Depth Of Myometrial Invasion Research Articles

Uterine Rupture in Nulliparous Woman Without Risk Factors: A Case Report and Literature Review

Objective: The aim of this study was to summarize the main features of spontaneous uterine rupture in primigravid patients before the onset of labor, emphasize the possibilities of therapeutic conduct, and offer points of reflection on the post-rupture management. Methods: We performed a literature review of all the individual case reports, retrospective case series, and reviews concerning uterine rupture in peer-reviewed journals from January 1975 to October 2021. Result: The diagnosis of uterine rupture was commonly made by abdominal pain, with or without concomitant nausea and vomiting. Uterine ruptures occur more frequently at the end of pregnancy or in the third trimester. The most frequently involved site is the uterine cornua followed by the posterior wall of the uterus. Other described cases identify the broad ligament, uterus sacral ligament, lower uterine segment, and anterior wall as possible points of rupture. The most frequently used suturing technique is the repair of the breach in two layers. Conclusion: Uterine rupture is an extremely rare obstetric emergency, correlated to life-threatening consequences for both the newborn and the woman. Considering the maternal and fetal risks, a tempestive diagnosis is mandatory.

Diagnostic Accuracy in the Detection of Depth of Myometrial Invasion with MRI in Early-Stage Endometrial Cancer

Objective: To study the diagnostic accuracy of pre-operative magnetic resonance imaging (MRI) in early-stage endometrial cancer with postoperative International Federation of Gynecology and Obstetrics (FIGO) staging after comprehensive staging surgery. Methods: Retrospectively, the medical records of 78 patients with early-stage endometrial cancer were analysed for the involvement of the myometrium with the tumour by diagnostic MRI and compared with histopathological reports after surgical staging. Results: The median age of patients was 56 years (ranging from 32 to 73). The median body mass index (BMI) of these women was 29 (ranging from 20 to 40). On histopathology, 72 women (92.3%) had type I endometroid endometrial cancer and 6 (7.7%) had type II carcinoma; four had papillary serous carcinoma, one had clear cell carcinoma and one had undifferentiated carcinoma. However, 43 (55.1%) had a grade I tumour, 12 (15.1%) had a grade II tumour and 17 (21.6%) had a grade III tumour. Further, 35 (44.8%) were staged laparoscopically, and 43 (55.1%) underwent open staging laparotomies. Pre-operative MRI radiological staging was carried out on all patients before surgery. However, 52 (66.7%) had stage IA disease, which suggested less than half of myometrial infiltration by tumour. Further, 21 (26.9%) showed more than half myometrial infiltration stage IB. One (1.2%) patient had stage IIIC1 disease with pelvic nodes of 2.5 × 2 cm near the obturator fossa; one (1.2%) patient had retroperitoneal nodes and para-aortic nodes of the largest 2 × 2 cm; three patients (3.8%) showed involvement of the endocervix with the tumour. Patients were histopathologically staged postoperatively according to the FIGO classification following complete staging surgery. Further, 46 (59%) were stage IA, 26 (33.3%) were stage IB, 3 (3.8%) showed stage II and 3 (3.8%) had stage IIIC1. The sensitivity for MRI for stage IA was 95.65% with (85% to 99.4%) 95% CI. The specificity was 75%, with 56.6% to 88.55 of the 95% CI. The positive likelihood ratio was 3.83, with a 95% confidence interval of 2.09 to 6.99. The sensitivity of MRI for stage IB was 69.23%, ranging from 48.2% to 85.6% of the 95% CI. The specificity was 94.23%, with 84% to 98% of the 95% CI. The positive likelihood ratio was 12, with a 95% confidence interval of 3.8 to 37. Conclusion: A pre-operative MRI contributes to the accurate staging of endometrial cancer to allow planning for the scale of the surgery. This is important for pre-operative counselling. The depth of myometrial infiltration aids in the planning of pelvic and para-aortic lymphadenectomy. Our study is comparable with the results of previous studies.

