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

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

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

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

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

No abstract available.
Endometrial Neoplasms* ; Female

No abstract available.
Endometrial Neoplasms* ; Female ; Prognosis*

No abstract available.
Endometrial Neoplasms* ; Female ; Humans

No abstract available.
Endometrial Neoplasms* ; Female

No abstract available.
Endometrial Neoplasms* ; Female ; Ovary*