International Journal of Gynecology & Obstetrics

Comparison of perioperative surgical outcomes between contained and free manual vaginal morcellation of large uteruses following total laparoscopic hysterectomy

AbstractObjectiveTo compare contained and free manual vaginal morcellation of large uteruses after total laparoscopic hysterectomy (TLH) in women at low risk of uterine malignancy in terms of feasibility and safety.MethodsA single‐center, observational, retrospective, cohort study was carried out including all patients undergoing TLH requiring manual vaginal morcellation for specimen extraction of large uteruses from January 2015 to August 2021 at the Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero‐Universitaria of Bologna, Bologna, Italy. Patients were divided into two groups according to the type of manual vaginal morcellation (contained or free), and compared in terms of demographic, clinical, and perioperative data.ResultsIn all, 271 patients were included: 186 (68.6%) in the contained morcellation group and 85 (31.4%) in the free morcellation group. The mean operative time was significantly lower in the contained morcellation group compared with the free morcellation group (median [interquartile range] 130 [45] vs. 155 [60] min; P < 0.001). No significant difference was found in complications related to the morcellation step, overall, intraoperative and postoperative complications, estimated blood loss, length of hospital stays, uterine weight, and rate of occult malignancy between the two groups.ConclusionContained vaginal manual morcellation of the uterus after total laparoscopic hysterectomy using a specimen retrieval bag appears to be a safe procedure with significantly lower operative time than free vaginal manual morcellation.

Does the addition of radiation to adjuvant chemotherapy improve the survival for early‐stage (tumor size ≤4 cm) small cell neuroendocrine carcinoma of the cervix after surgery? A population‐based study

Abstract Background To assess the potential benefit of adding radiotherapy to adjuvant chemotherapy in patients with early‐stage small cell neuroendocrine carcinoma of the cervix (SCNEC) (tumor size ≤4 cm) after surgery. Methods The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with early‐stage SCNEC who received primary surgery and at least adjuvant chemotherapy from 1988 to 2018. Eligible patients were categorized into radiation and nonradiation group, survival outcomes were compared before and after propensity scoring matching (PSM). Cox regression analysis was used to identify risk factors in the nonradiation group. Accordingly, a scoring system was constructed to select patients who might benefit from the addition of radiation. Results No statistically significant difference in overall survival was observed between the two groups whether before or after PSM ( P  > 0.05). However, the nonradiation group exhibited better survival outcomes than the radiation group for patients aged ≤50 years ( P  = 0.035) and patients receiving modified/radical hysterectomy ( P  = 0.031). Conversely, patients with stage T2a1 disease obtained greater benefit from radiation compared with nonradiation ( P  = 0.016). A scoring system incorporating T stage, tumor size, and number of lymph nodes examined during surgery was developed to stratify patients into low‐risk (total points ≤27.9) and high‐risk (total points >27.9) groups. Notably, patients in the high‐risk group had improved outcomes with the addition of radiotherapy ( P  = 0.0052). Conclusion The addition of radiation to adjuvant chemotherapy did not confer a survival benefit for every patient with early‐stage SCNEC, except for those with stage T2a1 disease. Moreover, a scoring system was developed to preliminarily identify patients who might benefit from the addition of radiation.

Circulating tumor HPV DNA as a specific biomarker for cervical cancer

AbstractObjectiveThe aim of this study was to determine whether circulating tumor human papillomavirus (HPV) DNA is a potential specific biomarker for cervical cancer (CC).MethodsThis retrospective matched study included 87 patients with cervical intraepithelial neoplasia (CIN), 29 CC patients (FIGO IA1‐IVA) and 29 HPV‐negative controls at Yuhuangding Hospital of Qingdao University (from July 2022 to September 2023). The digital droplet PCR (ddPCR) was used to detect and quantify ctHPV DNA in the plasma of patients with HPV16, 18, 33, 52, or 58‐associated CC.ResultsThe ctHPV DNA was exclusively detectable in HPV‐positive samples, with no detection in patients across various CIN stages (n = 87) or HPV‐negative controls (n = 29). Additionally, ctHPV DNA was identified in nine out of 10 late‐stage patients (90%) and six out of 19 early‐stage patients (31.6%).ConclusionThe ctHPV DNA serves as a specific biomarker for the diagnosis CC. Additionally, this discovery addresses the knowledge gap in ctHPV DNA research in the early stages of CC and promotes clinical diagnosis and treatment strategies.

Prognostic factors and novel nomograms for overall survival and cancer specific survival of malignant ovarian cancer patients with bone metastasis: A SEER‐based study

AbstractObjectiveOvarian cancer (OC) is a frequent and fatal disease in women, and bone metastasis of ovarian cancer (OCBM) leads to a poor survival trend. This study aimed to determine the factors which influence overall survival (OS) and cancer‐specific survival (CSS) of OCBM patients and to develop prognostic predictive models.MethodsData of OCBM patients were stratified from the Surveillance, Epidemiology and End Results database from 2010 to 2017 and were randomly divided into training and testing datasets (7:3). Prognostic factors were identified by Cox regression analyses and nomograms were then developed. Nomogram models were examined on the discriminative ability and accuracy by calibration plots, Brier score (BS), and time‐dependent receiver operating characteristic (ROC) curves. Decision curve analyses (DCA) was used for estimation of the clinical benefit of nomogram models.ResultsGrade, tumor size, tumor metastasis (liver, lung), primary site surgery, chemotherapy, and systemic therapy were realized as independent prognostic factors for OS and CSS, respectively. Agreement between the actual and predicted outcomes was proved by calibration plots. Nomograms performed well in OS and CSS predictions, as shown by area under the ROC curves (AUCs) and BSs for testing dataset as follows: for OS, 3‐/6‐/12‐month AUCs and BSs were 0.778/0.788/0.822 and 19.0/18.5/15.4, respectively; for CSS, 3‐/6‐/12‐month AUCs and BSs were 0.799/0.806/0.832 and 18.1/18.0/15.4, respectively. DCA suggested an agreeable clinical benefit of both nomograms.ConclusionThe nomograms developed for OCBM patients' survival prediction were proved to be accurate, efficient, and clinically beneficial, which were further deployed as web‐based calculators to help in clinical decision making and future studies.

Chemotherapy‐induced peripheral neuropathy among patients with ovarian cancer

AbstractObjectiveTo evaluate the course of chemotherapy‐induced peripheral neuropathy (CIPN) among patients with ovarian cancer receiving taxanes.MethodsIn a retrospective case–control study conducted between January 1, 2016, and May 31, 2018, in Xiangya Hospital in Changsha, China, women with ovarian cancer received taxane and platinum‐complex combination therapy. The European Organization for Research and Treatment of Cancer Quality of Life, Ovarian cancer module questionnaire, was used to assess the severity of neuropathy by telephone.ResultsOut of the 88 women included in the study, 61 (69.3%) reported CIPN. Twelve months after chemotherapy, the percentage was 19.3%. The percentage of patients suffering from sensory peripheral neuropathy (SPN) was higher than motor peripheral neuropathy at any time during the study. Sensory peripheral neuropathy was associated with the use of docetaxel and paclitaxel (docetaxel vs liposomal paclitaxel: odds ratio [OR] 4.39, 95% confidence interval [CI] 1.69–11.42, P<0.01; paclitaxel vs liposomal paclitaxel: OR 5.91, 95% CI 1.09–31.97, P=0.04). The average weakness score in acute CIPN was lower than chronic CIPN (1.46 vs 2.00, P=0.019). Patients treated with vitamin B1 and amifostine experienced better relief from CIPN.ConclusionThe present study showed a significant proportion of patients with ovarian cancer receiving taxanes suffered from long‐term residual neuropathy, and the use of docetaxel and paclitaxel was associated with SPN. Vitamin B1 or amifostine may improve the symptoms of CIPN.

The use of thermal ablation in diverse cervical cancer “screen‐and‐treat” service platforms in Zambia

AbstractObjectiveThermal ablation (TA) was implemented in public sector cervical cancer prevention services in Zambia in 2012. Initially introduced as a treatment modality in primary healthcare clinics, it was later included in mobile outreach campaigns and clinical research trials. We report the feasibility, acceptability, safety, and provider uptake of TA in diverse clinical contexts.MethodsScreening services based on visual inspection with acetic acid were offered by trained nurses to non‐pregnant women aged 25–59 years. Women with a type 1 transformation zone (TZ) were treated with same‐visit TA. Those with a type 2 or 3 TZ, or suspicious for cancer, were managed with same‐visit electrosurgical excision or punch biopsy, respectively. A provider survey was conducted.ResultsBetween 2012 and 2020, 2123 women were treated with TA: primary healthcare clinics, n = 746; mobile outreach clinics, n = 1127; research clinics, n = 250. Of the 996 women treated in primary healthcare and research clinics, 359 (48%) were HIV positive. Mild cramping during treatment was the most common adverse effect. No treatment interruptions occurred. No major complications were reported in the early (6 weeks) follow‐up period. Providers expressed an overwhelming preference for TA over cryotherapy.ConclusionTA was feasible, safe, and acceptable in diverse clinical contexts. It was the preferred ablation method of providers when compared with cryotherapy.

Concurrent anorectal and cervical cytology in women with positive and negative cervical smear test results: A cross‐sectional study

AbstractObjectiveConsidering the exponentially growing concerns about the increase of anal cancer rates in women with human papillomavirus (HPV) infection and cervical intraepithelial neoplasia, the authors evaluated concurrent anorectal and cervical cytology in women with positive and negative cervical smear tests.MethodThe current investigation was designed as a cross‐sectional study conducted in Arash Women's Hospital, Tehran, Iran, between November 2020 and November 2021. Cervical cytology, HPV test, and anal cytology samples were prepared. Then women with abnormal cervical cytology and/or positive high‐risk HPV were referred to a colposcopy clinic for further evaluation.ResultsFive hundred and forty‐three women were recruited during the study period. These women were divided into two groups of positive cervical cytology (n = 161) and negative cervical cytology (n = 382). There were no cases of anal intraepithelial neoplasia in either group. Negative anal cytology was reported in 99 (61.5%) of participants with a positive cervical cytology and 254 (66.7%) of participants with a negative cervical cytology. A total of 62 (38.5%) anal samples in the positive group and 127 (33.3%) in the negative group were unsatisfactory for further evaluation.ConclusionWe were unable to show any correlation between abnormal cervical cytology, dysplasia, or cervical high‐risk HPV with anal abnormal cytology.

Human papillomavirus positivity and cervical intraepithelial lesion in cervical biopsy and endocervical curettage in women younger than 30 years

Abstract Objectives Assess high‐risk human papillomavirus (HPV) prevalence and high‐grade squamous intraepithelial lesion/cervical intraepithelial neoplasia (HSIL/CIN) grade 2+ detection by cervical biopsy and endocervical curettage (ECC) in women younger than 30 years. Methods We retrospectively analyzed medical records from January 2016 to June 2024 at a tertiary hospital. All women aged 21 years and older who underwent HPV and Papanicolaou testing, plus those younger than 30 years referred for colposcopy, were included. Data on age, HPV status, cytology, colposcopy‐directed biopsy, and ECC findings were extracted. The primary outcome was HSIL/CIN 2+ incidence on pathology. Results Among 57 381 women, high‐risk HPV prevalence was 14.3% overall: 36.8% in those aged 21–24 years, 24.0% in those aged 25–29 years, and 12.7% in those 30 years and older. Of 735 women younger than 30 years, 291 were managed by follow‐up decision and 444 underwent biopsy/ECC; follow‐up decision was more common in women aged 21–24 years versus those 25–29 years (49% vs. 35.8%). Among the 444 women who underwent biopsy, HSIL/CIN 2+ and HSIL/CIN 3+ occurred in 37.8% and 14.6%, respectively, with similar HSIL/CIN 3+ rates in those aged 21–24 years versus those 25–29 years (16.8% vs. 13.9%). In 173 women with benign cytology, 30.1% had HSIL/CIN 2+ on pathology. The number needed to screen for HSIL was approximately 2–3 after co‐testing versus approximately 40 with Papanicolaou testing alone. In addition, Papanicolaou test alone demonstrated poor agreement with biopsy/ECC results (low Cohen κ ), confirming its inadequate performance. Two cases of cervical cancers were diagnosed at ages 22 and 29 years. Conclusions Similar high‐grade lesion rates in women aged 21–24 years and those 25–29 years support initiating cervical cancer screening at age 21 years. Given the substantial HSIL detection despite benign cytology, co‐testing with Papanicolaou and HPV testing is recommended in this age group.

Morbidity of radical surgery and postoperative radiotherapy in cervical cancer

AbstractCervical cancer is among the most common cancers affecting women worldwide. The standard treatment for early‐stage cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] 2018 stages IA1–IB2, IIA1) typically involves a radical or simple hysterectomy with lymph node assessment. Postoperative management may include observation or tailored adjuvant therapy, such as radiotherapy or chemoradiotherapy, depending on individual pathological risk factors. However, these interventions are associated with significant complications: surgical management can lead to urinary and sexual dysfunction, lymphocysts, and lower limb lymphedema, while radiotherapy may cause genitourinary, gastrointestinal, and sexual toxicities. Less‐radical surgery for selected cases could reduce surgical morbidity and advances in radiotherapy techniques, such as intensity‐modulated radiotherapy, volumetric modulated arc therapy, and other three‐dimensional conformal radiation therapies, have the potential to enhance precision and reduce toxicity. Nonetheless, the morbidity associated with combining radical surgery and adjuvant (chemo)radiotherapy remains an area of uncertainty, particularly in light of these emerging technologies. Most current data on this topic derive from retrospective studies involving heterogeneous populations and inconsistent quality‐of‐life assessment methods. Prospective studies employing standardized morbidity assessment tools are essential to determine the true impact of combined treatments compared to single‐modality approaches. Future research should prioritize understanding the long‐term effects of these treatment strategies, aiming to minimize adverse outcomes while maintaining optimal oncological control.

Planning and advocating for cervical cancer prevention in Kebbi State, Nigeria: Learning points for the global call to eliminate cervical cancer

AbstractThe WHO is leading a global call for the elimination of cervical cancer by the year 2030. Although the call in itself is ambitious, the adopted strategy is realistic. The WHO is optimistic that cervical cancer will be eliminated as a disease of public health concern if 90% of girls receive the HPV vaccine by 15 years of age, 70% of women are screened by HPV testing at 35 and 45 years, and 90% of identified cases are treated. The success of the global call will significantly depend on the capacity to operationalize, finance, and implement the strategy in low‐ and middle‐income countries (LMIC), where more than 80% of the disease burden resides. This capacity varies among and within countries. A SWOT (strength, weakness, opportunity, and threat) analysis of the WHO global strategy for elimination of cervical cancer, conducted through the lens of experience in planning and advocating for a comprehensive cervical cancer prevention program in Kebbi State, Nigeria, highlights the delicate balance between evidence of efficacy and science of implementation that program managers in LMIC have to consider while rolling out or scaling up cervical cancer prevention programs.

Preoperative detection of occult endometrial malignancies in endometrial hyperplasia to improve primary surgical therapy: A scoping review of the literature

AbstractThe risk of undertreating occult endometrial cancer is a problem faced by gynecologists when treating endometrial hyperplasia. The objective of this study is to highlight diagnostic adjuncts to endometrial sampling techniques to improve preoperative detection of co‐existing cancer. A systematic search of databases till July 2021: PubMed, ISI‐Clarivate Web of Science, Scopus, and CENTRAL. A search of the related literature was also carried out. Two authors screened potential studies. Studies were included if they examined the diagnostic performance of any predictors of concurrent cancer in patients diagnosed with endometrial hyperplasia. Authors charted variables related to literature characteristics (e.g., authors, year of publication), population characteristics (e.g., preoperative diagnoses), and variables related to our research questions (e.g., postoperative diagnoses, risk predictors). After screening 591 potential studies, 28 studies were included. Studies included the data of 7409 endometrial hyperplasia patients with 2377 concurrent endometrial cancer cases (32.1%). Forty potential predictors of concurrent cancer were investigated. We examined three categories of potential predictors: clinical (22 studies), histopathologic/imaging (16 studies), and molecular (six studies) predictors. The proposed predictors, age, menopausal status, diabetes, WHO and endometrial intraepithelial neoplasia histopathologic criteria, pelvic magnetic resonance imaging, and molecular profiling are promising diagnostic adjuncts.

A retrospective study for investigating the outcomes of endometrial cancer treated with radiotherapy

AbstractObjectiveTo clarify the role of radiotherapy for endometrial cancer.MethodsData were analyzed for 39 247 patients with endometrial cancer registered with the Gynecologic Cancer Registry of the Japan Society of Obstetrics and Gynecology from 2004 to 2011.ResultsThe rates of 5‐year overall survival (5y‐OS) in the radiotherapy and surgery groups were 53.6% and 94.5% in stage I or II, and 15.5% and 67.5% in stage III or IV, respectively. The prognosis in the radiotherapy group was significantly poorer than that in the surgery group. In multivariate analysis, age, advanced stage, histological type, risk of recurrence, and initial radiotherapy were independent prognostic factors. The rates of 5y‐OS with no adjuvant therapy, adjuvant chemotherapy, and adjuvant radiotherapy were 95.3%, 92.9%, and 87.1% for stage I or II, respectively, with significant differences among all groups (P < 0.001), and 60.0%, 70.4%, and 55.5% for stage III or IV, respectively, with significant differences of adjuvant chemotherapy with no adjuvant therapy (P < 0.001) and with adjuvant radiotherapy (P < 0.001). In multivariate analysis, age, advanced stage, histological type, lymphadenectomy, and adjuvant radiotherapy were independent prognostic factors.ConclusionPatients treated with radiotherapy had a significantly poorer prognosis and the appropriate indication of radiotherapy for endometrial cancer requires further study.

