Rates Of Endometrial Cancer Research Articles

Management of Asymptomatic Postmenopausal Women Referred to Outpatient Hysteroscopy Service with Incidental Finding of Thickened Endometrium – A UK District General Hospital Experience

The objective of this study was to review the management and outcome of asymptomatic postmenopausal women with increased endometrial thickness as there is lack of robust guidance for the same. Retrospective case series over a period of 2 years. District general hospital. Eighty-three. No prospective interventions were done. Only a review of the interventions done in an outpatient setting, namely, hysteroscopy and endometrial sampling, was carried out. Retrospective review of 1453 referrals to outpatient hysteroscopy service over a period of 2 years was carried out, and 83 patients referred with asymptomatic thickened endometrium on imaging were identified. Patients underwent hysteroscopy on the basis of the local policy, that is, if the endometrial thickness was more than 10 mm or in the presence of additional risk factors. The yield rate of endometrial cancer and atypical hyperplasia was 1.2% and 2.4%, respectively, among all patients (n = 83). The yield rate of endometrial cancer and atypical hyperplasia was 1.81% and 3.63%, respectively, among patients referred with endometrial thickness ≤10 mm after considering other risk factors. It is reasonable to use endometrial thickness of 10 mm or above as a cutoff threshold to offer endometrial biopsy or outpatient hysteroscopy for asymptomatic postmenopausal women. For asymptomatic women with endometrial thickness between 4 and 10 mm, decisions about further investigations should be made on a case-by-case basis, taking into account any risk factors for endometrial pathology. As this study had a reasonably good sample size, it can contribute toward formulation of robust guidance for management of postmenopausal women with asymptomatic endometrial thickening.

Abstract PD12-07: Incidences of endometrial events and frequencies of endometrial invasive diagnostic procedures in breast cancer survivors on tamoxifen: A nationwide study

Abstract BackgroundBreast cancer survivors who taking tamoxifen as adjuvant therapy have been reported to have more endometrial lesions. According to guidelines, a gynecological assessment is recommended for postmenopausal women, but there is no mention of premenopausal women. The purpose of this study is to compare the risk of endometrial cancer by age at diagnosis, and to investigate frequencies of gynecological exam in breast cancer patients taking tamoxifen in South Korea. MethodsA nationwide retrospective cohort study was conducted using South Korea Health Insurance Review and Assessment Service claims data. Between 2010 and 2015, a total of 60,545 (mean follow-up, 66.0 months) newly diagnosed female breast cancer survivors were included. Endometrial evaluation and Dilatation & Curettage (D&C) proportion were analyzed by age at diagnosis. The incidence of endometrial cancer and benign lesions were calculated as incident cases per person-year and analyzed with the Kaplan-Meier method. ResultsThe 26,374 patients who taking tamoxifen were divided into four groups by age at diagnosis. The incidence rate of endometrial cancer per 1,000 person-years was 1.13 and 1.45 for age range 50-59 and over 60 and 0.62 and 0.82 for in age under 40 and range 40-49. However, D&C proportion did not all differ from 10 to 11% in each subgroup. ConclusionsThis nationwide cohort study showed that the risk of endometrial cancer in premenopausal breast cancer women taking tamoxifen was lower than that of postmenopausal women. However, the invasive diagnostic procedure such as aspiration, biopsy, polypectomy and D&C was proceeding at a level that makes no difference with those in postmenopausal women. Citation Format: Soojeong Choi, Jae ho Jeong, Jinhong Jung, Young Jae Lee, Jong Won Lee, Beom Seok Ko, Byung Ho Son, Sei Hyun Ahn, Yura Lee, Hee jeong Kim, Il Yong Chung. Incidences of endometrial events and frequencies of endometrial invasive diagnostic procedures in breast cancer survivors on tamoxifen: A nationwide study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-07.

