Postmenopausal genital bleeding

The study was conducted on 748 women who reported genital bleeding occurring at least one year after the last menstruation. Benign causes were most frequent than malignant causes. Among the benign causes, the most frequent were cervicitis (19,95%), prolapsed uterus with decubitus ulcer (19,41%), dysfunctional hemorrhage (13,29%) and endometrial polyps (12,77%). In the group of malignant causes, cancer of the cervix was the neoplasm most often detected (59,26%); endometrial cancer was next, affecting 29,63%. The cancer of the cervix/ cancer of the body ratio was 2:1. In summary, many causes, both benign and malignant, can provoke abnormal postmenopausal bleeding. Thus, curettage of the uterus should be reserved for doubtful cases, i.e., in situations in which, after all non invasive methods of investigations have been exhausted, the possibility of the occurrence of malignant lesions still persist.

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Diagnostic accuracy of cytology for the detection of endometrial cancer in urine and vaginal samples

Nature Communications ◽

10.1038/s41467-021-21257-6 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Helena O’Flynn ◽

Neil A. J. Ryan ◽

Nadira Narine ◽

David Shelton ◽

Durgesh Rana ◽

...

Keyword(s):

Endometrial Cancer ◽

Diagnostic Accuracy ◽

Gynecological Cancer ◽

False Positive Rate ◽

Vaginal Fluid ◽

Postmenopausal Bleeding ◽

Cross Sectional ◽

Non Invasive ◽

Invasive Test ◽

Vaginal Cytology

AbstractPostmenopausal bleeding triggers urgent investigation by sequential invasive tests that are avoidable for the 90–95% of women who do not have endometrial cancer. A simple, non-invasive tool that accurately identifies cancer and safely reassures healthy women could transform patient care. Here we report, in a cross-sectional diagnostic accuracy study of 103 women with known cancer and 113 with unexplained postmenopausal bleeding, that urine and vaginal cytology has a combined sensitivity of 91.7% (95% CI 85.0%, 96.1%) and specificity of 88.8% (81.2%, 94.1%) for gynecological cancer detection. Cytology identifies 91 endometrial, two fallopian tube and one cervical cancer from 103 known cancer cases. In women with unexplained postmenopausal bleeding, cytology identifies all four endometrial cancers and three others (cervical, ovarian and bladder), for a 12/107 (11.2%) false positive rate. We show proof-of-principle that endometrial cancer can be detected in urine and vaginal fluid. Prospective validation of these findings will support incorporation of this non-invasive test into clinical practice.

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Comparison of diagnostic accuracy of hysteroscopy and ultrasonography in relation to histopathology in cases of postmenopausal bleeding

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205236 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4995

Author(s):

Dilpreet K. Pandher ◽

Alka Sehgal ◽

Ranjeev Bhagat ◽

Poonam Goel

Keyword(s):

Predictive Value ◽

Relevant Information ◽

Morbidity Rate ◽

Recurrent Bleeding ◽

Contraceptive Device ◽

Postmenopausal Bleeding ◽

Endometrial Polyps ◽

Predictive Values ◽

One Year ◽

Sensitivity Specificity

Background: To evaluate the role of hysteroscopy and ultrasound in relation to histological findings in patients of postmenopausal bleeding and to find out the sensitivity, specificity, positive predictive, negative predictive values and accuracy of ultrasound and hysteroscopy.Methods: A retrospective analysis of the 30 women who underwent hysteroscopic evaluation out of total 103 patients of postmenopausal bleeding over the period of one year (August 2017 and July 2018) was done. Records were taken out to collect the relevant information. USG and hysteroscopic findings were correlated with histopathology for the comparative analysis.Results: Indications of hysteroscopy cases were suspected polyp (5), fractional curettage (F/C) technically not feasible (7), inconclusive USG reports (5), recurrent bleeding with normal fractional curettage report (4), no tissue on F/C (1), removal of intra-uterine contraceptive device (1). Causes of postmenopausal uterine bleeding were found to be atrophic endometrium including one case of senile cystic atrophy (33.3%), secretory endometrium and endometrial polyps (23.3% each) and endometrial malignancy (20.0%) cases. Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy values of USG in various endometrial conditions was found to be 57.1%, 85.2%, 55.1%, 86.2% and 78.5% respectively and for hysteroscopy was 87.1%, 97.5%, 90.0%, 96.7% and 95.3% respectively.Conclusions: Hysteroscopy is a minimally invasive, safe and effective modality with least complications and morbidity rate and an ideal method for establishing the pathology as well as offering therapeutic intervention simultaneously.