Diagnostic accuracy in the detection of depth of myometrial invasion with MRI in early-stage endometrial cancer

Objective: To study the diagnostic accuracy of pre-operative magnetic resonance imaging (MRI) in early-stage endometrial cancer with postoperative International Federation of Gynecology and Obstetrics (FIGO) staging after comprehensive staging surgery. Methods: Retrospectively, the medical records of 78 patients with early-stage endometrial cancer were analyzed for the involvement of the myometrium with the tumor by diagnostic MRI and compared with histopathological reports after surgical staging. Results: The median age of patients was 56 years (ranging from 32 to 73). The median body mass index (BMI) of these women was 29 (ranging from 20 to 40). On histopathology, 72 women (92.3%) had type I endometroid endometrial cancer and 6 (7.7%) had type II carcinoma; four had papillary serous carcinoma, one had clear cell carcinoma and one had undifferentiated carcinoma. However, 43 (55.1%) had a grade I tumor, 12 (15.1%) had a grade II tumor and 17 (21.6%) had a grade III tumor. Further, 35 (44.8%) were staged laparoscopically, and 43 (55.1%) underwent open staging laparotomies. Pre-operative MRI radiological staging was carried out on all patients before surgery. However, 52 (66.7%) had stage IA disease, which suggested less than half of myometrial infiltration by tumor. Further, 21 (26.9%) showed more than half myometrial infiltration stage IB. One (1.2%) patient had stage IIIC1 disease with pelvic nodes of 2.5 × 2 cm near the obturator fossa; one (1.2%) patient had retroperitoneal nodes and para-aortic nodes of the largest 2 × 2 cm; three patients (3.8%) showed involvement of the endocervix with the tumor. Patients were histopathologically staged postoperatively according to the FIGO classification following complete staging surgery. Further, 46 (59%) were stage IA, 26 (33.3%) were stage IB, 3 (3.8%) showed stage II and 3 (3.8%) had stage IIIC1. The sensitivity for MRI for stage IA was 95.65% with (85 to 99.4%) 95% CI. The specificity was 75%, with 56.6 to 88.55% of the 95% CI. The positive likelihood ratio was 3.83, with a 95% confidence interval of 2.09 to 6.99. The sensitivity of MRI for stage IB was 69.23%, ranging from 48.2 to 85.6% of the 95% CI. The specificity was 94.23%, with 84 to 98% of the 95% CI. The positive likelihood ratio was 12, with a 95% confidence interval of 3.8 to 37. Conclusion: A pre-operative MRI contributes to the accurate staging of endometrial cancer to allow planning for the scale of the surgery. This is important for pre-operative counseling. The depth of myometrial infiltration aids in the planning of pelvic and para-aortic lymphadenectomy. Our study is comparable with the results of previous studies.

Diagnostic accuracy of multiparametric MRI in endometrial cancer and its adjunctive value in identifying high-risk women requiring surgical staging

Dear Editor, Endometrial cancer is the most common gynaecological cancer in developed countries, with a five-year survival rate of 81%.1,2 Prognostic factors include the International Federation of Gynecology and Obstetrics (FIGO) stage, depth of myometrial invasion (MI), lymph node involvement, cervical stromal involvement, and histological grade. Total hysterectomy with bilateral salpingo-oophorectomy (THBSO), pelvic and para-aortic

Protein biomarkers in cervicovaginal lavages for detection of endometrial cancer

BackgroundRates of endometrial cancer (EC) are increasing. For a definitive diagnosis, women undergo various time-consuming and painful medical procedures, such as endometrial biopsy with or without hysteroscopy, and dilation and curettage, which may create a barrier to early detection and treatment, particularly for women with inadequate healthcare access. Thus, there is a need to develop robust EC diagnostics based on non- or minimally-invasive sampling. The objective of this study was to quantify a broad range of immuno-oncology proteins in cervicovaginal lavage (CVL) samples and investigate these proteins as predictive diagnostic biomarkers for EC.MethodsOne hundred ninety-two women undergoing hysterectomy for benign or malignant indications were enrolled in this cross-sectional study. Classification of women to four disease groups: benign conditions (n = 108), endometrial hyperplasia (n = 18), low-grade endometrioid carcinoma (n = 53) and other EC subtypes (n = 13) was based on histopathology of biopsy samples collected after the surgery. CVL samples were collected in the operating room during the standard-of-care hysterectomy procedure. Concentrations of 72 proteins in CVL samples were evaluated using multiplex immunoassays. Global protein profiles were assessed using principal component and hierarchical clustering analyses. The relationships between protein levels and disease groups and disease severity were determined using Spearman correlation, univariate and multivariate receiver operating characteristics, and logistic regression analyses.ResultsWomen with EC and benign conditions exhibited distinctive cervicovaginal protein profiles. Several proteins in CVL samples (e.g., an immune checkpoint protein, TIM-3, growth factors, VEGF, TGF-α, and an anti-inflammatory cytokine, IL-10) discriminated EC from benign conditions, particularly, when tested in combinations with CA19–9, CA125, eotaxin, G-CSF, IL-6, MCP-1, MDC, MCP-3 and TRAIL (sensitivity of 86.1% and specificity of 87.9%). Furthermore, specific biomarkers (e.g., TIM-3, VEGF, TGF-α, TRAIL, MCP-3, IL-15, PD-L2, SCF) associated with histopathological tumor characteristics, including histological type and grade, tumor size, presence and depth of myometrial invasion or mismatch repair protein status, implying their potential utility for disease prognosis or monitoring therapies.ConclusionsThis proof-of-principle study demonstrated that cervicovaginal sampling coupled with multiplex immunoassay technology can offer a minimally to non-invasive method for EC detection.

