Myometrial Invasion Research Articles

Advancing Uterine Cancer Care: Transvaginal Ultrasonography in Preoperative Staging Analysis

Objective: To determine the role of transvaginal ultrasonography in the preoperative staging of uterine cancer. Methods: The research included 110 women who had been diagnosed with endometrial malignancy by histological confirmation, whichwas achieved through procedures such as dilation and curettage, hysteroscopy, or endometrial biopsy. Additionally, women who had ahigh suspicion of endometrial malignancy based on imaging results and were scheduled for surgery as their main therapy were alsoeligible to participate in the study. Results: A total of 110 individuals satisfied the criteria for inclusion in the research, with an average age of 49.89 ± 2.99 years. In relation to the extent of myometrial invasion, our study yielded sensitivity rates of 81%, 81%, and 69% for the subjective, Gordon, and Karlssontechniques, respectively. The corresponding specificity rates were found to be 67%, 60%, and 81% for the same approaches. The subjective, Gordon, and Karlsson techniques yielded corresponding overall accuracies of 74%, 70%, and 75%. The use of contrast-enhanced MRI yielded a sensitivity, specificity, and overall accuracy of 94%, 72%, and 84%, respectively, in the assessment of myometrial invasion. In the assessment of cervical stromal invasion, the ultrasound subjective technique showed a sensitivity of 33% and a specificity of 99%. On the other hand, the objective method yielded a sensitivity of 52% and a specificity of 92%. The total accuracy for both methods was determined to be 90% and 83% respectively. The use of contrast-enhanced MRI yielded a sensitivity, specificity, and overall accuracy of 69%, 100%, and 96% respectively in detecting cervical involvement. Conclusion: We concluded that the utilisation of pelvic ultrasound in the preoperative staging of endometrial cancer holds significantvalue. It demonstrates a notable sensitivity in evaluating myometrial invasion, exhibiting a reasonable to moderate level of concordancewith MRI. Furthermore, it exhibits a superior, albeit still moderate, level of agreement with MRI in assessing cervical invasion.

Assessment of serum levels and placental bed tissue expression of IGF-1, bFGF, and PLGF in patients with placenta previa complicated with placenta accreta spectrum disorders.

This study aims to detect the serum levels of IGF-1, bFGF, and PLGF and their expressions in placental bed tissues of patients with placenta previa complicated with PAS disorders. This case and control study included 40 multiparous pregnant women with complete placenta previa between 34 weeks and 38 weeks of gestation and they were divided into two groups: 25 patients with PAS (case group) and 15 patients without PAS (control group). The venous blood samples were collected 2 h before the cesarean section, and the placental bed tissues were taken intraoperatively at the placental implantation site and then were histologically examined to evaluate the gravity of the myometrial invasion of the placenta. According to FIGO PAS increasing grading, the 25 patients were also divided into three groups: PAS grade I group, PAS grade II group, and PAS grade III group. The concentrations of IGF-1, bFGF, and PLGF in serum were measured using ELISA, and the mean ratio of the relative mRNA expression of each biomarker in placental bed tissues was calculated using qRT-PCR. The staining intensity and the positive cells were quantitatively measured and expressed as means by using Image J software for IHC analysis. IGF-1 had low serum levels and high placental bed expression in placenta previa patients with PAS disorders compared to those without PAS (all p < 0.0001). PLGF had high serum levels (p = 0.0200) and high placental bed expression (p < 0.0001) in placenta previa patients with PAS disorders compared to those without PAS. IGF-1 serum levels decreased up to PAS grade II (means were 24.3 ± 4.03, 21.98 ± 3.29, and 22.03 ± 7.31, respectively for PAS grade I, PAS grade II, PAS grade III groups, p = 0.0006). PLGF serum levels increased up to PAS grade II (means were 12.96 ± 2.74, 14.97 ± 2.56, and 14.89 ± 2.14, respectively for the three groups, p = 0.0392). However, IGF-1 and PLGF mRNA placental bed expression increased up to PAS grade III. The relative expression of mRNA means for the three groups was 3.194 ± 1.40, 3.509 ± 0.63, and 3.872 ± 0.70, respectively for IGF-1; and 2.784 ± 1.14, 2.810 ± 0.71, and 2.869 ± 0.48, respectively for PLGF (all p < 0.0001). Their IHC (immunohistochemical) staining also had increasing trends, but p > 0.05. bFGF was not significantly expressed in placenta previa with PAS disorders in most of the analysis sections (p > 0.05). Low serum levels and high expression in placental bed tissues of IGF-1, or high serum levels and high expression in placental bed tissues of PLGF, may differentiate placenta previa patients with FIGO PAS grade I and PAS grade II from those without PAS disorders. However, they could not significantly predict the degree of placental invasiveness in FIGO PAS grades II and III.

