- Email: [email protected]
Asymptomatic high grade endometrial cancer
EMAS2017 / Maturitas 100 (2017) 93–202
PCO: 15% (most prevalent endocrine disorder) Local therapies have low and medium efficacy. The combination of estrogen with an antiandrogenic progestogen is the most effective treatment targeting symptoms and endocrine dysregulation. The individual cardiovascular risk has to be assessed and balanced with the benefit. http://dx.doi.org/10.1016/j.maturitas.2017.03.197 P098 Analysis of Codon 72 polymorphism in the p53 tumor suppressor gene in women with idiopathic recurrent pregnancy loss Sang Ho Yoon Dongguk University Ilsan Medical Center, Obstetrics and Gynecology, Goyang, Republic of Korea Objective: The balance of apoptosis and proliferation is an important part in the embryonic development during pregnancy. It has been reported that the p53 gene plays a significant role in angiogenesis and placental development, namely in reproduction and is suggested as a potential mediator of pregnancy. This study was performed to investigate whether the genetic polymorphism of the p53 gene is associated with idiopathic recurrent pregnancy loss (RPL). Study design: We conducted a case-control study. Study subjects consisted of 294 patients with idiopathic RPL and 300 postmenopausal controls. The genotyping for the p53 codon 72 polymorphism was performed using a Taqman assay. Continuous variables were compared using Student’s t test and the 2 test was used to evaluate differences in the genotype distributions between the RPL and the controls. Results: The median number (range) of spontaneous miscarriages was 3 (2–13) in RPL patients and 0 (0-0) in controls. There were no significant differences in the genotype distributions or allele frequencies of the p53 codon 72 polymorphism between the RPL and control group (Arg/Pro rates; 65.3/34.7% in the RPL vs. 64.8/35.2% in the control group, p = 0.864). There was also no significant association between the p53 codon 72 polymorphism and RPL risk in both recessive (Pro/Pro vs. Arg-carriers, p = 0.314) and dominant model (Pro-carriers vs. Arg/Arg, p = 0.383). For further analysis, if RPL patients were divided according to the numbers of pregnancy losses (≥2 and ≥3), neither group was significantly different compared with controls. Conclusions: The codon 72 polymorphism in the p53 gene did not show any correlation with idiopathic RPL in Korean women, implying that it may not be susceptible allelic variants or be insufficient to cause RPL. Keywords: Codon 72 polymorphism; p53 tumor suppressor gene; Recurrent pregnancy loss http://dx.doi.org/10.1016/j.maturitas.2017.03.198 P099 Application of robotic single-site surgery for early stage cervical cancer: A pilot study Sang Hoon Kwon ∗ , Chi Heum Cho Keimyung University, Daegu, Republic of Korea Aims: Recent reports propose that robotic single-site (RSS) surgery is feasible in treating a benign condition of gynecologic process. The aim of this study is to evaluate the feasibility and safety of
177
RSS surgery for the surgical treatment of early stage cervical cancer (carcinoma in situ of cervix & cervical cancer Ia1). Method: Patients with preoperative diagnosis of CIS and cervical cancer Ia1 by loop electrosurgical excision procedure were selected. 12 patients (10 patients: CIS, 2 patients: cervical cancer Ia1) who underwent RSS surgery from March 2014 to August 2015, at Dongsan medical center, were included in this study. All surgical procedures were performed by robotic single-site instruments ® (da Vinci Si surgical System, Sunnyvale, CA) via a single umbilical incision. All patients underwent type 1 hysterectomy with or without salpingo-oophorectomy according to the grossly ovarian pathology. Results: The Median patient age and body mass index were 42.5 years (range, 33–61 years) and 22.2 kg/m2 (range, 18.6–26.4 kg/m2 ). The median console time and total operative time was 52.5 min (range, 36–185 min) and 125 min (range, 90–280 min), respectively. There was no case of conversion to laparoscopy or laparotomy. There was only one wound disruption and dehiscence of umbilical skin. Patients were repaired at post-operative 1month. Conclusion: RSS surgery is feasible and safe in selected patients with early stage cervical cancer. Operative times were reasonable and surgical procedure was well tolerated by patients. Large-scaled studies comparing laparoscopic single site surgery in patients should be performed to confirm the safety and benefits of RSS surgery. http://dx.doi.org/10.1016/j.maturitas.2017.03.199 P100 Asymptomatic high grade endometrial cancer Laura Baquedano 1,∗ , Pluvio Jesús Coronado 2 , Maria Angeles Martinez-Maestre 3 , Yasmina José 1 , Miguel Angel Ruiz-Conde 1 , Diego Judez 4 1
Hospital Universitario Miguel Servet, Zaragoza, Spain 2 Hospital Clinico San Carlos, Madrid, Spain 3 Hospital Virgen del Rocío, Sevilla, Spain 4 Hospital Alca˜ niz, Teruel, Spain
Most women with endometrial cancer (EC) have abnormal uterine bleeding. However, there is a small percentage of patients who are asymptomatic at the time of diagnosis. The objective of the study is to analyze the epidemiological characteristics and risk factors of asymptomatic high grade EC. Material and methods: Retrospective multicentric cohort study in 3 Spanish hospitals: Hospital Universitario Miguel Servet in Zaragoza, Hospital Clínico San Carlos in Madrid and Hospital Virgen del Rocío in Sevilla. We studied the epidemiological characteristics and the presence of risk factors associated with high grade EC depending on the presence of symptoms at the time of diagnosis. We included all subtypes of high grade EC: G3 endometrioid (G3EC), serous carcinoma (SC), clear cell carcinoma (CCC) and malignant mixed mesodermal tumors (MMMT). A total of 373 cases of highgrade EC were included (135 G3EC, 96 SC, 64 CCC and 78 MMMT). Results: 90% of all patients (n = 335), had uterine bleeding at the time of EC diagnosis. All patients with asymptomatic EC (n = 37) were postmenopausal; of them, 24.3% (n = 9) were nulligest, 45.9% (n = 17) hypertensive, 45.9% (n = 17) were obese and 2.7% (n = 1) were under hormonal treatment. There were no significant differences between patients with asymptomatic high-grade carcinoma and those who present clinic in these factors: hypertension (p = 0.433), diabetes (p = 0.577), obesity (p = 0.825), use of hormone
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EMAS2017 / Maturitas 100 (2017) 93–202
therapy (p = 1.000), nulliparity (p = 0.459) and menopausal status (p = 0.237). Conclusions: Risk and epidemiological factors associated with high-grade EC are similar depending on the presence or absence of symptoms. http://dx.doi.org/10.1016/j.maturitas.2017.03.200 P101
P102 Different features of histopathological subtypes of ovarian tumor in pre- and post-menopausal women Eom Hye Mi 1,∗ , Jung Eun Jung 1 , Byun Jung Mi 1,2 , Kim Young Nam 1,2 , Jeong Dae Hoon 1,2 , Lee Kyung Bok 1,2 , Sung Moon Su 1,2 , Kim Ki Tae 1,2 1
Correlation between hysteroscopic image and anatomopathological result in the diagnosis of endometrial cancer in menopausal patients Laura Nieto-Pascual ∗ , M. Inmaculada Romero-Nieto, José Eduardo Arjona-Berral Reina Sofía University Hospital, Obstetrics and Gynaecology, Córdoba, Spain Objective: Before the appearance of bleeding in a menopausal patient, hysteroscopy is a test that allows us to visualize and evaluate the endometrial cavity in its entirety, which is extremely important in menopausal patients. According to the existing literature, hysteroscopy has a sensitivity of 75–86% and a specificity of 96–99% for the detection of endometrial cancer. Our objective was to evaluate the effectiveness of hysteroscopy in the diagnosis of malignant endometrial disease in menopausal patients in our unit in the last 5 years. Method: Between 2011 and 2016 we performed 761 hysteroscopies on suspicion of benign or