Expression of the Hippo Pathway Core Components in Endometrial Cancer and Its Association with Clinicopathologic Features.

The Hippo signaling pathway has a key role in tumorigenesis. This study aimed to evaluate the relationship between the expression of core components of the Hippo signaling pathway and its association with clinicopathological features in endometrial cancer. We retrospectively collected endometrioid endometrial cancer specimens from 60 patients between January 2002 and December 2009 at Gyeongsang National University Hospital. Relevant clinicopathological data were obtained through electronic medical records of patients. The expression patterns of six core components (YAP, p-YAP, LATS1/2, MST1/2, KIBRA, and Merlin) were identified by immunohistochemistry on tissue microarray sections. The positive expression ratio was 75.0% for YAP, 73.3% for p-YAP, 26.7% for MST1/2, 16.7% for KIBRA, 15.0% for Merlin, and 15.0% for LATS1/2. YAP expression was negatively correlated with MST 1/2 kinases (p = 0.045) and positively correlated with p-YAP (p = 0.012). Merlin, and MST 1/2 kinases (p = 0.043) showed a positive correlation. A subgroup of patients aged below 60 years (p = 0.004) and with myometrial invasion depth of less than 1/2 (p = 0.041) showed a positive association with YAP expression. p-YAP expression was negatively associated with a subset of patients with primary tumour size ≥4 cm (p = 0.03). Logistic regression analysis showed a significant association between age and YAP expression. The odds ratio of p-YAP expression was significantly lower in the group with tumour size ≥4 cm. Two prognostic factors, age and tumour size, were significantly associated with the expression of YAP and p-YAP in endometrial cancer. Further research should focus on their expression as a marker for prediction of clinicopathological implications in endometrial cancer.

Tissue Characteristics of Endometrial Carcinoma Analyzed by Quantitative Synthetic MRI and Diffusion-Weighted Imaging.

This study investigates the association of T1, T2, proton density (PD) and the apparent diffusion coefficient (ADC) with histopathologic features of endometrial carcinoma (EC). One hundred and nine EC patients were prospectively enrolled from August 2019 to December 2020. Synthetic magnetic resonance imaging (MRI) was acquired through one acquisition, in addition to diffusion-weighted imaging (DWI) and other conventional sequences using 1.5T MRI. T1, T2, PD derived from synthetic MRI and ADC derived from DWI were compared among different histopathologic features, namely the depth of myometrial invasion (MI), tumor grade, cervical stromal invasion (CSI) and lymphovascular invasion (LVSI) of EC by the Mann-Whitney U test. Classification models based on the significant MRI metrics were constructed with their respective receiver operating characteristic (ROC) curves, and their micro-averaged ROC was used to evaluate the overall performance of these significant MRI metrics in determining aggressive histopathologic features of EC. EC with MI had significantly lower T2, PD and ADC than those without MI (p = 0.007, 0.006 and 0.043, respectively). Grade 2-3 EC and EC with LVSI had significantly lower ADC than grade 1 EC and EC without LVSI, respectively (p = 0.005, p = 0.020). There were no differences in the MRI metrics in EC with or without CSI. Micro-averaged ROC of the three models had an area under the curve of 0.83. Synthetic MRI provided quantitative metrics to characterize EC with one single acquisition. Low T2, PD and ADC were associated with aggressive histopathologic features of EC, offering excellent performance in determining aggressive histopathologic features of EC.