The Utility of Apparent Water Diffusion Coefficient Maps for Evaluating the Presence of Myometrial Invasion in Patients with Endometrial Cancer.

To assess the utility of apparent diffusion coefficient maps (ADC) for diagnosing myometrial invasion (MI) in endometrial cancer (EC). This retrospective study included 164 patients (mean age, 56 years; range, 25-89 years) who underwent preoperative MRI for EC with <1/2 MI or no MI between April 2016 and July 2023. Five sequences were evaluated: T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), ADC, dynamic contrast-enhanced T1-weighted imaging (DCE-T1WI), and contrast-enhanced T1WI (CE-T1WI). Three experienced radiologists independently assessed the sequences for MI. For ADC, MI was determined if the endometrial-myometrial junction-tumor boundary had disappeared. Additionally, the assessment of MI was performed using the combination of T2WI, DWI, and ADC, as well as T2WI, DCE-T1WI, and CE-T1WI. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) for the presence of MI were calculated and compared between the sequences and combinations. Inter-reader agreement was assessed using kappa (κ) statistics. The sensitivity of ADC was significantly higher than T2WI (P < 0.001) and DCE-T1WI (P = 0.018) for one reader and significantly higher than CE-T1WI (P = 0.045 and 0.043) for two readers. The specificity of ADC was significantly lower than T2WI (P = 0.015 and < 0.001) and CE-T1WI (P = 0.031 and 0.01) for two readers and significantly lower than DCE-T1WI (P = 0.031) for one reader. The AUC of ADC was significantly higher than T2WI (P = 0.048) and DCE-T1WI (P = 0.049) for one reader. The combination including ADC showed higher positive predictive value for all three readers compared to any sequence or combination including contrast enhancement. Additionally, ADC demonstrated the highest agreement rates. ADC had high sensitivity for MI and the highest agreement rate among all sequences. Thus, this sequence, combined with other sequences, can be crucial for a comprehensive evaluation of MI.

Prediction of final pathology depending on preoperative myometrial invasion and grade assessment in low-risk endometrial cancer patients: A Korean Gynecologic Oncology Group ancillary study.

Fertility-sparing treatment (FST) might be considered an option for reproductive patients with low-risk endometrial cancer (EC). On the other hand, the matching rates between preoperative assessment and postoperative pathology in low-risk EC patients are not high enough. We aimed to predict the postoperative pathology depending on preoperative myometrial invasion (MI) and grade in low-risk EC patients to help extend the current criteria for FST. This ancillary study (KGOG 2015S) of Korean Gynecologic Oncology Group 2015, a prospective, multicenter study included patients with no MI or MI <1/2 on preoperative MRI and endometrioid adenocarcinoma and grade 1 or 2 on endometrial biopsy. Among the eligible patients, Groups 1-4 were defined with no MI and grade 1, no MI and grade 2, MI <1/2 and grade 1, and MI <1/2 and grade 2, respectively. New prediction models using machine learning were developed. Among 251 eligible patients, Groups 1-4 included 106, 41, 74, and 30 patients, respectively. The new prediction models showed superior prediction values to those from conventional analysis. In the new prediction models, the best NPV, sensitivity, and AUC of preoperative each group to predict postoperative each group were as follows: 87.2%, 71.6%, and 0.732 (Group 1); 97.6%, 78.6%, and 0.656 (Group 2); 71.3%, 78.6% and 0.588 (Group 3); 91.8%, 64.9%, and 0.676% (Group 4). In low-risk EC patients, the prediction of postoperative pathology was ineffective, but the new prediction models provided a better prediction.

