Malignant Endometrial Disease Research Articles

The vaginal microbiome is associated with endometrial cancer grade and histology.

The human microbiome has been strongly correlated with disease pathology and outcomes, yet remains relatively underexplored in patients with malignant endometrial disease. In this study, vaginal microbiome samples were prospectively collected at the time of hysterectomy from 61 racially and ethnically diverse patients from three disease conditions: 1) benign gynecologic disease (controls, n=11), 2) low-grade endometrial carcinoma (n=30), and 3) high-grade endometrial carcinoma (n=20). Extracted DNA underwent shotgun metagenomics sequencing, and microbial α and β diversities were calculated. Hierarchical clustering was used to describe community state types (CST), which were then compared by microbial diversity and grade. Differential abundance was calculated, and machine learning utilized to assess the predictive value of bacterial abundance to distinguish grade and histology. Both α- and β-diversity were associated with patient tumor grade. Four vaginal CST were identified that associated with grade of disease. Different histologies also demonstrated variation in CST within tumor grades. Using supervised clustering algorithms, critical microbiome markers at the species level were used to build models that predicted benign vs carcinoma, high-grade carcinoma versus benign, and high-grade versus low-grade carcinoma with high accuracy. These results confirm that the vaginal microbiome segregates not just benign disease from endometrial cancer, but is predictive of histology and grade. Further characterization of these findings in large, prospective studies is needed to elucidate their potential clinical applications.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

Preoperative platelet morphology parameters as prognostic predictors for endometrial malignant carcinoma stage and progesterone receptor.

To investigate preoperative platelet morphology parameters and other whole blood cells in patients of malignant endometrial carcinoma compared with benign disease.Retrospective analysis was performed through collecting patients’ hematological parameters before performing total abdominal/vaginal hysterectomy and standard radical surgery due to benign and malignant endometrial disease between 2006 and 2017. Parameters required included white blood cell (WBC), hemoglobin, platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), and platelet thrombocytocrit (PCT). And neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. For malignant carcinoma, Ki-67 percentage and progesterone receptor (PR) status were further collected.A total of 288 patients were included with 145 benign cases and 143 malignant cases. Patients of confirmed endometrial carcinoma showed a significant lower value of PDW (55.21 ± 4.72 vs 49.54 ± 5.89, P < .001), meanwhile significant higher values of MPV (7.12 ± 1.56 vs 8.89 ± 1.67, P < .001) and PCT (24.18 ± 6.89 vs 27.93 ± 8.93, P = .003). Further analysis of endometrial carcinoma patients showed that no significant difference in platelet parameters was found between patients with stage I to II and stage III to IV (P > .05), while increased value in PDW and reduced value in MPV was found in PR negative compared with positive patients.Preoperative platelet morphology parameters seemed to be used as one kind of predictive factors to discriminate malignant and benign endometrial disease. Limited by present study design, further prospective studies are required to support this finding.

Evaluation of complete blood count parameters to predict endometrial cancer.

Complete blood count parameters have been introduced to be diagnostic biomarkers for many cancer-related diseases associated with inflammatory process. The aim of our study was to detect whether there is any relationship between benign or malignant endometrial pathologies and complete blood count parameters. Four hundred and sixteen patients with a complaint of abnormal uterine bleeding who admitted to Zeynep Kamil Women and Children's Health Training and Research hospital between 2013 and 2016 and undergoing endometrial biopsy were included in the study. The patients were evaluated in three groups as follows: endometrial carcinoma (n: 97), endometrial hyperplasia (n: 135), and healthy control (n: 184) groups. All patients had a complete blood count on the day of biopsy or within the week of the biopsy, and the presence of a relationship between complete blood count parameters and benign or malignant endometrial disease was investigated. Mean corpuscular volume measurements were found to be significantly higher in endometrial carcinoma (P=.018) and endometrial hyperplasia (P=.001) groups compared to the control group. While red cell distribution width measurements were found to be significantly lower in patients with endometrial carcinoma group compared to other groups (P<.01); the area under curve obtained for MPV is 58.7% to determine endometrial carcinoma. Mean corpuscular volume and red cell distribution width are bio-markers that we can use as the predictive marker in patients with endometrial carcinoma and which are cheap, repeatable, and readily obtainable from complete blood count panels and promising.