Factor affecting lymph node metastasis in uterine papillary serous carcinomas: a retrospective analysis

The aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in patients with uterine serous cancer (USC) who underwent systematic staging surgery. Eighty patients who were operated on for pure uterine serous papillary carcinoma between 2008 and 2020 in our clinic were retrospectively analysed. The effects of demographic information and clinicohistopathological characteristics of the included patients on LNM were examined. The median age of the patients included in the study was 64.3 and the tumour diameter was 3.8 cm. At the time of diagnosis, 65.8% of the cases were in the advanced stage, while 34.2% were in the early stage. There was no LNM in 42 (52.5%) of the cases, only pelvic in six (7.5%), only paraaortic LNM in four (5%) patients, and both pelvic and paraaortic LNM in 24 (30%) patients. When factors that may affect LNM were evaluated with multivariate analysis, lymphovascular space invasion (LVSI) and cytology positivity were found to be independent risk factors (p < 0.05). In addition, the rate of isolated paraaortic lymph node involvement in LNM positive patients is 5%, which is 100% associated with LVSI. Impact Statement What is already known on this subject? Uterine papillary serous carcinomas (UPSC) are an uncommon and aggressive histological subtype of endometrial cancer. The high risk of recurrence and tendency to migrate into the abdomen of these tumours is not always connected with lymph node and distant organ metastasis, tumour size, LVSI positive and depth of myometrial invasion. What do the results of this study add? Most patients with UPSC are diagnosed at an advanced stage. In this study, in which 80 patients with pure serous histology were evaluated retrospectively, and LVSI and peritoneal cytology positivity were found to be two important prognostic factors for lymph node metastasis. What are the implications of these findings for clinical practice and/or further research? In this study, cytology and LVSI positivity were identified as two predictive markers for LNM, and it is seen that cytology positivity still maintains its importance in these tumours with peritoneal spread. Furthermore, patients with isolated paraaortic lymph node involvement were shown to be LVSI positive, and isolated paraaortic LNM should be investigated in patients with LVSI positivity.

The Accuracy of MRI in the Local Staging of Endometrial Cancer: An Experience From a Tertiary Care Oncology Institute in Pakistan.

Objective Our objective is to assess the diagnostic accuracy of contrast-enhanced magnetic resonance imaging (MRI) in identifying the depth of myometrial invasion and cervical stromal involvement in endometrial carcinoma (EC) along with nodal status and its correlation with surgical and histopathological (HP) findings. Materials and methods We performed a retrospective study on female patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Patients with endometrial carcinoma (CA) were searched from the electronic record system, and a total of 188 patients fulfilling the study criteria were selected. All the patients were evaluated using a 1.5T MRI and underwent a hysterectomy. The outcome of preoperative MRI was correlated withhistopathology results, keeping pathologyas the gold standard. Results A total of 188 patients were included in the study, with a mean age of 56.67 ± 12.47 years. Of the patients, 72 (38.3%)were diagnosed with stage 1a. The second common stage was1b, seen in 43 (22.9%) patients. It was found that the staging of endometrial CA on MRI and HP were significantly correlated for myometrial invasion (stage 1a and 1b), cervical stromal involvement (stage 2b), serosal and adnexal (stage 3a), vaginal(stage 3b), and nodal (stage 3c) involvement as shown by their p-values of <0.01. However, in cases of parametrial invasion (stage 3b), bladderinvolvement, and rectal involvement (stage 4), MRI showed decreased sensitivity as shown by their p-values of 0.833, 0.87, and 0.9, respectively. Conclusion Preoperative MRI can predict local disease and low-risk patients accurately, thereby helping in proper surgical planning and avoiding more extensive surgery such as lymphadenectomy in these patients.

PO32 Presentation Time: 10:30 AM: Outcomes After Adjuvant Radiation in Patients with Early-Stage Endometrial Cancer with Mismatch Repair Defects

