Fan Li

Disparities and trends of the incidence and mortality of female-specific cancers in the United States

Background Female-specific cancers (FSCs) impose substantial burdens on healthcare systems and economies worldwide. The significant impact of these cancers in the United States warrants further investigation. Objective This study aimed to analyze trends in incidence and mortality rates of six female-specific cancers (breast, cervical, uterine, ovarian, vaginal, and vulvar cancers) among diverse racial and ethnic groups in the United States, and to evaluate the attributable contributions of major risk factors to the cancer death burden as well as their temporal changes. Methods Incidence and mortality data were obtained from the SEER (22 registry) database, to examine cross-sectional and temporal trends by race/ethnicity. The burden of FSCs attributable to specific risk factors was estimated based on the Global Burden of Disease 2021 database. Results Between 2017 and 2021, Breast cancer incidence increased across all racial groups, most notably among non-Hispanic White (White) women, while mortality declined. Cervical cancer incidence decreased in most groups but remained stable among American Indians and Alaska Native (AIAN) women. Uterine cancer incidence increased across all racial groups, except for Whites. Incidence and mortality rates for ovarian and vaginal cancers remained stable or decreased, whereas vulvar cancer mortality was highest among White and AIAN women and lowest among non-Hispanic Asian Americans and Pacific Islander (AAPI) women. From 2000 to 2021, risk-attributable deaths decreased for breast, cervical, and ovarian cancers but increased for uterine cancer. Conclusions Significant sociodemographic disparities and unfavorable trends persist in the incidence and mortality of all six major female-specific cancers, highlighting the importance for effective prevention and intervention strategies.

Assessing local invasion in cervical cancer: the diagnostic performance of transrectal contrast-enhanced ultrasonography

Abstract Objectives To evaluate the diagnostic performance of transrectal ultrasound (TR-US) combined with contrast-enhanced TR-US (TR-CEUS) against MRI and histopathology for assessing cervical cancer local invasion, and to validate the “rim sign” as a biomarker for parametrial exclusion. Methods A retrospective study of 69 cervical cancer patients (54 surgical, 15 neoadjuvant therapy recipients) undergoing TR-US, TR-CEUS, and MRI was conducted. Tumour dimensions, vaginal/parametrial invasion, and the “rim sign” were evaluated. Diagnostic agreement was assessed using intraclass correlation coefficients (ICC) and Cohen’ s κ, while the specificity and negative predictive value (NPV) of the “rim sign” were calculated. Results TR-CEUS improved TR-US reliability in tumour measurement (ICC = 0.751 to 0.784), achieving MRI-comparable accuracy (ICC = 0.804 vs. histopathology). Combined TR-US/TR-CEUS enhanced interobserver consistency for vaginal infiltration (κ = 0.621 to 0.694) and parametrial invasion (κ = 0.579 to 0.678) compared to TR-US alone. TR-US/TR-CEUS showed good agreement with histopathology (κ = 0.672) and MRI (κ = 0.789) for parametrial assessment than TR-US (κ = 0.563/0.679). The “rim sign” demonstrated 95.8% specificity and 92.0% NPV for parametrial exclusion. Conclusions TR-US/TR-CEUS achieves diagnostic accuracy comparable to MRI while improving observer consistency. The “rim sign” serves as a high-specificity biomarker for preoperative parametrial exclusion, offering a cost-effective alternative to MRI. Advances in knowledge This study provides quantitative evidence of TR-CEUS improving diagnostic reproducibility for cervical cancer invasion. The “rim sign” is identified as a novel imaging biomarker with high specificity for parametrial preservation.

Contrast-Enhanced Ultrasonography for Transabdominal and Transrectal Ultrasound in Staging Cervical Cancer: A Reliability Study

This retrospective study aimed to evaluate the consistency of transrectal contrast-enhanced ultrasonography (TR-CEUS) with post-operative pathology and the value of contrast-enhanced ultrasonography (CEUS) in staging surgically treated cervical cancer when combined with conventional ultrasonography (US). From October 2020 to March 2023, hospitalized patients with stage IB and II cervical cancer confirmed by total hysterectomy were consecutively enrolled. The standard images of US and CEUS by transabdominal (TA-US/CEUS) and transrectal (TR-US/CEUS) approaches and magnetic resonance imaging (MRI) were acquired, on which the size and stage of the tumors were evaluated, and the consistency of results with the pathological specimen was analyzed. Thirty-nine patients with cervical cancer were finally enrolled in this study. The results showed that CEUS significantly improved the reliability of TA-US in evaluating tumor diameter; the intraclass correlation coefficient (ICC) was from 0.672 to 0.735. TR-US indicated good reliability with or without the addition of CEUS (ICC = 0.796 and 0.780). In terms of tumor staging, CEUS improved the consistency of transabdominal (weighted κ values from 0.689 to 0.731) and transrectal staging of tumors (κ from 0.758 to 0.785), and the staging of TR-US combined with TR-CEUS had the highest consistency with post-operative results, similar to MRI (κ, respectively 0.785 and 0.789). CEUS can reflect the heterogeneity of the tumor. Heterogeneous enhancement and perfusion defects were more common in >2 cm cervical cancer (50%, 20/40 and 52.5%, 21/40), respectively, and perfusion defects were more common in moderately to poorly differentiated tumors (66.67%, 20/30). For stage IB and IIA cervical cancer, CEUS can aid in assessing the International Federation for Gynecology and Obstetrics staging of tumors alongside TA-US and TR-US. The combination of TR-US and TR-CEUS has shown good consistency with pathology in the staging of cervical cancer, comparable to that of MRI.