficient colposcopy and the proportion of cervical type Ⅲ conversion area were higher in postmenopausal patients compared with pre-menopausal patients [87.5% (384/439) vs 32.5% (511/1 574), P<0.01; 80.0% (351/439) vs 21.9% (344/1 574), P<0.01]. The proportion and positive rate of endocervical curettage (ECC) in postmenopausal patients were higher than those in pre-menopausal patients [35.3% (155/439) vs 20.4% (322/1 574), P<0.01; 67.7% (105/155) vs 53.1% (171/322), P=0.003]. The proportion of lesions involving the vaginal wall was higher in postmenopausal patients compared with pre-menopausal patients [5.9% (26/439) vs 1.0% (16/1 574); χ²=40.443, P<0.01]. There was a positive correlation between vaginal wall lesions and cervical lesions in postmenopausal patients (r=0.660, P<0.01). (5) Postoperative pathology: the positive rate of margin and the proportion of pathological escalation after cervical conization were significantly higher in postmenopausal patients compared with pre-menopausal patients [14.6% (64/439) vs 4.8% (75/1 574), 10.9% (48/439) vs 5.5% (86/1 574); P<0.01]. Conclusions: Colposcopy in postmenopausal women is often inadequate, and the cervix is mostly type Ⅲ transformation zone. The lesion in postmenopausal women is more likely to involve the cervical canal and vaginal wall. Clinical attention should be paid to cervical tube curettage and comprehensive examination of the vaginal wall. The high rate of positive margins and a high proportion of pathological upgrading after cervical conization in postmenopausal patients requires further active intervention.

When Less is Not More: Population-level Perspective on Adnexal Cyst Surveillance for Post-Menopausal Women.

Ovarian simple cysts are found with high frequency in older women, and at least a third eventually regress in a year. Multiple large studies, including the sample from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial, have found no direct association with ovarian cancer incidence, corroborating earlier, smaller studies [ 1 Hartge P. Hayes R. Reding D. et al. Complex ovarian cysts in postmenopausal women are not associated with ovarian cancer risk factors: preliminary data from the prostate, lung, colon, and ovarian cancer screening trial. Am J Obstet Gynecol. 2000; 183: 1232-1237 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 2 Menon U. Gentry-Maharaj A. Hallett R. et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009; 10: 327-340 Abstract Full Text Full Text PDF PubMed Scopus (631) Google Scholar ]. The current practice of safely following, rather than resecting, asymptomatic ovarian cystic lesions accompanied a rejection of an older, simple biologic model of ovarian cystic lesions as cancer precursors or markers of subsequent cancer onset in either ovary. Instead, it is now widely accepted that aggressive or high-grade ovarian neoplasms arise via a solid tumor pathway from serous tubal intraepithelial carcinoma [ 3 Erickson B.K. Conner M.G. Landen Jr., C.N. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol. 2013; 209: 409-414 Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar ]. In this decision-analytic modeling study by Pandharipande et al, the question of managing ovarian cystic lesions in postmenopausal women is revisited within the practical and highly informative context of overall health status and wide-ranging life expectancy [ 4 Seguin C.L. Lietz A.P. Wright J.D. et al. Surveillance in older women with incidental ovarian cysts: Maximal projected benefits by age and comorbidity level. J Am Coll Radiol. 2020; 18: 10-18 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity LevelJournal of the American College of RadiologyVol. 18Issue 1PreviewThe aim of this study was to estimate effects on life expectancy (LE) of imaging-based ovarian surveillance after detection of incidental postmenopausal ovarian cysts, under different assumptions of patient age, comorbidity level, and cancer risk and detection. Full-Text PDF

VP61.08: Low‐risk ovarian lesions in postmenopausal women can be safely managed conservatively

VP61.08: Low‐risk ovarian lesions in postmenopausal women can be safely managed conservatively

Abstract B30: The effect of OCP use on the incidence of precancerous p53 lesions in fallopian tube fimbria