<h3>Purpose</h3> Although mismatch repair (MMR) deficiency is commonly identified in endometrial cancers, its significance on outcomes remains unknown. Our study aims to determine if MMR status affects clinical outcomes in early-stage endometrial cancer patients treated with adjuvant radiation therapy. <h3>Methods/Materials</h3> We identified 194 patients with FIGO 2009 stage I-II endometrioid endometrial cancer who underwent surgical resection followed by adjuvant radiation therapy at our institution with available MMR status. Locoregional recurrence (LRR) and distant metastases were analyzed using competing risk methods, and overall survival (OS) and progression free survival (PFS) were analyzed using Kaplan-Meier. <h3>Results</h3> The median age was 65 years, and the median follow-up time was 38 months. There were 73 patients (37.6%) with an MMR deficiency, and 121 (62.4%) patients with intact MMR. Eleven patients (5.7%) experienced LRR, and 14 patients (7.2%) experienced distant recurrence. The median OS and PFS of the cohort was not reached and MMR status was not associated with OS or PFS. MMR deficiency was significantly associated with the grade of the tumor (17.1% of grade 1 versus 54.4% of grade 2 and 46.9% of grade 3 patients (<i>p</i><0.01)), the depth of myometrial invasion (<i>p</i><0.01), and the presence of LVSI (<i>p</i><0.01). MMR status was not associated with the type of radiation delivered. In the entire cohort, patients who received external beam radiation therapy had significantly worse PFS than patients who underwent brachytherapy (<i>p</i>=0.03). In patients whose tumors were MMR deficient, there was also a significant difference in PFS based on the type of radiation delivered. Patients who underwent external beam radiation therapy (EBRT) had shorter PFS versus patients who underwent brachytherapy only (<i>p</i>=0.02). In patients with MMR deficient tumors, there was a significant correlation between radiation type and stage; patients with stage II disease were more likely to undergo both EBRT and brachytherapy (<i>p</i><0.01). After adjusting for stage, type of radiation delivered was trending towards significance (p=0.07). Greater depth of myometrial invasion was also associated with the use of both EBRT and brachytherapy (<i>p</i>=0.03). <h3>Conclusions</h3> Patients with stage I-II endometrial cancer have excellent oncologic outcomes with the use of adjuvant radiation therapy, regardless of MMR status.

Practical MRI of Endometrial Neoplasms, Part 2: MRI and FIGO Staging

MRI is the method of choice for the evaluation of endometrial carcinomas (ECs), from detection to evaluation of recurrent disease. Although the staging of ECs is done surgically using the system of the International Federation of Gynecology and Obstetrics (FIGO), preoperative assessment based on MRI findings helps in risk stratification and decision-making. The main parameters evaluated include the degree and depth of myometrial invasion, parametrial extent, and cervical stromal infiltration. The combination of T2-weighted imaging, dynamic contrast-enhanced MRI, and diffusion-weighted imaging increases the accuracy of EC diagnosis and staging. A proposed step-by-step guide was developed to help the radiologist formulate hypotheses and guide clinical reasoning from the approach of the patient to the preparation of the final report. A structured report is also proposed with the objective of improving report quality and facilitating communication with the treating physicians.

Peculiarities of molecular-biological and hormonal tumor status in patients with endometrial cancer

Endometrial cancer (EC) ranks second in the structure of oncogynecological diseases both in Ukraine and worldwide. More than 80 % of recurrences occur in the first two years after surgical treatment. Molecular biological markers are extensively studied in different oncological diseases, because they allow to understand the etiology and pathogenesis of malignant growth more deeply. Aim. To study molecular biological markers and tumor hormonal status in patients with EC and determine their practical significance. Materials and methods. Molecular biologic markers of the tumor were studied in 89 stage I–IV EC patients. To study the hormonal status of the tumor in EC patients, 119 examinations were carried out. Results. Significant correlations were found between the level of molecular biological marker (MBM) expression, hormonal status of the tumor, the presence of disease recurrence, and the age of EC patients. The novelty of the study lay in the substantiation of treatment individualization for EC patients based on the determination of the tumor molecular biological characteristics and their prognostic value. It has been proven that the expression level of the studied MBM, ER and PR receptors in EC patients differed depending on age, presence, localization and severity of disease recurrence. A group of patients with a high risk of the disease recurrence has been revealed among EC patients. For the first time, a technology has been developed for the combined treatment of patients with I–II (T1-2N0M0) stages of EC with a negative receptor status (EP–, PR–) and a high risk of the disease recurrence to assess MBM levels (VEGF, Bcl-2, Ki-67), degree of differentiation, myometrial invasion depth and tumor localization in the uterine cavity allowing to individualize the choice of adjuvant therapy regimen, thus improving the effectiveness of treatment and preventing the occurrence of locoregional relapses and distant metastases. Conclusions. For the first time, the expression levels of the studied molecular biological markers and ER and PR receptors have been shown to differ depending on age, localization, and relapse severity, which could be used to determine the risk of relapse in EC patients.