Safety and adherence to self‐administered intravaginal 5‐fluorouracil cream following cervical intraepithelial neoplasia ( CIN ) 2/3 treatment among HIV ‐positive women in Kenya: A phase 1 clinical trial

Abstract Objective To determine the safety, tolerance, and adherence to self‐administered intravaginal 5% fluorouracil (5FU) cream as adjuvant therapy following cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) treatment among women living with HIV (WLWH) in Kenya. Methods A phase I pilot trial was performed among 12 WLWH in Kenya, aged 18–49 years between March 2023 and February 2024 ( ClinicalTrial.gov NCT05362955 ). Participants self‐administered 2 g of 5FU intravaginally every other week for eight applications. Safety was assessed using a standardized grading scale, and adherence was evaluated using self‐report, inspection of used applicators, and weighing of the study drug. Results The mean age and CD4 count were 43.9 years and 781 cells/mm 3 , respectively. Seven (58%) had an eighth‐grade education or less. All 12 reported at least one grade I adverse event (AE), one (8%) reported a grade 2 AE, no grade 3 or 4 AEs were reported. Increased vaginal discharge ( n  = 9, 75%) and irritation ( n  = 5, 42%), with a mean duration of 3.2 and 2.8 days, respectively, were the most commonly reported AEs. Provider‐observed AEs included grade 1 cervical erythema and superficial abrasions. All participants tolerated all eight 5FU doses, and 96% adherence was demonstrated. Conclusion Self‐administered 5FU following CIN2/3 treatment among WLWH in Kisumu, Kenya, was safe, tolerable, and associated with high adherence. Randomized trials are needed to investigate whether adjuvant 5FU can improve treatment outcomes or serve as primary cervical precancer treatment in sub‐Saharan Africa. A self‐administered therapy may be transformative in increasing access to treatment and, hence, secondary prevention of cervical cancer.

A reflex testing protocol using two multivariate index assays improves the risk assessment for ovarian cancer in patients with an adnexal mass

AbstractObjectivesPatients with adnexal masses suspicious for malignancy benefit from referral to oncology specialists during presurgical assessment of the mass. OVA1 is a multivariate assay using a five‐biomarker panel which offers high overall and early‐stage sensitivity. However, OVA1 has a high false‐positive rate for benign masses. Overa, a second‐generation multivariate index assay was developed to reduce the false‐positive rate. The aim of the present study was to use Overa as a reflex for OVA1 and increase specificity.MethodsOVA1 cut‐off scores were established to place patients into three categories: low, intermediate, and high cancer risk. Samples with intermediate‐risk OVA1 scores were reflexed to the Overa and defined as high or low risk. This protocol was tested with 1035 prospectively collected serum samples and validated with an independent prospectively collected sample set (N = 207).ResultsThirty‐five per cent (359) of samples had intermediate OVA1 scores. Reflexing these to Overa eliminated 58% of the false‐positives and improved the overall specificity from 50% to 72%. This finding was confirmed in the independent dataset, in which the specificity increased from 56% to 73%.ConclusionsReflexing samples with intermediate OVA1 scores significantly decreases the false‐positive rate, thereby reducing unnecessary surgical referrals.

Correlation between multi‐type human papillomavirus infections and viral loads and the cervical pathological grade

AbstractObjectiveTo investigate the relationship between single/multiple HPV infections and cervical lesions, and the correlation between viral load and the degree of cervical lesions.MethodsA total of 27 284 patients who underwent testing for HPV were retrospectively screened and 3728 women were enrolled who tested positive for HPV when examined by liquid‐based ThinPrep cervical smear cytology test and diagnosed by histopathology at the Shanxi Provincial People's Hospital between May 2017 and March 2019. The genotype and viral load of HPV were determined by fluorescence quantitative polymerase chain reaction. Based on the pathological grade, the cervical lesions were stratified into three groups: chronic cervicitis/cervical intraepithelial neoplasia (CIN) I; CIN II/CIN III; and cervical cancer.ResultsThere were significant intergroup differences in the distribution of single and multiple HPV infections. There was a positive correlation between the viral load and cervical pathological grade when the infections were caused by HPV 16, 18, 31, 33, 51, 52, 53, and 58.ConclusionMulti‐type HPV infections are more likely to aggravate the degree of cervical lesions than single‐type infections. The HPV type‐dependent viral load is associated with the cervical pathological grade.

Turning the tide—Recommendations to increase cervical cancer screening among women who are underscreened

Response: Analysis of adjuvant therapy in early staged endometrioid endometrial cancer—FIGO 2023 classification

Relationship of lymph node status with survival and recurrence among women with endometrial cancer

AbstractObjectiveTo explore the relationship of lymph node ratio (LNR) and other lymph node parameters with disease‐free (DFS) and overall (OS) survival among women with endometrial cancer.MethodsRetrospective analysis of data of women diagnosed with endometrial cancer at Hacettepe University Hospitals, Ankara, Turkey, between 2003 and 2013. Women who had their surgical procedure, pathology review, and follow‐up at Hacettepe University Hospitals were included in the study. Receiver operator characteristic (ROC) curve analysis was used to determine the threshold LNR associated with survival.ResultsOverall, 376 women were included in the study. A higher number of excised metastatic lymph nodes was associated with decreased survival. ROC curve analysis determined a threshold LNR of 0.03. Women with LNR higher than 0.03 had decreased DFS (P<0.001) and OS (P<0.001) relative to those with LNR of 0.03 or lower. LNR of 0.1 was found to be a significant cutoff value for DFS (P=0.023) and OS (P=0.036) among women with at least one metastatic lymph node.ConclusionLNR may be used as a prognostic tool in endometrial cancer. Future studies will help to define a precise threshold of LNR in order to implement this prognostic factor in daily practice.

Risk‐stratifying clinicopathologic criteria for ovarian preservation in premenopausal women with early stage low‐risk endometrial cancer

AbstractObjectiveTo establish the rate of occult ovarian micro‐metastases in early stage disease and to provide an eligibility framework for providers to consider ovarian preservation in a patient population with presumed early stage disease.MethodsA retrospective review from January 2005 to December 2010 identified women with presumed early stage endometrial cancer from a single institutional database. Inclusion criteria included: (1) FIGO grade 1 endometrioid endometrial cancer on endometrial biopsy; or (2) the same pathology as (1) on frozen section specimen with less than 50% myometrial biopsy; and (3) no evidence of metastatic disease on preoperative imaging or visible metastatic disease in the peritoneal cavity.ResultsOf the 52 patients, 86.5% were diagnosed with stage IA and 11.5% were diagnosed with stage II disease. One patient (1.9%) had microscopic adnexal involvement in a fallopian tube, which upstaged her to stage IIA disease. None of the patients had ovarian involvement.ConclusionPreservation of the ovaries appears to be a safe and viable option for premenopausal women who are diagnosed with presumed early stage endometrioid endometrial cancer. It is believed that ovarian preservation in this select population will provide them with significant health benefits and improve their quality of life.

Development and validation of a risk prediction model for lower limb lymphedema in postoperative cervical cancer patients

Abstract Objective Lower limb lymphedema (LLL) is a common postoperative complication in patients with cervical cancer. Here, we analyzed the independent risk factors of LLL and constructed a nomogram prediction model for the early detection of LLL in postoperative cervical cancer patients. Methods A cross‐sectional study was conducted at a tertiary hospital in China between January 2020 and December 2023. A univariate analysis was carried out to determine the risk factors possibly related to LLL, and a logistic regression analysis was utilized to determine the independent risk factors related to LLL. Area under the receiver‐operating characteristic curve (AUC) calibration plots and decision curve analysis were used to assess the performance of the nomogram model. Results Independent predictors for LLL risk included body mass index, hypertension, urinary tract infection, number of lymph nodes dissected, radiotherapy, chemotherapy, and functional exercise frequency. The clinical prediction model was established based on the above seven risk factors and showed superior predictive power both in the training cohort (AUC = 0.861) and the validation cohort (AUC = 0.837). The nomogram was well‐calibrated. The decision curve analysis demonstrated that the LLL risk nomogram was clinically applicable. Conclusion The model has good discrimination and accuracy for LLL risk assessment, which can provide a reference for individualized clinical prediction of the risk of LLL in postoperative cervical cancer patients. Multicenter prospective trials are required to verify the predictive value of the model.

HE4 tumor marker as a predictive factor for lymphatic metastasis in endometrial cancer

AbstractEndometrial cancer is the most common genital cancer in high‐resource countries. Treatment is essentially surgical, but the role of lymphadenectomy in the treatment of low‐stage and low‐grade tumors has not been defined. Although no tumor factors have been validated for use as preoperative prognostic markers of endometrial cancer at yet, human epididymis protein 4 (HE4) has received much interest as a potential diagnostic and prognostic tumor marker. Since 2008, several studies have explored its utility in the management of endometrial cancer: HE4 may be a useful preoperative prognostic marker because it is associated with lymphatic metastasis and other unfavorable factors in endometrial cancer. In addition, some studies have explored a HE4 cutoff value to classify patients according to lymph node involvement. HE4 might be beneficial as a serum marker that helps clinicians in the decision‐making algorithm for treatment of endometrial cancer, enabling them to perform individualized operations and decrease the adverse effects of unnecessary surgery.

Socioeconomic impact on quality of care in pelvic gynecological cancers

Abstract Introduction Several European studies have shown health‐related social inequalities in pelvic gynecological cancers, with a social gradient in incidence and mortality, partly explained by more advanced stages at diagnosis in low socioeconomic populations. Disparities in treatment and quality of care in these patients could be another cause of inequality in care. Objectives This study evaluates the impact of socioeconomic factors on quality of care for pelvic gynecological cancers (adnexal, uterine corpus, and cervix). Methods This retrospective multicentric cohort study included women diagnosed with pelvic gynecological invasive cancer, between January 1 and December 31, 2022, in six university hospitals in North Paris. Two socioeconomic indicators, the FDep index and the Evaluation of Deprivation and Inequalities in Health Examination Centers (EPICES) score, were collected. The quality of care was assessed using a binary quality indicator based on selected European Society of Gynecological Oncology (ESGO) quality indicators for each cancer. We compared the “Non‐adherence to Quality Indicator” (NAQI) group, where one or more of the ESGO quality indicators were not met, to the “Adherence to Quality Indicator” (AQI) group using univariate analysis. An analysis of the time to first treatment, according to FDep and EPICES groups, using a Kaplan–Meier, estimation was completed. Results A total of 189 patients were included: 50 with ovarian cancer, 76 with endometrial cancer, and 63 with cervical cancer. Ninety‐nine patients (52.4%) belonged to the NAQI group and 90 patients (46.7%) to the AQI group. Patients were significantly in poorer general condition and presented more advanced Federation International of Gynecology Obstetrics (FIGO) stages in the NAQI than in the AQI group (ASA score 3–4: 20/84 [23.8%] vs. 5/76 (6.6%), P  < 0.01 and FIGO III–IV stage: 55/99 [55.6%] vs. 35/90 [38.9%], P  = 0.03). There was no significant difference for socioeconomic indicators between the NAQI and the AQI groups (FDep quintiles 3–4‐5 = 41/99 (41.4%) vs. FDep quintiles 1–2 = 39/90 (43.3%), P  = 0.91; EPICES score ≤ 30 = 31/63 (49.2%) vs. EPICES score > 30 = 21/51 (41.2%), P  = 0.50). According to FDep and EPICES groups, we found no difference in the time to first treatment. Conclusion We found no socioeconomic impact on hospital quality of care in pelvic gynecological cancers.

Prognostic value of distant metastatic sites in stage IV endometrial cancer: A SEER database study of 2948 women

AbstractObjectiveTo evaluate the prognosis of women with distant metastasis at the time of endometrial cancer (EC) diagnosis and identify prognostic factors according to metastatic site.MethodsA retrospective cohort study of women diagnosed with EC according to the SEER database between 2010 and 2014. Univariate and multivariate Cox regression was used to identify variables associated with overall survival. Kaplan‐Meier curves were used to compare survival among different groups.ResultsOverall, 2948 women with stage IV EC were identified. The most common distant metastatic site was the lung. Having a distant metastatic site independently predicted overall survival. Using brain metastasis as a reference, overall survival was longer for liver (P=0.049), lung (P=0.005), and bone (P=0.019) metastasis. Relative to no distant metastasis, overall survival was shorter for women with one (P<0.001) or two or more (P<0.001) sites of distant metastasis. Overall survival was independently influenced by tumor grade, insurance status, and surgery among women with only lung metastasis.ConclusionThe findings showed that the prognosis of women with stage IV EC differs by distant metastatic site, and identified several predictors of poor survival. They may help clinicians to better predict prognosis for newly diagnosed cases of EC with distant metastasis.

Predictors of postoperative overall and severe complications after surgical treatment for endometrial cancer: The role of the fragility index

AbstractObjectiveTo evaluate the predictive value of obesity, comorbidities, and fragility on overall and severe complication rate and survival among patients surgically treated for endometrial cancer.MethodsConsecutive patients with endometrial cancer treated at the Royal Infirmary Hospital of Edinburgh from June 1, 2015, to June 30, 2017, were retrospectively enrolled in an observational study. Considering pre‐existing medical conditions, comorbidities, and complications, modified fragility index (mFI) was calculated. Logistic regression was used to evaluate predicting variables of overall (G1–G4) and severe (G3–G4) complication rate.ResultsOne hundred patients were surgically treated for endometrial cancer. Elevated mFI >3 was related to a statistically higher access rate to the high dependency unit (HDU) or intensive care unit (ITU) (33.3% vs 6.6%, P=0.013). Overall, 31 women had postoperative complications. Using multivariate analysis, it was shown that undergoing laparotomy (odds ratio [OR] 7.06, 95% confidence interval [CI] 2.52–19.71; P<0.001) and having an mFI >3 (OR 7.19, 95% CI 1.43–36.25; P=0.021) were independent predictors of overall complications (G1–G4). Moreover, only smoking (OR 5.01, 95% CI 1.15–21.75; P=0.031) and mFI >3 (OR 5.16, 95% CI 1.07–24.94; P=0.047) were independent factors for severe complications (G3–G4).ConclusionModified fragility index was an important predictor of complications among patients treated for endometrial cancer and could be a useful tool for assisting clinicians in perioperative management.

An Israeli Gynecologic Oncology Group study of statin use and endometrial cancer prognosis

AbstractObjectiveTo assess whether statin use by endometrial cancer patients was associated with a survival advantage.MethodsA retrospective chart review study, by the Israeli Gynecologic Oncology Group, of consecutive endometrial cancer patients who underwent surgery in one of 11 medical centers between 2002 and 2014. Clinical and pathological reports, and measures of survival were compared between statin users and nonusers. Kaplan‐Meier and Cox proportional hazard models were used to assess the effect of using statins on survival measures.ResultsOver a mean follow‐up period of 6.2 years (range, 1–12 years) for 2017 endometrial cancer patients with complete data, 663 (32.8%) used statins prior to diagnosis and 1354 (67.1%) did not. No statistically significant differences between the groups were observed for most demographic and clinical characteristics. There was no difference between statin users and nonusers in 5‐year recurrence‐free survival (82% vs 83%; P=0.508), disease‐specific survival (86% vs 84%; P=0.549), or overall survival (77% vs 75%; P=0.901).ConclusionsIn this large cohort of patients with endometrial cancer, no significant associations were found between use of statins and endometrial cancer survival.

Clinical characteristics of primary Fallopian tube carcinoma: A single‐institution retrospective study of 57 cases

AbstractObjectiveTo analyze the clinical profile and prognosis of primary Fallopian tube cancer (PFTC) in order to improve earlier diagnosis.MethodsIn this retrospective study, 57 women with PFTC were assessed from 2006 to 2016. Pathology, clinical index, recurrence, and survival were analyzed.ResultsMean age was 57.35 ± 9.01 years, and 73% (19/26) of the patients with early‐stage PFTC (I/II) were aged less than 60 years. Of patients who presented with abnormal vaginal bleeding, 75% (9/12) were at an early stage and their condition was often misdiagnosed as endometrial carcinoma preoperatively. In patients with Stages I/II and Stages III/IV PFTC, 59.09% (13/22) and 96.43% (27/28), respectively, had adnexal masses on color Doppler ultrasonography. The 5‐year overall survival (OS) and disease‐free survival rates were 69.23% and 44.23%, respectively, and univariate analysis showed that tumor stage and residual tumor size significantly affected the two survival rates.ConclusionPrimary Fallopian tube cancer is more likely to be misdiagnosed in patients aged less than 60 years or those presenting with vaginal bleeding at the premenopausal stage. Magnetic resonance imaging, cervical smear, and endometrial brush may be helpful for early PFTC diagnosis. Satisfactory cytoreductive surgery is critical because tumor stage and residual tumor size are significantly associated with the OS rate.

Global determinants of gynecologic cancer incidence and mortality: A cluster‐based analysis with predictive insights

AbstractBackgroundGynecologic cancers, including cervical, ovarian, and endometrial cancers, remain a significant global health challenge. In 2022, 9 175 141 new cancer cases were reported among females, with 1 473 427 (16.1%) attributed to gynecologic cancers, reflecting an incidence rate of 30.4 per 100 000. These cancers were responsible for 680 372 deaths, representing 15.9% of total female cancer mortality at a rate of 17.3 per 100 000. Identifying the drivers of incidence and mortality is critical for addressing disparities and advancing the United Nations Sustainable Development Goals (SDGs), particularly those targeting health equity and gender equality.ObjectiveTo identify and analyze the socioeconomic, healthcare, lifestyle, and environmental determinants driving gynecologic cancer incidence and mortality globally. The study leveraged a cluster‐based approach across 68 countries, representing 34.9% of global nations and spanning diverse geographic and economic contexts.MethodsEighty‐seven variables were analyzed using Principal Component Analysis (PCA), consolidating them into 17 key components that explained 74.4% of the total variance. These components informed a hierarchical clustering process that grouped countries into four profiles based on shared characteristics. Cluster‐specific backward regression models examined the influence of these components on standardized incidence and mortality rates (Adjusted Rate Standardized, ARS). Monte Carlo simulations validated projections, providing robust insights into disparities.ResultsThe study revealed significant cluster‐specific variability in factors influencing gynecologic cancer outcomes. Cluster 1 excelled in lifestyle‐driven cancer prevention, whereas systemic barriers in Cluster 4 necessitate urgent healthcare investment and policy reform. Intermediate clusters exhibited variability influenced by social stability, environmental health, and healthcare infrastructure. The analysis underscored disparities in key predictors such as HPV vaccination coverage, healthcare expenditure, public health policies, and access to preventive services.ConclusionsThis study highlights the importance of tailored, cluster‐specific strategies to reduce disparities in gynecologic cancer outcomes. Interventions should prioritize equitable access to preventive care, lifestyle modifications, and healthcare investments, particularly in resource‐constrained regions. The findings align with SDG targets on health and well‐being (SDG 3) and gender equality (SDG 5), offering actionable insights to accelerate progress toward WHO's 90–70–90 goals and the elimination of cervical cancer as a public health threat.