malignant endometrial pathology in menopausal patients, and a targeted biopsy was performed in cases of suspected malignant endometrial disease. Twenty-five biopsies were taken on suspicion of endometrial carcinoma in the hysteroscopic image. All pathological anatomies diagnosed with endometrial cancer were analyzed in the referred period, obtaining 207 positive biopsies. The pathological anatomy was taken as Gold Standard for the diagnosis of endometrial cancer, and it was compared with the hysteroscopic diagnosis by calculating the indices of sensitivity, specificity, positive and negative predictive value. The degree of non-random concordance between the hysteroscopic image and the anatomopathological result was also assessed using the Cohen Kappa coefficient. Results: Hysteroscopy had a sensitivity of 86% and a specificity of 99%, with a positive predictive value of 91% and a negative predictive value of 99%. The concordance observed between the two diagnostic tests was very high, with an almost perfect agreement between the hysteroscopist and the pathologist: Kappa index of 0.88 (95% CI 0.84–0.91) and p < 0.0001. Conclusions: Hysteroscopy and guided biopsy are corroborated as the most efficient methods for the diagnosis of malignant endometrial pathology in menopausal patients. http://dx.doi.org/10.1016/j.maturitas.2017.03.201
Inje University/Paik Hospital, Busan, Republic of Korea 2 Inje university/Paik Institute for Clinical Research, Busan, Republic of Korea
Objective: To date, epidemiological evidence has supported a link between ovarian cancer risk and menopause. However, little is known about the menopausal status affects the risk of specific histological subtypes of ovarian tumor. We aimed to analyze the differences in various histopathological subtypes of ovarian tumor between pre- and post-menopausal women. Methods: We reviewed the medical records of patients who underwent surgery for a suspected ovarian neoplasm and histopathologically confirmed at Busan Paik hospital between 1997 and 2016. These tumors were regrouped according to 2014 World Health Organization (WHO) classification. Results: A total of 4683 cases (3404 with pre- and 1279 with post-menopausal) were included for analysis. Epithelial tumors account for 52.6% of the total cases, germ cell tumors for 27.1%, sex cord-stromal tumors (SCSTs) for 4.1%, tumor-like lesions for 14.0%, and secondary tumors for 0.8%. In epithelial tumors, epithelial ovarian carcinoma was predominantly seen in post-menopausal women (5.4% vs. 22.1%, P < 0.0001), whereas benign epithelial tumors were significantly associated with pre-menopausal women (40.5% vs. 31.9%, P < 0.0001). Germ cell tumors were noted more frequently in pre-menopausal women than post-menopausal women (31.3% vs. 16.1%, P < 0.0001). The majority of SCSTs were predominantly occurred in post-menopausal women (2.1% vs. 9.5%, P < 0.0001). Tumor-like ovarian lesions were significantly associated with pre-menopausal women (15.2% vs. 10.7%, P = 0.0001). Conclusions: We have demonstrated the differences in diverse histological subtypes of ovarian tumor according to menopausal status based on the new WHO classification in Korean women. http://dx.doi.org/10.1016/j.maturitas.2017.03.202 P103 Increasing accuracy of histopathological samples by hysteroscopic biopsy in postmenopausal bleeding Nicolae Bacalbasa 1 , Cristian Poalelungi 1 , Maxim Doroftei 2 , Stefania Tudorache 3 , Dominic Iliescu 3 , Iuliana Ceausu 1,∗ 1 ‘Carol Davila’ University of Medicine and Pharmacy, ‘Dr. I. Cantacuzino’ Department of OG, Bucharest, Romania 2 Malaxa Clinical Hospital, OG Department, Bucharest, Romania 3 UMF Craiova, SCJU, Craiova, Romania
Material and methods: The study evaluated the results from 244 postmenopausal women in hospitalized in the gynaecology department of the “Dr. I. Cantacuzino” Hospital, with the principal admitted diagnosis of metrorrhagia in postmenopause. Results: The women were admitted for bleeding in postmenopause, either in acute bleeding or for investing a recent