Variations in incidence and mortality rates of endometrial cancer at the global, regional, and national levels, 1990–2019

BackgroundEndometrial cancer (EC) is a commonly diagnosed cancer in women. A comprehensive knowledge of its epidemiological features is essential for understanding the disease burden and guiding prevention strategies. MethodsWe retrieved the incidence and mortality data of EC from the Global Burden of Disease database. Estimated average percentage change (EAPC) was used to quantify the trends of the age-standardized incidence and mortality rates (ASIR and ASMR, respectively) of EC from 1990 to 2019. ResultsGlobally, the ASIR of EC significantly increased by 0.69% (95% confidence interval [CI] 0.57–0.81%) per year between 1990 and 2019. This increasing trend was also observed in 160 countries or territories, regardless of the sociodemographic status. The most pronounced increase was found in Italy (EAPC = 4.81, 95% CI, 4.10–5.53), followed by Saudi Arabia and Singapore. Between 1990 and 2019, the ASMR of EC decreased significantly worldwide (EAPC = −0.85, 95% CI, −0.93 to −0.76) but increased significantly in 91 countries or territories, with the highest increase in Lesotho (EAPC = 3.27, 95% CI, 2.81–3.74). The ASMR–ASIR ratio of EC was higher in developing countries than in developed countries. This ratio showed a decreasing trend at the national level over the past three decades. ConclusionsEC incidence has ubiquitously increased worldwide. EC mortality has decreased at the global level but increased in many countries. More efforts are required to alleviate the disease burden of EC.

Abstract PO030: Understanding the influence of adiposity on the endometrium using human primary endometrial organoids

Abstract Endometrial cancer is the most commonly diagnosed type of gynecological cancer, and obesity is a major risk factor for this disease. Despite rising rates of obesity and endometrial cancer, it is still unclear how obesity alters the benign endometrium and the endometrial hormonal response to promote carcinogenesis. We used an endometrial organoid model to investigate how adiposity predisposes women to develop endometrial cancer. We hypothesized that increased adiposity would directly alter endometrial gene expression and diminish the protective progesterone response of the benign endometrium. Scaffold-free, three-dimensional endometrial organoids consisting of both epithelial and stromal cells from benign endometrial tissue were generated. Organoids were cocultured with different numbers of adipocyte spheroids to represent different levels of adiposity and were treated with a menstrual cycle level of hormones (E2 + P4 +T) over 14 days. Endometrial organoid gene expression was investigated using RNA-seq. Coculturing endometrial organoids with 30 adipocyte spheroids in the presence of E2, P4, and T caused significant differential expression of pathways involved in metabolism, angiogenesis, chromatin modification, and metal ion response, compared to endometrial organoids cultured without adipocyte spheroids. We investigated the metal ion response pathways that were altered and found that many of the most significantly differentially regulated genes in the metal ion response pathways belonged to the metallothionein (MT) family of genes. The expression of MT1A, MT1M, MT1X, and MT2A decreased approximately 50% in endometrial organoids cocultured with 30 adipocyte spheroids. Furthermore, although the results were not statistically significant, we observed a downregulation of the progesterone-responsive genes HSD17B2, IGFBP1, PAEP, PRL, FOXO1, and SPP1 in the endometrial organoids cultured with 30 adipocyte spheroids. Our results show that culturing endometrial organoids in conditions of increased adiposity alters endometrial gene expression and may change the way the endometrium responds to progesterone. Metallothioneins, which are downregulated in the presence of adipocyte spheroids, are important modulators of zinc and copper ions and reactive oxygen species in the cell. Progesterone plays an important protective role against endometrial cancer. In summary, our data show that adipocytes may influence the progesterone response of the benign endometrium. Further investigation into the role of progesterone-driven metallothioneins in the endometrium is currently underway. Citation Format: Alina R. Murphy, J. Julie Kim. Understanding the influence of adiposity on the endometrium using human primary endometrial organoids [abstract]. In: Proceedings of the AACR Virtual Special Conference: Endometrial Cancer: New Biology Driving Research and Treatment; 2020 Nov 9-10. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(3_Suppl):Abstract nr PO030.

Efficacy of Endometrial Cancer Follow-up Protocols: Time to Change?

The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy. Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014. Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serum marker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse. Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.

Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps.