Research progress of adoptive tumor infiltrating lymphocyte therapy for cervical cancer

Abstract Cervical cancer ranks as the fourth leading cause of cancer‐related mortality among women globally, posing a significant threat to women's health. Immunotherapy has emerged as the fourth line of treatment for cervical cancer, following surgery, chemotherapy, and radiotherapy. It is particularly effective for recurrent and/or metastatic cervical cancer, yielding favorable clinical outcomes. Common immunotherapeutic approaches include immune checkpoint inhibitors, adoptive cell therapy, and cervical cancer vaccines. Among these, adoptive cell immunotherapy (ACT) represents an innovative and promising modality that has transformed the field of cancer immunotherapy in recent years. This review will specifically focus on tumor‐infiltrating lymphocytes (TILs), examining the principles, limitations, improvement strategies, challenges, and future prospects of TIL‐based treatment for cervical cancer. Collectively, these approaches offer a novel theoretical foundation and translational research direction for cervical cancer immunotherapy centered on TIL therapy.

Dienogest use and the risk of breast and gynecologic cancers: A nationwide population‐based study

Abstract Objective To evaluate whether dienogest exposure is associated with the risk of breast, endometrial, or tubo‐ovarian cancer in women with endometriosis. Methods In this nationwide retrospective cohort study (January 2012 to December 2023), we used the Korean National Health Insurance Review & Assessment Service database. Women aged 20–49 years with endometriosis who received dienogest for at least 6 months were compared with an active control group treated with gonadotropin‐releasing hormone (GnRH) agonists, with cohorts balanced by inverse probability of treatment weighting. Incident breast, endometrial, and tubo‐ovarian cancers were ascertained, and adjusted hazard ratios (aHR) were estimated using Cox proportional hazards models. Results Among 1 887 957 women with endometriosis, 14 647 dienogest users and 181 587 GnRH agonist users met the eligibility criteria for the breast cancer cohort; sample sizes were similar for endometrial and tubo‐ovarian analyses. Compared with GnRH agonists, dienogest use was not associated with increased risk of breast cancer (aHR 1.01, 95% confidence interval [CI] 0.75–1.37), endometrial cancer (aHR 0.84, 95% CI 0.40–1.77), or tubo‐ovarian cancer (aHR 0.92, 95% CI 0.30–2.80). Use of dienogest for 0.5–1.5 years was associated with a reduced breast cancer risk (aHR 0.72, 95% CI 0.53–0.99), whereas associations for longer durations were inconsistent. Conclusion Dienogest use in women with endometriosis was not associated with higher or lower risks of breast, endometrial, or tubo‐ovarian cancer compared with GnRH agonists, supporting its oncologic safety. Further longer‐term studies are warranted to clarify duration‐specific effects.

Efficacy of Huayu Xiaozheng decoction combined with triptorelin and mifepristone in the treatment of uterine fibroids and its effect on uterine artery hemodynamics

Abstract Objective To expound the efficacy of Huayu Xiaozheng Decoction (HYXZD) combined with triptorelin and mifepristone in the treatment of uterine fibroids, with a particular focus on its effect on uterine artery hemodynamics. Methods A total of 102 women with uterine fibroids were enrolled and randomly allocated into a control group and an observation group. The control group received triptorelin plus mifepristone, while the observation group was additionally treated with HYXZD. Both groups were treated for 3 months. Clinical efficacy was compared, and the following parameters were measured before and after treatment: menstrual flow, fibroid volume, sex hormone levels (LH, E 2 , FSH), uterine artery hemodynamics (PI, RI, S/D), hemorheologic parameters (BVH/BVL, PAGT), serum tumor markers (CA125, CEA), adverse reactions, and 1‐year recurrence rate. Results The total effective rate was higher in the observation group relative to the control group ( P  < 0.05). Before treatment, no notable differences existed between groups in menstrual flow, fibroid volume, LH, E 2 , FSH, PI, RI, S/D, BVH, BVL, PAGT, CA125, or CEA ( P  > 0.05). Following treatment, both groups showed reductions in menstrual flow, fibroid volume, LH, E 2 , FSH, BVH, BVL, PAGT, CA125, and CEA, with greater reductions in the observation group ( P  < 0.05); PI, RI, and S/D increased in both groups, with better improvements in the observation group ( P  < 0.05). The adverse reaction rate was lower in the observation group versus the control group ( P  = 0.013). At the 1‐year follow up, recurrence occurred in 11.76% (6/51) of patients in the control group and 7.84% (4/51) of patients in the observation group ( P  = 0.505). Conclusion HYXZD combined with triptorelin and mifepristone improves clinical outcomes in uterine fibroid treatment by reducing fibroid size, optimizing hormone levels and hemodynamics, lowering tumor markers, and maintaining safety.

Cervical cancer screening: Is self‐sampling the answer?

Abstract Objective To evaluate the performance of self and clinician collected samples for high‐risk human papilloma virus (hr HPV) DNA detection and to assess the acceptance and attitude of women towards self‐collection. Methods This was a prospective single blind study done in 396 women (30–65 years) attending the gynecology outpatient department (OPD). Cervical swabs were collected in duplicate (self and clinician) in transport medium and stored at 4°C until further processing. A cervical smear was also collected at the same time. High risk HPV DNA was tested using real‐time polymerase chain reaction (PCR). The samples positive for HPV DNA in any of the samples either self or clinician underwent a colposcpy guided biopsy. Results A total of 396 women underwent screening. A total of 8% women complained of post coital bleeding. Cervical smear was inadequate in 15% and atypical squamous cells of undetermined significance (ASCUS) and above was reported in 3.7% samples. Overall agreement between self and clinician sampled HPV (C‐HPV) was 91.4% with Kappa unadjusted being 43.4% (95% CI: 35.8–51.1). Overall agreement between C‐HPV and cervical smear was 79.5% with Kappa unadjusted of 19.2% (95% CI: 12.8–25.5). Overall agreement between self and cervical smear was 80.0% with Kappa unadjusted value of 21.7% (95% CI: 14.7 to 28.7). A total of 23 women underwent biopsy of which 19 were diagnosed with cervical intraepithelial neoplasia‐1 (CIN‐1) and above with a positive predictivity rate of 100% with either screening result being positive. Conclusion HPV DNA self‐sampling can be a major breakthrough in breaking the shackles of underutilization of cervical cancer screening and thus decrease the morbidity and mortality of cervical cancer.

Revisiting intraperitoneal chemotherapy for advanced high‐grade serous ovarian cancer

Abstract Objective To compare overall survival (OS) in patients with high‐grade serous ovarian cancer (HGSOC) treated with intraperitoneal (IP) chemotherapy versus intravenous (IV) chemotherapy. Methods A retrospective study of Stage III HGSOC with optimal primary cytoreduction during 2007–2019, followed by adjuvant IP or IV chemotherapy. Results Overall, 54 patients were included, 23 (43%) treated by IP and 31 (57%) by IV chemotherapy. Median progression‐free survival (PFS) in the IP group was 39 months (95% confidence interval [CI] 34–44 months) versus 23 months (95% CI 18–28 months) in the IV group ( P  = 0.294). The IP chemotherapy had superior OS compared with IV chemotherapy, with median OS not reached, versus 76 months (95% CI 37–115 months) for the IV group ( P  = 0.075, hazard ratio 0.45, 95% CI 0.18–1.10). At 72 months, OS was 82% for the IP group versus 53% in the IV group. In a sensitivity analysis for Stage IIIc patients only ( n  = 39), the median OS was 130 months (95% CI 86–174 months) in the IP group, compared with 56 months (95% CI 35–76 months) for the IV group ( P  = 0.152). Toxicity profiles were similar in both groups, with no Grade ≥3 toxicity. Conclusion Stage III HGSOC patients treated with IP chemotherapy had significantly longer OS.

Environment, lifestyle, and cancer in women

AbstractEnvironmental and lifestyle factors significantly contribute to gynecological cancers. The risk of ovarian cancer, one the most lethal gynecological cancer, is associated with obesity, poor dietary habits, and environmental pollutants, exacerbating hormonal imbalances, inflammation, and oxidative stress. Protective factors, such as the Mediterranean diet and oral contraceptives, modulate risk by reducing ovulatory cycles, particularly in genetically predisposed women. Uterine cancer is associated with metabolic factors, with obesity driving hormonal disruptions and systemic inflammation. Physical inactivity and diets rich in animal fats increase the risk of endometrial cancer, along with air pollution and microbiome imbalances contribute to endometrial carcinogenesis. Cervical cancer is primarily driven by persistent high‐risk HPV infection, with smoking enhancing viral persistence and oncogenesis. Nutritional deficiencies in antioxidants and folate weaken immune defenses, while vaginal and gut microbiome dysbiosis fosters neoplastic progression. Vulvar and vaginal cancers, though less common, share risk factors such as obesity, smoking, and occupational exposures, disrupting immune responses and epithelial integrity. Microbial imbalances exacerbate these malignancies, creating a pro‐inflammatory microenvironment. The interplay between modifiable factors and genetic predisposition, including high‐penetrance mutations and polygenic risk scores, highlights the complexity complexity of prevention of gynecological cancers. Epigenetic mechanisms, such as DNA methylation and histone modifications, further modulate susceptibility and tumor progression, influenced by environmental and lifestyle exposures. In addition, promoting and supporting healthy lifestyle changes, including smoking cessation, increased physical activity, and a balanced diet, are crucial for improving long‐term outcomes and quality of life in gynecological cancer survivors. Addressing these factors through personalized prevention, leveraging predictive models incorporating genetics and modifiable risks, enables tailored lifestyle interventions and avoidance of environmental exposures. Combined with equitable public health initiatives, these strategies have the potential to reduce the burden of gynecological cancers and improve women's health globally.

Accuracy analysis of cervical cancer screening using urine and vaginal self‐sampling versus clinician‐collected samples: A systematic review and meta‐analysis

Abstract Objective The aim of the present study was to explore the differences in diagnostic performance between vaginal self‐sampling, urine self‐sampling, and clinician sampling in cervical cancer screening. Methods Following the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) 2020, we searched PubMed, Cochrane Library, Web of Science, and Embase. Study quality was assessed with Cochrane Review Manager 5.3. Diagnostic performance was evaluated by pooling sensitivity, specificity, and the area under the summary receiver operating characteristic (SROC) curve using STATA 18.0. Results The meta‐analysis included 15 studies with 3665 participants, all with abnormal cervical cancer screening results. The pooled sensitivity for both self‐sampling methods was 0.88 (95% confidence interval [CI]: 0.85, 0.91), the pooled specificity was 0.81 (95% CI: 0.68, 0.89), and the area under the curve (AUC) was 0.92 (95% CI: 0.89, 0.94). For high risk‐human papillomavirus (HR‐HPV), vaginal self‐sampling showed a sensitivity of 0.92 (95% CI: 0.90, 0.94) and specificity of 0.80 (95% CI: 0.58, 0.92), and AUC was 0.93 (95% CI: 0.91, 95); urine self‐sampling showed a sensitivity of 0.83 (95% CI: 0.77, 0.88) and specificity of 0.81 (95% CI: 0.65, 0.91), and AUC was 0.88 (95% CI: 0.85, 0.91). For >CIN2 lesions, vaginal self‐sampling showed a sensitivity of 0.98 (95% CI: 0.96, 0.99) and specificity of 0.63 (95% CI: 0.48, 0.77), and AUC was 0.98 (95% CI: 0.96, 0.99); urine self‐sampling showed a sensitivity of 0.95 (95% CI: 0.91, 0.97) and specificity of 0.62 (95% CI: 0.31, 0.86), and AUC was 0.95 (95% CI: 0.93, 0.97). Conclusion Vaginal and urine self‐sampling for HPV testing show promising diagnostic potential, with vaginal sampling outperforming urine. Both methods have similar sensitivity for detecting lesions >CIN2.

Spontaneous conception and pregnancy outcomes after multi‐agent chemotherapy and high‐dose radiotherapy for pelvic Ewing sarcoma: Case report and literature review

AbstractEwing sarcoma is an aggressive, rare bone and soft tissue malignancy, often affecting the long bones and pelvis. A woman was diagnosed with Ewing sarcoma of the left pelvis at 18 years of age. She underwent left paravesical lesion resection with ipsilateral ureteral reimplantation and received combined multi‐agent chemotherapy and high‐dose pelvic radiotherapy. A gonadotropin‐releasing hormone analog was administered to preserve ovarian function. The patient received oral contraceptives as hormone replacement therapy due to secondary amenorrhea. She spontaneously conceived after the withdrawal of oral contraceptives at 24 years. The pregnancy was complicated by early third‐trimester impaired fetal growth and preterm premature rupture of membranes at 32 weeks of pregnancy. Spontaneous preterm labor started and the patient delivered vaginally at 34 weeks, without any complications. Including our report, only 10 cases of pregnancy after pelvic Ewing sarcoma are reported in the literature. Pregnancy and delivery can be achieved after combined pelvic treatment for Ewing sarcoma, taking into account possible obstetric risks and complications. Complex bone surgery is associated with cesarean delivery, but previous high‐dose pelvic irradiation does not seem to affect mode of delivery. Our report provides further information on perinatal management, given the cases previously described.

Cancer therapy and reproductive impact

AbstractAll patients where the cancer treatment has gonadotoxic potential should be referred for oncofertility advice. The effect of chemotherapy and radiotherapy on the human ovary can vary from no impact to full‐blown premature ovarian failure due to hormonal and follicular depletion. Total contraindications to fertility cryopreservation include acute malignancy that requires immediate lifesaving therapy. In prepubertal girls, the only option for urgent fertility preservation is ovarian tissue cryopreservation. Prepubertal testicular tissue cryopreservation is experimental.

Commentary on “Age‐stratified risk factors of re‐intervention for uterine fibroids treated with high‐intensity focused ultrasound”

Pregnancy after advanced ovarian cancer with spontaneous uterine rupture in second trimester: A case report and review of the literature

AbstractFertility‐preserving surgery (FPS) in advanced ovarian cancer (AOC) is extremely rare and consequently, information about the pregnancies of these patients is anecdotal. Therefore, management of the pregnancy after AOC is challenging, especially if an unexpected situation arises. A 31‐year‐old nulliparous woman was admitted to our tertiary hospital in the 18th week of twin pregnancy with sudden severe abdominal pain. Her medical history included a low‐grade AOC stage IIIc diagnosed 2 years before pregnancy and treated by debulking FPS and systemic therapy with carboplatin/paclitaxel and bevacizumab. Clinical examination described normal vital signs and peritoneal irritation without any vaginal discharge. Sonography revealed free fluid in the pouch of Douglas and intact twin pregnancy. Laboratory work showed elevated leukocytes with neutrophilia. To evaluate appendicitis magnetic resonance imaging of the abdomen was indicated. This revealed a uterine rupture with the now extra‐cavitary position of the twins. Simultaneously, the patient's symptoms deteriorated, and emergency surgery was necessary where hemoperitoneum with avital fetuses were present. Despite excessive blood loss the uterus could be repaired and preserved. Previous resection of the uterine serosa during her debulking FPS, administration of bevacizumab affecting smooth muscles, and overstretching the uterus in the twin pregnancy were considered as possible risk factors for the presenting uterine rupture. Pregnancy after AOC is possible but should be monitored closely, especially due to the hidden long‐term consequences of its therapy. In the differential diagnosis of sudden abdominal pain during pregnancy uterine rupture should be considered even in patients with an unscared uterus.

Clinicopathologic characteristics and prognostic factors of patients with surgically treated high‐grade neuroendocrine carcinoma of the cervix: A multicenter retrospective study

AbstractObjectiveTo evaluate the prognostic factors and survival outcomes of patients with surgically treated high‐grade neuroendocrine carcinoma of the cervix (NECC).MethodsThis multicenter, retrospective study involved 98 cervical cancer patients with stage IA2–IIA2 and IIIC1/2p high‐grade NECC. We divided the patients into two groups based on histology: the pure and mixed groups. All clinicopathologic variables were retrospectively evaluated. Cox regression and Kaplan–Meier methods were used for analysis.ResultsIn our study, 60 patients were in the pure group and 38 patients were in the mixed group. Cox multivariate analysis showed that mixed histology was a protective factor impacting overall survival (OS) (P = 0.026) and progression free survival (PFS) (P = 0.018) in surgically treated high‐grade NECC. Conversely, survival outcomes were negatively impacted by ovarian preservation (OS: HR, 20.84; 95% CI: 5.02–86.57, P < 0.001), age >45 years (OS: HR, 4.50; 95% CI: 1.0–18.83, P = 0.039), tumor size >4 cm (OS: HR, 6.23; 95% CI: 2.34–16.61, P < 0.001), parity >3 (OS: HR, 4.50; 95% CI: 1.02–19.91, P = 0.048), and perineural invasion (OS: HR, 5.21; 95% CI: 1.20–22.53, P = 0.027). Kaplan–Meier survival curves revealed notable differences in histologic type (OS: P = 0.045; PFS: P = 0.024), chemotherapy (OS: P = 0.0056; PFS: P = 0.0041), ovarian preservation (OS: P = 0.00031; PFS: P = 0.0023), uterine invasion (OS: P < 0.0001; PFS: P < 0.0001), and depth of stromal invasion (OS: P = 0.043; PFS: P = 0.022).ConclusionPatients with mixed histologic types who undergo surgery for high‐grade NECC have a better prognosis. Meanwhile, ovarian preservation, tumor size >4 cm, parity >3, age >45 years and perineural invasion were poor prognostic predictors. Therefore, patients with high‐risk factors should be considered in clinical practice.

