1.Assessing myometrial infiltration by measuring the tumor free distance and depth of invasion through 2D transvaginal ultrasound among patients with endometrial cancer
Harry C. Navarete, Jr. ; Lara Marie David-Bustamante
Philippine Journal of Obstetrics and Gynecology 2018;42(4):1-17
Background:
Myometrial invasion is one of the most important prognostic factors in the preoperative evaluation of patients with endometrial cancer. Several techniques have been used for the preoperative evaluation such as transvaginal ultrasound (TVS), magnetic resonance imaging (MRI) and computed tomography (CT). Transvaginal ultrasound has been shown to have comparable accuracy with MRI, cost effective and is widely available.
Main Objective:
To determine the diagnostic accuracy of 2D transvaginal ultrasound in assessing myometrial infiltration by measuring the tumor free distance (TFD) and depth of invasion (DOI) among patients with endometrial cancer admitted for elective gynecologic surgery at Philippine General Hospital Department of Obstetrics and Gynecology.
Methods:
This prospective validation study involved 49 patients with endometrial cancer admitted for elective surgery at the Department of Obstetrics and Gynecology of the Philippine General Hospital from October 1, 2016 to February 28, 2017. All patients had 2D transvaginal ultrasound at least within 1 week prior to schedule of surgery. The tumor free distance (TFD) and the depth of invasion (DOI) were prospectively measured and compared with the histopathologic result. Diagnostic accuracy in assessing myometrial infiltration by measuring the tumor free distance and depth of invasion through 2D transvaginal ultrasound were computed and test of association was done using 2x2 Fischer Exact test at 0.05? while AUC-ROC was plotted.
Results:
The association between transvaginal ultrasound and final histopathology in assessing the myometrial infiltration was statistically significant (p=0.004). Moreover, the transvaginal ultrasound for assessing myometrial infiltration demonstrated 94.4% sensitivity and 43.8% specificity in detecting >50% infiltration wherein a likelihood would likely to occur by 1.68 times higher than those with <50% based on the final histopathology. Moreover, the accuracy values of TVS reflected in the AUC index were as follows, a TFD cut off value of ?0.82cm showed a higher sensitivity (46.88%) and specificity (100%) in predicting >50% myometrial infiltration while a DOI ratio of 0.50 is the cut off value which initiated a sensitivity (16.7%) and a higher specificity (75%) in predicting >50% infiltration. Finally, TFD (AUC = 0.749) yielded a higher accuracy as compared with DOI (AUC = 0.388) in predicting myometrial infiltration.
Conclusion
Assessment of myometrial infiltration by measuring the tumor free distance and depth of invasion through 2D transvaginal ultrasound among patients with endometrial cancer demonstrated clinically acceptable accuracy with higher sensitivity in detecting >50% myometrial infiltration. TFD (cut off value of ?0.82cm) has a higher accuracy compared with DOI in predicting >50% myometrial infiltration.
Endometrial Neoplasms
2.A comparative study of subjective and objective techniques using two‑dimensional ultrasound in the preoperative assessment of cervical and myometrial invasion in patients with endometrial cancer
Doreen Baco Abria-Ybañ ; ez ; Lara Marie David-Bustamante ; Kareen Nora Reforma
Philippine Journal of Obstetrics and Gynecology 2023;47(5):249-259
Context:
Endometrial cancer is the third most common malignancy of the female genital tract in
the Philippines, following cervical and ovarian cancer. Ultrasound as the first line in imaging has a
major role in preoperative treatment and planning.
Aims:
To compare the diagnostic accuracy of subjective versus objective ultrasound
measurement techniques in detecting cervical stromal invasion (CSI) and deep myometrial
invasion (MI).
Materials and Methods:
Fifty‑seven patients were enrolled in this cross‑sectional study. Deep
MI and CSI were evaluated both subjectively and objectively by measuring tumor‑free distance (TFD),
distance from the outer cervical os to lowest edge of the tumor border (Dist‑OCO), and distance
from the internal cervical os to caudal tumor border (Dist‑ICO). Histopathological result used as the
gold standard.
Results:
Subjective assessment for deep (MI) had 79.3% sensitivity, 82.1% specificity, 82.1%
positive predictive value (PPV), 82.1% negative predictive value (NPV), and 80.7%. Subjective
assessment for CSI had a sensitivity, specificity, PPV, NPV, and overall accuracy of 80%, 90.4%,
44.4%, 97.9%, and 89.5%. Objective measurement (TFD ≤0.8 cm) to detect deep MI had 86.2%
sensitivity, 57.1% specificity, 67.4% PPV, 80% NPV, and 71.9% overall accuracy. Adjusting TFD
cutoff to 0.65 increased to 71.4% specificity, making it comparable with subjective assessment.
