Taliya Lantsman

An evaluation of the utility of computed tomography in high-risk endometrial cancer surveillance

Endometrial cancer is a collection of heterogeneous histologies and molecular subtypes with different risk profiles. High-risk endometrial cancer surveillance regimens vary amongst providers. The National Comprehensive Cancer Network (NCCN) recommends symptom and exam-based surveillance for all endometrial cancers after remission, regardless of cancer stage and histology. Our objective was to identify the first method of detection of recurrence in high-risk endometrial cancers and examine disease recurrence and treatment patterns. A retrospective review of patients diagnosed with high-risk endometrial cancer between November 2013 and February 2020 was conducted at a large academic institution. High-risk endometrial cancers were classified by histology and pathologic stage and were categorized by primary method of detection. Two hundred and twenty-nine patients were identified with high-risk endometrial cancer, 63 (28 %) of whom had a recurrence. Most recurrences were first detected with routine imaging in 31 patients (49.2 %) and symptom surveillance in 24 patients (38.15 %). Regardless of the detection method, most patients underwent systemic treatment. The average survival after recurrence was 2.0 years in the imaging cohort and 1.6 years in the non-imaging surveillance cohort. The most common site of recurrence in our cohort of high-risk endometrial cancer was in the lung, and most recurrences were identified with asymptomatic imaging. Though there was no statistically significant difference between the survival of those who underwent imaging surveillance vs. standard of care, there was a trend toward survival that deems further exploration with a larger cohort.

Association between Cervical Dysplasia and Adverse Pregnancy Outcomes

Objective The aim of this study was to determine if cervical dysplasia during pregnancy is associated with pregnancy complications, including preterm delivery and pre-eclampsia. Study Design A retrospective cohort analyses was performed with propensity-score matching to compare complication rates between pregnant women without history of abnormal cervical cancer screening and pregnant women referred for cervical dysplasia assessment to colposcopy clinic. A composite outcome of pregnancy complications included intra-amniotic infection, preterm premature rupture of membranes, pre-eclampsia, preterm delivery, low birth weight, oligohydramnios, and intrauterine fetal demise. Complication rates were compared between women with and without cervical dysplasia using logistic regression models. Results Overall cohort included 2,814 women, 279 of whom attended colposcopy clinic for cervical dysplasia assessment. Propensity score–matched cohort included 1,459 women, 274 of whom attended colposcopy clinic. Composite complications of pregnancy rates were not significantly different between control and colposcopy groups in both cohorts (25.3% and 29.0%, P = 0.20; 26.5% and 29.3%, P = 0.45). Dysplasia was not associated with composite pregnancy complications in overall and matched cohorts (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 0.77–1.56) and (OR = 1.03, 95% CI: 0.72–1.49). When cervical dysplasia was determined on biopsy or colposcopy, dysplasia was not associated with complications in the overall and matched cohorts. Conclusion Biopsy and/or colposcopy determined cervical dysplasia during pregnancy was not associated with pregnancy complications.