The safety and efficacy of myomectomy in the treatment of recurrent uterine fibroids after HIFU

AbstractObjectiveTo evaluate the safety and efficacy of myomectomy for recurrent uterine fibroids (UFs) after high‐intensity focused ultrasound (HIFU) ablation.MethodsThis was a retrospective study. Patients who underwent abdominal myomectomy (AM) and laparoscopic myomectomy (LM) from January 2018 to December 2021 at the Three Gorges Hospital of Chongqing University were included. Among them, 73 had undergone prior HIFU ablation (Group 1), while 120 had not undergone HIFU (Group 2). Outcome measures included operating time, estimated blood loss (EBL), blood transfusion, postoperative activity times (PAT), duration of hospital stay (DOHS), and complications.ResultsThe operating time was 90.0 min (70.5, 115.0) for Group 1 and 110.0 min (81.5, 130.0) for Group 2 (P < 0.05). During all AM pathways, there were no significant differences observed between the two groups in EBL, blood transfusion, PAT, DOHS, and complications; however, operating time was shorter in Group 1. The operating time, EBL, blood transfusion, PAT, DOHS, and complications were similar in both groups during LM pathway. During the follow‐up 40 (range: 24–53) months, the rate of relief, recurrence, and reintervention in Groups 1 and 2 was 78.1% versus 74.1%, 14.6% versus 16.4%, and 3.7% versus 2.6%, respectively (P > 0.05).ConclusionMyomectomy is a safe and effective surgical method for treating recurrent UFs after HIFU. Myomectomy for treating recurrent UFs resulted in a shorter operative and hospital stay, reduced blood loss, faster postoperative recovery, and fewer complications, better symptom relief rates, and lower risk of recurrence or reintervention. These findings indicate that previous HIFU ablation does not worsen the outcomes of the subsequent myomectomy.

Gynecologic oncology robot‐assisted surgery in octogenarians: Impact of age on hospital stay

AbstractObjectiveTo compare postoperative stay in octogenarians and younger patients undergoing gynecologic oncology robot‐assisted surgery.MethodsA retrospective review of robot‐assisted surgery in Gynecological Oncology division during 2019–2022. We included all consecutive cases. Octogenarians (age ≥80 years) and younger patients were investigated by univariable analysis for characteristics and outcome.ResultsA total of 816 robot‐assisted surgeries were performed, 426 (52.2%) endometrial cancer, 159 (19.5%) ovarian cancer, 27 (3.3%) cervical cancer, 35 (4.3%) endometrial intraepithelial neoplasia, and in 169 (20.7%) the final pathology was benign. There were 60 (7.4%) octogenarians and 756 (92.6%) younger patients. The proportion of patients with an American Society of Anesthesiology score greater than 2 was higher among octogenarians (66.7% vs 32.0%, P < 0.001). The median console time, surgical time, and total operation theater time were similar between groups (P = 0.303, P = 0.643 and P = 0.688, respectively). Conversion rate did not differ between groups (0.4% among younger patients vs 0% in octogenarians, P > 0.99). The median length of stay in the recovery room was similar in both groups (median 170 min, interquartile range [IQR] 125–225 min vs 170 min, IQR 128–240 min in octogenarians, P = 0.731). Length of hospital stay was similar in both age groups; median 1 day (IQR 1–1) among octogenarians versus 1 (0–1) in younger patients (P = 0.136).ConclusionOctogenarians undergoing robotic surgery have no increased risk of length of stay or conversion to laparotomy compared with younger patients.

Robotic‐assisted laparoscopic versus abdominal and laparoscopic myomectomy: A systematic review and meta‐analysis

AbstractBackgroundMyomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot‐assisted laparoscopic myomectomy (RLM).ObjectivesTo compare the perioperative and postoperative outcomes of RLM, AM, and LM.Search StrategyWe searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023.Selection CriteriaWe included all studies reporting peri‐ and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM.Data Collection and AnalysisTwo or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random‐effects model for meta‐analysis when appropriate. We used the funnel plot to assess the publication bias.Main ResultsA total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22–61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10–0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different.ConclusionsThe safety and effectiveness of RLM are superior to those of AM but inferior to those of LM.

Predictors for sentinel lymph node mapping failure using indocyanine green injection in apparent early stages of endometrial cancer: A single‐center prospective study

AbstractObjectiveThe current study aimed to analyze predictive factors of sentinel lymph node mapping failure in apparently early stages of endometrial cancer using intracervical indocyanine green injection.MethodsA single‐center prospective study was conducted between June 2019 and August 2023 at the Department of Gynecology and Obstetrics, University Hospital Brno, Czech Republic. All patients with apparently early stage (I or II according to FIGO [International Federation of Gynecology & Obstetrics] 2009) endometrial cancer, who were indicated for sentinel node biopsy were consecutively included. The injection of 4–6 mL of indocyanine green was applied superficially and deeply into cervical tissue at the 3‐ and 9‐o'clock positions. Patients' clinical data, surgical characteristics, and histopathological information were recorded. Univariable and multivariable regression analyses were applied.ResultsA total of 225 patients were eligible during the study period. Considering bilateral and unilateral failed mapping together, the only statistically significant factors for risk of failure in univariable analysis were body mass index (BMI; P = 0.036), FIGO 2009 stage (P = 0.019), and the presence of a myoma (P = 0.017). Nevertheless, when the multivariable logistic regression analysis was applied, all factors became statistically insignificant except for myoma (P = 0.031). Regarding only bilateral mapping failure, in univariable analysis, BMI (P = 0.021) and FIGO 2009 stage (P = 0.046) were significant predictors of failure. Interestingly, multivariable logistic regression analysis revealed that in addition to BMI (P = 0.007), age (P = 0.004) was also an independent predictor of bilateral failure.ConclusionsHigher BMI and age were statistically significant independent factors for bilateral sentinel node mapping failure in early‐stage endometrial cancer.

Factors affecting the long‐term prognosis of patients in the AYA generation with epithelial ovarian cancer: A multicenter propensity score matching analysis

AbstractObjectiveOvarian carcinoma (OvCa) is more common in the elderly, but also affects the adolescent and young adult (AYA) generation, which refers to those aged 15–39 years. Although the characteristics of OvCa may differ between AYAs and non‐AYAs, limited information is currently available on differences in prognostic factors. Therefore, we herein investigated prognostic factors for and the prognosis of OvCa in AYAs. We also examined the prognostic impact of fertility‐sparing surgery in a subgroup analysis.MethodsWe retrospectively collected data on 4897 patients with OvCa from the databases of multiple institutions and ultimately included 1161 patients with epithelial ovarian cancer (EOC). We performed a survival analysis to compare AYAs and non‐AYAs with backgrounds that conformed to those of AYAs using the propensity score (PS) matching method. A Cox regression analysis was also conducted to evaluate each predictor of recurrence‐free survival (RFS) and overall survival (OS) in the original population. As a subgroup analysis, a multivariate analysis stratified by the AYA and non‐AYA generations was performed.ResultsIn total, 119 AYA patients were included in this study. After PS adjustments, no significant differences were observed in RFS or OS between AYAs and non‐AYAs. Prognostic factors differed between AYAs and non‐AYAs, particularly in histology and cytology. A multivariate analysis stratified by the AYA and non‐AYA generations described that uterine‐preserving surgery (UPS) did not have a significant impact on the prognosis of AYAs or non‐AYAs. In cases with recurrence, no significant differences were observed in RFS and recurrent sites in the two groups.ConclusionCharacteristic prognostic factors for EOC in AYAs were identified. The present results indicate the limited prognostic impact of UPS for EOC in AYAs.

The role of the multidisciplinary team in surgical management of intractable tubo‐ovarian abscess as a late sequelae of challenging Crohn's disease in the modern era: A case report and review of current literature

AbstractChronic, severe Crohn's disease in a young female patient can result in surgical complexity. The rarity of the presentation of intractable pelvic abscesses within this etiology with additional considerations given to fertility concerns and hence requirement for input from a multi‐disciplinary team makes this a vital case in building a consensus for evidence‐based surgical management. A 29‐year‐old nulliparous woman was referred to our tertiary centre for surgical management of Crohn's disease with known tubo‐ovarian abscess and abdominoperineal and abdominal wall sinuses. Her previous surgical history included 4 midline laparotomies, subtotal colectomy and proctectomy with stoma formation. The patient underwent egg collection to preserve fertility. This was followed by midline laparotomy and abdominoperineal resection, which involved a retrograde radical modified hysterectomy using the Hudson technique, alongside excision of the perineal sinus, with reconstruction of the perineal defect using an internal pudendal artery perforator gluteal fold flap, and in addition to excision and drainage of the abdominal wall abscess. Involvement was sought from gynecological oncology, colorectal, urology, plastics, stoma, fertility, microbiology, and gastroenterology teams, which enabled successful preservation of end organ function and improvement in patient psychological well‐being. This case is a paradigm of surgical challenge, requiring expert gynecological oncology techniques including a retroperitoneal approach, nerve and vessel sparing considerations alongside colorectal and urological procedures. Moreover, we believe that our blueprint for effective multi‐disciplinary practice will inform the future management of gynecological surgery. Therefore this report aims to contribute towards the optimum management of the gynecological sequelae of Crohn's disease.

Prognostic factors associated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in recurrent ovarian cancer

AbstractObjectiveTo identify factors affecting survival for women undergoing cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsA retrospective study at Baskent University School of Medicine, Ankara, Turkey. Data were evaluated for 71 women with recurrent ovarian cancer who underwent cytoreductive surgery with R0 resection plus HIPEC between 2016 and 2019. Potential factors affecting survival (platinum sensitivity, bevacizumab administration before HIPEC, albumin and CA125 levels, presence of ascites, age, number of chemotherapy lines, and time interval between last chemotherapy and HIPEC) were evaluated. Complications of HIPEC were documented.ResultsThe median age was 58 years, and the median follow‐up was 12 months. In univariate analyses, platinum sensitivity, albumin level, and time since last chemotherapy cycle affected overall survival. In multivariate Cox regression analysis, use of bevacizumab before HIPEC (hazard ratio [HR], 6.7; 95% confidence interval [CI], 1.39–32.3; P=0.018) and presence of ascites (HR, 5.3; 95% CI, 1.65–17.5; P=0.005) were independent negative prognostic factors. Seven (8.9%) women experienced grade III–IV complications.ConclusionIn recurrent ovarian cancer, HIPEC is a promising treatment with mild‐to‐moderate toxicity. However, the presence of ascites and progression under bevacizumab treatment before HIPEC seem to be negative prognostic factors; these findings will be important for patient selection.

Minimally invasive surgical treatment of recurrent endometrial carcinoma: A systematic review

Abstract Background While the role minimally invasive surgery (MIS) is established for primary endometrial carcinoma (EC), its feasibility in recurrent cases remains underexplored. Objective To systematically review the literature about MIS for EC recurrence. Search Strategy A systematic literature search was conducted across six electronic databases, targeting studies published until October 31, 2024. Selection Criteria Inclusion criteria encompassed all peer‐reviewed studies reporting MIS for recurrent EC. Data Collection and Analysis Data extraction focused on surgical outcomes and survival metrics, following PRISMA guidelines. Main Results Out of 9652 results, 15 studies with 17 cases of patients with EC recurrence met the inclusion criteria. All patients underwent successful MIS, with no intraoperative complications reported. Complete resection (when reported) was achieved in 100% of cases, and adjuvant treatment was administered in 64.7% of patients. The mean follow‐up duration was 23.6 months, with a disease‐free survival rate of 63.6%. Risk of bias assessment indicated a predominance of low to medium risk of bias within studies. Conclusion MIS might be feasible and safe in cases of abdominal recurrence of EC when the number of recurrence localizations is less than three. MIS might be a management option independently from EC histology, grade and stage (except for stage IV), previous adjuvant therapy and group of risk. The endoscopic approach could be both laparoscopic and robotic, without any apparent difference in terms of feasibility, safety and survival outcomes. However, data on this topic are limited and our findings need to be confirmed by additional studies.

Ureter metastasis from a primary cervical malignancy 3 years after initial treatment

SynopsisMetastatic mucinous adenocarcinoma of the lower ureter is reported in a 55‐year‐old woman presenting with gross hematuria who was treated for cervical cancer 3 years prior.

Targeting the ST3 beta‐galactoside alpha‐2,3‐sialyltransferase 1 ( ST3Gal1 ) as a potential therapeutic strategy to overcome anti‐ VEGF resistance in endometrial cancer

Abstract Objective To investigate the role of ST3 beta‐galactoside alpha‐2,3‐sialyltransferase 1 (ST3Gal1) in endometrial cancer (EC) progression and its potential as a therapeutic target to enhance the efficacy of antiangiogenic treatment. Methods ST3Gal1 expression and its clinical relevance were analyzed in EC tissues. Functional assays evaluated its effects on vascular endothelial growth factor‐A (VEGF‐A) expression, epithelial–mesenchymal transition (EMT), and cell invasiveness. Mechanistic studies, including Duolink proximity ligation assays and co‐immunoprecipitation, examined ST3Gal1–VEGF‐A interactions. ST3Gal1 was inhibited genetically or pharmacologically using soyasaponin I (SsaI), both in vitro and in xenograft models, alone or combined with bevacizumab. Angiogenic and EMT marker expression and focal adhesion kinase (FAK)/paxillin pathway activation were assessed. Results ST3Gal1 was amplified and overexpressed in EC and correlated with advanced stage, deep myometrial invasion, and poor prognosis. It directly glycosylated VEGF‐A and activated FAK/paxillin signaling, promoting VEGF‐A expression and EMT. ST3Gal1 inhibition via SsaI reduced VEGF‐A signaling, reversed EMT marker expression, and suppressed cell migration and invasion, particularly in RL95‐2 cells. In vivo, SsaI significantly inhibited tumor growth and angiogenesis, with the most pronounced effect observed in combination with bevacizumab. Dual treatment disrupted ST3Gal1–VEGF‐A interactions and downregulated angiogenic and EMT markers. Conclusion ST3Gal1 promotes EC progression by enhancing VEGF‐A signaling and EMT via the FAK/paxillin pathway. Its inhibition improves the efficacy of antiangiogenic therapy, supporting ST3Gal1 as a promising therapeutic target to overcome anti‐VEGF‐A resistance in advanced EC.

Assessing para‐aortic nodal status in high‐grade endometrial cancer patients with negative pelvic sentinel lymph node biopsy

Abstract Objective To determine the accuracy of pelvic sentinel lymph node biopsy (SLN) in detecting positive para‐aortic (PA) lymph nodes in high‐grade uterine cancer, and to determine the recurrence rate in patients with high‐grade uterine cancers who did not receive adjuvant chemotherapy based on negative pelvic SLNs. Methods This was a retrospective cohort study of patients with newly diagnosed, high‐grade endometrial cancer who underwent surgery, including pelvic SLNs with or without PA node dissection, at a tertiary care institution between 2015 and 2020. Baseline demographics, surgical management, pathology data, and outcomes were analyzed using descriptive statistics, and survival analysis. Results Postoperative histology of the 110 patients meeting inclusion criteria was 45.5% grade 3 endometrioid, 36.4% serous, 10.9% clear cell, and 7.3% carcinosarcoma. On final pathology, 63.7% were stage 1, and 23.6% were stage 3C with positive nodes. A total of 63 patients (57.3%) had a PA lymph node dissection (56 bilateral, 7 unilateral) in addition to the pelvic SLN. Among this group, 5.8% (95% confidence interval 1.2%–16.0%) had a positive PA node despite a negative pelvic SLN. Among those with a negative pelvic SLN and no adjuvant chemotherapy ( n  = 75), the rate of distant recurrence was 14.7%, and 3‐year recurrence‐free survival was 71.9%. Conclusion The rate of isolated PA node metastasis in high‐grade endometrial cancers despite a negative pelvic SLN may be significantly higher than the accepted rate of isolated PA node metastasis in low‐grade endometrial cancer. This supports adjuvant treatment decisions continuing to incorporate primary tumor pathology and molecular classification.

Conservative re‐treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma: We can hope, at least

AbstractBackgroundIn women with recurrent disease who were conservatively treated for atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EEC), the reasons why conservative treatment was chosen persist and outcomes of performing a conservative re‐treatment are unclear, as pooled estimates on oncologic outcomes of such a re‐treatment are lacking.ObjectivesTo provide pooled estimates of oncologic outcomes of conservative re‐treatment in women with recurrent AEH or EC.Search StrategyA systematic review and meta‐analysis was performed by searching six electronic databases from their inception to March 2022.Selection CriteriaStudies that allowed extraction of data about oncologic outcomes of conservative re‐treatment of women with recurrent AEH and EEC after a conservative treatment.Data Collection and AnalysisPooled prevalence of complete response (CR), poor response (PR), and recurrence after conservative re‐treatment was calculated.Main ResultsFifteen studies (12 retrospective and 3 prospective) with 492 women (42.1% AEH and 57.9% EEC) were included in the systematic review, and 10 studies (8 retrospective and 2 prospective) were suitable for the meta‐analysis. Pooled prevalence was 85.3% (95% confidence interval [CI] 77.0%–91.0%) for CR, 14.7% (95% CI 9.0%–23.0%) for PR, and 40.4% (95% CI 15.5%–71.4%) for recurrence.ConclusionsConservative re‐treatment in AEH or EC recurrent women has a high CR rate and acceptable recurrence rate that might allow it to be considered a safe and viable option, at least as a first round of conservative treatment. Women with an unsatisfied desire for motherhood or with high surgical risk might avoid hysterectomy and attempt childbearing or spare high‐risk surgery.