Abstract Background: High-grade serous ovarian carcinoma (HGSOC) accounts for &amp;gt;70% of ovarian cancer-related deaths and is the most common ovarian cancer histotype, most originating from precancerous p53 lesions in the fallopian tube (FT) fimbria. Use of oral contraceptive pills (OCPs) for 5 years or more is associated with a &amp;gt;40% reduction in risk of HGSOC, but the mechanism is unknown. We hypothesize that OCP use reduces the incidence of p53 lesions. Our preliminary data show higher incidence of p53 lesions in post- compared to premenopausal women; therefore we aim to quantify p53 lesions in postmenopausal women who previously did or did not use OCPs. This will provide insight into the protective effects of OCPs against HGSOC. Preliminary Results: We determined the presence of p53 lesions by immunohistochemistry (IHC) in FT of women up to 40 years old (n=27) and &amp;gt;60 years old (n=24) who underwent salpingectomies for noncancer reasons. p53 lesions were identified in 3/27 cases of the younger cohort (11%) and in 10/24 of the older cohort (42%). Thus, we conclude an increased incidence of p53 lesions in older compared to younger women. Proposed Design: IHC for p53 will be performed on FT fimbria of women &amp;gt;55 years old who received salpingectomy for noncancer reasons. Based on an assumed reduction in p53 lesions of 35% in women who used OCPs for 5 years or more compared to nonusers (25 vs. 42%), analysis of 190 cases from each group will provide &amp;gt;80% power (p&amp;lt;0.05). Cases will be identified through Population Data BC and blind analysis by p53 IHC will be performed at the Vancouver General Hospital. Data will be flowed back to Pop Data BC to compare to OCP data. Conclusion: Our preliminary study found that 42% of postmenopausal women had p53 lesions, informing this study design. The study registered through this abstract will be the first to examine the impact of OCPs on the earliest known precursors of HGSOC. Citation Format: Kendall Greening, Anthony Karnezis, Dawn Cochrane, David Farnell, Lien Hoang, Gillian Hanley, David Huntsman. The effect of OCP use on the incidence of precancerous p53 lesions in fallopian tube fimbria [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research; 2019 Sep 13-16, 2019; Atlanta, GA. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(13_Suppl):Abstract nr B30.

Abstract B091: Vulvar squamous cell carcinoma: Comprehensive genomic profiling of HPV(+) versus HPV(–) forms reveals a different set of potentially actionable biomarkers

