The Accuracy of Endometrial Sampling in the Diagnosis of Patients With Endometrial Carcinoma and Hyperplasia

2021 ◽  
pp. 180-184
Author(s):  
Chelsea Chandler ◽  
Alexander Olawaiye
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Carcinoma ◽  
Sensitivity And Specificity ◽  
Clinical Case ◽  
Meta Analysis ◽  
Atypical Hyperplasia ◽  
Endometrial Sampling ◽  
Landmark Study

This article provides a summary of a landmark study regarding the diagnosis of endometrial cancer. How accurate is endometrial sampling in women with endometrial carcinoma and hyperplasia? The article describes a meta-analysis in which the results of 39 studies using a variety of different endometrial sampling devices are compared by their sensitivity and specificity for diagnosis endometrial carcinoma and atypical hyperplasia of the endometrium. The article briefly reviews criticisms and limitations of the included studies, discusses implications, and concludes with a relevant clinical case.

scholarly journals A clinical case of successful treatment of a giant serous endometrial carcinoma imitating ovarian cancer

2021 ◽  
Vol 12 (4) ◽  
pp. 80-85
Author(s):  
Aleksander I. Berishvili ◽  
Yuri V. Ivanov ◽  
Dmitry P. Lebedev ◽  
Fedor G. Zabozlaev ◽  
Edward V. Kravchenko ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Endometrial Cancer ◽  
Endometrial Carcinoma ◽  
Umbilical Hernia ◽  
Clinical Case ◽  
Skin Flap ◽  
Abdominal Cavity ◽  
Correct Diagnosis ◽  
Greater Omentum ◽  
Excess Skin

Background: Giant tumors of the abdominal cavity, as a rule, occur in elderly patients with characteristic features and represent a serious problem in terms of choosing a radical method of therapy. Of particular difficulty are cases of giant serous endometrial cancer, requiring a differential diagnosis with ovarian cancer. Clinical case description: A clinical case of giant serous endometrial cancer mimicking ovarian cancer in a 55-year-old woman is presented. The patient came to the oncology department with complaints of abdominal enlargement, difficulty breathing and bloody discharge from the genital tract. The examination revealed the following: a giant formation (4065 cm), occupying the entire pelvic and the entire abdominal cavities, ascites, lesions of the retroperitoneal lymph nodes, and the greater omentum, an umbilical hernia. A chest CT showed multiple contrast-accumulating circular shadows of 313 mm (metastases). By the decision of the council, after the preliminary chemoembolization of both the uterine and ovarian arteries, a supravaginal amputation of the uterus with appendages was performed, along with the resection of the greater omentum, removal of the umbilical hernia with positioning a plastic mesh implant and excision of an excess skin flap. The histological examination of the intraoperative material made it possible to verify the diagnosis of a serous endometrial carcinoma with subtotal tumor necrosis, the myometrium invasion of more than a half of its thickness, with the egress to the perimetrium, metastatic lesions of both ovaries, the greater omentum, anterior abdominal wall. Stage T3b (FIGO IIIB). In the postoperative period, 6 courses of Paclitaxel / Carboplatin (AUC4-5) chemotherapy were carried out with a pronounced clinical effect. The patient was discharged in a satisfactory condition. The control PET-CT scan after the 6th chemotherapy course showed no pathology in the thoracic cavity, and no process progress in the abdominal cavity. Currently, the remission of the disease is 9 months. Conclusion: An algorithm for the diagnostic measures aimed at making the correct diagnosis is presented, and the tactics of treating a patient with giant serous endometrial cancer is described.

scholarly journals Microscale endometrial sampling biopsy in detecting endometrial cancer and atypical hyperplasia in a population of 1551 women

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Guo Zhang ◽  
Yue Wang ◽  
Xu-Dong Liang ◽  
Rong Zhou ◽  
Xiu-Li Sun ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Atypical Hyperplasia ◽  
Endometrial Sampling

scholarly journals Postmenopausal Bleeding: An Update

2021 ◽  
Vol 3 (1) ◽  
pp. 28-33
Author(s):  
Shaikh Zinnat Ara Nasreen ◽  
Nusrat Mahjabeen ◽  
Safinaz Shahreen
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Hormone Replacement ◽  
Treatment Modalities ◽  
Clinical Approach ◽  
Postmenopausal Bleeding ◽  
Endometrial Sampling ◽  
Unopposed Estrogen ◽  
Endometrial Intraepithelial Neoplasia