Prediction of lymph node metastasis based on tumor size in stage 1A endometrioid endometrium cancer.

Endometrium cancer (EC) is the most prevalent cancer affecting women in developed countries. There is debate about the need to perform lymphadenectomy in cases with a tumor diameter >2 cm. The aim of our study is to research the prediction of lymph node metastasis using tumor size in stage 1A endometrioid endometrium cancer (EEC). The study enrolled cases operated in the clinic due to stage 1A EEC (FIGO 2009) from December 2010-2021. The correlations of age, age interval, parity, type of operation, tumor diameter, myometrial invasion, histological grade, and lymph node metastasis were statistically analyzed. The cut-off point for tumor size was determined with the ROC curve and Youden index. The study analyzed a total of 292 cases, and the mean age of cases was 62.3±10.0 years. Of the cases, 79.5% had histological grade 1, and 20.5% had grade 2. Myometrial invasion ≤50% was detected in 69.5%, and no myometrial invasion was detected in 30.5%. The mean tumor diameter was 34.0±18.0. Lymph node metastasis was identified in 6 cases (2.1%). Based on the tumor diameter cut-off value of 35 mm, sensitivity was 100%, and specificity was 50.3%. 116 cases with tumor diameter >35 mm and 176 with diameter ≤35 mm, and grade 2 histology and lymph node positivity were found statistically significant between these groups (respectively, p=0.012 and p=0.038). The lymph node metastasis risk was 0% in cases with tumor diameter ≤35 mm, while it was 5.2% in cases with tumor diameter >35 mm. The general approach in stage 1A EEC is not to perform lymphadenectomy. However, when the tumor diameter is noted, lymphadenectomy may be considered as the lymph node metastasis risk increases in cases with a tumor diameter of 35 mm or more. There is a need for more clinical studies on this topic.

The value of dynamic contrast-enhanced MRI and diffusion-weighted sequence in the evaluation of endometrial lesions

Background/Aim: Endometrial abnormalities represent a diagnostic challenge due to overlapping imaging features with normal endometrium. Aim of this study was to assess accuracy of dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging (MRI) in evaluation of endometrial lesions in comparison with T2 and to assess local staging validity and degree of myometrial invasion in malignancy. Methods: Forty patients with abnormal vaginal bleeding or sonographic thickened endometrial were recruited. MRI examination of pelvis was per-formed using 1.5 T scanner with a pelvic array coil. Conventional T1-and T2, dynamic contrast-enhanced (DCE) sequences and diffusion-weighted image (DWI) were performed. Results: Mean age of patients was 53.2 years and 60 % of patients COM-plained of post-menopausal bleeding. Irregular margin, type III enhancement curve, a high signal in T2WI and DWI and low signal of apparent diffusion coefficient (ADC) were significantly associated with malignancy. The optimum ADC threshold value for distinguishing benign from malignant endometrial lesions was 0.905 × 10 -3 mm 2 /S, with 95.5 % sensitivity and 92.9 % specificity. DWI was most sensitive to malignant endometrial lesions, followed by DCE (89.6 %, 98.4 %) and T2 (86.7 %, 91.4 %). DWI and DCE staging correlated with FIGO staging (p = 0.0001 and p = 0.019, respectively). DWI had the best sensitivity for myometrial invasion (95.6 %), followed by DCE (91.9 %) and T2WI (90.1 %). All three sequences had 89.7 % specificity. Conclusion: DWI and DCE MRI were superior to conventional MRI at distinguishing malignant from benign endometrial lesions and can improve myometrial invasion depth evaluation and therapy planning when COM-bined with morphological T2WI. ADC cutoff at a high b value improved MRI diagnostic sensitivity and specificity.

Predictive models for lymph node metastasis in endometrial cancer: A systematic review and bibliometric analysis.