Abstract Introduction: One major form of vulvar squamous cell carcinoma (vSCC) is associated with detectable high-risk strains of human papillomavirus (hrHPV) and is often accompanied by usual-type vulvar intraepithelial neoplasia (VIN). The second major form of vSCC is often associated with chronic dystrophic or inflammatory lesions in postmenopausal women, does not harbor detectable HPV infection, and is often preceded by p53-mutant differentiated VIN. While studies have examined the two subtypes, no large-scale genomic study has been performed to our knowledge. We sought to assess the genomics of a large cohort of aggressive vSCCs, with an aim to identify distinct mutational signatures based on the presence or absence of hrHPV genome reads. Methods: 280 vSCC were tested by hybridization capture of up to 406 cancer-related genes evaluated for base substitutions, small indels, amplification (amp), and rearrangements. HPV genome sequences were detected by de novo assembly of non-human sequencing reads and BLASTn comparison against all viral nucleotide sequences in the NCBI RefSeq database. Tumor mutational burden (TMB, mutations/Mb) was determined on ~1.1 Mbp of sequenced DNA. PD-L1 status was determined by IHC (Dako 22C3), with ≥50% tumor proportion score defined as high positive. Results: 102/280 vSCCs contained hrHPV sequences. Of these, 90 were HPV-16, 7 HPV-18, 1 HPV-31, 3 HPV-33, 1 HPV-58, and 1 HPV-67. Patients were significantly younger in the HPV(+) group (median 59 v. 64 years, p=0.001). Compared with the HPV(–) cohort, HPV(+) cases showed significantly more pathogenic genomic alterations (GA) in PIK3CA (31% vs. 17%, p=0.004), PTEN (14% vs. 2%, p&amp;lt;0.0001), EP300 (14% vs. 1%, p&amp;lt;0.0001), STK11 (14% vs. 1%, p&amp;lt;0.0001), AR (5% vs. 0%, p=0.006), and FBXW7 (10% vs. 3%, p=0.03). In contrast, HPV(–) cases showed significantly more alterations in TP53 (82% vs. 3%, p&amp;lt;0.0001), TERTp (71% vs. 8%, p&amp;lt;0.0001), CDKN2A (55% vs. 2%, p&amp;lt;0.0001), CCND1 (23% vs. 2%, p&amp;lt;0.0001), FAT1 (25% vs. 4%, p&amp;lt;0.0001), NOTCH1 (19% vs. 6%, p=0.002), and EGFR (amp: 12% vs. 0%, p&amp;lt;0.0001), as well as a higher rate of 9p24.1 (PDL1/PDL2) amp (7% vs. 1%) and PD-L1 IHC high-positive tumor staining (33% vs. 9%, p=0.04). Differences in alterations were observed between known primary and metastatic sites in cases with similar HPV status but did not reach significance (table). HPV(+)HPV(–) PrimaryMetastasisPrimaryMetastasis # of cases504112442 Age (range)58 (36-81)60 (29-83)64 (25-89)63 (45-89) Median TMB (range)5.2 (0-18.3)6.1 (0-47.8)3.5 (0-90.5)5.0 (0-13) PIK3CA GA26%37%17%17% PTEN GA18%10%2%2% STK11 GA10%22%1%2% FBXW7 GA10%10%5%0% TP53 GA0%5%82%81% TERTp GA6%10%73%64% CDKN2A GA0%5%55%52% CCND1 GA2%2%20%29% EGFR amp0%0%12%14% CD274(PD-L1) amp*0%0%6%10% PD-L1 IHC high*8%11%30%33% TMB &amp;gt;10*6%24%3%19% Conclusions: vSCCs show significant differences in molecular profile based on HPV status. 63% of metastatic HPV(+) cases (54% overall) have a potentially actionable alteration in the PI3K/mTOR pathway, and 42% of metastatic HPV(–) cases (39% overall) have at least one potential predictive biomarker* for response to immunotherapy. Our findings provide compelling rationale for tandem comprehensive genomic profiling and HPV assessment of advanced vulvar SCCs to more fully inform therapeutic options and stratification in clinical trials. Citation Format: Erik A Williams, Adrienne J Werth, Meagan Montesion, Ethan S Sokol, Dean C Pavlick, Nikunj A Shah, Jo-Anne Vergilio, Natalie A Danziger, Jonathan K Killian, Douglas A Lin, Vincent A Miller, Jeffrey S Ross, Julia A Elvin. Vulvar squamous cell carcinoma: Comprehensive genomic profiling of HPV(+) versus HPV(–) forms reveals a different set of potentially actionable biomarkers [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B091. doi:10.1158/1535-7163.TARG-19-B091

Abstract DP-006: THE EFFECT OF AGE AND OCP USE ON THE INCIDENCE OF PRE-CANCEROUS P53 LESIONS AND THE DEVELOPMENT OF HIGH GRADE SEROUS OVARIAN CARCINOMA