The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia and to find out the real source. Postmenopausal bleeding is ‘endometrial cancer until proven otherwise’, although only 1-14% of such patients will actually have cancer. Clinical risk factors of endometrial carcinoma such as obesity, unopposed estrogen use, polycystic ovary syndrome, diabetes mellitus and family history of gynaecologic malignancy also should be considered during evaluation. Postmenopausal bleeding usually attributed to an intrauterine source, but it may arise from the cervix, vagina, vulva or fallopian tubes & ovaries. The origin of bleeding can also involve non-gynaecologic sites, such as the urethra, bladder, anus/rectum/bowel, or perineum. Meticulous history and thorough physical examination are must. Initial evaluation is by TVS, if endometrial thickness (ET) is <4mm no further evaluation is required but follow up consultation must. If ET is> 4mm, hysteroscopic evaluation and endometrial sampling is recommended Blind endometrial sampling is not accurate as only reveals when endometrial cancer exceeds more than 50% of the endometrial surface area so may be done if hysteroscopic evaluation is not possible. Higher dose of progesterone may be required for endometrial protection when higher doses of estradiol as hormone replacement therapy are used, or in women with high BMI. Unopposed estrogen therapy is associated with a duration and dose-related increase in risk of endometrial hyperplasia and cancer. Endometrial protection requires an adequate dose and duration of progestogen. Endometrial hyperplasia with atypia has much malignant potential but endometrial hyperplasia without atypia may be managed medically with 3 monthly endometrial sampling, if no regression or further progression hysterectomy is the choice of treatment. Finally, patient counseling with discussion of risks /benefits of different options of treatment modalities is the cornerstone of success of addressing postmenopausal bleeding.

scholarly journals Diagnostic accuracy of MRI for detecting cervical invasion in patients with endometrial carcinoma: A meta-analysis

2020 ◽  
Author(s):  
Qiu Bi ◽  
Guoli Bi ◽  
Junna Wang ◽  
Jie Zhang ◽  
Hongliang Li ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Endometrial Carcinoma ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Preoperative Assessment ◽  
High Specificity ◽  
Cochrane Library ◽  
Dce Mri ◽  
3.0 T ◽  
Magnetic Resonance Imaging Mri

Abstract Background: Clinical management and the prognosis of endometrial cancer is closely related to cervical invasion. The diagnostic performance of MRI for detecting cervical invasion has not been comprehensively assessed. We aim to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the preoperative assessment of cervical invasion and to analyze the influence of different imaging protocols in patients with endometrial carcinoma.Methods: An extensive search of articles about MRI in assessing cervical invasion in patients with endometrial carcinoma was performed in PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials from January 2000 to July 2019. Two reviewers independently evaluated the methodological quality of each study by using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Diagnostic accuracy results and additional useful information were extracted. Pooled estimation data was obtained by statistical analysis. Results: A total of 42 eligible studies were included in the meta-analysis. Significant evidence of heterogeneity was found for detecting cervical invasion (I2 = 74.1%, P = 0.00 for sensitivity and I2 = 56.2%, P = 0.00 for specificity). And the pooled sensitivity and specificity of MRI were 0.58 and 0.95 respectively. The use of higher field strength (3.0 T) demonstrated higher pooled sensitivity (0.74). Using diffusion-weighted imaging (DWI) alone presented higher pooled sensitivity (0.86) than using other sequences. Studies that used dynamic contrast-enhanced MRI (DCE-MRI) alone showed higher sensitivity (0.80) and specificity (0.96) than that used T2-weighted image (T2WI) alone.Conclusions: MRI shows high specificity for detecting cervical infiltration in endometrial carcinoma. Using DWI or a 3.0-T device may improve the pooled sensitivity. The use of DCE-MRI demonstrate higher pooled sensitivity and specificity than T2WI.

Initial Severity and Antidepressant Benefits

2018 ◽  
Author(s):  
Michael Maksimowski ◽  
Zheala Qayyum
Keyword(s):  
Clinical Case ◽  
Meta Analysis ◽  
Major Depressive ◽  
Depressed Patients ◽  
Antidepressant Efficacy ◽  
Initial Severity ◽  
Initial Depression ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study on major depressive disorder. What are the drug–placebo differences among antidepressants when both published and unpublished data are analyzed? Does antidepressant efficacy depend on the severity of initial depression scores? Starting with these questions, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The main finding from this meta-analysis is that antidepressant-placebo differences are inconsequential for mildly-to-moderately depressed patients and minimal for severely depressed patients. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.