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HE4 in the Diagnostic Approach of Endometrial Cancer in Patients with Postmenopausal Bleeding, the METRODEC Protocol: Protocol for a Multicenter Prospective Study

Diagnostics ◽

10.3390/diagnostics11071274 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1274

Author(s):

Manon Degez ◽

Hélène Caillon ◽

Anne Chauviré-Drouard ◽

Maxime Leroy ◽

David Lair ◽

...

Keyword(s):

Endometrial Cancer ◽

Gynecological Cancer ◽

Biological Marker ◽

Preoperative Assessment ◽

Endometrial Biopsy ◽

Routine Practice ◽

Diagnostic Study ◽

Postmenopausal Bleeding ◽

Post Menopausal ◽

One Year

Background: Endometrial cancer is the most common pelvic gynecological cancer in France. The most frequent symptom is post-menopausal bleeding and is one of the primary reasons for consultation in gynecological emergencies. The treatment is very codified and consists of a surgical intervention for anatomopathological analysis. The latter is frequently reassuring. These interventions are often performed in mild situations and there is currently no element to be sufficiently reassuring to avoid surgery. This study aims to explore the sensitivity of an innovative marker: Human Epididymis 4 (HE4) in the diagnosis approach of endometrial cancer in case of postmenopausal bleedings. Methods: This is a prospective multicenter diagnostic study with three centers involved. Inclusion criteria are any patient with post-menopausal bleeding who is to undergo hysteroscopy, endometrial biopsy, or endometrial resection. In accordance with the recommendations for the management of post-menopausal bleedings, the medical conduct consists of performing a clinical examination, an ultrasound and, in general, even in case of paraclinical examination reassuring, an anatomopathological analysis. This pathological analysis can be obtained in several ways: biopsy, hysteroscopy-curettage (which is the most frequently performed surgery), and hysterectomy. Our protocol consists of taking a blood sample from each woman who will undergo one of the interventions mentioned above. The dosage of HE4 and CA125 requires the withdrawal of an additional heparinized tube during the preoperative assessment usually performed. This research is therefore classified as non-interventional. The primary outcome is to evaluate the sensitivity of the HE4 marker in patients with postmenopausal bleeding in the diagnosis of endometrial cancer. The secondary outcomes are other parameters (specificity, VPP, VPN) of HE4, Evaluating the diagnostic capabilities of the CA125 marker alone and associated with HE4, as well as those of the REM and REM-B algorithms. We aim to include 100 patients over a period of one year in three centers. Discussion: As of now, there is no biological marker used in routine practice in the diagnosis of endometrial cancer. The ultimate goal of HE4 in endometrial cancer is to avoid surgery for those who are identified as non-sick. This study is the precursor of others for use in routine practice, HE4 would represent a great help to diagnosis if our study demonstrates it as reliable in the management of these patients and avoid many unnecessary and risky surgeries.

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Glucose Calibration Modeling in Blood with Spline Regression Approaching to Non-Invasive Tools

International Journal of Scientific Research in Science Engineering and Technology ◽

10.32628/ijsrset2184111 ◽

2018 ◽

pp. 144-149

Author(s):

Ria Hayatun Nur ◽

Indahwati A ◽

Erfiani A

Keyword(s):

Diabetes Mellitus ◽

Linear Regression ◽

Good Health ◽

Cubic Spline ◽

The Body ◽

Spline Regression ◽

Linear Quadratic ◽

Important Thing ◽

Non Invasive

In this globalization era, health is the most important thing to be able to run various activities. Without good health, this will hinder many activities. Diabetes mellitus is one of the diseases caused by unhealty lifestyle.There are many treatments that can be done to prevent the occurrence of diabetes. The treatments are giving the insulin and also checking the glucose rate to the patients.Checking the glucose rate needs the tools which is safety to the body. This research want to develop non invasive tool which is safety and do not injure the patient. The purpose of this research is also finding the best model which derived from Linear, Quadratic, and Cubic Spline Regression. Some respondents were taking to get the glucose measuring by invasive and non invasive tools. It could be seen clearly that Spline Linear Regression was the best model than Quadratic and Cubic Spline Regression. It had 70% and 33.939 for R2 and RMSEP respectively.

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Glandular cancer of the cervix or endometrial cancer – difficulties in diagnostics

Current Gynecologic Oncology ◽

10.15557/cgo.2014.0022 ◽

2014 ◽

Vol 12 (3) ◽

pp. 239-244

Author(s):

Maria Szubert ◽

◽

Paulina Kwiatkowska-Wypych ◽

Martyna Sikora ◽

Jarosław Szwalski ◽

...

Keyword(s):

Endometrial Cancer ◽

Cancer Of The Cervix

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A Clinico-pathological Study of Transvaginal Endometrial Thickness Measurement in Asymptomatic Postmenopausal Patients and Patients with Postmenopausal Bleeding

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.851 ◽

2019 ◽

pp. 1

Author(s):

Ayse Filiz Gokmen Karasu ◽

Seda Ates ◽

Tugba Gurbuz ◽

Nurhan Sahin ◽

Taha Takmaz ◽

...