Racial Disparities in Patients with Stage IIIC Endometrial Cancer

<h3>Purpose/Objective(s)</h3> To report the impact of race on clinical outcomes in patients with stage IIIC endometrial carcinoma (EC). <h3>Materials/Methods</h3> A retrospective multi-institutional cohort study was conducted across 13 Northern American academic centers and included patients with stage IIIC endometrial carcinoma (EC) who received both chemotherapy and radiation in an adjuvant setting. Overall survival (OS) and recurrence-free survival (RFS) were calculated by Kaplan-Meier method. Univariable and multivariable analysis were performed by Cox proportional hazard models for RFS/OS. Propensity score matching was used to estimate the effect of race on survival outcomes. Statistical analyses were conducted using statistical software. <h3>Results</h3> A total of 90 Black and 568 non-Black patients (83%) were identified with a median age at diagnosis of 62 (Interquartile Range (IQR) 55-70). Median follow-up was 45.3 months (IQR 24-71 months). Black patients were significantly older (p<0.0001), had significantly more non-endometrioid histology (p<0.0001), grade 3 tumors (p<0.0001) and were more likely to have >1 positive paraaortic lymph nodes (PALN) compared to non-black patients. The presence of lymphovascular space invasion (LVSI), depth of myometrial involvement, number of total nodes involved, adnexal and cervical involvement and stage were not correlated with race (all p>0.1). As for treatment type, chemoradiotherapy sequencing approach was not correlated with race and no difference in number of chemotherapy cycles between Black and non-Black patients (p=0.32) was observed. Black patients were more often treated with external beam radiation therapy (EBRT) (43.3% and 24%, respectively) while a higher proportion of non-black patients received both EBRT and vaginal cuff brachytherapy (VBT) (65% vs. 38 %) (P<0.0001) despite similar cervical involvement. The 5-year estimated OS and RFS rates were 45% and 47% compared to 77% and 68% for Black patients vs. non-black patients, respectively (p<0.001). After propensity score matching, the 2 groups were well balanced for most of the covariates (age, histology, stage, grade, number of positive PALN, adnexal and cervical involvement) except for depth of myometrial invasion and radiation type. The estimated hazard ratios (HRs) of Black vs. non-Black patients were 1.613 (95% CI = (1.01, 2.575), p-value = 0.045) for OS and 1.487 (95% CI = (0.906, 2.440), p-value = 0.116) for RFS, indicating that Black patients have significantly worse OS. RFS differences did not reach statistical significance. <h3>Conclusion</h3> Compared to non-Black patients, Black patients have higher rates of non-endometrioid histology, grade 3 tumors and number of PALNs. After propensity score matching, Black patients had worse OS but no statistically significant difference in RFS. Racial disparities could be mitigated by better access to care, equitable inclusion on randomized trials, and identification of genomic/molecular differences to better tailor adjuvant treatment.

Practical MRI of Endometrial Neoplasms, Part 1: Background and Imaging Protocols

MRI is the method of choice for the evaluation of endometrial carcinomas (ECs), from detection to evaluation of recurrent disease. Although the staging of ECs is done surgically using the system of the International Federation of Gynecology and Obstetrics (FIGO), preoperative assessment based on imaging findings helps in risk stratification and decision-making. The main parameters evaluated include the degree and depth of myometrial invasion, parametrial extent, and cervical stromal infiltration. The combination of T2-weighted imaging, dynamic contrast-enhanced MRI, and diffusion-weighted imaging increases the accuracy of EC diagnosis and staging.

Study on Preoperative Neutrophil/Lymphocyte (NLR) and Platelet/Lymphocyte Ratio (PLR) as a Predictive Factor in Endometrial Cancer.

To evaluate predictive factors between serum inflammatory markers and malignancy potential of endometrium. This retrospective study was conducted at the gynecological oncology unit, department of obstetrics and gynecology, at the faculty of medicine of Thammasat University. The study period was from 2017 to 2020. Endometrial cancer and benign gynecologic disease cases who underwent hysterectomy (with or without adnexectomy) during the study period were recruited. Demographic characteristics, histopathology reports and serum markers were also collected. The study included a study group of 49 participants with endometrial cancer and a control group consisting of 119 cases of benign uterine disease. The study group had statistically significantly higher mean ages, proportional menopausal status and instances of underlying diseases when compared with the control group. Neutrophil/Lymphocyte ratios (NLR) and Platelet/Lymphocyte ratios (PLR) could not meaningfully predict the malignant potential of endometrium in hysterectomy specimens. NLR and PLR were statistically associated with depth of myometrial invasion (MI) in endometrial cancer cases. NLR equal to or greater than 1.93 predicted MI more than half thickness with sensitivity, specificity, accuracy, positive (PPV) and negative predictive value (NPV) at a percentage of 83.3, 52.8, 37.0, 90.5 and 60.4, respectively. PLR equal to or greater than 134.95 predicted MI of greater than fifty percent thickness with sensitivity, specificity, accuracy, PPV and NPV at 75.0, 55.6, 36.0, 87.0 and 60.4 percent, respectively. NLR and PLR have positive associations with myometrial invasion of endometrial cancer.