PCO: 15% (most prevalent endocrine disorder) Local therapies have low and medium efficacy. The combination of estrogen with an antiandrogenic progestogen is the most effective treatment targeting symptoms and endocrine dysregulation. The individual cardiovascular risk has to be assessed and balanced with the benefit. http://dx.doi.org/10.1016/j.maturitas.2017.03.197 P098 Analysis of Codon 72 polymorphism in the p53 tumor suppressor gene in women with idiopathic recurrent pregnancy loss Sang Ho Yoon Dongguk University Ilsan Medical Center, Obstetrics and Gynecology, Goyang, Republic of Korea Objective: The balance of apoptosis and proliferation is an important part in the embryonic development during pregnancy. It has been reported that the p53 gene plays a significant role in angiogenesis and placental development, namely in reproduction and is suggested as a potential mediator of pregnancy. This study was performed to investigate whether the genetic polymorphism of the p53 gene is associated with idiopathic recurrent pregnancy loss (RPL). Study design: We conducted a case-control study. Study subjects consisted of 294 patients with idiopathic RPL and 300 postmenopausal controls. The genotyping for the p53 codon 72 polymorphism was performed using a Taqman assay. Continuous variables were compared using Student’s t test and the 2 test was used to evaluate differences in the genotype distributions between the RPL and the controls. Results: The median number (range) of spontaneous miscarriages was 3 (2–13) in RPL patients and 0 (0-0) in controls. There were no significant differences in the genotype distributions or allele frequencies of the p53 codon 72 polymorphism between the RPL and control group (Arg/Pro rates; 65.3/34.7% in the RPL vs. 64.8/35.2% in the control group, p = 0.864). There was also no significant association between the p53 codon 72 polymorphism and RPL risk in both recessive (Pro/Pro vs. Arg-carriers, p = 0.314) and dominant model (Pro-carriers vs. Arg/Arg, p = 0.383). For further analysis, if RPL patients were divided according to the numbers of pregnancy losses (≥2 and ≥3), neither group was significantly different compared with controls. Conclusions: The codon 72 polymorphism in the p53 gene did not show any correlation with idiopathic RPL in Korean women, implying that it may not be susceptible allelic variants or be insufficient to cause RPL. Keywords: Codon 72 polymorphism; p53 tumor suppressor gene; Recurrent pregnancy loss http://dx.doi.org/10.1016/j.maturitas.2017.03.198 P099 Application of robotic single-site surgery for early stage cervical cancer: A pilot study Sang Hoon Kwon ∗ , Chi Heum Cho Keimyung University, Daegu, Republic of Korea Aims: Recent reports propose that robotic single-site (RSS) surgery is feasible in treating a benign condition of gynecologic process. The aim of this study is to evaluate the feasibility and safety of
177
RSS surgery for the surgical treatment of early stage cervical cancer (carcinoma in situ of cervix & cervical cancer Ia1). Method: Patients with preoperative diagnosis of CIS and cervical cancer Ia1 by loop electrosurgical excision procedure were selected. 12 patients (10 patients: CIS, 2 patients: cervical cancer Ia1) who underwent RSS surgery from March 2014 to August 2015, at Dongsan medical center, were included in this study. All surgical procedures were performed by robotic single-site instruments ® (da Vinci Si surgical System, Sunnyvale, CA) via a single umbilical incision. All patients underwent type 1 hysterectomy with or without salpingo-oophorectomy according to the grossly ovarian pathology. Results: The Median patient age and body mass index were 42.5 years (range, 33–61 years) and 22.2 kg/m2 (range, 18.6–26.4 kg/m2 ). The median console time and total operative time was 52.5 min (range, 36–185 min) and 125 min (range, 90–280 min), respectively. There