To estimate the risk of concurrent endometrial cancer in endometrium when endometrial intraepithelial neoplasia (EIN) is found within an endometrial polyp and to identify the possible predictive factors for concurrent endometrial cancer. Histopathologic data of women who underwent hysteroscopy for resection of endometrial polyps at Ankara Baskent University Hospital, between 2011 and 2019 were screened. Patients whose polypectomy report was EIN in a polyp, and who had a final report of the hysterectomy specimen were included. Patients were divided into two groups according to the presence of concurrent cancer in the hysterectomy material: group 1, concurrent cancer present and group 2, concurrent cancer absent. Statistical analyses were performed using SPSS. A total of 4125 women underwent hysteroscopy for the resection of endometrial polyps. Of those women, 161 (3.9%) were diagnosed as having EIN and 115 met the criteria. The rate of concurrent endometrial cancer was 28.6% (33/115). According to multivariate analysis, nulliparity (odds ratio [OR] 0.38; 95% confidence interval [CI] 1.04-3.67; p=0.036) and postmenopausal status (OR 0.64; 95% CI 0.42-0.98; p=0.042) were found to be independent factors significantly associated with concurrent endometrial cancer. The incidence of concurrent cancer is higher in postmenopausal or nulliparous women when EIN is detected in a polyp.

Population-Based Screening for Endometrial Cancer: Human vs. Machine Intelligence.

Incidence and mortality rates of endometrial cancer are increasing, leading to increased interest in endometrial cancer risk prediction and stratification to help in screening and prevention. Previous risk models have had moderate success with the area under the curve (AUC) ranging from 0.68 to 0.77. Here we demonstrate a population-based machine learning model for endometrial cancer screening that achieves a testing AUC of 0.96.We train seven machine learning algorithms based solely on personal health data, without any genomic, imaging, biomarkers, or invasive procedures. The data come from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). We further compare our machine learning model with 15 gynecologic oncologists and primary care physicians in the stratification of endometrial cancer risk for 100 women.We find a random forest model that achieves a testing AUC of 0.96 and a neural network model that achieves a testing AUC of 0.91. We test both models in risk stratification against 15 practicing physicians. Our random forest model is 2.5 times better at identifying above-average risk women with a 2-fold reduction in the false positive rate. Our neural network model is 2 times better at identifying above-average risk women with a 3-fold reduction in the false positive rate.Our machine learning models provide a non-invasive and cost-effective way to identify high-risk sub-populations who may benefit from early screening of endometrial cancer, prior to disease onset. Through statistical biopsy of personal health data, we have identified a new and effective approach for early cancer detection and prevention for individual patients.

Bioinformatics Identification of the Expression and Clinical Significance of E2F Family in Endometrial Cancer.

BackgroundBesides being one of the most prevalent cancers among women, incidence and mortality rates of endometrial cancer (EC) are still increasing. The E2F family of transcriptional factors is involved in cell differentiation, apoptosis, and inhibition of DNA damage response, thus affecting growth and invasion of tumor cells.MethodsWe used multiple bioinformatics tools to explore the role of E2F family in endometrial cancer.ResultsThe expression of E2F1/2/3/7/8 was significantly upregulated in endometrial cancer tissues, converse to E2F4, which was downregulated. Methylation downregulates all E2Fs except for E2F2. Accordingly, E2F1/2/3/5/7/8 are potential diagnostic biomarkers for EC. In particular, EC patients displaying upregulated E2F1, and E2F3 expression had a worse overall survival and relapse-free survival. E2F8, E2F7, and E2F1 were the top three, most-frequently altered genes in endometrial cancer. E2F family activates apoptosis pathways, regulates cell cycle, and impairs DNA damage response pathways. Drug-sensitivity analysis demonstrated that the level of E2F2/3/8 negatively correlated with drug resistance. Meanwhile, immune infiltrations analysis revealed that E2F family is associated with recruitment of several immune cells. Enrichment analysis on its part revealed that the E2F family is mainly associated with cell cycle, sequence-specific DNA binding, nuclear transcription factor complex, PI3K-Akt signaling, and p53 signaling pathway. We also identified multiple E2Fs-associated miRNA and kinase targets in endometrial cancer.ConclusionOur study revealed the unique expression signature and clinical significance of E2F family in EC, demonstrating the potential clinical utility of these transcription factors (TF) in endometrial cancer.