Abstract BACKGROUND: High grade serous ovarian cancer (HGSOC) accounts for &amp;gt;70% of ovarian cancer related deaths and is the most common ovarian cancer histotype, most originating from pre-cancerous p53 lesions in the fallopian tube (FT) fimbria. Use of oral contraceptive pills (OCPs) for 5 years or more is associated with &amp;gt;40% reduction in risk of HGSOC, but the mechanism is unknown. We hypothesize that OCP use reduces the incidence of p53 lesions. Our preliminary data show higher incidence of p53 lesions in post- compared to pre-menopausal women, therefore we aim quantify p53 lesions in post-menopausal women who previously did or did not use OCPs. This will provide insight into the protective effects of OCPs against HGSOC. PRELIMINARY RESULTS: We determined the presence of p53 lesions by immunohistochemistry (IHC) in FT of women up to 40 years old (n=27) and &amp;gt;60 years old (n=24) who underwent salpingectomies for non-cancer reasons. p53 lesions were identified in 3/27 cases of the younger cohort (11%) and in 10/24 of the older cohort (42%). Thus, we conclude an increased incidence of p53 lesions in older compared to younger women. PROPOSED DESIGN: IHC for p53 will be performed on FT fimbria of women &amp;gt;55 years old who received salpingectomy/hysterectomy for non-cancer reasons. Based on an assumed reduction in p53 lesions of 35% in women who used OCPs for 5 years or more compared to non-users (25 vs. 42%), analysis of 190 cases from each group will provide &amp;gt;80% power (p&amp;lt;0.05). Cases will be identified through Population Data BC and blind analysis by tp53 IHC will be performed at the Vancouver General Hospital. Post-menopausal status will be confirmed by endometrium histology and data flowed back to Pop Data BC to compare to OCP data. CONCLUSION: Our preliminary study found that 42% of post menopausal women had p53 lesions, informing this study design. The study registered through this abstract will be the first to examine the impact of OCPs on the earliest known precursors of HGSOC. Citation Format: Kendall Greening, Anthony Karnezis, Dawn Cochrane, Gillian Hanley, David Huntsman. THE EFFECT OF AGE AND OCP USE ON THE INCIDENCE OF PRE-CANCEROUS P53 LESIONS AND THE DEVELOPMENT OF HIGH GRADE SEROUS OVARIAN CARCINOMA [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr DP-006.

Discussion on the diagnosis and treatment of high-grade squamous intraepithelial lesions in post-menopausal women

Objective: To analyze the performance of colposcopy and investigate the diagnosis and treatment characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in post-menopausal women. Methods: A retrospective study was performed on 1 449 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by loop electrosurgical excision procedure (LEEP) or extrafascial hysterectomy as the primary therapy at the First Affiliated Hospital of Nanjing Medical University, from November 2015 to October 2017. In order to investigate the diagnosis and treatment of HSIL in post-menopausal women, a case-control study was conducted to compare the difference in performance of colposcopy and treatment modality between 213 post-menopausal patients (14.7%, 213/1 449) and 1 236 pre-menopausal patients (85.3%, 1 236/1 449). Results: (1)The proportion of cases pathologically upgraded to cervical cancer was significantly greater in post-menopausal patients (9.4%, 20/213) compared with pre-menopausal patients (3.8%, 47/1 236; P<0.05). (2) The proportion of ≥HSIL diagnosed by colposcopy showed no significant difference between post-menopausal patients (76.1%, 162/213) and pre-menopausal patients (78.2%, 967/1 236; P=0.479). The proportion of type Ⅲ transformation zone (TZ) was significantly greater in post-menopausal patients (91.1%, 194/213) compared with pre-menopausal patients (59.1%, 731/1 236; P<0.05). The rate of missed diagnosis of cervical cancer was significantly higher in type Ⅲ TZ (6.4%, 59/925) compared with type Ⅰ and(or) Ⅱ TZ (1.5%, 8/524; P<0.05). The proportion of HSIL detected by endocervical curettage alone was greater in post-menopausal patients (9.9%, 21/213) compared with pre-menopausal patients (2.6%, 32/1 236; P<0.05). (3)Initial treatment with LEEP: the positive rate of endocervical margin was significantly greater in post-menopausal patients (20.5%, 36/176) compared with pre-menopausal patients (10.5%, 130/1 236;P<0.05); in patients who were diagnosed as HSIL after LEEP, the positive rate of endocervical margin and the residual rate were both greater in post-menopausal patients compared with pre-menopausal patients [15.4% (25/162) versus 8.8% (105/1 189), P=0.008; 52.0% (13/25) versus 26.7% (28/105), P=0.014]. (4)Thirty-seven post-menopausal patients were treated by extrafascial hysterectomy as the primary therapy, 5 cases (13.5%, 5/37) were diagnosed as cervical cancer (stage Ⅰa1) after the surgery. Conclusions: (1) The lesions of HSIL in post-menopausal patients still have definite features under colposcopy as same as pre-menopausal patients. Endocervical curettage could help detect more HSIL in post-menopausal patients. Compared with pre-menopausal patients, post-menopausal HSIL patients have an increased risk of cervical cancer and are more likely missed by cervical tissue sampling. (2) LEEP has the dual effects of diagnosis and treatment, and is still the recommended treatment for post-menopausal HSIL patients. However, the increase in positive rate of endocervical margin and residual rate requires further active intervention. (3) Considering those post-menopausal HSIL patients who cannot accept conization as the initial treatment, the selection of hysterectomy type requires more thorough study.