Recurrent Postmenopausal Bleeding: a Prospective Cohort Study

Study ObjectiveTo estimate the prevalence of genital tract diseases in women with initial and recurrent postmenopausal bleeding (PMB) to help inform diagnostic pathways. DesignProspective cohort study (Canadian Task Force classification: II-2). SettingLarge urban teaching hospital. PatientsOf 1938 consecutive women with postmenopausal bleeding, 106 (5%) were investigated for a recurrent episode after having normal findings of previous investigations. InterventionsAll women underwent pelvic examination and ultrasound scanning. An endometrial biopsy was performed when endometrial thickness was >4 mm in women with a first episode of PMB, with recourse to outpatient hysteroscopy after correlation between clinical and pathologic findings. All women with a recurrent PMB episode underwent endometrial biopsy and outpatient hysteroscopy. Measurements and Main ResultsThe risk of having endometrial cancer or hyperplasia with atypia was significantly less in women with recurrent PMB (9%) as compared with those with a first episode of PMB (8%) (p = .002), but were significantly more likely to have benign endometrial polyps (28%) compared with women with a first episode of PMB (19%) (relative risk, 1.47; 95% confidence interval, 1.07–2.02; p = .02). ConclusionRecurrent PMB results in less likelihood of premalignant and malignant endometrial disease; however, in 1 of 4 women PMB is caused by endometrial polyps. First-line investigation in women with recurrent PMB should be tests that have high accuracy for enabling diagnosis of focal diseases, such as outpatient hysteroscopy or saline infusion sonography.

Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta‐analysis

Measurement of endometrial thickness is an important tool in the assessment of women with postmenopausal bleeding, but the role of endometrial thickness measurement by ultrasound in asymptomatic women is unclear. The aims of this study were to determine: (1) the normal endometrial thickness measured by ultrasonography, (2) the prevalence of serious endometrial pathology and (3) the sensitivity and specificity of endometrial thickness measurement by transvaginal ultrasonography (TVS) for diagnosing premalignant and malignant endometrial disease in asymptomatic postmenopausal women. A MEDLINE and EMBASE search (from inception to January 2011) was performed. Articles reporting on endometrial thickness measurement in the diagnosis of endometrial carcinoma and atypical hyperplasia in asymptomatic postmenopausal women not using hormone replacement therapy (HRT) were selected. Endometrial thickness and the prevalence of endometrial (pre)malignancies were recorded. If possible, 2 × 2 tables were extracted. Thirty-two studies reporting on 11100 women were included. The estimated mean endometrial thickness was 2.9 mm (95% CI, 2.6-3.3 mm). The pooled estimated prevalences of endometrial carcinoma and atypical endometrial hyperplasia were 0.62% (95% CI, 0.42-0.82%) and 0.59% (95% CI, 0.22-0.96%), respectively. Summary estimates for sensitivity and specificity of TVS endometrial thickness measurement in the prediction of endometrial carcinoma were 0.83 (95% CI, 0.19-1.00) and 0.72 (95% CI, 0.23-0.95) for a 5-mm cut-off and 0.33 (95% CI, 0.04-0.85) and 0.94 (95% CI, 0.92-0.96) for a 6-mm cut-off. The results from this systematic review do not justify the use of endometrial thickness as a screening test for endometrial carcinoma and atypical endometrial hyperplasia in asymptomatic postmenopausal women not using HRT.