Lymph node metastasis is associated with a poorer prognosis in endometrial cancer. The objective was to synthesize and critically appraise existing predictive models for lymph node metastasis risk stratification in endometrial cancer. This study is a systematic review. We searched the Web of Science for articles reporting models predicting lymph node metastasis in endometrial cancer, with a systematic review and bibliometric analysis conducted based upon which. Risk of bias was assessed by the Prediction model Risk Of BiAS assessment Tool (PROBAST). A total of 64 articles were included in the systematic review, published between 2010 and 2023. The most common articles were "development only." Traditional clinicopathological parameters remained the mainstream in models, for example, serum tumor marker, myometrial invasion and tumor grade. Also, models based upon gene-signatures, radiomics and digital histopathological images exhibited an acceptable self-reported performance. The most frequently validated models were the Mayo criteria, which reached a negative predictive value of 97.1%-98.2%. Substantial variability and inconsistency were observed through PROBAST, indicating significant between-study heterogeneity. A further bibliometric analysis revealed a relatively weak link between authors and organizations on models predicting lymph node metastasis in endometrial cancer. A number of predictive models for lymph node metastasis in endometrial cancer have been developed. Although some exhibited promising performance as they demonstrated adequate to good discrimination, few models can currently be recommended for clinical practice due to lack of independent validation, high risk of bias and low consistency in measured predictors. Collaborations between authors, organizations and countries were weak. Model updating, external validation and collaborative research are urgently needed. None.

Evaluation of factors influencing lymph node metastasis in endometrial cancers: A retrospective study.

The role of lymphadenectomy in the management of early endometrial cancer remains controversial. The aim of our study was to evaluate risk factors associated with nodal metastases in endometrial cancer and to devise a predictive risk model based on the significant risk factors in predicting node metastasis. A retrospective study was conducted on women diagnosed with uterus-confined endometrial cancer, and who underwent surgical staging with pelvic and/or paraaortic lymphadenectomy from our center during July 1, 2017 to June 30, 2019. Clinical details, Magnetic Resonance imaging (MRI)-detected myometrial invasion, and pre and post-operative histological details of tumor were correlated with pelvic and/or para-aortic lymph node metastasis. Risk factors were assessed using logistic regression model and risk models devised. 128 patients were included in the study. Paraaortic lymphadenectomy was done in 72.7% patients. Nodal metastasis was seen in 14.8% of patients. Logistic regression analyses revealed lymphovascular invasion (P = 0.002), parametrial involvement (P = 0.017) and nonendometrioid histology (P = 0.004) to be significant risk factors. Tumor size >2 cm, grade 3 and deep myometrial invasion had higher risk for nodal metastasis, although non-significant. Risk models were derived with sensitivity of 79-89.5%, specificity of 58.7-69.7%, Negative predictive value (NPV) of 95-97% and accuracy of 63-71%. Lymphovascular invasion, nonendometrioid histology and parametrial involvement are independent predictors of lymph node metastasis in endometrial cancer. Risk models using these risk factors can better predict the risk of nodal metastasis and thus avoid lymph node dissection in low risk patients. Our risk models had reasonably good sensitivity in nodal metastasis prediction and require further validation.

A phase II trial evaluating the efficacy and safety of repeated high dose medroxyprogesterone acetate (MPA) therapy for patients with recurrent early-stage endometrial cancer or atypical endometrial hyperplasia: Japanese Gynecologic Oncology Group study (JGOG2051/KGOG2031, REMPA trial).

Fertility preserving therapy using medroxyprogesterone acetate (MPA) is an important option for young patients with endometrial cancer or atypical endometrial hyperplasia (AEH). However, the effectiveness and feasibility of repeated MPA therapy for patients with intrauterine recurrence following initial MPA therapy is controversial. Only a few single-institution retrospective studies have been conducted on repeated MPA therapy, therefore, multicenter prospective studies for repeated MPA therapy are highly needed. The aim of this study is to assess whether repeated MPA therapy is effective and feasible for patients with intrauterine recurrence following initial MPA therapy. This is a prospective, single-arm, a multicenter phase II trial on repeated MPA therapy for intrauterine recurrence following fertility-preserving therapy for AEH or stage IA (the International Federation of Gynecology and Obstetrics [FIGO] 2008) non-myoinvasive endometrioid carcinoma grade 1. Patients are treated with oral MPA (500-600 mg/day). Pathologically assessment via dilation and curettage will be performed every 2 months until complete response. The major inclusion criteria are 1) intrauterine recurrence of AEH or stage IA (FIGO 2008) endometrioid carcinoma grade 1 without myometrial invasion or extrauterine spread confirmed by imaging tests after complete remission with the previous MPA therapy. 2) The number of recurrences should be up to twice. 3) histologically diagnosed as AEH or endometrioid carcinoma grade 1, 4) 20-42 years of age, and 5) strong desire and consent for fertility-sparing treatment. The primary endpoint is 2-year recurrence-free survival rate. A total of 115 patients will be enrolled from multiple institutions in Japan and Korea within 4 years and followed up for 2 years. Japan Registry of Clinical Trials Identifier: jRCTs031200256.