Preoperative Evaluation of 3D-MRI on the Depth of Myometrial Invasion of Endometrial Carcinoma: 3D Study of Endometrial Carcinoma

Background: To evaluate the preoperative diagnostic efficacy of 3D-MRI for the depth of myometrial invasion of endometrial carcinoma. Methods: A total of 116 patients with endometrial carcinoma who had undergone pelvic MRI before surgery were included. Mimics 21.0 (Materialize Co., Belgium) software was used to reconstruct three-dimensional MRI models (3D-MRI). The tumor volume and surface area, uterine volume and surface area were measured, and the tumor volume ratio was calculated. TVR (Tumor Volume Ratio) = tumor volume/uterine volume, TAR (Tumor Area Ratio) = tumor surface area/uterine surface area. Postoperative pathology was used as the gold standard to compare the accuracy, sensitivity, specificity, negative predictive value, and positive predictive value of conventional MRI and 3D-MRI in preoperative assessment of endometrial carcinoma myometrial invasion. Results: The accuracy and specificity of 3D-MRI in the diagnosis of deep myometrial invasion were better than conventional MRI (p &lt; 0.05). There was no statistically significant difference in tumor volume or surface area between stage IA and stage IB (p &gt; 0.05), while TVR and TAR showed significant statistical differences (8.05 ± 0.66 vs. 19.12 ± 3.20, p &lt; 0.01; 21.38 ± 1.04 vs. 35.15 ± 3.42, p &lt; 0.01). Further analysis, the area under the ROC curve of TVR is 0.738, p &lt; 0.01, and the best cut-off value is 13.59%; the area under the ROC curve of TAR is 0.770, p &lt; 0.01, and the best cut-off value is 27.41%. Conclusions: Preoperative 3D-MRI can effectively assess the myometrial invasion of endometrial carcinoma.

Prognositc Significance of Microcystic Elongated and Fragmanted (MELF) Myometrial Invasion Pattern: A Retrospective Study

Objective:Endometrioid endometrial carcinomas (EEC) are the most commonly diagnosed malignancies of the female genital tract. Myometrial invasion depth is one of the most significant pathological prognostic parameters. Different morphological invasion patterns have been characterized. This study aimed to investigate the prognostic significance of the microcystic elongated and fragmented (MELF) myometrium invasion pattern in patients with EEC and its relationship with other clinicopathological parameters.Methods:This study included 101 patients with EEC in our institution between 2011 and 2020. The MELF pattern was evaluated in hematoxylineosin- stained sections. Pan-cytokeratin staining was performed on paraffin-embedded blocks of lymph nodes for cases without lymph node metastasis.Results:The MELF pattern was observed in 29 (29.8%) patients. It was significantly associated with lymphovascular invasion (p<0.001), pathologic stage (p=0.048), infiltrative pattern (p<0.001), and necrosis (p=0.005). No significant correlation was observed between the MELF pattern and overall and disease-free survival rates.Conclusions:The MELF pattern is associated with other prognostic parameters, but its prognostic significance for survival has not been found. If the MELF pattern is observed in the hysterectomy material for cases without lymph node dissection during the first surgery, these patients may need additional surgery or adjuvant therapy due to the high risk of lymphovascular invasion and lymph node metastasis.

Expression of miR-128-3p, miR-193a-3p and miR-193a-5p in endometrial cancer tissues and their relationship with clinicopathological parameters.