The well-being of women following total laparoscopic hysterectomy versus total abdominal hysterectomy for endometrial cancer

Total laparoscopic hysterectomies (TLH) are increasingly being used in the management of endometrial carcinoma. There is insufficient research on patient satisfaction and well-being after TLH for malignant endometrial disease. The objective of this questionnaire-based retrospective study was to compare post-operative well-being after total abdominal hysterectomy (TAH) versus TLH for endometrial carcinoma. Eighty-one women who underwent a TLH or TAH for endometrial carcinoma and atypical endometrial hyperplasia in a tertiary UK hospital were the sample of this study. Data regarding well-being and post-operative satisfaction were obtained via a self-administered questionnaire. Results were analysed. The primary outcome was health-related well-being. The length of post-operative hospital stay, satisfaction with scar, return to normal activities, severity of post-operative pain and sexual activity were secondary outcome measures. Seventy women responded (TAH n = 41; TLH n = 29). There was no difference between overall well-being between both groups. TLH group reported a shorter hospital stay (TAH = 4 days; TLH = 2 days; p = 0.000), a quicker return to normal activities with 24.4% of the TAH group taking 12 weeks or more, compared to 3.4% of the TLH group (p = 0.019) and increased satisfaction with their scars than the TAH group (‘very’ or ‘fairly satisfied’ with scar TAH 92.7%; TLH 100%; p = 0.039). This study has found that patients’ well-being after endometrial carcinoma is not significantly affected by surgical technique. This is in line with previous studies using patients with benign disease. However, laparoscopic techniques do have a reduced impact on a patient’s life through shorter hospital stays and quicker return to normal activities

Hallazgos histeroscópicos en mujeres asintomáticas con ecografía sugestiva de patología endometrial

Objective The main objective of this study was to determine the prevalence of atypical hyperplasia and endometrial adenocarcinoma detected by hysteroscopy in asymptomatic postmenopausal women with vaginal ultrasonographic findings suggestive of endometrial disease. The second aim was to ascertain the usefulness of hysteroscopy in the diagnosis of premalignant and malignant lesions in these patients. Subjects and methods We performed a descriptive study of 1,237 hysteroscopies carried out over a 7-year period (January 2000 to December 2006) in the Gynecology Department of Hospital Donostia. All the women were asymptomatic and were referred to our clinic due to an ultrasound examination suggestive of endometrial disease. Results The most frequent hysteroscopic findings were endometrial polyps (64.3%), followed by a diagnosis of normality (15.7%). A total of 1,046 endometrial biopsies were performed. In addition, 27 patients underwent hysterectomy; 14 were diagnosed with atypical hyperplasia (1.13%) and 20 with stage I endometrial adenocarcinoma (1.61%). The specificity and negative predictive value of hysteroscopy in the diagnosis of premalignant and malignant lesions were high (specificity: 97.5%, negative predictive value 99.6%, positive likelihood ratio 31.25). Conclusions The results of our study suggest that the efficiency of transvaginal ultrasound screening in asymptomatic menopausal women in the diagnosis of premalignant and malignant endometrial disease is not high. Hysteroscopy allows a reliable diagnosis in this group of women.

Saline-Infusion Sonography Endometrial Sampling Compared With Endometrial Biopsy in Diagnosing Endometrial Pathology

To evaluate prospectively whether saline-infusion sonography endometrial sampling will improve diagnosis of benign and malignant endometrial disease compared with blind endometrial biopsy in perimenopausal and postmenopausal women with abnormal uterine bleeding. After initial assessments and endometrial biopsies, women aged 40 or older with abnormal uterine bleeding were referred for transvaginal ultrasonography. Patients with abnormal endometrial evaluations were offered sonohysterography and invited to enter the saline-infusion sonography endometrial sampling study. Saline-infusion sonography endometrial sampling was performed at the end of sonohysterography using an endometrial sampling curette at the sight of the endometrial abnormality or at a representative site in the endometrial cavity if the cavity was normal. Histopathologic diagnoses of blind endometrial biopsy and saline-infusion sonography endometrial sampling were compared with final outcomes. Kappa values for the two sampling techniques were calculated for diagnostic accuracy. A total of 88 saline-infusion sonography endometrial samples were obtained; final outcomes were attained in 80 cases. When comparing saline-infusion sonography endometrial sampling with final outcomes, saline-infusion sonography endometrial sampling provided a diagnosis 89% of the time (95% confidence interval [CI] 82-95%) compared with endometrial biopsy at 52% (95% CI 42-62%). Forty-five patients with endometrial biopsies had final outcomes. When comparing endometrial biopsy with final outcomes, endometrial biopsy underestimated the incidence of pathology, especially when focal lesions and malignancy were present. This difference was statistically significant (P<.005). Saline-infusion sonography endometrial sampling is superior to endometrial biopsy in diagnosing endometrial pathology in perimenopausal and postmenopausal women with abnormal uterine bleeding. II.

