Ursula Catena

Hysteroscopic endometrial tumor localization and sentinel lymph node mapping. An upgrade of the hysteroscopic role in endometrial cancer patients

Given the growing interest in sentinel node mapping (SLN) biopsy in Endometrial Cancer (EC) patients, many efforts have been made to maximize the SLN bilateral detection rate. However, at present, no previous research assessed the potential correlation between primary EC location in the uterine cavity and SLN mapping. In this context, this study aims to investigate the possible role of intrauterine EC hysteroscopic localization in predicting SLN nodal placement. EC patients surgically treated from January 2017 to December 2021 were retrospectively analyzed. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and SLN mapping. During hysteroscopy, the location of the neoplastic lesion was described as follows: uterine fundus (comprising the most cranial portion of the uterine cavity up to the tubal ostium including the cornual areas), corpus uteri (from the tubal ostium to the inner uterine orifice), and diffuse (when the tumor invades more than 50% of the uterine cavity). Three hundred ninety patients met the inclusion criteria. The tumor pattern diffused to the whole uterine cavity was statistically associated with SLN uptake on common iliac lymph nodes (OR 2.4, 95%CI 1-5.8, p = 0.05). Patients'age is an independent factor associated with SLN failure (OR: 0.95, 95%CI 0.93-0.98, p < 0.001). The study showed a statistically significant association between EC hysteroscopically spread throughout the whole uterine cavity and SLN uptake at the common iliac lymph nodes. Furthermore, patient age negatively affected the SLN detection rate.

Levonorgestrel-releasing intra-uterine device alone for managing early-stage endometrial cancer and endometrial hyperplasia with atypia in patients unfit for surgery: the ENDOIUD study

This study aimed to clarify the role of levonorgestrel-releasing intra-uterine device as a stand-alone therapy in managing patients with endometrial atypical hyperplasia/endometrial cancer who are not suitable for surgery, through the evaluation of cause-specific survival and the control of vaginal bleeding. This is a retrospective, multi-center study conducted in 9 referral gynecologic centers in Italy. Data regarding the clinical and oncological outcomes of patients with endometrial atypical hyperplasia/endometrial cancer (International Federation of Gynecology and Obstetrics Stage I) were analyzed. Patients were judged unsuitable for surgery due to an American Society of Anesthesiologists score ≥3 and the presence of multiple severe co-morbidities and, therefore, triaged to receive levonorgestrel-releasing intra-uterine device alone. A total of 78 women were enrolled. Fifteen patients (19.2%) had a diagnosis of endometrial atypical hyperplasia, whereas the other 63 (80.8%) had endometrial cancer. The baseline hemoglobin levels averaged 11.6 (range; 6-16), increasing to 12.1 (range; 7.8-14.9) during follow-up after levonorgestrel-releasing intra-uterine device insertion (p = .003). No patient experienced any side effects, and bleeding control was rated as excellent in most patients. Median disease-free survival was 43 months (range; 5-120) and median overall survival was 45 months (range; 5-120). Levonorgestrel-releasing intra-uterine device alone is a safe and effective approach, showing no side effects, and a promising oncological outcome in women with early-stage endometrial atypical hyperplasia/endometrial cancer unfit for surgery. Future prospective studies are required to clarify how to select patient candidates for this therapy and how to predict response to levonorgestrel-releasing intra-uterine device.

Evaluation of decision regret and reproductive concerns following fertility-sparing treatment in adolescents and young adults with atypical endometrial hyperplasia or endometrioid endometrial cancer-a single-center cross-sectional study.

To examine decision regret and reproductive concerns following fertility-sparing treatment in adolescents and young adults (defined as aged 15-39 years) with endometrial atypical hyperplasia or endometrioid endometrial cancer. All adolescents and young adults diagnosed with endometrial atypical hyperplasia or endometrioid endometrial cancer between January 1, 2021, and December 31, 2023, who underwent fertility-sparing treatment at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS hospital in Rome, Italy, were contacted. Patients were asked to fill out the 5-item Decision Regret Scale score and the 18-item Reproductive Concerns After Cancer score, assessing the following areas of concern: fertility potential, partner disclosure of fertility status, child's health, personal health, acceptance of possible infertility, and becoming pregnant. Thirty-two patients gave informed consent and were included. Complete treatment response was achieved in 93.9% of cases, whereas among those with endometrioid endometrial cancer the complete response rate was 100.0%. After a median follow-up of 29 months (range; 11-44 months), 1 patient (3.1%) experienced persistent disease and 6 patients (18.8%) had a relapse. Five patients (15.6%) underwent hysterectomy. Among the 20 patients who tried to conceive following diagnosis, a total of 12 pregnancies were achieved in 11 patients (pregnancy rate 60.0%). The live birth rate per pregnancy was 66.7%; 2 pregnancies were still ongoing. Mean Decision Regret Scale score was 16.6 (SD 24.0, range; 0-100). Mean Reproductive Concerns After Cancer score for all items was 2.78 (SD 1.17, range; 1-5), with greatest concern for acceptance of possible infertility (mean 3.23, SD 1.08), fertility potential (mean 3.12, SD 1.24) and child's health (mean 3.02, SD 1.31). Regardless favorable oncological and obstetrical outcomes and mild decision regret, reproductive concerns are common following fertility-sparing treatment in adolescents and young adults with endometrial atypical hyperplasia or endometrioid endometrial cancer.