Prevalence of endometrial cancer symptoms among overweight and obese women presenting to a multidisciplinary weight management center

Endometrial cancer rates are rising in parallel with the obesity epidemic. We aimed to determine the prevalence of endometrial hyperplasia or cancer (EH/EC) bleeding symptoms among at-risk women. We conducted a retrospective cohort study of overweight and obese women at a multidisciplinary weight management center who had completed a gynecologic/menstrual history questionnaire from May 2018 to October 2019. The primary outcome of any EH/EC symptom was defined as follows: in premenopausal women, any recent abnormal uterine bleeding (AUB); in postmenopausal women: any bleeding/discharge. The prevalence of EH/EC symptoms was compared by menopausal status using Fisher’s exact tests, and multivariable regression identified independent factors associated with having EH/EC symptoms. A total of 103 women were included, and 4 (4%) had a history of EH/EC. Of the 84 (n = 82%) of women with no prior hysterectomy, 57% (n = 33/58) of premenopausal women reported any EH/EC symptom compared to 15% (n = 15/26) of postmenopausal women (p < 0.001). Two-thirds of symptomatic premenopausal women had two or more symptoms, most commonly heavy menses (49% (n = 25/51)) and irregular periods (39% (n = 17/44)). Sixty percent (n = 20/33) had discussed these with a gynecologist, and one third had undergone an endometrial biopsy. A history of polycystic ovarian syndrome (RR:1.72, 95% CI 1.24–2.38) was associated with EH/EC symptoms, while being postmenopausal was not (RR:0.32, 95%CI: 0.12–0.87). We demonstrate that EH/EC bleeding symptoms are prevalent in this at-risk population, but frequently are not discussed with gynecologists. Providers who care for obese women should ask about EH/EC symptoms, and provide prompt referrals to facilitate prevention and early detection of this cancer.

BRCA1 and BRCA2 pathogenic variant carriers and endometrial cancer risk: A cohort study

BackgroundAn association between BRCA pathogenic variants and an increased endometrial cancer risk, specifically serous-like endometrial cancer, has been postulated but remains unproven, particularly for BRCA2 carriers. Mechanistic evidence is lacking, and any link may be related to tamoxifen exposure or testing bias. Hysterectomy during risk-reducing bilateral salpingo-oophorectomy is, therefore, of uncertain benefit. Data from a large, prospective cohort will be informative. MethodsData on UK BRCA pathogenic variant carriers were interrogated for endometrial cancer diagnoses. Standardised incidence ratios (SIRs) were calculated in four distinct cohorts using national endometrial cancer rates; either from 1/1/1980 or age 20, prospectively from date of personal pathogenic variant report, date of family pathogenic variant report or date of risk-reducing salpingo-oophorectomy. Somatic BRCA sequencing of 15 serous endometrial cancers was performed to detect pathogenic variants. ResultsFourteen cases of endometrial cancer were identified in 2609 women (1350 BRCA1 and 1259 BRCA2), of which two were prospectively diagnosed. No significant increase in either overall or serous-like endometrial cancer risk was identified in any of the cohorts examined (SIR = 1.70, 95% confidence interval = 0.74–3.33; no cases of serous endometrial cancer diagnosed). Results were unaffected by the BRCA gene affected, previous breast cancer or tamoxifen use. No BRCA pathogenic variants were detected in any of the serous endometrial cancers tested. ConclusionsWomen with a BRCA pathogenic variant do not appear to have a significant increased risk of all-type or serous-like endometrial cancer compared with the general population. These data provide some reassurance that hysterectomy is unlikely to be of significant benefit if performed solely as a preventive measure.

Outcome and Radiotherapy Side Effects of High-Risk Endometrial Cancer

The endometrial cancer is radiosensitive. Adjuvant radiotherapy is previously said that it may improve survival rate of high-risk endometrial cancer and decrease recurrences rate. This study evaluated overall survival, disease-free survival (DFS) in high risk endometrial cancer, and postradiotherapy side effects. Analytic retrospective research using medical record was conducted. During the 2013-2018 period there were 185 patients with endometrial cancer undergoing radiotherapy. Prognostic factors for OS which are statistically significant were age, BMI, LVSI, stage, waiting time interval, and recurrence. The prognostic factor group of age >60 years significantly had OS (p = 0.04) and DFS-3 years (p = 0.03) which was better than that of the age group 9 weeks had OS 35% (p = 0.03) with OR of 3.2 (95% CI 1.1-8.8), and lower DFS-3 years (76% vs 91%; p = 0.03). Combination of radiotherapy modalities caused 61% of side effects, but statistically not significant. OS and DFS-3 years in patients >60 years old and obese were better than

Extended endocrine therapy in premenopausal breast cancer patients: Where are we now?