was no case of conversion to laparoscopy or laparotomy. There was only one wound disruption and dehiscence of umbilical skin. Patients were repaired at post-operative 1month. Conclusion: RSS surgery is feasible and safe in selected patients with early stage cervical cancer. Operative times were reasonable and surgical procedure was well tolerated by patients. Large-scaled studies comparing laparoscopic single site surgery in patients should be performed to confirm the safety and benefits of RSS surgery. http://dx.doi.org/10.1016/j.maturitas.2017.03.199 P100 Asymptomatic high grade endometrial cancer Laura Baquedano 1,∗ , Pluvio Jesús Coronado 2 , Maria Angeles Martinez-Maestre 3 , Yasmina José 1 , Miguel Angel Ruiz-Conde 1 , Diego Judez 4 1
Hospital Universitario Miguel Servet, Zaragoza, Spain 2 Hospital Clinico San Carlos, Madrid, Spain 3 Hospital Virgen del Rocío, Sevilla, Spain 4 Hospital Alca˜ niz, Teruel, Spain
Most women with endometrial cancer (EC) have abnormal uterine bleeding. However, there is a small percentage of patients who are asymptomatic at the time of diagnosis. The objective of the study is to analyze the epidemiological characteristics and risk factors of asymptomatic high grade EC. Material and methods: Retrospective multicentric cohort study in 3 Spanish hospitals: Hospital Universitario Miguel Servet in Zaragoza, Hospital Clínico San Carlos in Madrid and Hospital Virgen del Rocío in Sevilla. We studied the epidemiological characteristics and the presence of risk factors associated with high grade EC depending on the presence of symptoms at the time of diagnosis. We included all subtypes of high grade EC: G3 endometrioid (G3EC), serous carcinoma (SC), clear cell carcinoma (CCC) and malignant mixed mesodermal tumors (MMMT). A total of 373 cases of highgrade EC were included (135 G3EC, 96 SC, 64 CCC and 78 MMMT). Results: 90% of all patients (n = 335), had uterine bleeding at the time of EC diagnosis. All patients with asymptomatic EC (n = 37) were postmenopausal; of them, 24.3% (n = 9) were nulligest, 45.9% (n = 17) hypertensive, 45.9% (n = 17) were obese and 2.7% (n = 1) were under hormonal treatment. There were no significant differences between patients with asymptomatic high-grade carcinoma and those who present clinic in these factors: hypertension (p = 0.433), diabetes (p = 0.577), obesity (p = 0.825), use of hormone
178
EMAS2017 / Maturitas 100 (2017) 93–202
therapy (p = 1.000), nulliparity (p = 0.459) and menopausal status (p = 0.237). Conclusions: Risk and epidemiological factors associated with high-grade EC are similar depending on the presence or absence of symptoms. http://dx.doi.org/10.1016/j.maturitas.2017.03.200 P101
P102 Different features of histopathological subtypes of ovarian tumor in pre- and post-menopausal women Eom Hye Mi 1,∗ , Jung Eun Jung 1 , Byun Jung Mi 1,2 , Kim Young Nam 1,2 , Jeong Dae Hoon 1,2 , Lee Kyung Bok 1,2 , Sung Moon Su 1,2 , Kim Ki Tae 1,2 1
Correlation between hysteroscopic image and anatomopathological result in the diagnosis of endometrial cancer in menopausal patients Laura Nieto-Pascual ∗ , M. Inmaculada Romero-Nieto, José Eduardo Arjona-Berral Reina Sofía University Hospital, Obstetrics and Gynaecology, Córdoba, Spain Objective: Before the appearance of bleeding in a menopausal patient, hysteroscopy is a test that allows us to visualize and evaluate the endometrial cavity in its entirety, which is extremely important in menopausal patients. According to the existing literature, hysteroscopy has a sensitivity of 75–86% and a specificity of 96–99% for the detection of endometrial cancer. Our objective was to evaluate the effectiveness of hysteroscopy in the diagnosis of malignant endometrial disease in menopausal patients in our unit in the last 5 years. Method: Between 2011 and 2016 we performed 761 hysteroscopies on suspicion of benign or malignant endometrial pathology in menopausal patients, and a targeted biopsy was