Three-dimensional power Doppler ultrasound scanning for the prediction of endometrial cancer in women with postmenopausal bleeding and thickened endometrium

The purpose of this study was to evaluate the role of 3-dimensional power Doppler angiography (3D-PDA) to discriminate between benign and malignant endometrial disease in women with postmenopausal bleeding and thickened endometrium. Ninety-nine postmenopausal women (median age, 63.1 years; range, 48-84 years) with uterine bleeding and a thickened endometrium (>or= 5 mm) at baseline transvaginal sonography were assessed by 3D-PDA before endometrial biopsy. Endometrial volume, vascularity index (VI), flow index, and vascularity-flow index were calculated with the virtual organ computer-aided analysis method. Histologic diagnoses were endometrial cancer (44 cases), hyperplasia (13 cases), polyp (23 cases), cystic atrophy (14 cases), and submucous myoma (5 cases). Endometrial volume, VI, and vascularity-flow index were significantly higher in malignant vs benign conditions. Receiver operating characteristic analysis revealed that VI was the best parameter for the prediction of endometrial cancer. The findings show that 3D-PDA may be useful for the prediction of endometrial cancer in women with postmenopausal bleeding and thickened endometrium at baseline sonography.

Role of hydrosonography in prevention and screening of premalignant and malignant endometrial disease

The study emphasizes the significance of hydrosonography in prevention and early diagnostics of endometrial pathology. To express the significance of hydrosonography in relation to timely detection and treatment of premalignant and malignant endometrial disease. Our study included 104 patients referred to transvaginal sonography, after which hydrosonography was recommended in order to obtain precise visualization of the endometrium because of suspected endometrial pathology. After hydrosonography, dilatation and curettage with endometrial biopsy were performed in all patients. Biopsy specimens were histologically analyzed. The application of contrast sonography described in our research helped diagnose and timely treat as many as 30.8% of patients suffering from premalignant and malignant endometrial disease (23.2% of premalignant and 7.6% of malignant). Discomforts (bleeding and pelvic pain) occurred in 72.1% of patients, out of whom 43.3% had already undergone curettage once or more than once because of the same or similar symptoms, while 27.9% of cases presented for regular control, i.e. they were symptom free. The obtained results clearly emphasized the significance of application of contrast sonohysterography as a method for timely detection of endometrial pathology and its adequate treatment. The study shows that application of contrast sonohysterography before exploratory curettage significantly facilitates the use of invasive diagnostics and improves accuracy and validity of the obtained results, especially in cases of endometrial focal changes; consequently, it is also possible to achieve positive cost-benefit effect.

Accuracy of transvaginal ultrasound in diagnosing endometrial pathology in women with post-menopausal bleeding on tamoxifen

The incidence of endometrial pathology is increased in women with tamoxifen-induced post-menopausal bleeding (PMB). The aim of this study was to determine the accuracy of transvaginal ultrasound (TVS) in diagnosing endometrial pathology in symptomatic women taking tamoxifen, using endometrial thickness measurements (5 mm and 10 mm cut-offs) and morphological changes within the uterine cavity to define abnormality. The sensitivity of TVS was 97% (95% confidence interval (CI) 83% to 100%) and the specificity 35% (95% CI 17% to 56%) at a 5 mm threshold. The corresponding likelihood ratios for a positive test were 1.47 (95% CI 1.16-2.10) and a negative test were 0.09 (95% CI 0.02-0.53). The use of a higher 10 mm threshold, characterization of endometrial morphology or combining endometrial thickness and morphology did not improve overall accuracy. TVS measurement of endometrial thickness using a 5 mm cut-off is highly accurate in excluding endometrial disease in symptomatic women taking tamoxifen and may negate the need for further diagnostic testing in women unless symptoms recur. A positive TVS result is of little value, so further testing is mandatory in order to detect benign and malignant endometrial disease associated with tamoxifen and PMB.