The prognostic value of co-expression of stemness markers CD44 and CD133 in endometrial cancer.

The purpose of this study was to investigate the correlation between stemness markers (CD44 and CD133) and clinical pathological features, and to further explore the prognostic value of co-expression of CD44 & CD133 in endometrial cancer (EC). Clinical data of stage I-III EC patients who underwent initial surgical treatment at two large tertiary medical centers from 2015 to 2020 were retrospectively collected. Cohen's kappa coefficient was used to show the consistency of the expression between CD44 and CD133. The correlation between co-expression of CD44 & CD133 and prognosis of EC patients was explored using univariate and multivariate Cox regression analysis. Then, the prognosis models for early-stage (stage I-II) EC patients were constructed. Finally, stratified analysis was performed for EC patients in high-intermediate-risk and high-risk groups, Kaplan-Meier analysis was used to compare the survival differences between patients with and without adjuvant therapy in different co-expression states (low expression, mixed expression, high expression) of CD44 & CD133. A total of 1168 EC patients were included in this study. The consistency of the expression between CD44 and CD133 was 70.5%, the kappa coefficient was 0.384. High expression of CD44 & CD133 was associated with early FIGO stage (P=0.017), superficial myometrial invasion (P=0.017), and negative lymphatic vessel space invasion (P=0.017). Cox regression analysis showed that the co-expression of CD44 & CD133 was significantly correlated with the prognosis of early-stage (stage I-II) patients (P=0.001 for recurrence and P=0.005 for death). Based on this, the nomogram models were successfully constructed to predict the prognosis of early-stage EC patients. Meanwhile, Kaplan-Meier analysis showed that patients with adjuvant therapy had a better overall prognosis than those without adjuvant therapy in high-intermediate-risk and high-risk groups. However, there was no statistically significant difference in survival between patients with and without adjuvant therapy in high expression of CD44 & CD133 group (P=0.681 for recurrence, P=0.621 for death). High expression of CD44 & CD133 was closely related to the adverse prognosis of early-stage EC patients. Meanwhile, patients with high expression of CD44 & CD133 may not be able to achieve significant survival benefits from adjuvant therapy.

ARID1 and BRG1 Expression in Endometrial Cancer.

Endometrial cancer (EC) is the predominant malignancy among gynecologic cancers and ranks fourth among all types of cancer. Recently, researchers have focused on the development of new prognostic biomarkers. Subunits of the SWI/SNF protein complex, like the ARID1 and BRG1, have been associated with the development of endometrial cancer. The present study aimed to evaluate the expression patterns of ARID1A and BRG1 in a collection of endometrioid adenocarcinomas of the uterus using immunohistochemistry. The study comprised a total of thirty-three individuals diagnosed with stage I endometrioid endometrial cancer, treated with radical hysterectomy. The histological material was then examined to assess the cytoplasmic and nuclear expression of the proteins. ARID1A exhibited expression in both the cytoplasm and nucleus of cancer cells, whereas BRG1 was mainly expressed in the nuclei. In addition, ARID1A exhibited a notable decrease in expression in grade 3 histology, with no significant correlation with the depth of myometrial invasion. The reduced expression was highly related to tumor expansion into the endocervix. The findings demonstrated a total absence of ARID1A expression in 27% of endometrioid carcinomas, with a significant reduction in expression in an additional 51% of cancer cells. These findings align with the most recent published data. In contrast, in the current study, BRG1 was rarely down-regulated and was extensively expressed in the majority of endometrioid carcinomas, preventing the possibility of statistical analysis. In summary, ARID1A expression loss can be used as a biomarker to guide post-operative therapy; however, further investigation is needed, especially for early-stage endometrial cancer.