Approximately 25% of new breast cancers are diagnosed in premenopausal patients, 50%-70% presenting as estrogen receptor-positive (ER+) breast tumors. Five-year adjuvant endocrine therapy (ET) with Tamoxifen is the cornerstone treatment for those patients but the evidence that up to 50% of ER+breast cancer distant recurrences develop after this time has now raised some questions. ATLAS and aTTom trials are the only two studies addressing the extension of Tamoxifen beyond 5years in premenopausal patients. They showed significant DFS and OS benefits at a cost of increased rates of endometrial cancer and pulmonary embolus. Therefore, the selection of the patients at higher recurrence risk and hence deemed to get the most benefit from an extended endocrine therapy has become a major concern. Many clinical and genomic prognostic tools have shown validity in identifying patients at high late recurrence risk, but only the BCI prognostic score was shown to also be predictive of response to extended endocrine therapy. Nevertheless, all the evidence available on extended endocrine therapy in premenopausal patients was derived from trials in which patients were treated with tamoxifen alone and are hardly applicable to the current clinical scenario. In fact, the results of the SOFT and TEXT trials demonstrated the superiority of the addition of ovarian function suppression (OFS) and its association with the aromatase inhibitor (AI) Exemestane to Tamoxifen alone. However, the introduction in the clinical practice of AI+OFS-based endocrine therapy for the premenopausal patients will very soon lead to an impasse since neither data exist on extended therapy after this treatment schedule nor is there an ongoing trial intended to obtain new evidence.

RNA sequencing analysis reveals apoptosis induction by hydrogen treatment in endometrial cancer via TNF and NF-κB pathways.

BackgroundTo evaluate the activity of hydrogen in endometrial cancer and elucidate its underlying molecular mechanisms.MethodsIshikawa, HEC1A and AN3CA cells were incubated in DMEM medium with or without hydrogen. RNA sequencing was used to explore the association of hydrogen treatment with signaling pathways and functional genes in endometrial cancer cells. The apoptotic rates of the three endometrial cancer cells were evaluated by fluorescein isothiocyanate (FITC) Annexin V and Annexin V-allophycocyanin (APC)/propidium iodide double staining.ResultsRNA sequencing analysis revealed that hydrogen induced TNF/NF-κB and apoptosis pathways in endometrial cancer cells. The gene sets between hydrogen treatment groups and non-treated groups were mapped in accordance with Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) terms. Hydrogen treatment significantly increased the apoptotic rates of endometrial cancer cells.ConclusionsTaken together, our data indicate that hydrogen can serve as a therapeutic target for endometrial cancer via TNF/NF-κB pathway and apoptosis induction.

Effects of ‎tamoxifen on the reproductive system of female breast cancer patients: an ultrasound-based cohort study

Background: Tamoxifen (TMX) is regarded as standard treatment for breast cancer (BC) patients‎. In recent years, several studies have reported gynecological side effects and due to TMX's estrogenic effects. Here, we evaluate the side effects of TMX on the ‎endometrium and ovaries of female BC patients. Methods: This was an ultrasound-based cohort study conducted in three oncology centers in Baghdad, Iraq. A total of ‎‎255 female patients were included, 140 premenopausal (PreM) and 115 postmenopausal (PostM), with estrogen receptor (ER)-positive BC using TMX adjuvant hormonal treatment for at least three months after surgery and adjuvant ‎chemo/radiotherapy.‎ Ultrasound (US) on the endometrium and ovaries of the women following ‎BC surgery/chemotherapy (baseline) and at 3, 6, 12, and 24 months following was performed‎. Data collected included age, menopausal status, co-morbid chronic illness and medications, including duration of TMX treatment. Results: Presence of ovarian cyst was significantly higher in the PreM ‎compared to PostM ‎women, while there were no significant differences for other gynecological findings.‎ At ‎baseline, endometrial thickness (ET) was significantly higher in the PreM compared to the PostM women. In both groups, women with increased ET became more frequent from baseline to 3 ‎months, from 3 to 6 ‎months, from 6 to 12 months, and from 12 ‎ to 24 months. At all time periods, ‎women with increased ET was ‎significantly higher in the PostM compared PreM women, resulting ‎in a risk of ET increase by 6 folds (ranging from 3 – ‎‎11 folds) ‎in PostM compared to PreM women. Conclusions: Longer duration of TMX is associated with increased ET. Duration of TMX did not appear to increase the risk of various gynecological outcomes, for example endometrial cancer rate was low. Finally, there was an increase in ET, which appeared to be six-folds higher in PostM compared to PreM women.‎

Current and future approaches to screening for endometrial cancer.

