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Ultrasound in Obstetrics & Gynecology :... Apr 2024To assess the ability of the International Endometrial Tumor Analysis (IETA)-1 polynomial regression model to estimate the risk of endometrial cancer (EC) and other... (Observational Study)
Observational Study
Estimating risk of endometrial malignancy and other intracavitary uterine pathology in women without abnormal uterine bleeding using IETA-1 multinomial regression model: validation study.
OBJECTIVES
To assess the ability of the International Endometrial Tumor Analysis (IETA)-1 polynomial regression model to estimate the risk of endometrial cancer (EC) and other intracavitary uterine pathology in women without abnormal uterine bleeding.
METHODS
This was a retrospective study, in which we validated the IETA-1 model on the IETA-3 study cohort (n = 1745). The IETA-3 study is a prospective observational multicenter study. It includes women without vaginal bleeding who underwent a standardized transvaginal ultrasound examination in one of seven ultrasound centers between January 2011 and December 2018. The ultrasonography was performed either as part of a routine gynecological examination, during follow-up of non-endometrial pathology, in the work-up before fertility treatment or before treatment for uterine prolapse or ovarian pathology. Ultrasonographic findings were described using IETA terminology and were compared with histology, or with results of clinical and ultrasound follow-up of at least 1 year if endometrial sampling was not performed. The IETA-1 model, which was created using data from patients with abnormal uterine bleeding, predicts four histological outcomes: (1) EC or endometrial intraepithelial neoplasia (EIN); (2) endometrial polyp or intracavitary myoma; (3) proliferative or secretory endometrium, endometritis, or endometrial hyperplasia without atypia; and (4) endometrial atrophy. The predictors in the model are age, body mass index and seven ultrasound variables (visibility of the endometrium, endometrial thickness, color score, cysts in the endometrium, non-uniform echogenicity of the endometrium, presence of a bright edge, presence of a single dominant vessel). We analyzed the discriminative ability of the model (area under the receiver-operating-characteristics curve (AUC); polytomous discrimination index (PDI)) and evaluated calibration of its risk estimates (observed/expected ratio).
RESULTS
The median age of the women in the IETA-3 cohort was 51 (range, 20-85) years and 51% (887/1745) of the women were postmenopausal. Histology showed EC or EIN in 29 (2%) women, endometrial polyps or intracavitary myomas in 1094 (63%), proliferative or secretory endometrium, endometritis, or hyperplasia without atypia in 144 (8%) and endometrial atrophy in 265 (15%) women. The endometrial sample had insufficient material in five (0.3%) cases. In 208 (12%) women who did not undergo endometrial sampling but were followed up for at least 1 year without clinical or ultrasound signs of endometrial malignancy, the outcome was classified as benign. The IETA-1 model had an AUC of 0.81 (95% CI, 0.73-0.89, n = 1745) for discrimination between malignant (EC or EIN) and benign endometrium, and the observed/expected ratio for EC or EIN was 0.51 (95% CI, 0.32-0.82). The model was able to categorize the four histological outcomes with considerable accuracy: the PDI of the model was 0.68 (95% CI, 0.62-0.73) (n = 1532). The IETA-1 model discriminated very well between endometrial atrophy and all other intracavitary uterine conditions, with an AUC of 0.96 (95% CI, 0.95-0.98). Including only patients in whom the endometrium was measurable (n = 1689), the model's AUC was 0.83 (95% CI, 0.75-0.91), compared with 0.62 (95% CI, 0.52-0.73) when using endometrial thickness alone to predict malignancy (difference in AUC, 0.21; 95% CI, 0.08-0.32). In postmenopausal women with measurable endometrial thickness (n = 848), the IETA-1 model gave an AUC of 0.81 (95% CI, 0.71-0.91), while endometrial thickness alone gave an AUC of 0.70 (95% CI, 0.60-0.81) (difference in AUC, 0.11; 95% CI, 0.01-0.20).
CONCLUSION
The IETA-1 model discriminates well between benign and malignant conditions in the uterine cavity in patients without abnormal bleeding, but it overestimates the risk of malignancy. It also discriminates well between the four histological outcome categories. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Endometritis; Retrospective Studies; Endometrial Neoplasms; Endometrium; Uterine Neoplasms; Uterine Hemorrhage; Ultrasonography; Endometrial Hyperplasia; Polyps; Atrophy
PubMed: 37927006
DOI: 10.1002/uog.27530 -
BioMed Research International 2022To investigate the effect of hysteroscopy surgery combined with Mirena on postoperative adverse reactions and recurrence rate of endometrial polyps (EP).