Multiparametric MRI radiomics for predicting disease-free survival and high-risk histopathological features for tumor recurrence in endometrial cancer.

Current preoperative imaging is insufficient to predict survival and tumor recurrence in endometrial cancer (EC), necessitating invasive procedures for risk stratification. To establish a multiparametric MRI radiomics model for predicting disease-free survival (DFS) and high-risk histopathologic features in EC. This retrospective study included 71 patients with histopathology-proven EC and preoperative MRI over a 10-year period. Clinicopathology data were extracted from health records. Manual MRI segmentation was performed on T2-weighted (T2W), apparent diffusion coefficient (ADC) maps and dynamic contrast-enhanced T1-weighted images (DCE T1WI). Radiomic feature (RF) extraction was performed with PyRadiomics. Associations between RF and histopathologic features were assessed using logistic regression. Associations between DFS and RF or clinicopathologic features were assessed using the Cox proportional hazards model. All RF with univariate analysis p-value < 0.2 were included in elastic net analysis to build radiomic signatures. The 3-year DFS rate was 68% (95% CI = 57%-80%). There were no significant clinicopathologic predictors for DFS, whilst the radiomics signature was a strong predictor of DFS (p<0.001, HR 3.62, 95% CI 1.94, 6.75). From 107 RF extracted, significant predictive elastic net radiomic signatures were established for deep myometrial invasion (p=0.0097, OR 4.81, 95% CI 1.46, 15.79), hysterectomy grade (p=0.002, OR 5.12, 95% CI 1.82, 14.45), hysterectomy histology (p=0.0061, OR 18.25, 95% CI 2.29,145.24) and lymphovascular space invasion (p<0.001, OR 5.45, 95% CI 2.07, 14.36). Multiparametric MRI radiomics has the potential to create a non-invasive a priori approach to predicting DFS and high-risk histopathologic features in EC.

The diagnostic and prognostic significance of L1 cell adhesion molecule, Sperm-associated antigen 9 and P53 expression in endometrial lesions (immunohistochemical study)

Background Endometrial carcinoma is the most common invasive neoplasm of the female reproductive tract. L1 cell adhesion molecule (L1CAM), Sperm-associated antigen 9 (SPAG9), and P53 have a role in the process of tumorigenesis and progression of several human malignant tumors, however, the role of them in cancer of endometrium is still not clear. Aim The study was performed to evaluate L1CAM, SPAG9, and P53 expression about different clinicopathological parameters in endometrial endometrioid adenocarcinoma. Methods The immunohistochemical study was performed on 50 cases of endometrial lesions including endometrial hyperplasia without atypia (10 cases), endometrial hyperplasia with atypia (10 cases), and endometrial endometrioid carcinoma (30 cases). Immunohistochemical staining techniques were used to evaluate the role of L1CAM, P53, and SPAG9 in endometrial endometrioid adenocarcinoma (EEC) and their relation to different clinicopathological data and patient’s survival followed for 36 months. Results This study declared that both L1CAM and SPAG9 were found to be upregulated in EEC. Their over-expression was related to adverse clinicopathological parameters including high tumor grade, deep myometrial invasion, lymphovascular Invasion (LVI), and advanced tumor stage, while there was no significant relation between their expression and tumor size, cervical affection, and lymph node involvement. A high statistically significant link between L1CAM expression and poor patient survival was detected. Mutant type P53 was significantly related to adverse clinicopathological data as high tumor grade, deep myometrial invasion, lymphovascular space invasion (LVSI), and high tumor stage. There was a positive significant relation between mutant type P53 and high SPAG9. Conclusions The early identification of EEC in asymptomatic high-risk women may benefit from L1CAM and SPAG9 testing in combination with P53 protein. Also, they could be viewed as separate predictive variables in the EEC and might play a crucial part in the EEC’s chemoresistance.