Galectins‐1, ‐3, ‐7, ‐8 and ‐9 as prognostic markers for survival in epithelial ovarian cancer: A systematic review and meta‐analysis

AbstractBackgroundGalectins are a family of proteins that have recently emerged as regulators of cancer biology.ObjectivesTo investigate the impact of peritumoral and tumoral galectin expression on ovarian cancer prognosis.Search strategyWe searched Medline, Cochrane, and EMBASE databases from inception until March 22, 2020.Selection criteriaAll studies correlating galectins and ovarian cancer prognosis were selected.Data collection and analysisThe literature search presented 11 studies, which contained 1034 patients. Meta‐analysis was performed with RevMan 5.3 software.Main resultsStudies were stratified into two groups depending on the location of galectin expression (peritumoral stroma or nucleus/cytoplasm of tumor cells). Tumoral galectin‐7 and galectin‐9 expression was significantly associated with poor overall survival (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.32–3.21, P = 0.001; OR 1.71, 95% CI 1.27–2.30, P < 0.001, respectively). The total effect of high tumoral expression of galectins in overall survival and progression‐free survival was significant (OR 1.51, 95% CI 1.02–2.23, P = 0.04; OR 2.76, 95% CI 1.73–4.40, P < 0.001, respectively).ConclusionsOur results suggest that galectins are implicated in ovarian cancer prognosis; however, further research is needed to ascertain their actual importance as well as their diagnostic accuracy.

Cancer of the vagina: 2025 update

AbstractPrimary vaginal cancer is a rare gynecologic malignancy, with most vaginal cancers representing metastases from other primary sites. Staging and treatment protocols are often extrapolated from those used in cervical cancer. In contemporary medicine, the roles of the pathologist and radiologist are increasingly vital in supporting diagnosis and staging. Given the rarity of this malignancy, referral to centers of excellence is recommended for further assessment and treatment.

Molecular subtypes of endometrial cancer: Implications for adjuvant treatment strategies

AbstractBackgroundWhen determining adjuvant treatment for endometrial cancer, the decision typically relies on factors such as cancer stage, histologic grade, subtype, and a few histopathologic markers. The Cancer Genome Atlas revealed molecular subtyping of endometrial cancer, which can provide more accurate prognostic information and guide personalized treatment plans.ObjectiveTo summarize the expression and molecular basis of the main biomarkers of endometrial cancer.Search StrategyPubMed was searched from January 2000 to March 2023.Selection CriteriaStudies evaluating molecular subtypes of endometrial cancer and implications for adjuvant treatment strategies.Data Collection and AnalysisThree authors independently performed a comprehensive literature search, collected and extracted data, and assessed the methodological quality of the included studies.Main ResultsWe summarized the molecular subtyping of endometrial cancer, including mismatch repair deficient, high microsatellite instability, polymerase epsilon (POLE) exonuclease domain mutated, TP53 gene mutation, and non‐specific molecular spectrum. We also summarized planned and ongoing clinical trials and common therapy methods in endometrial cancer. POLE mutated endometrial cancer consistently exhibits favorable patient outcomes, regardless of adjuvant therapy. Genomic similarities between p53 abnormality endometrial cancer and high‐grade serous ovarian cancer suggested possible overlapping treatment strategies. High levels of immune checkpoint molecules, such as programmed cell death 1 and programmed cell death 1 ligand 1 can counterbalance mismatch repair deficient endometrial cancer immune phenotype. Hormonal treatment is an appealing option for high‐risk non‐specific molecular spectrum endometrial cancers, which are typically endometrioid and hormone receptor positive. Combining clinical and pathologic characteristics to guide treatment decisions for patients, including concurrent radiochemotherapy, chemotherapy, inhibitor therapy, endocrine therapy, and immunotherapy, might improve the management of endometrial cancer and provide more effective treatment options for patients.ConclusionsWe have characterized the molecular subtypes of endometrial cancer and discuss their value in terms of a patient‐tailored therapy in order to prevent significant under‐ or overtreatment.

Pelvic inflammatory disease is associated with ovarian cancer development in women with endometriosis: A cohort study in Taiwan

AbstractObjectiveEndometriosis and pelvic inflammatory disease are considered to be risk factors for ovarian cancer, as dysbiosis probably contributes to ovarian cancer development via chronic inflammation and immune response alteration. Therefore, we hypothesized that pelvic inflammatory disease predisposes to ovarian cancer development in women with endometriosis.MethodsWe selected patients who were diagnosed with endometriosis or pelvic inflammatory disease between January 1, 2000 and December 31, 2015, in a 2 million longitudinal health and welfare database in Taiwan with cancer and death registries. Patients were divided into five groups: (1) those with endometriosis, (2) those with pelvic inflammatory disease, (3) those with endometriosis diagnosed before pelvic inflammatory disease, (4) those with pelvic inflammatory disease diagnosed before endometriosis, and (5) healthy women. Propensity score matching with inverse probability of treatment weighting was used to adjust for covariates across the study groups.ResultsThe risk of ovarian cancer was significantly higher in women with endometriosis and subsequent pelvic inflammatory disease than in those with endometriosis alone (hazard ratio 8.07; 95% confidence interval 4.53–14.37; P < 0.001). The same result was found for ovarian cancer incidence per 1000 person‐years.ConclusionOur data show that pelvic inflammatory disease is associated with cancer development in women with pre‐existing endometriosis.

Alternative management for gynecological cancer care during the COVID‐2019 pandemic: A Latin American survey

AbstractObjectiveTo determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID‐19 pandemic among Latin American gynecological cancer specialists.MethodsTwelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software.ResultsA total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post‐cancer treatment follow‐up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo‐oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively).ConclusionLatin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID‐19 pandemic, which may reflect the region’s particularities.The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.

Impact of uterus‐preserving surgery on Stage I primary mucinous epithelial ovarian carcinoma: A multi‐institutional study with propensity score‐weighted analysis

AbstractObjectiveTo investigate the clinical characteristics of women with Stage I primary mucinous epithelial ovarian carcinoma (mEOC) and evaluate the impact of uterus‐preserving surgery (UPS) in terms of survival prognosis.MethodsA regional multi‐institutional retrospective study conducted between January 1986 and March 2017 by reviewing records of the Tokai Ovarian Tumor Study Group. Clinical and pathologic data and survival outcomes were assessed for women with Stage I primary mEOC. The baseline imbalance between women with and those without UPS was adjusted by an inverse probability of treatment weighting method using the propensity score (PS) of independent clinical variables.ResultsAmong 4730 women with malignant ovarian tumors, 185 had Stage I primary mEOC and were included in the study. The mean age was 47.6 years (range 12–87 years), and 56 (30.3%) women underwent UPS. After PS‐based adjustment, women in the UPS group did not have a poorer prognosis regarding overall survival (P=0.776) or recurrence‐free survival (P=0.683). Even after age stratification, there was no statistical difference in survival outcomes between the UPS and non‐UPS groups.ConclusionUPS was not associated with decreased survival and may be a treatment option for women with Stage I primary mEOC irrespective of age.

Sentinel lymph node mapping in endometrial cancer: A comparison of main national and international guidelines

AbstractObjectivesTo compare national and international guidelines regarding sentinel lymph node (SLN) mapping in endometrial cancer.MethodsA descriptive comparative study of the National Comprehensive Cancer Network (NCCN), the Society of Gynecologic Oncology (SGO), the European Society of Gynecological Oncology (ESGO), the British Gynecological Cancer Society (BGCS), and the Japan Society of Gynecologic Oncology (JSGO) guidelines.ResultsThere is a broad consensus that SLN mapping is an appropriate alternative to pelvic lymphadenectomy for uterine‐confined endometrioid endometrial cancer (five of five guidelines). It is broadly accepted that a full lymphadenectomy should be performed in case of failed SLN mapping (four of five guidelines), and that mapping with the fluorescent dye indocyanine green is superior to other methods (four of five guidelines). It is agreed that the cervix is the preferable site for dye injection (four of five guidelines), and pathology ultrastaging is advocated by most guidelines (three of five guidelines). Regarding high‐risk patients (i.e., high‐grade histology and non‐endometroid carcinomas), some guidelines accept (three of five), but others currently do not advocate (one of five guidelines), SLN mapping as a sole method for lymph node evaluation. There is no consensus regarding para‐aortic lymph node evaluation in pelvic SLN‐positive patients.ConclusionGuidelines for SLN mapping are comparable with regards to surgical technique, ultrastaging, and management in case of failed mapping. Nevertheless, some variations exist regarding the management of high‐grade histology and positive pelvic lymph nodes.

Conservative treatment versus surgical excision of ovarian dermoid cysts: Impact on ovarian stimulation and IVF cycle success

AbstractObjectiveTo analyze outcomes of IVF treatment among women diagnosed with an ovarian dermoid cyst (DC).MethodsRetrospective analysis of women with an ovarian DC who underwent IVF with fresh blastocyst transfer at a single center in New York from January 2010 to March 2018. Outcomes were compared between women with conservative treatment and those with surgical excision of the DC. Multivariate logistic regression was used to assess associations between variables and the presence of a DC during treatment.ResultsOverall, 119 women with a DC were included. No differences were found in demographic characteristics, controlled ovarian hyperstimulation parameters, and IVF outcomes between women with an intact DC (n=65, 54.6%) and those who underwent cystectomy (n=54, 45.4%) (all P<0.05). Similarly, there was no difference in anti‐Mϋllerian hormone and basal antral follicle count among women with a DC (respectively, β=−0.1, P=0.8, and β=−1.0, P=0.28) or resected DC (respectively, β=0.9, P=0.07, and β=1.5, P=0.08) as compared with control women with no DC (n=352).ConclusionOvarian reserve, embryo implantation and IVF success rates were not lower in the presence of an ovarian DC. Surgical therapy, if indicated, can be safely postponed until family planning goals have been achieved.

Influence of the human immunodeficiency virus on cervical precancerous lesions

Abstract Objective To study the influence of HIV status on the occurrence of cervical precancerous lesions (CPL). Methods This analytical cross‐sectional study was carried out between December 1, 2019 and May 31, 2020. All women with documented HIV status screened for CPL with biopsies performed were recruited. The main variables recorded included maternal age, educational level, number of sexual partners, age at first sexual intercourse, smoking, alcohol consumption, HIV status, CD4 count, and cervical biopsy result. Fisher exact test and Student's t test were used for comparison. A p value <0.05 was considered statistically significant. Results Concerning women attending our screening units, CPL was more frequent among those living with HIV/AIDS (20/92; 21.7%) than among those not living with HIV/AIDS (29/290; 10.0%) ( p  = 0.004). As regards women living with HIV/AIDS, those with a CD4 count below 350/mL were more at risk of having a CPL (odds ratio [OR] 21.39, 95% confidence interval [CI] 5.60–81.56, p  ˂ 0.001). High‐grade lesions (cervical intraepithelial neoplasia Stage 2 or 3) were more often found in women living with HIV/AIDS (OR 3.83, 95% CI 1.09–13.45, p  = 0.033). Conclusion More attention should be paid to women living with HIV/AIDS, especially those with CD4 count less than 350/mL, who should be screened more often with biopsy frequently conducted if indicated.

Para‐aortic lymphadenectomy below inferior mesenteric artery versus renal vessels in stage IIIC epithelial ovarian cancer: A comparison of surgical outcomes

AbstractObjectiveTo compare the surgical outcomes of para‐aortic lymphadenectomy up to the level of inferior mesenteric artery (IMA) and renal vessels in women with stage IIIC epithelial ovarian cancer after primary optimal cytoreductive surgery.MethodsIn a retrospective study at Peking University People's Hospital, Beijing, China, undertaken between January 1, 2001, and December 31, 2015, patients were classified into two groups based on the level of the para‐aortic lymphadenectomy at either IMA (group A) or renal vessels (group B). Progression‐free survival (PFS) and overall survival were assessed.ResultsThe study involved 102 women (56 in group A and 46 in group B). The two groups were comparable regarding clinical characteristics, and there were no statistically significant differences in perioperative variables between the groups. 15.2% of patients (7/46) had metastases at renal vessels level without metastases below IMA. Median PFS in group B was longer than group A (41 months vs 23 months, P=0.041) and 5‐year survival rate was greater in group B compared to group A (74.6% vs 48.2%, P=0.003). Median overall survival was longer in group B compared to group A (not reached vs 55 months, P=0.03).ConclusionPara‐aortic lymphadenectomy at the level of renal vessels was safe and could improve the prognosis of patients with advanced ovarian cancer who completed optimal cytoreduction.

Genetic variants of DNAH11 and LRFN2 genes and their association with ovarian and breast cancer

AbstractObjectiveTo investigate the association of newly identified genetic variants G>A (rs2285947) of the DNAH11 gene and G>A (rs2494938) of the LRFN2 gene with ovarian and breast cancers in women belonging to Jammu and Kashmir state, where the prevalence of ovarian and breast cancers is remarkably high in the population.MethodsA candidate gene prospective case‐control association study design was adopted, in which 354 cases (219 cases of ovarian cancer and 135 cases of breast cancer) were histopathologically confirmed and 330 healthy controls matched for age and ethnicity were recruited. The details of cases and controls were also recorded in a predesigned pro forma after their written informed consent. Both variants were genotyped by TaqMan allele discrimination assay using real‐time polymerase chain reaction. Logistic regression analysis was performed to estimate the corrected odds ratio (OR), confidence interval (CI), and level of significance (P value) for potential confounding factors.ResultsThe rs2285947 variant of DNAH11 was found to be significantly associated with both ovarian and breast cancers with adjusted ORs of 1.7 (95% CI 1.2–2.4; P=0.004) and 1.70 (95% CI 1.13–2.54; P=0.0009), respectively. However, no significant association of variant rs2494938 of LRFN2 was observed with ovarian cancer (estimated OR 0.9, 95% CI 0.6–1.4; P=0.919) or breast cancer (estimated OR 1.27, 95% CI 0.8–1.9; P=0.216).ConclusionsThe collected data proposed that the variant rs2285947 of DNAH11 gene is a potential risk factor for ovarian and breast cancers in the studied population.

Neutrophil‐to‐lymphocyte ratio as a prognostic factor in advanced stage ovarian carcinoma treated with neoadjuvant chemotherapy

AbstractObjectivesTo evaluate the prognostic significance of neutrophil‐to‐lymphocyte ratio (NLR) upon diagnosis, and its impact on surgical outcome, among patients with advanced stage ovarian carcinoma treated with neoadjuvant chemotherapy (NACT).MethodsA retrospective cohort study included all women with stage IIIC and IV ovarian carcinoma receiving NACT in Rabin Medical Center, Petah‐Tikva, Israel; January 1, 2005, to June 30, 2017. Demographics and treatment outcome were compared between patients with NLR at diagnosis ≥6.0 and those with NLR <6.0. Primary outcome was optimal debulking (<1 cm largest residual disease). Overall survival was compared between groups using Kaplan‐Meier survival analysis.ResultsOf 111 patients, 33 (29.7%) had NLR ≥6.0 at diagnosis, and 78 (70.3%) had NLR <6.0. No difference was found in rates of optimal debulking between the group with NLR ≥6.0 and that with NLR <6.0 (78.9% vs 84.7%, respectively, P=0.555).Using Kaplan‐Meier survival analysis, NLR ≥6.0 was associated with significantly worse overall survival (P<0.05). In a multivariate Cox proportional hazard model, elevated NLR was not statistically associated with poor overall survival (P=0.080).ConclusionsIn advanced stage ovarian carcinoma, NLR ≥6.0 at diagnosis did not predict surgical outcome, however it was a predictive factor for poor overall survival.

Serum HE4 is associated with clinical prognostic factors and survival outcome in female patients with primary peritoneal carcinoma

AbstractObjectiveThe aim of this study was to investigate whether serum HE4 was associated with clinical risk prognostic factors and survival outcome.MethodsIn this study, 72 patients with primary peritoneal carcinoma (PPC) from January 2011 to October 2019 participated. Serum HE4 and CA125 levels were detected at primary diagnosis, post‐surgery, pre‐recurrence and the presence of recurrence. The relations between serum HE4 levels with clinical prognostic factors were analyzed, and the hazard ratios between serum HE4 levels with overall survival and recurrence‐free survival were also analyzed by univariate and multivariate survival analysis.ResultsHE4 and CA125 levels were significantly elevated in serous type, high histological grade, advanced stage and positive lymph node status and residual tumor diameter more than 1 cm, respectively, compared with those in non‐serous type, low histological grade, early stage, negative lymph node status and residual tumor diameter no more than 1 cm, respectively. HE4 was an independent prognostic factor for recurrence‐free survival and overall survival with hazard ratios of 5.36 (95% confidence interval: 2.19–13.15) and 4.48 (95% confidence interval: 1.87–10.74), respectively.ConclusionHE4 is correlated with clinical risk prognostic factors in PPC and is effective in the recurrence detection and predicting outcome in PPC patients.

Is cystectomy an option as conservative surgery for young patients with borderline ovarian tumor? A multi‐institutional retrospective study

AbstractObjectiveTo investigate the impact of cystectomy for borderline ovarian tumor (BOT) on tumor recurrence compared with salpingo‐oophorectomy using inverse probability of treatment weighting (IPTW).MethodsA central pathologic review and a search of the medical records from 14 collaborating institutions from 1986 to 2017 identified 4708 women with a malignant ovarian neoplasm. Data for young women with Stage I BOT were extracted. To compare recurrence‐free survival between the surgery groups, Cox regression analyses and the IPTW‐adjusted Kaplan‐Meier method were employed.ResultsDuring a median follow‐up of 62.0 (1.2–270.4) months, 10 of the 285 patients identified (3.5%) developed recurrence. In multivariate analysis, the practice of cystectomy was not a significant prognostic indicator of recurrence‐free survival (hazard ratio [95% confidence interval] 1.276 [0.150–10.864]; P = 0.823). In the IPTW‐adjusted cohort, the 5‐year recurrence‐free survival rates were 95.8% and 96.0% in patients receiving cystectomy and salpingo‐oophorectomy, respectively (P = 0.378).ConclusionIf patients are selected appropriately, cystectomy in itself may not increase tumor recurrence in young women with early‐stage BOT. A large‐scale prospective clinical study is necessary to validate this finding.

