Ala Aiob

Risk factors and predictive modeling for occult endometrial cancer in women with atypical hyperplasia: a retrospective study

Abstract Purpose Atypical endometrial hyperplasia (AEH) is a known precursor to endometrioid endometrial carcinoma. However, occult carcinoma may already be present at diagnosis, complicating surgical planning. Accurate preoperative risk stratification is crucial, especially for guiding the selective use of sentinel lymph node biopsy. This study aimed to identify predictors of occult carcinoma and develop a model to estimate the risk of malignancy. Methods We conducted a retrospective case–control study of 101 women diagnosed with AEH who underwent hysterectomy between 2010 and 2024 at Galilee Medical Center. Clinical, metabolic, and imaging data were extracted. Patients were stratified based on the final pathology into two groups: those with occult carcinoma and those with AEH only. Multivariable logistic regression was employed to identify independent predictors and construct a predictive model. Results Occult endometrial carcinoma was identified in 37 women (36.6%). Women with occult endometrial carcinoma were older and more likely to present with postmenopausal bleeding. Occult carcinoma was more frequently detected after Pipelle biopsy than after hysteroscopy or dilation and curettage (43.2% vs. 17.2%). In multivariable analysis, Pipelle biopsy (OR 4.68), hyperlipidemia (OR 5.86), obesity (OR 2.97), and increasing age (OR 1.07 per year) were independently associated with occult carcinoma. A predictive model estimated individual risk ranging from 5.6% to 95.0% according to accumulation of risk factors. Conclusion Older age, biopsy method, obesity, hyperlipidemia, and bleeding presentation are independently associated with an occult endometrial carcinoma in women with atypical endometrial hyperplasia. The proposed model may support preoperative risk stratification and counseling, but it requires external validation before clinical use, including decisions regarding sentinel lymph node biopsy.

Rate of occult atypical hyperplasia or endometrial cancer in women of older age groups with nonatypical endometrial hyperplasia (KGOG 2026)

Enrichment for the POLE mutated against p53 wild subtype using clinicopathologic factors and cyclin B1 immunohistochemistry in endometrial cancer

Mini-laparotomic-assisted laparoscopic radical hysterectomy: an innovative technique for cervical cancer surgery—a case series

Abstract Purpose To assess the feasibility, safety, and short-term surgical outcomes of mini-laparotomic-assisted laparoscopic radical hysterectomy in the treatment of early-stage cervical cancer. This pilot feasibility case series is the first to provide a detailed description of the technique and its initial clinical results. Methods A retrospective case series of seven women with early-stage cervical cancer underwent mini-laparotomic-assisted laparoscopic radical hysterectomy at a single tertiary care center between November 2023 and October 2024. The surgical procedure included laparoscopic pelvic lymphadenectomy, radical hysterectomy, and salpingectomy, followed by colpotomy and uterine extraction through a mini-laparotomy (4–8 cm). Data on baseline characteristics, intraoperative parameters, and postoperative outcomes were collected and analyzed retrospectively. Results The median age was 50 years (range 42–76), and the median BMI was 27.9 kg/m 2 (range 20–43). Histological subtypes included five cases of squamous cell carcinoma, one case of adenocarcinoma, and one case of adenosquamous carcinoma. Pathological staging revealed IB2 in three patients, IA1 in two, and one each for IB1 and IA2. The median operative time was 345 min (range 295–395), and the median estimated blood loss was 500 mL (range 200–700). No intraoperative or postoperative complications were reported. Conclusion Mini-laparotomic-assisted laparoscopic radical hysterectomy appears to be a feasible and safe surgical option for early-stage cervical cancer. This technique combines the oncologic rigor of open surgery with the advantages of minimally invasive methods, addressing significant limitations of conventional laparoscopy, including tumor manipulation and intracorporeal colpotomy performed under CO₂ pneumoperitoneum. As the initial report describing this approach, the findings support its potential as an effective alternative to the traditional open radical hysterectomy. Further studies involving larger cohorts and long-term follow-up are needed to validate its oncologic and perioperative benefits.