Survival analysis of patients with rare tumors of the uterine corpus – carcinosarcoma

Background/Aim. Uterine carcinosarcoma (UCS), formerly known as malignant mixed M?llerian tumor, is a rare, aggressive malignancy of the female genital tract. The aim of this study was to analyze the most important clinical and pathohistological characteristics of UCSs on operated patients, as well as to determine which of those factors are affecting progression-free survival (PFS) and overall survival (OS) of patients. Methods. The study was conducted as a retrospective analysis of medical data documentation of patients with a diagnosis of UCS who were surgically treated at the Department of Gynecology, Clinic for Operative Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia, in 10 years? period (from the beginning of 2009 to the end of 2018). The analysis included data for a total of 31 patients. Results. Of all the examined parameters (age of the patient, clinical stage of the disease, histological grade, depth of myometrial invasion, and lymphovascular invasion ? LVI), the greatest influence on the choice of therapeutic procedure had a histological tumor grade. Conclusion. Our research showed the joint influence of the examined clinical and pathohistological factors on PFS and OS of patients with UCS. The only independent parameter that showed a statistically significant impact on survival is LVI.

Correlation of prognostic factors and degree of myometrial invasion in endometrial carcinoma: prospective cohort study

Correlation of prognostic factors and degree of myometrial invasion in endometrial carcinoma: prospective cohort study

Comparison of the diagnostic efficacy of DWI and DCE-MRI in depth of myometrial invasion, cervical invasion and FIGO staging in patients with endometrial cancer

Comparison of the diagnostic efficacy of DWI and DCE-MRI in depth of myometrial invasion, cervical invasion and FIGO staging in patients with endometrial cancer

Artificial Intelligence and Radiomics for Endometrial Cancer MRI: Exploring the Whats, Whys and Hows.

Endometrial cancer (EC) is intricately linked to obesity and diabetes, which are widespread risk factors. Medical imaging, especially magnetic resonance imaging (MRI), plays a major role in EC assessment, particularly for disease staging. However, the diagnostic performance of MRI exhibits variability in the detection of clinically relevant prognostic factors (e.g., deep myometrial invasion and metastatic lymph nodes assessment). To address these challenges and enhance the value of MRI, radiomics and artificial intelligence (AI) algorithms emerge as promising tools with a potential to impact EC risk assessment, treatment planning, and prognosis prediction. These advanced post-processing techniques allow us to quantitatively analyse medical images, providing novel insights into cancer characteristics beyond conventional qualitative image evaluation. However, despite the growing interest and research efforts, the integration of radiomics and AI to EC management is still far from clinical practice and represents a possible perspective rather than an actual reality. This review focuses on the state of radiomics and AI in EC MRI, emphasizing risk stratification and prognostic factor prediction, aiming to illuminate potential advancements and address existing challenges in the field.

Investigation of the Role of Preoperative Serum CA 125 Levels in Determining the Necessity of Lymphadenectomy in Cases Diagnosed with Endometrium Cancer: A Retrospective Study

Objective: The aim of this study is to investigate the relationship between preoperative serum CA 125 levels and clinicopathological parameters in patients operated for endometrial carcinoma (EC) and to reveal the effectiveness of preoperative serum CA 125 levels in determining the necessity of lymphadenectomy. Materials and Methods: The study included retrospective data of 88 patients who underwent surgery due to EC. The relationship between the patients' preoperative serum tumor marker CA-125 levels and tumor grade, stage, histological type, lymph node positivity was evaluated statistically. The statistical significance of CA-125 levels in determining the need for lymph node dissection was analyzed. Results: When the preoperative diagnostic methods of the cases were evaluated according to their surgical stage; the mean CA 125 value was 31.21±35.54 (4.4-150.3) IU/ml in early stage (Stage I-II) patients and 349.13±497.34 (19.5-1566) IU/ml in advanced stage (Stage III-IV) patients (p=0.001). Considering the depth of myometrial invasion and preoperative CA 125 values, the mean preoperative CA 125 values were 21.43±20.06 (4.4-44.1) IU/ml in cases with myometrial invasion less than 1/2, while this value was 141.03±329.47 (6.8-1566) IU/ml in cases with more than 1/2 and the difference between the groups was found to be statistically significant (p=0.025). CA 125 levels of cases with positive lymph nodes were statistically significantly higher than CA 125 levels of cases with negative lymph nodes (p&lt;0.05). While the CA 125 level was 35 IU/ml and above in all cases with positive lymph nodes, the CA 125 level was 35 IU/ml and above in 30.2% of the cases with negative lymph nodes (p&lt;0.05). Conclusions: The results we obtained in this study support the association of increased preoperative CA 125 levels with lymph node positivity, advanced stage and myometrial involvement above ½ in cases with EC.