Intergenerational gestational surrogacy in a patient with ovarian dysgerminocarcinoma

Abstract A 20‐year‐old woman was diagnosed with an ovarian dysgerminoma on the right ovary and underwent fertility‐preserving right salpingo‐oophorectomy and staging. Eight months later she was found to have a left ovarian solid mass. She underwent controlled ovarian hyperstimulation and oocyte cryopreservation before total abdominal hysterectomy, left salpingo‐oophorectomy, and exploratory surgery were performed. The patient was optimally debulked, with no recurrent cancer to date. Thirty‐six oocytes were mature and cryopreserved using vitrification. Now, the patient's mother has undergone embryo transfer that resulted in a clinical pregnancy, acting as a gestational carrier, for her daughter. To our knowledge, this is the first case describing the uterine transfer of embryos into a gestational carrier where the embryos were generated using oocytes obtained through controlled ovarian hyperstimulation in the context of active ovarian cancer. In the appropriate clinical setting, women desiring future fertility with a diagnosis of ovarian cancer without the option of ovarian‐sparing surgery may be candidates for controlled ovarian hyperstimulation for the purposes of fertility preservation, especially if altruistic gestational carriers are available and willing.

Efficacy and toxicity of intraperitoneal chemotherapy as compared to intravenous chemotherapy in the treatment of patients with advanced ovarian cancer

AbstractObjectiveTo assess the efficacy and toxicity of intraperitoneal (IP) chemotherapy compared to intravenous (IV) chemotherapy.MethodsToxicity profiles, recurrence patterns, and long‐term survival outcomes of 271 women with Stage IIIC or IV high‐grade serous ovarian cancer (HGSC) treated with primary cytoreductive surgery followed by adjuvant IP or IV chemotherapy during 2001–2015 were reviewed.ResultsWomen who received IP chemotherapy (n = 91) were more likely to have undergone aggressive and longer surgery with no residual disease compared to the IV arm (n = 180). Chemotherapy‐related toxicities were comparable between the two groups. Extraperitoneal recurrences were more common in the IP arm compared to the IV arm. Five‐year progression‐free survival was 19% versus 18% (P = 0.63) and overall survival was 73% versus 44% (P < 0.01) in the IP versus IV arms, respectively. After adjustment for significant clinicopathologic factors in a multivariable model, use of IP was no longer a statistically significant predictor of overall survival.ConclusionIP chemotherapy in advanced HGSC has not been widely adopted due to concerns about toxicity and inconvenience. Use of IP chemotherapy was associated with comparable safety profile and efficacy to IV chemotherapy in women with Stage IIIC/IV HGSC. Recurrences were more likely to be extraperitoneal with IP treatment.

Colonic perforation due to ovarian cancer invasion: An unusual event

Synopsis The present study reports a case of colonic perforation, which is a rare presentation of ovarian cancer that requires emergent surgical treatment.

Colposcopists' practice patterns in Latin America: An international cross‐sectional survey

Abstract Cervical cancer is a public health issue worldwide. Colposcopy is a key tool in the early diagnosis of preinvasive disease. Its practice is heterogeneous due to variations in its performance and the training of professionals. This study aimed to describe colposcopy practice patterns among Latin American gynecologists. A web survey was conducted among colposcopists. A 60‐item questionnaire was designed and piloted with 40 physicians. The survey was conducted online voluntarily through a link that was sent to 2217 gynecologist members of the Latin American Federation of Lower Genital Tract Pathology and Colposcopy (FLPTGIC) between April 2024 and January 2025. The survey was answered by 787 colposcopists, with a response rate of 35.49%. The majority were from Mexico (17.92%); 60.61% were women between 30 and 50 years of age. Almost all practitioners (98.68%) performed cervical assessments after applying acetic acid, and 49.94% used Lugol's iodine routinely. More than 90% examined the vulva, and 68.74% examined the vagina during colposcopy. Fewer than half of the participants always reported the colposcopic diagnosis according to the Rio 2011 Colposcopy Nomenclature, and three‐quarters reported whether the squamocolumnar junction was visible. More than one‐third (37.48%) followed the American Society of Colposcopy and Cervical Pathology guidelines, and 3.2% used International Federation for Cancer Prevention and Colposcopy terminology. When diagnosing dysplasia, more than 90% performed resective methods (91.74%), and colposcopy is the main follow‐up strategy. There is a high degree of heterogeneity in training, colposcopic practice patterns, and therapeutic decisions in cases of preinvasive disease among Latin American professionals, even though several scientific associations have established standards and guidelines.

Response: Endometriosis and malignancy—The intriguing relationship

Is cytology/HPV co‐testing for cervical cancer screening useful in Japan?

AbstractObjectiveIn Japan, no region has introduced primary HPV testing for cervical cancer screening. We assessed the diagnostic value and possible harm of HPV testing in Japan.MethodsThis cross‐sectional study with historical controls used cytology‐based screening and co‐testing data in Japan. As surrogate indicators of possible harm, colposcopy referral rate and cervical intraepithelial neoplasm (CIN) 1 detection rates were calculated. As surrogate indicators with diagnostic values, the detection rates of CIN2 or greater (CIN2+) and CIN3+ were calculated.ResultsThe data of 297 970 women (182 697 for cytology‐based, 115 273 for co‐testing) were examined. The detection rates of CIN1, CIN2+, and CIN3+ were significantly higher in the co‐testing group than in the cytology‐based group (P < 0.001, P < 0.0001, P < 0.01, respectively). Between ages 25–49, CIN2+ detection rates were significantly higher in the co‐testing group than in the cytology‐based group (P < 0.05 for each 5‐year age group). Between ages 30–49, CIN3+ detection rates were significantly higher in the co‐testing group than in the cytology‐based group (P < 0.05 for each 5‐year age group).ConclusionLimiting the target age group may minimize the possible harm of screening. Cytology/HPV co‐testing may be useful in Japanese populations if balance is maintained between benefit and harm.

Leveraging artificial intelligence for evidence‐based recommendations in uterine fibroid therapy: Addressing the unmet need in German healthcare—A clinical trial

Abstract Objective To evaluate the potential of an artificial intelligence (AI)‐driven large language model, ChatGPT 4.0, to provide personalized, evidence‐based treatment recommendations for uterine fibroids. Methods ChatGPT 4.0 was trained using evidence‐based data from Uptodate and German medical literature. The algorithm generated individualized recommendations based on clinical characteristics and patient preferences. Usability and quality were assessed through questionnaires completed by 40 gynecologists and 45 women with fibroids. Results Most gynecologists found the algorithm user‐friendly and comprehensive, with 15 expressing a willingness to integrate it into practice and 24 acknowledging its potential to enhance healthcare efficiency. Although only half believed it would improve patient outcomes, the tool was generally well received. Patients found the algorithm easy to understand and helpful for exploring treatment options, with the majority feeling it empowered informed discussions with their healthcare providers. A minority expressed dissatisfaction with usability or helpfulness. Conclusion ChatGPT 4.0 offers a promising AI‐driven tool for personalized fibroid management in the absence of formal guidelines. Although not a substitute for official recommendations, it could support clinical decision making and enhance patient education. Further integration with standardized guidelines and prospective trials is needed to optimize its clinical utility.

The impact of lymph node dissection on apparent Stage I epithelial ovarian carcinoma: A population‐based study

Abstract Objective To explore the impact of lymphadenectomy on the prognosis of women of reproductive age with clinically apparent Stage I epithelial ovarian cancer (EOC). Methods Data of women of reproductive age with Stage I EOC, diagnosed between 2010 and 2016, were extracted from the Surveillance, Epidemiology, and End Results database. Five‐year cancer‐specific survival (CSS) was evaluated using the Kaplan–Meier method. Multivariate Cox analysis was performed to evaluate the effect of lymph node dissection on survival. Propensity score (PS) matching was conducted to balance various clinicopathologic factors. Results Of 2222 patients included, 1609 (72.4%) received lymph node dissection. The rate of histopathologically confirmed lymph node metastasis was highest in serous subtype (10.2%) and lowest in mucinous subtype (2.2%). No significant difference between the lymphadenectomy and non‐lymphadenectomy groups in 5‐year CSS was observed in the original cohort ( P  = 0.364) or in the PS matching cohort ( P  = 0.248). Nevertheless, there was a significant difference between the lymphadenectomy and non‐lymphadenectomy groups for patients with Stage IC EOC (92.4% vs. 88.1%, P  = 0.027). According to the multivariate analysis, performance of the lymphadenectomy was not significantly associated with CSS in the original cohort ( P  = 0.163) or the PS matching cohort ( P  = 0.101). Conclusion Dissection of lymph nodes was not significantly associated with improved prognosis for most Stage I EOC, but, lymphadenectomy may be necessary for women of reproductive age with Stage IC subtype.

Cervical adenocarcinoma in situ during pregnancy and subsequent fertility‐sparing therapy challenge

AbstractObjectiveAdenocarcinoma in situ (AIS) of the cervix is a premalignant lesion, and a precursor of invasive disease. It is less frequent than its squamous counterpart. During pregnancy, AIS is a scarcely described scenario, whose diagnosis barely differs from non‐pregnant patients. Its management is challenging with hysterectomy being the definitive treatment. However, its high incidence in young patients makes fertility‐sparing management an approachable option for selected patients. The objective of this study is twofold. Firstly, we describe a case of a patient with AIS during pregnancy and the postpartum period. Secondly, the available literature is reviewed.MethodsRetrospective medical record review of a single case and a medical literature search in Pubmed of AIS cases in pregnant women.ResultsA 31‐year‐old woman with cervical AIS diagnosed during pregnancy underwent serial fertility‐sparing surgeries including a loop electrosurgical excision procedure and endocervical curettage during the second trimester, and a re‐conization and a simple traquelectomy during the postpartum period, until negative margins were achieved. Upon reviewing the literature from 1965 to 2020, 23 other cases were found.ConclusionSurgical management of cervical AIS during pregnancy is a safe procedure. Subsequent conservative surgeries imply a real challenge to preserve fertility.

He Tapu Te Whare Tangata (sacred house of humanity): Under‐screened Māori women talk about HPV self‐testing cervical screening clinical pathways

AbstractObjectiveTo develop an in‐depth understanding of HPV self‐testing cervical screening clinical pathways for never‐/under‐screened Māori women.MethodsBased on a community‐based cluster randomized controlled trial in Aotearoa (New Zealand), a Kaupapa Māori (by Māori, for Māori) qualitative study enrolled Māori women who met the eligibility criteria of the HPV trial intervention (aged 25–69 years, no screen in >4 years). In total, 28 were recruited (22 had a negative test, six had a positive test and colposcopy). They were asked about their clinical pathway.ResultsThe HPV self‐test was seen as empowering and promoting bodily autonomy, although some women expressed fears or misconceptions about this new technology. While those with a negative test were relieved, for the six women who had a positive test, there were many fears, compounded by seeking out information on the Internet. When attending colposcopy, the importance of support and responsive care was emphasized.ConclusionHPV self‐testing has the potential to improve access to cervical screening and reduce inequities for Māori. Care must be taken in the delivery of screening and colposcopy results. Primary care and colposcopy services need to take special care with never‐/under‐screened Māori women to provide sensitive, responsive care, and mitigate trauma.

The treatment strategy of patients with positive margins after cervical cold knife conization—A 7‐year retrospective study in China

Abstract Objective To explore treatment strategies for patients with positive margins after cervical cold knife conization (CKC) by estimating the risk of residual or recurrent CIN2 or worse (CIN2+). Methods A retrospective study included 569 patients receiving CKC for CIN3 in Xiangya Hospital from January 2013 to December 2017. Demographic characteristics and test results were obtained before CKC, after CKC, at 6, 12, and 24 months, then annually thereafter. The primary end point was residual/recurrent CIN2+ post‐CKC. Results Fourteen (2.46%) patients had residual/recurrent CIN2+ with a median time of occurrence at 12 months post‐CKC. Taking the average age and hrHPV viral load tested by Hybrid Capture 2 (HC2) as thresholds, the risk of residual/recurrent CIN2+ was higher in women aged over 40 years or with a baseline HC2 of 300 or more for the ratio of relative light units to positive cut‐off values. Patients with positive margins were at higher risk of residual/recurrent CIN2+ (hazard ratio 3.66, 95% confidence interval 1.25–10.71), especially when endocervix was involved. A total of 536 (94.20%) patients received HPV testing within 6 months after CKC. Patients with both positive HPV testing results and positive margins were at the highest risk of residual/recurrent CIN2+. Conclusion Patients with positive endocervical margins are at high risk for residual/recurrent CIN2+, independent of the severity of margins. HPV testing within 6 months after CKC may be a feasible triage strategy for these patients.

Impact of sentinel lymph node mapping on survival in patients with high‐risk endometrial cancer in the early stage: A matched cohort study

AbstractObjectiveThe aim of this study was to compare patient survival using sentinel lymph node (SLN) procedure and pelvic lymphadenectomy for stating early‐stage high risk endometrial cancer.MethodsPatients who underwent surgery for early‐stage high risk endometrial cancer between 2010 and 2017 were extracted from the incidence registry of the SEER program. We identified patients who underwent SLN mapping. Patients who initially underwent pelvic lymphadenectomy were selected as the comparison group. One‐to‐one matching was performed according to age, ethnicity, histology, extension and grade. The primary outcome was disease‐specific survival. The secondary outcome was overall survival.ResultsA total of 326 patients who underwent SLN mapping and 326 who underwent pelvic lymphadenectomy initially were included in the study. The three‐year analysis did not find a significant difference between the SLN and lymphadenectomy groups on disease‐specific survival probability (88.2% vs 82.7, P = 0.07) and on overall survival probability (82.7% vs 78.2%, P = 0.57). Patients who underwent SLN mapping had a lower mean number of lymph nodes removed (mean 3 vs 16, P < 0.001) and there was a higher rate of patients with positive pelvic lymph nodes (18% vs 14%, P = 0.04). Following adjustment for confounding factors, disease‐specific survival did not vary according to the lymph node intervention performed (P = 0.056), but the SLN group had better overall survival than those in the lymphadenectomy group (P = 0.047).ConclusionThe SLN technique was not associated with poorer disease‐specific survival than pelvic lymphadenectomy even after adjustment. These results suggest that SLN is an acceptable and safe procedure in surgical staging for early‐stage high‐risk endometrial cancer.

Minimally invasive surgery and abdominal radical hysterectomy in patients with early‐stage cervical cancer: A meta‐analysis

AbstractObjectiveTo compare risk of recurrence and death related to minimally invasive surgery (MIS) and abdominal radical hysterectomy (ARH) in early‐stage cervical cancer (CC) patients.MethodsAll relevant literatures in databases were retrieved from the built time of databases to October 2020. Observational studies comparing MIS and ARH in early‐stage CC patients were involved. Newcastle‐Ottawa Scale was used for quality assessment, including studies with a score of at least 6. Main outcomes involved overall survival (OS) and disease‐free survival (DFS).ResultsTwenty‐two studies were involved, including 14 894 patients, among which 7213 (48.6%) underwent MIS. The OS (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.03–1.43) and DFS (HR 1.25, 95% CI 1.07–1.42) of patients undergoing MIS was obviously shortened compared with those of patients undergoing ARH. Subgroup analysis revealed that OS (HR 1.42, 95% CI 1.10–1.74) and DFS (HR 1.46, 95% CI 1.18–1.74) of patients with a tumor ≥2 cm in diameter were significantly reduced by MIS.ConclusionOverall survival and DFS after MIS for early‐stage CC treatment were worse than those after ARH, especially for patients with a tumor ≥2 cm in diameter.

Reliability and diagnostic performance of smartphone colposcopy

AbstractObjectiveTo evaluate the interobserver and intraobserver reliability of smartphone colposcopy (SPC) versus conventional colposcopy and to determine diagnostic performance.MethodsA smartphone back camera was used to capture cervical images before and after application of acetic acid, and after application of lugol solution. Captured images were reviewed independently by two experienced colposcopists and findings were noted as per colposcopy. Smartphone‐based diagnostic performance was calculated, and kappa statistics were used for measurement of agreement between SPC and conventional colposcopy findings.ResultsA total of 114 women were included in the study. The kappa statistic for intraobserver reliability was 0.77 for both normal colposcopic findings and the transformation zone, indicating substantial agreement. Kappa values were 0.54 for acetowhite epithelium, 0.51 for lugol staining, and 0.51–0.60 for atypical vascularization. Kappa values for interobserver reliability were 0.76 for normal colposcopic findings, 0.56 for acetowhite epithelium, and 0.60 for lugol staining. The sensitivity, specificity, PPV, and NPV of SPC for CIN2+ were 88.2 (95% CI, 72.5–96.7), 48.7 (95% CI, 37.4–60.2), 0.42 (95% CI, 0.36–0.48), and 0.91 (95% CI, 0.79–0.96), respectively.ConclusionSPC showed substantial agreement between the histologic diagnoses based on the captured images and conventional colposcopic findings.

A novel prognostic nomogram utilizing the 2018 FIGO staging system for cervical cancer: A large multicenter study

AbstractObjectiveTo evaluate the prognostic performance of the revised 2018 FIGO staging system for cervical cancer.MethodsThis retrospective multicenter study enrolled cervical cancer patients with 2009 FIGO Stage IA1–IIA2 who underwent surgeries between January 2006 and December 2017 in four tertiary hospitals. Patients were restaged according to the 2018 FIGO staging system by reviewing their medical data.ResultsOf 3238 cervical cancer patients included, 1841 (56.9%) patients were restaged: 641 (34.9%) due to tumor size, 544 (29.5%) due to lymph node metastasis, 614 (33.4%) due to the inconsistency between pre‐ and postoperative assessments, and 42 due to the cancellation of invasion width in Stage IA. After restaging, a clear tendency of decreased recurrence‐free survival (RFS) and overall survival (OS) with increasing stage was observed. Multivariate Cox analysis showed that 2018 FIGO stage, parametrial involvement, and histology were independent prognostic factors for both OS and RFS (P < 0.05). Based on these factors, we established predictive nomograms with c‐indexes of 0.735 and 0.721, showing good predictive ability for cervical cancer.ConclusionThe revised 2018 FIGO staging system can better reflect the survival of cervical cancer patients. Based on it, we established a nomogram that can predict the prognosis of cervical cancer patients more precisely.