Keyword(s):

Endometrial Thickness ◽

Transvaginal Ultrasound ◽

Thickness Measurement ◽

University Hospital ◽

Postmenopausal Bleeding ◽

Pathological Study ◽

Endometrial Polyps ◽

Endometrial Sampling ◽

Proliferative Endometrium

Objective: We aimed to determine the frequency of endometrial pathologies of patients who presented to our outpatient clinic with postmenopausal bleeding (PMB) and asymptomatic menopausal patients with a finding of thickened endometrium on transvaginal ultrasonography.Study Design: This study was performed at Bezmialem University Hospital. Women who presented to our clinic from January 2015 to January 2017 were analyzed. Patients were divided to two groups. All patients underwent transvaginal ultrasound with a 7.5 MHz probe. Endometrial sampling was performed by either blind D&C (dilatation & curettage) or pipelle sampling. We excluded patient specimens that were obtained by hysteroscopy.Results: Electronic records of a total of 368 patients in menopause were inspected. Out of these patients; 287 (78%) underwent endometrium sampling indicated by bleeding. Eighty-one patients (22%) were asymptomatic; however, a thickened endometrium echo on TVUSG examination (≥ 5 mm) was suspected. The median age was 57 (42-85). In both groups the two leading causes of endometrial pathology was; endometrial polyps followed by proliferative endometrium. The frequency of endometrial cancer was 9.4 % for the PMB group and 1.2 % in the asymptomatic patient groupConclusion: Evaluation of PMB as soon as possible is essential for diagnosing endometrial pathologies. Role of endometrial thickness is decisive in detecting patients at high risk for malignancy especially with comorbid conditions. Histopathological evaluation is mandatory for ruling out malignancy.

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Three plasma-based microRNAs as potent diagnostic biomarkers for endometrial cancer

Cancer Biomarkers ◽

10.3233/cbm-200972 ◽

2021 ◽

pp. 1-12

Author(s):

Xingchen Fan ◽

Minmin Cao ◽

Cheng Liu ◽

Cheng Zhang ◽

Chunyu Li ◽

...

Keyword(s):

Endometrial Cancer ◽

Operating Characteristic ◽

Characteristic Curve ◽

External Validation ◽

Diagnostic Value ◽

Diagnostic Biomarkers ◽

Non Invasive ◽

Polymerase Chain ◽

Public Datasets ◽

Plasma Mirnas

BACKGROUND: MicroRNAs (miRNAs), with noticeable stability and unique expression pattern in plasma of patients with various diseases, are powerful non-invasive biomarkers for cancer detection including endometrial cancer (EC). OBJECTIVE: The objective of this study was to identify promising miRNA biomarkers in plasma to assist the clinical screening of EC. METHODS: A total of 93 EC and 79 normal control (NC) plasma samples were analyzed using Quantitative Real-time Polymerase Chain Reaction (qRT-PCR) in this four-stage experiment. The receiver operating characteristic curve (ROC) analysis was conducted to evaluate the diagnostic value. Additionally, the expression features of the identified miRNAs were further explored in tissues and plasma exosomes samples. RESULTS: The expression of miR-142-3p, miR-146a-5p, and miR-151a-5p was significantly overexpressed in the plasma of EC patients compared with NCs. Areas under the ROC curve of the 3-miRNA signature were 0.729, 0.751, and 0.789 for the training, testing, and external validation phases, respectively. The diagnostic performance of the identified signature proved to be stable in the three public datasets and superior to the other miRNA biomarkers in EC diagnosis. Moreover, the expression of miR-151a-5p was significantly elevated in EC plasma exosomes. CONCLUSIONS: A signature consisting of 3 plasma miRNAs was identified and showed potential for the non-invasive diagnosis of EC.

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Pancreatic Carcinoma Metastatic to the Gingiva

Clinics and Practice ◽

10.3390/clinpract11010010 ◽

2021 ◽

Vol 11 (1) ◽

pp. 58-64

Author(s):

Arijan Zubović ◽

Margita Belušić-Gobić ◽

David Harmicar ◽

Jasna Marušić ◽

Damir Vučinić ◽

...