Dist‑OCO (≤2.1 cm) yielded 100% sensitivity, 86.3% specificity, 30% PPV, 100% NPV, and 87%
overall accuracy. Dist‑ICO was first used in this study, hence no cutoff yet. By using receiver operating
characteristics, cutoff was 0.45 cm, which yielded a 60% sensitivity and 92% specificity (area under
the curve 0.731, P = 0.09).
Conclusions
Subjective assessment of CSI and deep MI performs better than objective
measurement techniques. TFD and Dist‑OCO as the objective measurements showed clinically
comparable accuracy to subjective assessment by an expert. Dist‑ICO needs to be validated to a
larger population to determine its clinical value in predicting CSI.
Endometrial Neoplasms
3.Prevalence of premalignant and malignant changes in hysteroscopically removed endometrial polyps in reproductive aged women: A 5-year review of cases in a Tertiary Government Hospital in the Philippines
Maria Angela B. de de Castro-Abesamis ; Chiaoling Sua Lao
Philippine Journal of Reproductive Endocrinology and Infertility 2022;19(2):31-
Objective:
To determine the prevalence of premalignant and malignant changes in
hysteroscopically removed endometrial polyps in reproductive aged women, and to determine
clinical, ultrasonographic and hysteroscopic characteristics of such women.
Methods:
This is a cross-sectional study of patients diagnosed with endometrial polyp, and
underwent hysteroscopy from 2015-2019. A review of the medical records (ultrasound results,
intraoperative findings and histopathology results) was done.
Results:
A total of 117 patient records were included in the analysis. The median age of
all patients who underwent hysteroscopy was 38 years old (age range: 19-44 years). The
prevalence of endometrial hyperplasia or carcinoma in the 18-44 year old age group was 8.5%
(n=10/117). Among patients with endometrial hyperplasia or carcinoma, 70% were nulligravid,
40% had anovulation disorder, and 40% had infertility. Most of the patients were overweight or
obese (70%). Co-morbidities were present in only 3 cases, and diabetes mellitus (30%) was
the predominant illness seen in these patients.
Conclusion
Our findings showed a higher prevalence (8.5%) of endometrial hyperplasia or
carcinoma in endometrial polyps among Filipino reproductive-aged women, compared to reports
in published literature. Among the different clinical characteristics, ultrasound and hysteroscopic
findings, no particular factor had a significant association with endometrial hyperplasia or
malignancy.
Hysteroscopy
;
Endometrial Neoplasms
;
Endometrial Hyperplasia
4.Establishing a threshold for endometrial sampling in post-menopausal women with an incidentally found thickened endometrium: A retrospective cohort study
Patricia Ann A. Factor ; Lisa T. Prodigalidad-Jabson
Philippine Journal of Obstetrics and Gynecology 2018;42(1):1-8
Background:
Pelvic ultrasonography is currently not recommended as a screening tool for endometrial cancer, particularly in asymptomatic women; however, its use for other indications such as pelvic masses has led to incidental findings of thickened endometrium in post menopausal women.
Objectives:
The aim of the study is to evaluate the clinical utility of endometrial ultrasound in asymptomatic Filipino postmenopausal women and to provide a threshold for invasive endometrial sampling.
Methodology:
A cohort of postmenopausal women (aged ?50 years) who underwent pelvic ultrasonography at a tertiary hospital for indications other than vaginal bleeding was retrospectively evaluated. Women were included if they had an endometrial lining of at least 5 mm and had an endometrial biopsy. Receiver operating characteristic (ROC) analysis was used to determine the endometrial thickness threshold for which endometrial thickness is able to correctly differentiate benign endometrial pathology from endometrial hyperplasia and carcinoma.
Results:
Out of 90 women included in the study, carcinoma was identified in 3 (3.33%) and hyperplasia was noted in 4 (4.44%). The most common histopathology noted was: endometrial polyp (35.56%), atrophic endometrium (30%) and benign endometrial tissues (18.98%). The calculated area under ROC curve was 54.39% (95% CI 34.38-79.41%), which indicates the inability of endometrial thickness to differentiate benign endometrium from endometrial carcinoma or hyperplasia in asymptomatic women with an incidentally found thickened endometrium.