scholarly journals Hysteroscopy-view with targeted biopsy in the assessment of endometrial carcinoma. What’s the rate of underestimated diagnosis of atypical hyperplasia? The results of a multicenter Italian trial

2020 ◽  
Author(s):  
Giancarlo Garuti ◽  
Stefano Angioni ◽  
Liliana Mereu ◽  
Stefano Calzolari ◽  
Luca Mannini ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Meta Analysis ◽  
Endometrial Biopsy ◽  
Atypical Hyperplasia ◽  
Public Hospitals ◽  
High Rate ◽  
Operator Training ◽  
Benign Pathology ◽  
Diagnostic Work ◽  
Rate Of Failure

Abstract Objective: In the last two decades many reports demonstrated the unreliability of endometrial biopsy pathology showing an AH (Atypical Hyperplasia) to exclude a synchronous EEC (Endometrioid Endometrial Carcinoma), with an underestimation of EEC in up to 50% of women. Hysteroscopy is now considered the standard diagnostic tool for endometrial pathology. However, a recent meta-analysis showed that hysteroscopically-guided biopsy provides a high rate of failure with respect to dilatation and curettage (D&C) and endometrial resection, in underestimating AH instead of concurrent EC. The aim of this study was to assess the sensitivity of hysteroscopy-view and hysteroscopic sampling in diagnosing EEC. Materials and Methods: A multicenter, retrospective, observational trial was conducted between January 2012 and December 2018 in 14 Italian Gynecological Units (University-affiliated or Public Hospitals). Eligible patients were identified as those women in whom either a pathologic report of EEC was found on hysterectomy specimen and a preoperative hysteroscopy assessment with endometrial biopsy targeted under vision had been performed. As primary outcome we calculated the sensitivity of hysteroscopy-view and biopsy pathology on hysteroscopically-driven sampling in the diagnostic work-up of EC. Results: 948 patients (age 65,83±10,43) resulted eligible for analysis. Hysteroscopy-view showed a sensitivity of 54.2%, specificity 47,2% and accuracy 54% in the diagnosis of EC. Moreover, hysteroscopic view was significantly able to distinguish carcinoma from hyperplasia (p<0.001). We evidenced an important difference of the results comparing the centers involved. Hysteroscopy-driven biopsy presented a sensitivity of 76,2%, a specificity of 52,8% and an accuracy of 75,3%. AH pathology was reported in 19% of the cases. Conclusion: Our study showed that EEC diagnosis via hysteroscopy diagnosis could be improved through the implementation of operator training. Hysteroscopy-driven biopsies have excellent sensitivity and accuracy in the diagnosis of EEC, and the advantages of using hysteroscopy for making a diagnosis can improve the management of the patients with EEC. While it seems reasonable that hysteroscopy is the preferred technique for diagnosing and treating a benign pathology of the uterus, it could play a major role even in the diagnosis of a malignancy.

scholarly journals The Value of Endometrial Volume as Estimated by Three-Dimensional Ultrasound for Detecting Endometrial Cancer in Postmenopausal Women: A Systematic Review and Meta-Analysis

EMJ Radiology ◽  
2020 ◽  
Keyword(s):  
Endometrial Cancer ◽  
Confidence Interval ◽  
Endometrial Carcinoma ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Three Dimensional ◽  
3D Ultrasound ◽  
Postmenopausal Bleeding ◽  
Endometrial Volume

Objective: To analyse the diagnostic performance of endometrial volume calculated by three-dimensional (3D) ultrasound for diagnosing endometrial carcinoma in women with postmenopausal bleeding. Methods: An extensive search of papers analysing the role of endometrial volume calculated by 3D ultrasound for diagnosing endometrial carcinoma in women with postmenopausal bleeding was performed in MEDLINE/PubMed and Web of Science from January 1996 to January 2020. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results: The extended search identified 318 citations but after exclusions, eight articles wereincluded in the meta-analysis. The risk of bias for most studies was high for the four domains assessed in QUADAS-2. Overall, after excluding three studies that contributed significantly to heterogeneity, pooled estimated sensitivity and specificity for diagnosing endometrial cancer were 87% (95% confidence interval: 80–92%) and 60% (95% confidence interval: 51–68%), respectively. Heterogeneity was low or moderate. Conclusion: Endometrial volume as estimated by 3D ultrasound using virtual organ computer-aided analysis (VOCALTM) software has a moderate diagnostic performance for detecting endometrial malignancy in women with postmenopausal bleeding.

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