Keyword(s):

Pancreatic Carcinoma ◽

Pancreatic Tumor ◽

Maxillofacial Surgery ◽

The Body ◽

Retroperitoneal Mass ◽

Immunohistochemical Examination ◽

Normal Result ◽

Highly Sensitive ◽

Gingival Neoplasm ◽

Malignant Lesions

Metastatic tumors to the oral cavity are uncommon, representing approximately 1% of all cases of oral malignant lesions even when a metastatic disease is present. The 53-year-old female is presented complaining of abdominal pain, weight loss, and a loose stool recurring not more than three times per day. A computed tomography (CT) scan of the abdomen showed a retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with a gastric mucosa biopsy showed a normal result. After laparoscopic surgery, the primary site of adenocarcinoma was not confirmed. The patient was referred to the Maxillofacial Surgery Clinic with pain, swelling, and occasional bleeding around the lower right second mollar. Immunohistochemicaly, the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2), which are highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor to the lower right gingiva and highlights the importance of immunohistochemical examination and how it helped identify both the origin and the nature of gingival neoplasm.

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Deep learning model for classifying endometrial lesions

Journal of Translational Medicine ◽

10.1186/s12967-020-02660-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

YunZheng Zhang ◽

ZiHao Wang ◽

Jin Zhang ◽

CuiCui Wang ◽

YuShan Wang ◽

...

Keyword(s):

Endometrial Cancer ◽

Endometrial Hyperplasia ◽

Histogram Equalization ◽

Atypical Hyperplasia ◽

Endometrial Polyps ◽

Submucous Myoma ◽

Objective Model ◽

Medical University ◽

Deep Learning Model ◽

Better Than

Abstract Background Hysteroscopy is a commonly used technique for diagnosing endometrial lesions. It is essential to develop an objective model to aid clinicians in lesion diagnosis, as each type of lesion has a distinct treatment, and judgments of hysteroscopists are relatively subjective. This study constructs a convolutional neural network model that can automatically classify endometrial lesions using hysteroscopic images as input. Methods All histopathologically confirmed endometrial lesion images were obtained from the Shengjing Hospital of China Medical University, including endometrial hyperplasia without atypia, atypical hyperplasia, endometrial cancer, endometrial polyps, and submucous myomas. The study included 1851 images from 454 patients. After the images were preprocessed (histogram equalization, addition of noise, rotations, and flips), a training set of 6478 images was input into a tuned VGGNet-16 model; 250 images were used as the test set to evaluate the model’s performance. Thereafter, we compared the model’s results with the diagnosis of gynecologists. Results The overall accuracy of the VGGNet-16 model in classifying endometrial lesions is 80.8%. Its sensitivity to endometrial hyperplasia without atypia, atypical hyperplasia, endometrial cancer, endometrial polyp, and submucous myoma is 84.0%, 68.0%, 78.0%, 94.0%, and 80.0%, respectively; for these diagnoses, the model’s specificity is 92.5%, 95.5%, 96.5%, 95.0%, and 96.5%, respectively. When classifying lesions as benign or as premalignant/malignant, the VGGNet-16 model’s accuracy, sensitivity, and specificity are 90.8%, 83.0%, and 96.0%, respectively. The diagnostic performance of the VGGNet-16 model is slightly better than that of the three gynecologists in both classification tasks. With the aid of the model, the overall accuracy of the diagnosis of endometrial lesions by gynecologists can be improved. Conclusions The VGGNet-16 model performs well in classifying endometrial lesions from hysteroscopic images and can provide objective diagnostic evidence for hysteroscopists.

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Sensors for the detection of ammonia as a potential biomarker for health screening

Scientific Reports ◽

10.1038/s41598-021-86686-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Peter P. Ricci ◽

Otto J. Gregory

Keyword(s):

Vapor Phase ◽

Detection System ◽

Health Screening ◽

The Body ◽

Peptic Ulcers ◽

Non Invasive ◽

Sensing Platform ◽

Potential Biomarker ◽

Screening Protocol ◽

H Pylori

AbstractThe presence of ammonia within the body has long been linked to complications stemming from the liver, kidneys, and stomach. These complications can be the result of serious conditions such as chronic kidney disease (CKD), peptic ulcers, and recently COVID-19. Limited liver and kidney function leads to increased blood urea nitrogen (BUN) within the body resulting in elevated levels of ammonia in the mouth, nose, and skin. Similarly, peptic ulcers, commonly from H. pylori, result in ammonia production from urea within the stomach. The presence of these biomarkers enables a potential screening protocol to be considered for frequent, non-invasive monitoring of these conditions. Unfortunately, detection of ammonia in these mediums is rather challenging due to relatively small concentrations and an abundance of interferents. Currently, there are no options available for non-invasive screening of these conditions continuously and in real-time. Here we demonstrate the selective detection of ammonia using a vapor phase thermodynamic sensing platform capable of being employed as part of a health screening protocol. The results show that our detection system has the remarkable ability to selectively detect trace levels of ammonia in the vapor phase using a single catalyst. Additionally, detection was demonstrated in the presence of interferents such as carbon dioxide (CO2) and acetone common in human breath. These results show that our thermodynamic sensors are well suited to selectively detect ammonia at levels that could potentially be useful for health screening applications.

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