performed in cases of suspected malignant endometrial disease. Twenty-five biopsies were taken on suspicion of endometrial carcinoma in the hysteroscopic image. All pathological anatomies diagnosed with endometrial cancer were analyzed in the referred period, obtaining 207 positive biopsies. The pathological anatomy was taken as Gold Standard for the diagnosis of endometrial cancer, and it was compared with the hysteroscopic diagnosis by calculating the indices of sensitivity, specificity, positive and negative predictive value. The degree of non-random concordance between the hysteroscopic image and the anatomopathological result was also assessed using the Cohen Kappa coefficient. Results: Hysteroscopy had a sensitivity of 86% and a specificity of 99%, with a positive predictive value of 91% and a negative predictive value of 99%. The concordance observed between the two diagnostic tests was very high, with an almost perfect agreement between the hysteroscopist and the pathologist: Kappa index of 0.88 (95% CI 0.84–0.91) and p < 0.0001. Conclusions: Hysteroscopy and guided biopsy are corroborated as the most efficient methods for the diagnosis of malignant endometrial pathology in menopausal patients. http://dx.doi.org/10.1016/j.maturitas.2017.03.201
Inje University/Paik Hospital, Busan, Republic of Korea 2 Inje university/Paik Institute for Clinical Research, Busan, Republic of Korea
Objective: To date, epidemiological evidence has supported a link between ovarian cancer risk and menopause. However, little is known about the menopausal status affects the risk of specific histological subtypes of ovarian tumor. We aimed to analyze the differences in various histopathological subtypes of ovarian tumor between pre- and post-menopausal women. Methods: We reviewed the medical records of patients who underwent surgery for a suspected ovarian neoplasm and histopathologically confirmed at Busan Paik hospital between 1997 and 2016. These tumors were regrouped according to 2014 World Health Organization (WHO) classification. Results: A total of 4683 cases (3404 with pre- and 1279 with post-menopausal) were included for analysis. Epithelial tumors account for 52.6% of the total cases, germ cell tumors for 27.1%, sex cord-stromal tumors (SCSTs) for 4.1%, tumor-like lesions for 14.0%, and secondary tumors for 0.8%. In epithelial tumors, epithelial ovarian carcinoma was predominantly seen in post-menopausal women (5.4% vs. 22.1%, P < 0.0001), whereas benign epithelial tumors were significantly associated with pre-menopausal women (40.5% vs. 31.9%, P < 0.0001). Germ cell tumors were noted more frequently in pre-menopausal women than post-menopausal women (31.3% vs. 16.1%, P < 0.0001). The majority of SCSTs were predominantly occurred in post-menopausal women (2.1% vs. 9.5%, P < 0.0001). Tumor-like ovarian lesions were significantly associated with pre-menopausal women (15.2% vs. 10.7%, P = 0.0001). Conclusions: We have demonstrated the differences in diverse histological subtypes of ovarian tumor according to menopausal status based on the new WHO classification in Korean women. http://dx.doi.org/10.1016/j.maturitas.2017.03.202 P103 Increasing accuracy of histopathological samples by hysteroscopic biopsy in postmenopausal bleeding Nicolae Bacalbasa 1 , Cristian Poalelungi 1 , Maxim Doroftei 2 , Stefania Tudorache 3 , Dominic Iliescu 3 , Iuliana Ceausu 1,∗ 1 ‘Carol Davila’ University of Medicine and Pharmacy, ‘Dr. I. Cantacuzino’ Department of OG, Bucharest, Romania 2 Malaxa Clinical Hospital, OG Department, Bucharest, Romania 3 UMF Craiova, SCJU, Craiova, Romania
Material and methods: The study evaluated the results from 244 postmenopausal women in hospitalized in the gynaecology department of the “Dr. I. Cantacuzino” Hospital, with the principal admitted diagnosis of metrorrhagia in postmenopause. Results: The women were admitted for bleeding in postmenopause, either in acute bleeding or for investing a recent