Prevalence of high‐risk human papillomavirus genotypes in two regions of Peru

Abstract Objective This study aims to discover the most prevalent high‐risk (hr) HPV genotypes in the regions of Loreto and La Libertad, Peru. Methods In 2015, cervical cell samples were collected during pelvic examinations from women in the geographically distinct regions of Loreto and La Libertad, Peru. In 2017, additional samples were collected in La Libertad. A total of 429 women between the ages of 18 and 65 years living in these regions were enrolled in the study. All samples were analyzed by polymerase chain reaction for the hrHPV genotypes 16, 18, and 35. Results Sample collection from 126 women in 2015 in Loreto revealed an hrHPV incidence of 15.9% (20 of 126), with 60% (12 of 126) of HPV infections due to hrHPV 16. Samples from La Libertad revealed an hrHPV incidence of 14.5% incidence (44 of 303) (among 303 women). Of these infections, 38% (17) were attributable to hrHPV type 35 and 20% (9) were due to hrHPV type 16. Conclusion The prevalence of hrHPV genotypes in Peru may differ from those observed in North America and Europe. Loreto appears to follow the prevalence trend observed in North America, with hrHPV type 16 accounting for the majority of cases. However, hrHPV type 35 may account for a greater contribution to the cervical cancer burden in La Libertad. Further research, specifically on cervical tumor specimens, is needed.

Reduced response to controlled ovarian stimulation after radical trachelectomy: A pitfall of fertility‐sparing surgery for cervical cancer

AbstractObjectiveTo clarify the decrease in response to controlled ovarian stimulation in patients who receive in vitro fertilization treatment after radical trachelectomy.MethodsThe outcomes of ovarian stimulation were retrospectively evaluated and compared between patients who have undergone radical trachelectomy and control patients who had male factor infertility or unexplained infertility.ResultsA total of 30 ovarian stimulation cycles in 14 radical trachelectomy patients and 54 cycles in 30 control patients were reviewed. The median age at ovarian stimulation was 34.8 years in the radical trachelectomy group and 36.5 years in the control group. Compared with the control group, the radical trachelectomy group had significantly lower mean estradiol concentration (1461.7 pg/ml, SD 775.0 vs. 1950.9 pg/ml, SD 1057.3, P = 0.029) during controlled ovarian stimulation cycle and smaller median number of retrieved oocytes (5, range 1–14 vs. 8, range 1–19, P = 0.007), despite the higher use of gonadotropin (3527.5 IU, SD 1313.4 vs. 2670.8 IU, SD 905.1, P = 0.001).ConclusionThe response to controlled ovarian stimulation decreased after radical trachelectomy.

Feasibility and acceptability of human papillomavirus self‐sampling in a semi‐urban area in northern Tanzania

AbstractObjectiveTo assess the feasibility and acceptability of HPV self‐sampling in Arusha region, northern Tanzania, because the ability for women to self‐collect HPV samples can help reduce the number of health facility visits and improve cervical cancer screening coverage rates.MethodsWe conducted a facility‐ and community‐based cross‐sectional study among 350 women aged 25–55 years in Arumeru district, Arusha region, northern Tanzania. Women were trained to self‐collect an HPV sample, and follow‐up visits were used to provide results after laboratory testing. Data were analyzed using Stata version 15.1 and summarized using mean and standard deviation for numeric variables and frequencies and percentages for categorical variables.ResultsAmong 350 women, 65 (18.6%) ever screened for cervical cancer, all provided self‐collected samples, and 349 (99.4%) would advise their female friends to undergo the same procedure. The prevalence of positive HPV results was 31 (8.9%), of which 26 (83.9%) were further examined. Two women found with lesions were treated following the national guidelines.ConclusionThis study has demonstrated that the HPV self‐sampling intervention for cervical cancer screening is a feasible and acceptable intervention, especially in resource‐limited countries like Tanzania. Scaling‐up policies should consider addressing the potential barriers to the uptake of this intervention.

Cervical cancer in women under 25 years of age and outside the screening age: Diagnosis profile and long‐term outcomes

AbstractObjectiveTo evaluate the pattern of cervical cancer (CC) diagnosis and outcomes in women under 25.MethodsThirty‐two women younger than 25 years of age treated between 2001 and 2016 were studied and the year, symptom or cytology before diagnosis, time since sexual debut, age group, histology, and stage were considered. Data were compared with older age groups, and survival analysis was performed using a subset of them.ResultsThirty‐two CC diagnoses (1.5% of all cases) exhibited a positive linear trend (P = 0.075). Driven by cytology, 18 were asymptomatic and 14 were symptomatic (with vaginal bleeding in 11). The mean time since sexual debut was 6.9 years. Advanced stage (44% vs 29%) and adenosquamous histology (12.5% vs 1.7%–5.0%) were higher in younger women. Five‐year overall survival rate was 76%, better for squamous cell carcinoma (SCC) (86% vs 43% for other histologies; P = 0.018). There were seven deaths, all within 15 months of diagnosis. Age groups of less than 25 years (53%) and 25–29 years (48.5%) had similar proportions of Stage IA1.ConclusionThe rate of CC‐diagnosed women under 25 years was 1.5% of all cases, exhibiting more advanced stage and non‐SCC histology. For asymptomatic women, cytology allowed the diagnosis at an early stage. Being symptomatic and non‐SCC was associated with a higher proportion of advanced stages and poor survival.

Risk factors analysis of recurrent disease after treatment with a loop electrosurgical excision procedure for high‐grade cervical intraepithelial neoplasia

AbstractObjectiveTo evaluate the risk factors of recurrent high‐grade cervical intraepithelial neoplasia grade 2 or worse (CIN2+) after loop electrosurgical excision procedure (LEEP).MethodsThis retrospective study included patients with histopathologically confirmed CIN2/3 who underwent LEEP in 2015–2020. Cox regression analysis was used to evaluate the risk factors of recurrence.ResultsRecurrent CIN2+ was found in 268 patients after LEEP (268/4369, recurrence rate, 6.1%). High‐risk (hr‐) HPV infection (hazard ratio [HR] 12.09, 95% confidence interval [CI] 7.78–18.79), margin status (HR 6.48, 95% CI 4.75–8.84), baseline diagnosis (HR 1.45, 95% CI 1.08–1.95), smoking (HR 3.17, 95% CI 2.27–4.43), and immunosuppression (HR 1.96, 95% CI 1.33–2.91) were significant independent risk factors of recurrence. HPV16 (HR 3.61, 95% CI 2.43–5.37), HPV33 (HR 2.62, 95% CI 1.12–6.12), and HPV52 (HR 1.61, 95% CI 1.02–2.55) infection showed a higher risk of recurrence. High‐risk HPV had the highest accuracy (sensitivity 88.5%; negative predictive values 98.7%) in predicting recurrence compared with liquid‐based cytology test and margins.ConclusionGiven that positive margins present a higher risk, wide excision may be required to avoid residual lesions. More attention should be paid to the correlation between recurrence and hr‐HPV genotypes. After treatment for high‐grade CIN, HPV‐based testing is recommended at 6 months. Timely identification of high‐risk factors enables risk stratification, and enables individual management or individual follow‐up and recall strategies.

Experiences in the prevention and screening of cervical cancer within Thailand

AbstractCervical cancer is the third most common cancer among Thai women, after breast and colon cancer, with an age‐standardized incidence rate (ASR) of 11.7/100 000 women each year, as of 2015. Over decades, comprehensive national cervical cancer screening programs, research, and the HPV vaccination policy have gradually helped decrease the incidence of cervical cancer in Thailand. In 2017, the Thai Ministry of Public Health signed a memorandum of understanding with the Royal Thai College of Obstetricians and Gynecologists to eliminate invasive cervical cancer from Thailand. This is a tremendous challenge for Thailand as a whole. The present paper reviews and discusses the experiences in the prevention and screening of cervical cancer in Thailand.

Acceptability and preferences for self‐collected screening for cervical cancer within health systems in rural Uganda: A mixed‐methods approach

AbstractObjectiveTo understand the knowledge, preferences, and barriers for self‐collected cervical cancer screening (SC‐CCS) and follow‐up care at the individual and health system level to inform the implementation of community‐based SC‐CCS.MethodsSurveys and focus group discussions (FGDs) with women and FGDs with healthcare providers were conducted in Uganda. Survey data were analyzed using frequencies and FGD data were analyzed using thematic content analysis. Data were triangulated between methods.ResultsSixty‐four women were surveyed and 58 participated in FGDs. Facilitators to screening access included decentralization, convenience, privacy, confidentiality, knowledge, and education. Barriers to accessing screening included lack of transportation and knowledge, long wait times, difficulty accessing health care, and lack of trust in the health system. Additional implementation challenges included insufficiently trained human resources and lack of infrastructure.ConclusionIntegrating SC‐CCS within rural health systems in low‐resource settings has been under‐evaluated. Community‐based SC‐CSS could prevent high cervical cancer‐related mortalities while working within the human and financial resource limitations of rural health systems. SC‐CCS is acceptable to women and healthcare providers. By addressing rural women's preferences and barriers to care, decision‐makers can build health systems that provide community‐centered care close to women's homes across the care continuum.

Fibroids and pregnancy

Abstract The prevalence of uterine fibroids in pregnancy varies between 1.6% and 10.7%. Pregnancies involving uterine fibroids are generally uncomplicated. However, complications can occur, particularly in cases of multiple fibroids, when the fibroids are larger than 5 cm, or when they are located in the lower uterine segment. Between 10% and 30% of pregnant women with fibroids experience complications during pregnancy, labor, and the postpartum period. The most common complication during pregnancy, which can occur in 8% of women, is red degeneration. High‐quality data on the relationship between fibroids and pregnancy outcome are very limited. Potential obstetric complications include preterm birth (increased risk, OR 1.5; 95% CI, 1.3–1.7), malpresentation of the baby (OR 2.65; 95% CI, 1.60–3.70), placental abruption (OR 2.63; 95% CI, 1.38–3.88), placenta previa (OR 2.21; 95% CI, 1.48–2.94), cesarean birth (OR 2.60; 95% CI, 2.02–3.18), postpartum hemorrhage (OR 2.95; 95% CI, 1.86–4.66), and other rare occurrences. Most women with uterine fibroids are able to deliver vaginally without complications. Cesarean birth is typically performed for standard obstetric indications. It is recommended that cesarean myomectomy should be avoided when possible.

Spontaneous uterine rupture after myomectomy in patients during pregnancy: Clinical cases in a single university center

Abstract Uterine rupture is an infrequent yet sometimes fatal complication of a subsequent vaginal birth attempt following a previous uterine surgery. We have chosen to write about spontaneous uterine ruptures following myomectomy due to the scarcity of data on this subject, stemming from the limited number of reported cases. Furthermore, with the increasing trend of advanced maternal age, there is a growing cohort of pregnant women with a history of myomectomy, thereby presenting a timely opportunity to examine this phenomenon in greater depth. A total of 28 studies reporting pregnancies after prior myomectomy, resulting in 3.502 viable (≥24 weeks) deliveries, were reviewed. The overall incidence of uterine rupture after myomectomy of 0.6%, comparable with those reported in other reviews. Our review confirmed that the incidence of uterine rupture is very low, 0.4%, in the group of women who experienced a trial of labor after myomectomy (TOLAM). In particular, the difference of incidences of uterine rupture before or during labor was not statistically significant. Therefore, uterine rupture may not be significantly influenced by a TOLAM and so this option could be considered in pregnant women as feasible and relatively safe. This study presents three medical cases that occurred at our institution in 2023 of pregnant patients who had undergone surgery for myomectomy and experienced uterine rupture out of labor. The first is a clinical case of a 42‐year‐old woman affected by endometriosis who had undergone laparoscopic myomectomy 1 year before conception. The actual pregnancy was conceived by intracytoplasmatic sperm injection (ICSI). The patient presented at 22 +4  weeks' gestation to the emergency department (ED) for abdominal pain. On hospital presentation, transabdominal ultrasound evidenced a single fetus, with fetal heart rate 163 beats/min and free fluid in the Morrison's pouch with a blood clot at the uterine fundus. Abdominal computed tomography (CT) scan with and without contrast was performed due to the unclear origin of the hemoperitoneum. CT scan revealed abundant abdominal free fluid, especially perihepatic (3 cm), in the left hypochondrium (2 cm), parieto‐colic gutter and anterior the uterus, without contrast spreading; the uterus had inhomogeneous density and profiles. One hour after hospitalization, the patient was admitted to the operating room: a 10 cm fundal uterine rupture with protruding amniotic sac was present. The second is a clinical case of a 32‐year‐old woman who had undergone laparoscopic myomectomy 23 months before conception. An intramural myoma 6 cm in diameter was located on the posterior wall of the uterus. The patient conceived spontaneously 23 months later. The woman presented at 36 +3  weeks' gestation to the ED for irregular uterine contractions (1 uterine contraction every 10–15 min). Three hours after admission, irregular uterine contractions were still present (1 uterine contraction every 10–15 min): the patient was thereby hospitalized. One hour after hospitalization, the patient reported a prolonged contraction and the transabdominal ultrasound check evidenced fetal bradycardia. An immediate cesarean section was performed, showing a massive hemoperitoneum which was promptly drained. After fetal extraction and manual removal of the placenta, a close uterine inspection was performed, showing a 15 cm uterine rupture involving the posterior wall. The third is a clinical case of a 28‐year‐old woman who had undergone laparoscopic myomectomy 2 years before conception. The patient reported that the uterine cavity was opened to remove an intramural myoma of 6 cm in diameter located on the left anterolateral wall of the uterus. She conceived spontaneously 2 years later, and the course of the pregnancy was uncomplicated. The patient presented at 31 +0  weeks' gestation to the ED for abdominal pain. On hospital presentation, transabdominal ultrasound scan evidenced a single fetus with normal heart rate and a growing blood clot at the uterine fundus. The patient was admitted to the operating room for exploratory laparotomy, confirming a massive hemoperitoneum. A 7 cm uterine rupture with protruding amniotic sac was present in the left posterolateral uterine wall. The surgeon hence proceeded to perform hysterotomy, amniorrhexis, fetal extraction of a fetus alive and vital, and manual removal of the placenta. The patient's uterus was surgically repaired with double layer suture. The amount of total blood loss was 1800 mL. A total of four units of packed red blood cells and two units of fresh frozen plasma were transfused. The patient recovered well and was discharged 7 days after surgery.

Introduction of DNA ‐ HPV test in the Brazilian cervical cancer screening program: When the idea is good but does not fit the budget

Abstract Objective To evaluate the financial applicability of the DNA‐HPV test for cervical cancer screening in a developing country like Brazil. Methods This was a retrospective, observational study based on documentary data, conducted to assess the cost‐effectiveness of cervical cancer screening strategies in Brazil. The study used national cervical cancer screening data collected between January 1 and December 31, 2020 for women between 25 and 64 years old, performing a cost‐effectiveness assessment of two different screening tests. No sensitivity analysis was conducted due to the descriptive nature of this preliminary cost assessment. Results Based on the cervical smear, the Brazilian protocol has an estimated cost of US$117.5 million. In contrast, when using the HPV DNA test, the estimated cost is US$1.39 billion. Conclusion The current use of the cervical smear is the least expensive and the only one that aligns with Brazil's financial resources allocated to health.

Nomogram prediction model based on non‐enhanced computed tomography for adnexal torsion: A retrospective multicenter study

AbstractObjectiveTo develop and validate an individualized nomogram for predicting adnexal torsion in women with abdominal pain and an adnexal mass based on preoperative non‐contrast computed tomography (CT) findings.MethodsThis retrospective study included 200 women with surgically resected ovarian lesions who underwent preoperative non‐contrast CT for abdominal pain from January 2017 to September 2023 in seven hospitals. The 200 patients were randomly divided into a development group (140 cases) and a validation group (60 cases). The independent risk factors for adnexal torsion from non‐contrast CT signs were screened using univariate and multivariate logistic regression analyses. The corresponding nomogram prediction model was drawn according to the regression coefficients. The areas under the receiver operating characteristic curves (AUC) and the calibration plots were used to estimate the discrimination and calibration of the prediction model, respectively.ResultsThe most common lesion causing adnexal torsion was ovarian cyst (30.1%), followed by mature cystic teratoma (25.7%), whereas malignant tumors and tubo‐ovarian abscesses were more common in non‐torsioned patients. Multivariable regression analysis showed that navel sign (odds ratio [OR] 14.78; P = 0.005), whirl sign (OR 38.05; P = 0.002), and peri‐adnexal fat haziness (OR 0.20; P = 0.012) were independent significant parameters predicting adnexal torsion. The AUC of the development group and validation group were 0.903 and 0.861, respectively, and the calibration curve suggested good agreement between the predictive probability and the actual probability.ConclusionNavel sign, whirl sign, and peri‐adnexal fat haziness, and an integrated nomogram derived from these non‐contrast CT findings, can be useful for predicting adnexal torsion, especially when ultrasound and contrast‐enhanced CT cannot be used.

The epidemiology and pathogenesis of uterine fibroids

Abstract Uterine fibroids, or leiomyomas, are the most common benign tumors of the female reproductive tract, ultimately affecting a majority of women worldwide, primarily during their reproductive years. While their origin appears genetic, manifesting in monoclonal tumors, diverse features and mechanisms contribute to their growth and further development. Understanding the interplay between epidemiological and biological factors is vital for clinicians and essential for investigators, whether basic, translational, clinical, or epidemiological, who aim to shed light on this ubiquitous clinical problem. Leiomyomas are experienced globally, and while there are relatively minor differences in the lifetime prevalence for women, the tumors appear to develop in those of African ancestry earlier than white women. While most leiomyomas are not symptomatic, those that cause symptoms can adversely affect lifestyle, physical function, and fertility and exert substantial socioeconomic pressure on healthcare systems. Because most leiomyomas are asymptomatic, it is also apparent that, in many cases, presenting symptoms may not be caused by the tumors themselves. As a result, it is essential that the clinician understand the pathogenesis of these tumors and how they manifest with symptoms. Despite their prevalence and evolving understanding of genetic, racial, and environmental factors contributing to their growth and development, much remains to be learned about these ubiquitous tumors in a way that can inform strategies for prevention, early detection, and effective therapy. This paper reviews the current understanding of the epidemiology and pathogenesis of uterine fibroids, highlighting key risk factors, genetic and molecular mechanisms, and implications for public health.