Effect of Hysteroscopic Polypectomy Combined with Mirena Placement on Postoperative Adverse Reactions and Recurrence Rate of Endometrial Polyps: Based on a Large-Sample, Single-Center, Retrospective Cohort Study.
OBJECTIVE
To investigate the effect of hysteroscopy surgery combined with Mirena on postoperative adverse reactions and recurrence rate of endometrial polyps (EP).
METHODS
A total of 312 patients who underwent hysteroscopic polypectomy of EP in our hospital from June 2017 to November 2020 were enrolled retrospectively. Among them, 42 patients did not take any treatment after the operation (control group), 156 patients were treated with levonorgestrel intrauterine birth control system (Mirena group), and 114 patients were treated with oral spironolone ethinylestradiol tablets (oral group). The clinical data of 312 patients were recorded and followed up regularly. All patients were followed up through an outpatient clinic or telephone to 12 months after the operation. The patients' age, disease course, number of pregnancies, clinical manifestations, endometrial thickness before the operation, duration of operation, amount of bleeding during the operation, and number and size of polyps were analyzed. The recurrence and postoperative side effects of EP in the three groups were followed up within 12 months after the operation.
RESULTS
There was no significant difference in endometrial thickness among the three groups before treatment ( > 0.05). After 3 months, 6 months, and 12 months of treatment, the endometrial thickness of the three groups decreased, while the decrease in the Mirena group and the oral group was better compared to the control ( < 0.05). The decrease in the Mirena group was better than that in the oral group ( < 0.05). There was no significant difference in hemoglobin levels among the three groups before treatment ( > 0.05). After 3, 6, and 12 months of treatment, the hemoglobin levels of the three groups increased to varying degrees, while the levels of the Mirena group and oral group were better compared to the control ( < 0.05). Three months after the operation, the improvement of clinical symptoms was similar in the three groups, and there was no significant difference among the three groups ( > 0.05). At 6 and 12 months after the operation, the improvement of clinical symptoms in the oral group and Mirena group was better compared to the control group ( < 0.05), but there was no significant difference between the oral group and Mirena group ( > 0.05). After the operation, some patients had complications such as lower abdominal pain, breast distension pain, irregular vaginal bleeding, and abnormal liver function. There was no significant difference in the number of complications among the three groups ( > 0.05). During the follow-up to 12 months after the operation, the recurrence rate in the oral group and Mirena group was lower compared to the control ( < 0.05), and the recurrence rate in the Mirena group was lower than that in the oral group ( < 0.05).
CONCLUSION
Placing Mirena immediately after hysteroscopic polypectomy of EP can reduce the recurrence rate of endometrial polyps, increase the level of hemoglobin, and reduce the thickness of the endometrium, which can be employed and popularized according to the condition of patients in clinical work.
Topics: Endometrium; Female; Humans; Hysteroscopy; Levonorgestrel; Polyps; Pregnancy; Retrospective Studies; Uterine Neoplasms
PubMed: 35528176
DOI: 10.1155/2022/1232495 -
BMC Women's Health Jun 2024Insulin resistance (IR) induces hyperinsulinemia, which activates downstream signaling pathways such as the phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT)...
BACKGROUND
Insulin resistance (IR) induces hyperinsulinemia, which activates downstream signaling pathways such as the phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) pathway, ultimately leading to abnormal proliferation and apoptosis of endometrial cells. This is thought to be a key pathogenic mechanism underlying the development of endometrial polyps (EP). This study aims to investigate the relationship between IR and the development of EP, the expression levels of downstream signaling molecules, including PI3K and AKT, and related laboratory parameters were examined.
METHODS
A total of 100 patients who visited the gynecology outpatient clinic of Zhongda Hospital affiliated with Southeast University from May 2021 to March 2023 and were diagnosed with abnormal endometrial echoes by vaginal ultrasound and underwent hysteroscopic diagnostic curettage were enrolled in this study. General data and relevant hematological indicators were compared, and intraoperative specimens were obtained for pathological examination. Possible factors influencing the development of endometrial polyps were analyzed using Pearson correlation analysis and logistic regression analysis.