Due largely to the rise in obesity and prolonged life expectancy, endometrial cancer (EC) rates have increased by 56% since the early 90s. Women at high risk (Lynch Syndrome) have a 12-47% lifetime risk of developing EC and professional societies recommend annual surveillance using transvaginal ultrasound (TVS) and endometrial biopsy (outpatients hysteroscopy) from the age of 30-35 years with hysterectomy from the age of 40 years. In women at low risk, screening is not currently advocated. The emerging data from Genome Wide Association studies (GWAS) in combination with epidemiological data may refine risk stratification in the future. In addition to screening, preventative approaches such as intrauterine progesterone may help reduce disease burden in those identified at 'higher risk'.

A REVIEW ON RISK FACTORS,STAGING AND SURVIVAL RATES OF ENDOMETRIAL CANCER IN BOTH BLACK AND WHITE WOMEN IN INFERTILITY PATIENTS IN USA

This article is focused mainly on risk factors,staging and survival rates of endometrial cancer in infertility patients in both black and white women in United States, These risk factors split in to two groups&nbsp; such as exogenous&amp; endogenous. Exogenous mainly (fertility treatment clomiphene, tamoxifen, human chorionic gonadotropins,human menopausal Gonadotropins&amp; Birth control pills, intra uterine devices) These factors which increases the concentrations of unopposed estrogen for a short periods of time but&nbsp; successful leads to fertility, long-term leads to endometrial cancer, and endogenous risk factors includes mainly (Poly cystic ovary syndrome, Obesity,Diabetes, and Hypertension) these risk factors in infertility women may lead to increased unopposed estrogen in the body may leads&nbsp; to development of endometrial cancer over a period of time. It is the commonest reproductive cancer. Our objective was toassess association between exogenous and endogenous risk factors, in infertility patients staging and survival rates in infertility patients which leads to an endometrial cancer .It is estimated that by 2030, endo metrialcancer will become the 6th most common cancer overall, and the 3rd most common among women. In addition, five year survival after an EC diagnosis is lower for black women when compared to white women at every stage of diagnosis. “Early detection leads to early prevention”.

Association of clinical features of polycystic ovarian syndrome with body mass index and gonadotropin hormones

Background: Diagnosing polycystic ovarian syndrome (PCOS) is utmost important to treat accurately and also to assess further complications, as PCOS has higher rates of endometrial cancer, cardiovascular disease, dyslipidemia, and type 2 diabetes mellitus. Aims and Objectives: The objectives of this study were to know the clinical features of PCOS and to know the association of PCOS with gonadotropin hormones and body mass index (BMI). Materials and Methods: A prospective study conducted on PCOS patients from January 2018 to April 2019. PCOS was diagnosed by clinical, laboratory, and radiological investigations. PCOS patients were advised to undergo gonadotropin hormones analysis. Results: About 50% of patients with oligomenorrhea, acne, hirsutism, and polycystic ovaries had luteinizing hormone/follicular-stimulating hormone (LH/FSH) ratio >2/1. Around 60% of patients with polycystic ovaries had BMI 25. Polycystic ovaries have shown signification in relation to LH/FSH >2/1 (95% confidence interval [CI] 2.05–31.09; P = 0.002), FSH ≥7 (95% CI 0.02–0.40; P = 0.001), and LH ≥10 (95% CI 0.05–0.75; P = 0.001). Conclusion: PCOS diagnosis is a multidisciplinary approach should be evaluated by clinical features, hormonal evaluation, and radiological investigations. Diagnosing polycystic ovaries by ultrasonography and hyperandrogenism are a hallmark for PCOS.