Value of contrast-enhanced ultrasound and intraluminal angiography in the differential diagnosis of benign and malignant endometrial lesions in postmenopausal women

Objective To explore the value of contrast-enhanced ultrasound (CEUS) and intraluminal contrast in the differential diagnosis of postmenopausal endometrial benign and malignant lesions. Methods The ultrasound data of 90 patients with postmenopausal endometrial lesions diagnosed in our hospital between March 2016 and March 2018 were retrospectively analyzed. According to pathological findings, they were divided into benign group (55 cases) and malignant group (35 cases). The endometrial thickness of endovascular contrast, rise time (RT), time to peak (TTP), base intensity (BI), and peak intensity (PI) of CEUS in two groups were compared. Receiver operating characteristic curves (ROC) were used to compare the efficacy of different ultrasound parameters in benign and malignant endometrial by using pathology diagnosis as gold standard. Results The endometrial thickness and PI were significantly higher in the malignant group than those in the benign group (P 0.05). The ROC curve showed that PI has the highest area under curve (AUC) in the differential diagnosis of benign and malignant endometrial lesions (AUC=0.983), followed by RT and TTP (AUC=0.889, 0.872), and intimal thickness (AUC=0.766). AUC of PI was significantly higher than RT, TTP and intimal thickness (P<0.05), and the best cut-off point for PI ≥20.23 dB. The sensitivity of PI, RT, and TTP in differentiating benign and malignant endometrial lesions was significantly higher than that in intimal thickness (P<0.05), whereas the specificity and positive likelihood ratio (+ LR) of PI were significantly higher than those of RT, TTP, and intimal thickness (P<0.05). Conclusions Compared with intracavitary ultrasound, CEUS has better diagnostic value in differentiating benign and malignant endometrial tumors. Among them, the diagnostic sensitivity and specificity of PI≥20.23 dB are higher. Key words: Endometrial neoplasms; Phlebography; Hysterosalpingography; Menopause

OP03.05: Clinical history of low‐risk ovarian lesions in postmenopausal women

To investigate the ultrasound-based clinical history of incidental low-risk ovarian lesions in postmenopausal women and to propose a proper management. Women presenting with incidental sonographic diagnosis of ovarian unilocular cysts ≥ 5 cm and ≤ 7 cm, multilocular cysts (<10 locules) ≤ 7 cm, and solid lesions ≤ 5 cm with acoustic shadowing, moving with no tender and colour score 1-2, were prospectively recruited from January 2006 to December 2011, and followed-up until December 2017. All patients were assessed by transvaginal sonography (TVS), according to the IOTA protocol. A proper counselling on a low malignant risk was given. Sonographic follow-up was proposed at 3, 6 and 9 months, then yearly. Surgery was performed in case of changes of lesion's volume (>50%) and/or sonographic parameters, or on patient's request. Demographic, medical, sonographic and pathologic data were recorded. 125 postmenopausal patients with 134 ovarian masses were enrolled. Median age (IR) was 65 years (58-73). 52 (42%) and 63 (50%) patients had at least one medical disease and one previous abdominal surgery, respectively. Unilocular, multilocular and solid lesions were observed in 55, 61 and 18 cases, respectively. 9 women reported bilateral cysts. Median lesion mean diameter and volume (IR) of unilocular, multilocular ovarian cysts and solid lesions was 48 mm (31-55) and 52 mL (15-87), respectively. All lesions had a mean (±SD) risk of malignancy of 2.7±1% by LR1 and identified as benign by simple rules. In the 88 patients with a follow-up period longer than 12 months (median 66, IR 37-91), surgery was performed in 23 cases, with an overall surgery-free survival rate at 50 months of 83.4%, 90,5%, and 82.2% for patients with unilocular, multilocular and solid lesions, respectively. No malignant lesions were reported in the 48 operated patients. Conservative expectant management should be the standard option for incidental low-risk ovarian lesions in postmenopausal women.