RESULTS
In terms of body mass index, waist circumference, fasting insulin, insulin resistance index, serum total testosterone, and free testosterone index, women of childbearing age in the endometrial polyp group had higher values than those in the non-polyp group, while sex hormone-binding globulin in the endometrial polyp group was lower than that in the non-polyp group, and the differences were statistically significant (P < 0.05). The expression scores and mRNA expression levels of PI3K and AKT proteins were higher in the EP group than in the non-EP group (p < 0.05). Pearson correlation analysis showed a positive correlation between HOMA-IR and the expression scores of PI3K and AKT proteins (p < 0.01).
CONCLUSIONS
Insulin resistance and abnormal activation of the phosphatidylinositol 3-kinase/protein kinase B signaling pathway may be potential pathogenic mechanisms for the development of endometrial polyps.
Topics: Humans; Female; Insulin Resistance; Polyps; Proto-Oncogene Proteins c-akt; Adult; Phosphatidylinositol 3-Kinases; Middle Aged; Uterine Diseases; Body Mass Index; Signal Transduction; Endometrium; Sex Hormone-Binding Globulin; Testosterone; Insulin
PubMed: 38909214
DOI: 10.1186/s12905-024-03218-5 -
Journal of Cancer Research and Clinical... Jul 2023The aim of the present study was to evaluate the incidence of unexpected uterine malignancies in patients undergoing hysterectomy for benign indications and to evaluate...
PURPOSE
The aim of the present study was to evaluate the incidence of unexpected uterine malignancies in patients undergoing hysterectomy for benign indications and to evaluate their clinical characteristics.
METHODS
We conducted a retrospective review of patients who underwent benign hysterectomy in the Department of Gynecology, the First Hospital of Shanxi Medical University from January 2015 to December 2020. The clinical data of these patients were retrieved and collected.
RESULTS
Their median age was 49.8 years (31-82 years). The mean parity was 1.86 ± 2.54. Their mean BMI was 27.5 ± 7.6 kg/m2. 42.90% were (2438/5683) postmenopausal. The benign indications of procedure were as follows: symptomatic uterine leiomyomas 2218/5683 (39.02%), pelvic organ prolapse 1406/5683 (24.74%), symptomatic endometriosis or adenomyosis 1132/5683 (19.91%), and 927/5683 (16.31%) to treat other benign conditions such as abnormal uterine bleeding, infection, polyps, and endometrial hyperplasia without atypia. In minimally invasive surgery subgroups, 1560/2621 (59.52%) specimens were removed by in-bag manual morcellation through vaginal cuff. The mean operative time of minimally invasive surgery with in-bag morcellation was shorter than abdominal hysterectomy (96.75 ± 35.7 vs. 140 ± 32.6, P < .001), and the estimated blood loss was also less than abdominal hysterectomy (47.35 ± 42.3 vs. 170 ± 60.4, P < .001). A total of 19/5683 (0.33%) unexpected uterine malignancies were recorded, of which 14/5683 (0.26%) were unexpected endometrial carcinomas and 5/5683 (0.08%) were unexpected uterine sarcomas.
CONCLUSION
Preoperative examination in the context of benign hysterectomy must be undertaken with care, and patients should be educated about the very slight possibility of a malignant diagnosis.
Topics: Female; Humans; Middle Aged; Incidence; Uterine Neoplasms; Hysterectomy; Leiomyoma; Endometrial Neoplasms; Retrospective Studies
PubMed: 36083311
DOI: 10.1007/s00432-022-04343-0 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Sep 2019To investigate the clinical value of vaginal endoscopy in the diagnosis and treatment for vaginal and uterine diseases in young girls and adolescent girls. Methods:...