Exploring the significance of tumor volume in endometrial cancer: Clinical pathological features, prognosis, and adjuvant therapies.

To assist clinicians in formulating treatment strategies for endometrial cancer (EC), this retrospective study explores the relationship between tumor volume and clinical pathological features, as well as prognosis, in patients undergoing staging surgery. Preoperative pelvic MRI examinations were conducted on 234 histologically confirmed EC patients. The ITK-SNAP software was employed to manually delineate the region of interest in the MRI images and calculate the tumor volume (MRI-TV). The analysis focused on investigating the relationship between MRI-TV and the clinical pathological features and prognosis of EC patients. Larger MRI-TV was found to be associated with various adverse prognostic factors (G3, deep myometrial invasion, cervical stromal invasion, lymphovascular space invasion, lymph node metastasis, advanced international federation of gynecology and obstetrics staging, and receipt of adjuvant therapy). The receiver operating characteristic curve indicated that MRI-TV ≥ 8 cm3 predicted deep myometrial invasion, and MRI-TV ≥ 12 cm3 predicted lymph node metastasis. Penalized spline (P-spline) regression analysis identified 14 cm3 of MRI-TV as the optimal prognostic cutoff value. MRI-TV ≥ 14 cm3 was an independent prognostic factor for overall survival and disease-free survival. For patients with MRI-TV ≥ 14 cm3, the disease-free survival rate with adjuvant therapy was superior to that of the sole staging surgery group. This study demonstrates a significant correlation between MRI-TV and clinical pathological features and prognosis in EC. For patients with MRI-TV ≥ 14 cm3, staging surgery followed by adjuvant therapy was superior to sole staging surgery.

FcRn Expression in Endometrial Cancer and Its Association with Clinicopathologic Features.

Endometrial cancer (EC) has robust molecular diagnostic evidence that correlates well with prognosis. In various types of cancers, FcRn has been identified as an early marker for prognosis. This study aims to assess FcRn expression and its association with clinicopathological features in endometrial cancer. We employed a tissue microarray (TMA) from a retrospective cohort of 41 patients diagnosed with endometrioid endometrial cancer post hysterectomy between January 2002 and December 2009 at Gyeongsang National University Hospital. Relevant clinical data collection for the cohort involved reviewing patients' electronic medical charts. FcRn expression in microarrays of patient EC tissue was examined in conjunction with clinicopathologic data. Experiments, including siRNA knock-down, PCR mRNA semiquantification, Western blot, and confluence change tests, were conducted on the Ishikawa cell line. The overall FcRn expression rate in EC patients was 41.8%. FIGO stage showed a statistically significant relationship with FcRn expression, while age, lymphovascular invasion, myometrial invasion, and tumor size had no effect. In endometrioid cancer cells of FIGO stage IA, FcRn was less frequently expressed than in other high-staged EC patients (p = 0.021). In experiments on the Ishikawa cell line, the siRNA knock-down group exhibited quantitatively lower FCGRT mRNA expression and lower FcRn protein signal compared to the scrambled RNA control group. The change in confluence over time measured at three hotspots did not show a significant difference between groups. To the best of our knowledge, this study represents the initial assessment of FcRn expression in endometrioid EC samples. FcRn expression was significantly associated with the FIGO stage. Ishikawa cell line proliferation did not significantly change in response to decreased FcRn expression. Further studies are needed to elucidate FcRn expression in EC as a potential molecular parameter.