EVALUATION OF CONCURRENT ENDOMETRİAL CANCSER İN PATİENTS WİTH ENDOMETRIAL HYPERPLASIA; 10 YEARS EXPERIENCE AS A TERTİARY CENTER

ABSTRACTObjective: we aimed to determine the incidence of simultaneous endometrial cancer in patients with endometrial hyperplasia who underwent surgical treatment.Material and method: Our study was designed retrospectively.The medical data of patients who was diagnosed endometrial hyperplasia(EH) by the endometrial biopsy and accepted surgical treatment were examined and collected between 2007 - 2017 at the gynecologic oncology depertmant of Eskişehir Osmangazi University(ESOGÜ). The data of 522 patients with endometrial hyperplasia as a result of endometrial sampling were evaluated. Due to 187 patients received medical treatment, 35 patients lacked medical data and 15 patients suspected endometrial CA were excluded from the study. A total of 285 patients with endometrial hyperplasia were included in the study.Result: Of the 285 patients included in the study, 64 (22.4%) were simple hyperplasia, 31 (10.8%) were simple atypia hyperplasia, 72 (25.2%) were complex hyperplasia and 118 (41.4%) were complex atypia hyperplasia. Endometrial hyperplasia could not be detected in 84 (29.4%) patients after a final pathology. We found endometrial cancer in 36 (12.6%) patients and endometrial hyperplasia in 165 (57.8%) patients. We found 1 (1.5%) patient EC in simple hyperplasia. EC was detected in 1 (3.2%) patient in SAH. 6 patients (8.3%) had EC in CH. 28 (23.7%) EC’s were detected in patients with CAH. According to the 2014 WHO classification system ,Concurrent endometrial cancer rates were determined as AEH 19.4% and EH without atypia was 5.1%. Conclusion: Concurrent EC ratio in simple hyperplasia was 5.1% this rate was found to be 8.3 % in CH. Management of patients with endometrial hyperplasia without atypia If medical treatment is to be chosen, these rates should be considered and it is recommended to consider all risk factors for EC.

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

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

The Prognostic Value of Preoperative Serum CA125 in Endometrioid Endometrial Cancer with Cervical Stromal and Parametrial Invasion

Background: Although endometrial cancer is not ranked among the ten most common cancer types in Iran, it is the 12th most prevalent in women and the third most common cancer of the female genital tract after breast and ovarian cancer. The mortality rate of endometrial cancer in Iran is 0.6 in 100,000 persons. Several studies have evaluated the correlation of preoperative CA125 in endometrial cancer with several surgicopathologic and prognostic variables, disease recurrence, and the need for lymphadenectomy. Recent data have suggested adjuvant extrafascial hysterectomy after neoadjuvant therapy instead of the initial radical hysterectomy for locally advanced disease. Therefore, it would be helpful to use a preoperative assessment, including serum CA125 measurement to predict the extent of the disease and plan a less complicated therapy. Objectives: To evaluate the cut-off value of CA125 in parametrial and cervical stromal invasion of endometrioid endometrial cancer. Methods: A sample of 128 endometrial cancer cases, surgically staged from 2012 to 2018 in Imam Hossein Hospital were evaluated. According to the exclusion criteria, 82 cases were finally analyzed. A receiver operating characteristic (ROC) curve was used to determine the cut-off value of preoperative CA125 for parametrial and cervical stromal involvement. Results: A high preoperative CA125 level was significantly associated with advanced disease stage, cervical stromal invasion, pelvic lymph node metastases, and higher grade (P < 0.05); the test showed a marginally significant correlation for parametrial invasion, which may be due to sample size limitation (P = 0.058). However, the correlation between CA125 and myometrial/lymphovascular invasions were not statistically significant (P = 0.112 and P = 0.168, respectively). The optimal cut-off value for preoperative CA125 was 45.5 u/mL in parametrial invasion (100% sensitivity, 89% specificity, 33.3% positive predictive value, and 100% negative predictive value), and 41.9 u/mL for cervical stromal invasion (87.5% sensitivity, 87.8% specificity, 43.75% positive predictive value, and 98.48% negative predictive value). Conclusions: Primary radical surgery may not be the first treatment approach in cervical/parametrial involvement. Neoadjuvant (chemo)radiotherapy and adjuvant extrafascial hysterectomy could be an alternative approach with fewer complications. Using preoperative CA125 along with physical examination and imaging modalities would be helpful in this regard. More investigations are needed to assess an agreed cut-off value for preoperative CA125 and endometrial cancer extension.