To investigate the clinical value of vaginal endoscopy in the diagnosis and treatment for vaginal and uterine diseases in young girls and adolescent girls. Methods: The clinical data of 156 young girls and adolescent girls treated with vaginoscopy from February 2000 to August 2017 were analyzed retrospectively. Results: Of the 37 cases of young girls, the clinical symptoms were the most common in vaginal hemorrhage, accounting for 40.5% (15 cases), the second one in vaginal foreign body, accounting for 29.7% (11 cases), the third one in abnormal vaginal secretion, accounting for 24.3% (9 cases), and the last one in low abdominal pain, accounting for 5.4% (2 cases). The final diagnosis of vaginal foreign body was 13 cases (35.1%). Of the 119 adolescent girls, the clinical symptoms of the visit were the most common in menstrual abnormalities or irregular vaginal bleeding, accounting for 75.6% (90 cases). The final diagnosis of abnormal uterine bleeding-ovulatory dysfunction was the most common with 59 cases (49.6%), following by 16 cases of abnormal uterine bleeding-polyp, 2 cases of abnormal uterine bleeding-malignancy and hyperplasia, and 1 cases of abnormal uterine bleeding-coagulopathy. There were 37 cases (31.1%) of reproductive tract malformation. All 156 patients successfully completed vaginal endoscopy and operation with only 1 case of urinary system infection. No other complications occurred and no damage in the hymen. Conclusion: Vaginal endoscopy is a safe, effective and near-noninvasive way for the diagnosis and treatment of vaginal or uterine diseases in young girls and adolescent girls. In the case of abnormal vaginal secretions and vaginal bleeding, it should be properly recommended to use the vaginal endoscopy for diagnosis and treatment.
Topics: Adolescent; Endoscopy; Female; Foreign Bodies; Humans; Retrospective Studies; Uterine Hemorrhage; Vagina
PubMed: 31645493
DOI: 10.11817/j.issn.1672-7347.2019.190441 -
IJU Case Reports May 2023Robot-assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery.
INTRODUCTION
Robot-assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery.
CASE PRESENTATION
In this report, robot-assisted total laparoscopic hysterectomy and robot-assisted nephroureterectomy were performed simultaneously for a 69-year-old Japanese female with giant cervical polyp and ureteral cancer. All specimens could be removed from the vagina. The operative time was 379 min, the estimated intraoperative blood loss was 29 mL, and the patient was discharged on the sixth postoperative day without complications.
CONCLUSION
We reported our experience with simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy. To our knowledge, this is the first report of simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy surgery.
PubMed: 37144083
DOI: 10.1002/iju5.12585 -
BMC Women's Health May 2021To investigate the clinical efficacy of the MyoSure hysteroscopic tissue removal system in the treatment of endometrial and cervical polyps in women with an intact hymen.
BACKGROUND
To investigate the clinical efficacy of the MyoSure hysteroscopic tissue removal system in the treatment of endometrial and cervical polyps in women with an intact hymen.
METHODS
Retrospective analysis was performed on the clinical data of 32 patients treated with the MyoSure hysteroscopic tissue removal system for endometrial and cervical polyps.
RESULTS
All the patients successfully completed the procedure. No intraoperative complications, such as cervical trauma, uterine perforation or TURP syndrome, were reported. The surgical time ranged from 5 to 35 min, with an average time of 19.3 min, and the intraoperative blood loss ranged from 2 to 50 ml with an average blood loss of 10.8 ml. After surgery, all patients were shown to have intact hymens. No residual polyp tissues were observed under the microscope, and abnormal uterine bleeding was relieved.
CONCLUSIONS
The MyoSure hysteroscopic tissue removal system can be a safe and effective treatment for endometrial and cervical polyps in women with an intact hymen.
Topics: Female; Humans; Hymen; Hysteroscopy; Polyps; Pregnancy; Retrospective Studies; Uterine Diseases; Uterine Neoplasms
PubMed: 34022866
DOI: 10.1186/s12905-021-01362-w -
Climacteric : the Journal of the... Feb 2022Postmenopausal bleeding has been reported in about 4-11% of menopausal women. The most common cause of postmenopausal bleeding is atrophy of the vaginal mucosa or...
OBJECTIVE
Postmenopausal bleeding has been reported in about 4-11% of menopausal women. The most common cause of postmenopausal bleeding is atrophy of the vaginal mucosa or endometrium. Endometrial hyperplasia, endometrial polyps, submucous leiomyomas and endometrial cancers are also known causes of postmenopausal bleeding. Here, we present a patient whose cause of postmenopausal vaginal bleeding was infiltration of the endometrium with chronic lymphocytic leukemia (CLL).
CASE REPORT
A 78-year-old woman, who has been followed up with a diagnosis of CLL for 5 years, presented with a complaint of postmenopausal bleeding. After dilation and curettage, pathology revealed that the cause of the postmenopausal bleeding was CLL infiltration into the endometrium.
CONCLUSION
Any involvement of the female genital organs in CLL is rare. Therefore, hematological malignancies should be considered in the differential diagnosis of postmenopausal bleeding.