Conclusion
Based on the results of the study, endometrial thickness alone cannot be used as basis for deciding whether to perform endometrial sampling, there is no endometrial thickness threshold for which the endometrial hyperplasia and carcinoma can be correctly identified. The decision to perform an endometrial biopsy should be done on a case to case basis. In the absence of a high index of suspicion for endometrial hyperplasia and carcinoma even in the presence of thickened endometrium, endometrial sampling is unnecessary.
Endometrial Neoplasms
;
Endometrial Hyperplasia
;
Incidental Findings
5.Metformin as an adjunct to progestin therapy in endometrial hyperplasia and early-stage endometrial cancer: A systematic review and meta-analysis of randomized controlled trials.
Patricia Ann A. Factor ; Koleen C. Pasamba
Acta Medica Philippina 2024;58(11):62-71
Background:
Metformin has been studied for its anti-proliferative effects on endometrial cells, and it is hypothesized to have a synergistic effect with progestin therapy in suppressing endometrial cell proliferation. This systematic review and meta-analysis aimed to determine the efficacy of adjunctive metformin in the clinical regression of endometrial hyperplasia and early-stage endometrial carcinoma.
Methodology:
This meta-analysis followed the Cochrane methodology and adhered to the PRISMA 2020 guidelines. Randomized controlled trials (RCTs) were included if they enrolled reproductive-aged women with endometrial hyperplasia (with and without atypia) and endometrial carcinoma who were treated with progestin and metformin. The primary outcome was the complete response rate at 12-16 weeks, and secondary outcomes included relapse rate, clinical pregnancy rate, and live birth rate. Odds ratios (ORs) and 95% confidence intervals (CIs) were used for dichotomous data.
Results:
Six RCTs were included. The addition of metformin to progestin therapy may increase the complete response rate of endometrial hyperplasia without atypia (OR 5.12, 95% CI 1.17 to 22.41; n=102) and live birth rates (OR 2.51, 95% CI 1.34 to 4.69; n=188) compared to progestin therapy alone, but the certainty of the evidence is low. Metformin did not have a significant effect on the clinical response of endometrial hyperplasia with atypia and endometrial carcinoma, relapse rates, and clinical pregnancy rates.
Conclusion
Current evidence is uncertain on the potential benefit of metformin with progestin in endometrial hyperplasia and carcinoma. Future high-quality randomized controlled trials with larger sample sizes and longer follow-up periods are needed to support practice recommendations.
Endometrial Hyperplasia
;
Endometrial Neoplasms
;
Metformin
;
Progesterone
6.Clinicopathological analysis and multidisciplinary treatment according to surgical staging in endometrial carcinoma.
Ki Chul LEE ; Kwan Hoon LEE ; Jae Sung HONG ; Ji Yang PARK ; Sang Kyun HAN ; Jin Woo KIM ; Sung Eun NAMKOONG ; Seung Jo KIM
Korean Journal of Obstetrics and Gynecology 1993;36(7):2967-2977
No abstract available.
Endometrial Neoplasms*
;
Female
7.The prognostic significance of steroid hormone receptors, bcl-2 and p53 mutation in correlation with clinicopathological prognostic factors in endometrial cancer.
Sang Woon KIM ; Jae Wook KIM ; Eun Gyung CHOI ; Young Tae KIM ; Nam Hoon JO ; Woo Ik YANG
Korean Journal of Obstetrics and Gynecology 2000;43(12):2127-2134
No abstract available.
Endometrial Neoplasms*
;
Female
8.Clinicopathologic Characteristics and Prognosis of Endometrial Cancer : A Study of 100 Cases.
Woo Jin JEON ; Eul Ju MOON ; Sang Young RYU ; Jong Hoon KIM ; Byoung Gie KIM ; Sang Yoon PARK ; Jae Kyu LEE ; Eui Don LEE ; Jong Sung LEE ; Kyung Hee LEE
Korean Journal of Obstetrics and Gynecology 2000;43(9):1616-1623
No abstract available.
Endometrial Neoplasms*
;
Female
;
Prognosis*
9.Clinicopathological correlation in endometrial carcinoma.
Byung Soo HAN ; Hak Hee LEE ; Joon SONG ; Chan Yong PARK
Korean Journal of Obstetrics and Gynecology 1992;35(4):562-570
No abstract available.
Endometrial Neoplasms*
;
Female
10.Expression of p53, p21WAF1 and Ki-67 in Endometrial Carcinoma.
Hoon HUR ; Sun Gyung LEE ; Seung Bo KIM ; Joo Hee LEE ; Kyo Young KIM
Korean Journal of Obstetrics and Gynecology 2000;43(8):1353-1359
No abstract available.
Endometrial Neoplasms*
;
Female