In order to explore the expression of microRNA-128-3p (miR-128-3p), microRNA-193a-3p (miR-193a-3p) and microRNA-193a-5p (miR-193a-5p) in the endometrial carcinoma and their relationship with clinicopathological parameters, the post-operative clinical samples of 61 endometrial cancer patients who underwent surgical resection in our hospital from February 2019 to February 2022 were collected as cancer tissues. The post-operative clinical samples of 61 normal endometrium patients who underwent surgical resection due to non-tumor diseases in our hospital were collected as para cancer tissues. miR-128-3p, miR-193a-3p and miR-193a-5p were measured by fluorescence quantitative polymerase, and the relationship between them and clinicopathological parameters and the correlation among them were analyzed. Results showed that miR-128-3p, miR-193a-3p and miR-193a-5p were lower in cancer tissues than in adjacent tissues (P<0.05). miR-128-3p, miR-193a-3p and miR-193a-5p were not related to the age and histopathological type of endometrial cancer patients (P>0.05). Still, they were related to FIGO stage, degree of differentiation, depth of myometrial invasion, lymph node metastasis and distant metastasis (P<0.05), and compared with FIGO stage I-II, medium and high differentiation, depth of myometrial invasion<1/2, no lymph node metastasis and no distant metastasis, FIGO stage III-IV, low differentiation miR-128-3p, miR-193a-3p and miR-193a-5p were lower in endometrial cancer patients with myometrial invasion depth≥1/2, lymph node metastasis and distant metastasis (P<0.05). miR-128-3p, miR-193a-3p and miR-193a-5p were the risk factors of endometrial carcinoma (P<0.05). miR-128-3p and miR-193a-3p were positively correlated (r = 0.423, P = 0.001); miR-128-3p and miR-193a-5p were positively correlated (r = 0.342, P = 0.007); miR-193a-3p and miR-193a-5p were positively correlated (r = 0.555, P = 0.001). miR-128-3p, miR-193a-3p and miR-193a-5p are low expressed in the cancer tissues of endometrial cancer patients and are related to the adverse clinicopathological parameters of patients. They are expected to become potential prognostic markers and therapeutic targets of the disease.

Prediction of endometrial cancer recurrence by using a novel machine learning algorithm: An Israeli gynecologic oncology group study

ObjectivesEndometrial cancer is the most common gynecologic malignancy in developed countries. The overall risk of recurrence is associated with traditional risk factors. MethodsMachine learning was used to predict recurrence among women who were diagnosed and treated for endometrial cancer between 2002 and 2012 at elven university-affiliated centers. The median follow-up time was 5 years.The following data were retrieved from the medical records and fed into the algorithm: age, chronic metabolic diseases, family and personal cancer history, hormone replacement therapy use, endometrial thickness, uterine polyp presence, complete blood count results, albumin, Ca-125 level, surgical staging, histology, depth of myometrial invasion, LVSI, grade, pelvic washing cytology, and adjuvant treatment.We used XGBoost algorithm, which fits the training data using decision trees, and can also rate the factors according to their influence on the prediction. Results1935 women were identified of whom 325 had recurrent disease. On the randomly picked samples, the specificity was 55% and the sensitivity was 98%. Our model showed an operating characteristic curve with AUC of 0.84. ConclusionsA machine learning algorithm presented promising ability to predict recurrence of endometrial cancer. The algorithm provides an opportunity to identify at-risk patients who may benefit from adjuvant therapy, tighter surveillance, and early intervention.

Role of MRI in pre-operative staging of endometrial cancer: A diagnostic accuracy study

Endometrial cancer (EC) is a commonly occurring cancer among post-menopausal women. Pre-treatment imaging of the extent of disease can influence the decisions in the management of EC. MRI with its diffusion weighted (DW) images can help in better depiction of the primary tumour, its local extension and extrauterine spread to the peritoneum and lymph nodes. This study was conducted to know the role of MRI for pre-operative staging of endometrial cancer and as a guide for pelvic lymph nodal dissection.It was a descriptive cross-sectional study conducted at a tertiary care hospital patients diagnosed with primary endometrial adenocarcinoma on biopsy. Patients with advanced disease requiring chemotherapy prior to surgery were excluded. Fifty consecutive patients were subjected to MRI Pelvis with abdominal screening in the week preceding definitive surgery, Findings from imaging were compared with final histopathology for concurrence on tumour size, depth of myometrial invasion, presence of adnexal, nodal and cervical stromal involvement.Majority of the patients in this study were post-menopausal women. Sensitivity of MRI for staging of Endometrial Carcinoma in this study was 91.84% and Accuracy was 90%. When compared to HPE for lymph node positivity, MRI had sensitivity of 100%, specificity of 97.87%, PPV of 75%, NPV of 100% and accuracy of 98%.Pre-operative MRI in the week prior to the planned surgery can help in accurately staging the endometrial carcinoma in terms of myometrial infiltration, cervical stromal infiltration as well as pelvic lymph nodal involvement.