Topics: Aged; Endometrial Hyperplasia; Endometrial Neoplasms; Endometrium; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Polyps; Postmenopause; Ultrasonography; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 33955311
DOI: 10.1080/13697137.2021.1917540 -
Cureus Jul 2022Currently, the application of peritoneal washings as a diagnostic tool for endometrial cancer staging is not well defined. The case described aims to highlight the...
Currently, the application of peritoneal washings as a diagnostic tool for endometrial cancer staging is not well defined. The case described aims to highlight the current ambiguity surrounding the use of peritoneal washings in clinical practice. A 69-year-old G3P3003 presented to her gynecologist with complaints of new-onset heavy vaginal bleeding. The patient sought an endometrial biopsy, which suggested serous endometrial intraepithelial carcinoma (EIC) focally suspicious for invasive carcinoma, with the involvement of polyps. Based on these results, a robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, bilateral sentinel lymph node dissection, and omentectomy were performed. Results from her final pathology exhibited a stage IA uterine serous carcinoma (USC) involving a polyp (4.2 cm in greatest dimension) with no myometrial or lymphovascular invasion, but washings were positive for adenocarcinoma. Based on her family history of malignancy, the patient underwent germline panel testing. The patient's somatic tumor testing demonstrated proficient DNA mismatch repair status, microsatellite stability, low tumor mutational burden (4 mut/Mb), low loss of heterozygosity (9%), amplification of the ERBB2 (HER2/neu) gene by both immunohistochemistry (3+, 20% positive) and fluorescence in-situ hybridization. Her tumor also had weakly positive estrogen receptor expression (1+, 10% positive); furthermore, some pathogenic variants in KRAS (c.37G>T), PIK3CA (c.263G>A), and TP53 (c.743G>A) were identified. Given the incongruent findings found with the positive peritoneal washing and negative lymph node involvement in addition to molecular testing, management for this patient was unclear. Ultimately, this case highlights a number of advances within the field of gynecological oncology but also emphasizes the persistent ambiguity and incongruency in the management of patients with early-stage high-risk histologies. Moving forward it will become increasingly important to be able to develop a more standardized process to assess how these diagnostic tools should inform prognosis and treatment plans.
PubMed: 35949786
DOI: 10.7759/cureus.26663 -
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing... Oct 2019To understand the prevalence of gynecologic diseases among married female workers. The data of married female workers who underwent occupational health examination in...
To understand the prevalence of gynecologic diseases among married female workers. The data of married female workers who underwent occupational health examination in a physical examination center from January to December 2017 were collected. The relationship between the detection of common gynecological diseases, age and occupational types examined by gynecological routine, TCT, breast B-mode ultrasound, uterus and appendix B-mode ultrasound were analyzed. Among the 1142 female workers, the total detection rate of reproductive tract infections was 67.25% (768/1142), the total detection rate of breast-related diseases was 75.22% (859/1142) ; the total detection rate of gynecological tumors and benign lesions was 14.71% (168/1142). The detection rate of breast hyperplasia was the highest 67.08% (766/1142), followed by vaginitis 51.66% (590/1142). Among the abnormalities detected in breast-related diseases, gynecological tumors and benign lesions, the highest detection rate was found in public institutions (85.66% and 27.13%), and the lowest was found in factory workers (70.24% and 7.89%). With the increase of age, the detection rate of breastrelated diseases (breast hyperplasia, breast cyst), gynecological tumors, benign lesions (uterine myoma), and Nessler's cyst abnormalities in married female workers increased (χ(2)(trend)=7.647、21.653、107.411、53.802, <0.05), while the detection rate of columnar epithelium of cervix decreased (χ(2)(trend)=7.404, <0.05). There was no significant difference in the total detection rate of reproductive tract infectious diseases (vaginitis, cervical polyps, cervical hypertrophy) among married famale workers of different ages (<0.05) . The common gynecological diseases of married female workers are affected by many factors such as age and occupation. Health examination and health education should be carried out regularly to reduce the incidence of gynecological diseases among female workers according to different ages and occupations.
Topics: Breast Diseases; Female; Genital Diseases, Female; Genital Neoplasms, Female; Humans; Incidence; Occupations; Prevalence; Reproductive Tract Infections; Ultrasonography, Mammary
PubMed: 31726513
DOI: 10.3760/cma.j.issn.1001-9391.2019.10.015