Diagnosis and classification of uterine fibroids

Abstract Uterine fibroids, or leiomyomas, are benign uterine tumors with a lifetime prevalence of approximately 75%. While only a minority become symptomatic, their impact on quality of life remains profound owing to heavy menstrual bleeding, bulk symptoms, and reproductive dysfunction. Interestingly, fibroids are not reliably diagnosed on physical examination, nor can their impact be predicted through palpation. Consequently, the diagnosis and phenotypic categorization of uterine fibroids relies primarily on imaging to guide subsequent clinical management. Ultrasound should be the first‐line diagnostic modality, and magnetic resonance imaging should be reserved for complex cases and/or surgical planning. Adherence to standardized structured reporting across imaging modalities is critical to improve diagnostic accuracy, differentiate fibroids from conditions such as adenomyosis or malignancies, predict therapeutic responses, and plan surgical interventions. Imaging reports should follow the FIGO classification system for uterine fibroids, to enable a standardized description of their relationship to the endometrium, myometrium, and uterine serosa.

Medical treatment of fibroids: FIGO best practice guidance

Abstract Even though uterine fibroids are a widespread condition, the range of approved medical treatment options remains limited. In fact, only a few drugs are officially approved for the therapy of fibroids. In both the USA and the European Medicines Agency region, selected gonadotropin‐releasing hormone (GnRH) antagonists have been approved for this indication. GnRH analogs are primarily indicated for the preoperative management of uterine fibroids, largely because of their unfavorable long‐term adverse effect profile. The previously approved therapy with ulipristal acetate had to undergo extensive restrictions because of safety concerns. Nevertheless, there are additional medications that may be used in clinical practice. These include combined oral contraceptives, oral progestins, the levonorgestrel‐releasing intrauterine system (LNG‐IUS), and tranexamic acid. Although not specifically approved for the treatment of fibroids, these agents can reduce the intensity of bleeding in cases of heavy menstrual bleeding and thereby improve symptoms and lead to an improved quality of life for the patients.

Cancer of the cervix uteri: 2025 update

AbstractSince the publication of the 2021 FIGO Cancer Report, there has been further progress in the global effort to attain the WHO goal of cervical cancer elimination using a three‐pillar approach of vaccination, screening, and treatment. The HPV vaccination is now included in the national program of over 140 countries. Two‐dose schedules are being implemented in 80 countries and one‐dose schedules in 60 countries. Screening has seen major advances with the wider implementation of HPV testing, including the option of self‐sampling, portable screening and treatment devices, and the incorporation of artificial intelligence. Diagnostic accuracy is being enhanced with immunohistochemistry and receptor assays. Surgical treatment of invasive cancer is being revolutionized with the possibility of conservative surgery in very early stages, minimizing complications and adverse effects and offering feasibility of fertility sparing. New data on minimally invasive surgery are redefining the role of laparoscopy and robotic surgery in early stages with small tumor size. Sentinel lymph node evaluation is an emerging alternative to complete lymphadenectomy. Immunotherapy has opened up new possibilities for the management of recurrent and metastatic disease. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality‐of‐life issues, with insights into the results from recent landmark trials.

Strategic approaches for global cervical cancer elimination: An update review and call for national action

AbstractCervical cancer remains a major health burden, particularly in low‐ and middle‐income countries, despite being one of the most preventable cancers. WHO's 90–70–90 targets aim to eliminate cervical cancer globally by 2030. These targets include 90% of girls fully vaccinated with the HPV vaccine by the age of 15 years, 70% of women screened using a high‐performance test by the age of 35 years and again by 45 years, and 90% of women with cervical disease receiving appropriate treatment. Achieving these goals requires coordinated national efforts to strengthen health systems, ensure equitable access to care, and integrate cervical cancer control into broader health policies. This review outlines key strategic approaches, including the transition from conventional screening methods to HPV‐based screening, the adoption of innovative triage techniques, the implementation of single‐dose HPV vaccination, and the integration of primary treatment with palliative care. The strategy places strong emphasis on addressing health inequities, enhancing monitoring systems, and fostering partnerships between governments, non‐governmental organizations, and the private sector. With concerted global and national action, the elimination of cervical cancer is not only a possibility but an imminent reality.

FIGO position statement on the effectiveness and safety of the HPV vaccine

Abstract Cervical cancer, which is primarily caused by persistent infection with oncogenic high‐risk human papillomavirus (hrHPV) types, remains a substantial health problem with the highest incidence and mortality rates in low‐ and middle‐income countries (LMICs). HPV vaccination induces a robust immune response against the HPV types included in the vaccine and protects against subsequent development of cervical cancer precursors. Furthermore, countries with high vaccination coverage have observed a significant reduction in the incidence of cervical cancer. The vaccine has also been shown to be safe, with adverse effects generally limited to mild local reactions. Vaccination schedules vary from one to three doses, depending on the target population and region, with several countries moving to a single‐dose schedule – a growing body of evidence supports the effectiveness of this, especially when given at a younger age. Public health strategies that support equitable and accessible vaccination are vital for achieving the WHO target of 90% of girls being fully vaccinated with the HPV vaccinate by the age of 15. The implementation and promotion of HPV vaccination programs are important components of the global efforts to eliminate cervical cancer.

Incidence, risk factors, and a prognostic nomogram for distant metastasis in endometrial cancer: A SEER‐based study

AbstractObjectiveTo evaluate the metastatic pattern, identify the risk factors, and establish a nomogram for predicting prognosis of endometrial cancer (EC) with distant metastasis.MethodsA retrospective cohort study of women diagnosed with EC was conducted according to the Surveillance, Epidemiology, and End Results (SEER) database during 2010–2017. Multivariate logistic analysis and Cox analysis were performed to identify the risk factors in promoting distant metastasis and predictors associated with overall survival (OS) in this particular subpopulation. A nomogram was then constructed and validated by the concordance index (C‐index), the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis.ResultsA total of 2799 cases of distant metastasis in EC patients were identified, with an overall incidence rate of 3.74% from 2010 to 2017. Black race, unmarried status, non‐endometrioid histologic types, and grade IV were significant risk factors for distant metastasis in EC patients. Meanwhile, race, histology, grade, metastasis status, surgery, lymphadenectomy, and chemotherapy were identified as independent prognostic factors for OS. A nomogram to predict 1‐, 3‐, and 5‐year OS was established, and presented favorable accuracy and clinical applicability. Patients were further divided into high‐ and low‐risk groups according to the model.ConclusionThe nomogram was developed as a highly accurate, individualized tool to better predict the prognosis of EC patients with distant metastasis, which would help clinicians to identify high‐risk patients, and adjust and tailor their treatment strategies.

Prophylactic HPV vaccination in HPV‐related gynecologic cancers: European Society of Gynecological Oncology (ESGO) prevention committee opinion

AbstractMany clinicians recommend that patients diagnosed with HPV‐related gynecologic cancers receive prophylactic HPV vaccination at the time of cancer diagnosis or after cancer treatment. In view of the large use of such practice, we aimed to assess the literature evidence supporting the use of prophylactic HPV vaccines after diagnosis or treatment of HPV‐related gynecologic cancers. Women who develop HPV‐related cervical, vaginal, and vulvar cancers represent a subgroup of patients who may be particularly sensitive to HPV infection and re‐acquire infections. The rationale that the use of prophylactic HPV vaccination at the time or after treatment for cervical, vaginal, and vulvar cancers might reduce the risk of future HPV‐related diseases might be explained by the data coming from the use of HPV vaccination after treatment of pre‐invasive disease; however, the evidence on the use of HPV vaccination in the setting of HPV‐related gynecologic cancers is currently absent. In this context, observational and experimental studies document an important drop in effectiveness of HPV vaccination by age. Physicians should be aware of catch‐up programs in their countries and should be ready to counsel patients about prophylactic HPV vaccine efficacy according to their age. In general, no evidence exists supporting the use of prophylactic HPV vaccine in patients diagnosed with HPV‐related gynecologic cancers; therefore, the European Society of Gynecological Oncology (ESGO) prevention committee opinion is to counsel these patients as any HPV‐related non‐gynecologic cancer (such as anal or oropharyngeal cancer) and non‐cancer patient, suggesting vaccination according to patient's age and prognosis, knowing there is a decrease of efficacy with increasing age. Studies on the use of prophylactic HPV vaccine in patients diagnosed with HPV‐related gynecologic cancers are strongly needed.

Comparative prognosis analysis of ovarian squamous cell carcinoma versus serous carcinoma: Insights from the SEER database

Abstract Objective The aim of this study was to identify survival rates and potential prognostic factors of ovarian squamous cell carcinoma (OSCC), offering valuable insights for clinical decision making. Methods Leveraging the Surveillance, Epidemiology, and End Results (SEER) database, we selected 11 078 serous carcinoma (SC) patients and 198 OSCC patients based on predetermined criteria diagnosed from 2000 to 2020. We compared the overall survival (OS) and cancer‐specific survival (CSS) before and after propensity score matching (PSM) in two groups. Prognostic differences were also compared between OSCC and SC groups at different stages. Univariate and multivariate Cox regression analyses were performed to investigate the impact of clinical and pathologic variables on the survival of patients with OSCC. Finally, we developed and validated a nomogram predictive model. Results OSCC tumors exhibited distinct characteristics, being relatively larger, more frequently unilateral, and better differentiated than SC tumors. After PSM, Kaplan–Meier analysis revealed significantly lower survival rates for OSCC patients in Stages IIB–IV, while Stages IA–IC displayed comparable survival. Independent risk factors for OSCC patients included advanced age, single marital status, higher tumor stage, and increased tumor size. Conversely, higher median household income and chemotherapy emerged as independent protective factors. Our predictive model and nomogram accurately forecasted patient survival rates in both SEER and internal validation datasets. Conclusion OSCC patients face significantly poorer prognosis than their SC counterparts, except in the very early stages. Higher median household income was associated with better OSCC survival.

Determinants of cervical cancer screening uptake among women with access to free screening: A community‐based study in peri‐urban Ghana

AbstractObjectiveCervical cancer can be prevented by regular screening; however, screening rates are low in developing countries. We evaluated the proportion of women screened, modalities of screening utilized, and factors influencing uptake among Ghanaian women with access to free screening services.MethodsParticipants were women aged 25–65 in Asokore‐Mampong, Ghana. A structured questionnaire collected socio‐demographic characteristics, risk factors, knowledge of, and utilization of cervical cancer screening. Adjusted logistic regression evaluated predictors of screening.ResultsOf 710 participants, the majority had heard of cervical cancer (64.6%) and screening (57.7%). Screening utilization was 24.6%. Visual inspection with acetic acid was the most common screening method (97.1%). For those who had never been screened, common reasons were believing they were healthy (21.7%), fearing pain (12.9%), lacking awareness of screening (11.8%), and being too busy (11.6%). Participants who were aged 35–44 (aOR 1.82; 95% CI 1.09–3.03; p = 0.023), married (aOR 3.98; 95% CI 1.68–9.40; p = 0.002), formally employed (aOR 9.31; 95% CI 2.86–30.35; p <0.001), and had higher cervical cancer knowledge (aOR 3.98; 95% CI 2.64–6.02; p <0.001) were more likely to have been screened.ConclusionDespite geographic proximity to a health center that provides free cervical cancer screening, screening uptake among Ghanaian women remains low.

HPV vaccination coverage in women between 15 and 55 years old in Spain: Temporal trend during the period 2007–2020

AbstractObjectiveThe objective of this study was to analyse the temporal trend of HPV vaccination coverage (VC) in Spain in women aged 15‐55 years not included in systematic vaccination programmes during the period 2007‐2020.MethodsWe assessed the vaccine coverage rate in this population based on three estimations: 1) annual vaccination coverage with at least one dose (VCR ≥ 1d), 2) annual VC for the full schedule (VCR3d), and 3) cumulative VC for the full schedule (aVCR).ResultsAnnual VCR ≥ 1d and VCR3d were highest in 2008 (2.40% and 0.66% respectively) and subsequently decreased drastically in 2011 (0.55% and 0.15%). From 2017 to 2019 there was an increase from 1.4‐fold to 1.6‐fold, respectively, which decreased in 2020. In relation to aVCR, there was an increasing trend throughout the study period with approximately 4.03% of the study population having been vaccinated against HPV in 2020.ConclusionIn Spain, the cumulative vaccination coverage against HPV in women between 15‐55 years old not included in current vaccination programmes remains very low. Nonetheless, the temporal trend has shown a slight increase in recent years. Despite the COVID‐19 pandemic in 2020, no significant negative impact on vaccination coverage has been observed in this population.

Cytologic DNA methylation for managing minimally abnormal cervical cancer screening results

Abstract Objectives To explore the role of a DNA methylation assay for managing minimally abnormal cervical cancer screening results in a prospective cohort undergoing opportunistic cervical cancer screening. Methods In the cohort of the METHY2 and METHY3 screening studies of women undergoing opportunistic cervical cancer screening, cervical cytology samples were sent for high‐risk human papillomavirus (hrHPV) DNA assays, cytologic pathology and methylation assays of PAX1 / JAM3 (CISCER). This study evaluated the discriminative power of CISCER in managing women with minimally abnormal cervical cancer screening results for CIN3+. Absolute CIN3+ risks and colposcopy referrals within one screening round were calculated. Results A total of 1857 women with minimally abnormal cervical cancer findings had cervical histologic outcomes and were included in the analysis. In women with a minimally abnormal cervical cancer result, the sensitivity and specificity of CISCER was 74.9% (95% confidence interval [CI], 68.3%–81.4%) and 89.1% (95% CI 87.6%–90.6%) for detecting CIN3+. CISCER analysis discriminated well for minimally abnormal cervical cancer results, yielding a CIN3+ risk of 40.5% (95% CI 34.9%–46.2%) after a positive result and a CIN3+ risk of 2.7% (95% CI 2.0%–3.6%) after a negative result. Conclusions In women with a minimally abnormal cervical cancer screening result, the CISCER provides excellent detection of CIN3+. The use of CISCER in women with a minimally abnormal cervical cancer screening result can lead to a substantial reduction in the number of direct colposcopy referrals.

Do MRI structured reports with FIGO classifications of leiomyomas contain adequate information for clinical decision making?

Abstract Objective To evaluate if structured reports (SR) of pelvic magnetic resonance imaging (MRI) scans using the PALM‐COEIN FIGO (the International Federation of Gynecology & Obstetrics) uterine leiomyomas classification (SR‐FIGO) contain adequate information for clinical decision making compared with narrative reports (NR). Methods Three reporting templates for pelvic MRI scans were compared: NR, SR without the PALM‐COEIN FIGO classification of leiomyomas, and SR‐FIGO, for presence of 19 key‐features (KF) deemed relevant for leiomyoma management. Kruskal‐Wallis test was used to evaluate KF distribution across the report types. One gynecologist and one gynecologist‐in‐training evaluated the reports and MRI scans to assess the presence of sufficient information to decide on: (1) treatment type (observation/medical treatment/surgery/uterine artery embolization); (2) surgical approach (hysteroscopic/laparoscopic/robotic/open); (3) surgery type (myomectomy/hysterectomy); (4) necessity to review MRI scans; and (5) time spent reviewing MRI scans. The responses of the gynecologist and gynecologist‐in‐training to points 1 to 5 among report types were compared using χ 2 test. Results Twenty NR, 20 SR, and 20 SR‐FIGO were reviewed. The number of KF was significantly different among reports ( P  < 0.001): SR‐FIGO had the highest number of KF, followed by SR, and NR. In pairwise comparison, significant differences were observed between NR and SR ( P  = 0.001) and between NR and SR‐FIGO ( P  = 0.001), but not between SR and SR‐FIGO ( P  = 0.063). There were significant differences in answers to question 1 between the gynecologist and gynecologist‐in‐training for SR ( P  = 0.007) and SR‐FIGO ( P  = 0.024), with the gynecologist deeming SR and SR‐FIGO to provide enough information for treatment decisions more commonly than the gynecologist‐in‐training. Conclusion Although this investigation revealed that SR offers a greater wealth of information in contrast to NR, additional investigation is required to ascertain whether the integration of the PALM‐COEIN FIGO classification in SR enhances the clinical decision making capacity of gynecologists.

Improved cervical screening using HPV type restriction and cycle threshold limit setting with the AmpFire assay: A prospective screening cohort of women with and without HIV in Botswana

Abstract Objective The aim of this study was to evaluate the performance of HPV type restriction and cycle threshold (Ct)‐limit setting to optimize detection of cervical intraepithelial neoplasia (CIN) with primary HPV testing. Methods Baseline cervical screening at time of entry into a prospective longitudinal cohort of women with and without HIV was conducted from February 2021 to July 2022 in Botswana. All women underwent HPV testing of 15 individual types using the AmpFire assay; all HPV‐positive and a random subset of HPV negative had histopathology collected. Performance parameters of HPV type restriction groupings were calculated, and sensitivity by individual HPV type Ct‐value limits were plotted. Results Among 2964 women who underwent primary HPV screening, 1293 (43.6%) tested HPV‐positive. Among women with HIV (WWH), HPV types 16/18/33 were associated with the greatest burden of CIN2+/CIN3+ (53%/56%). In WWH, grouping by HPV types separately reported in commercial assays (16/18/45) had low sensitivity (44% [CI: 36%–52%]) but high specificity (86% [CI: 84%–88%]) for CIN2+; 8‐type HPV restriction (16/18/31/33/35/45/52/58) improved sensitivity (79% [CI: 72%–86%]) and maintained reasonable specificity (67% [CI: 65%–70%]) for CIN2+. Similar results were seen in women without HIV. Ct‐limit setting for medium oncogenic HPV types (31,33,35,52,58) maintained a sensitivity of 72% in WWH while reducing over‐detection of non‐pathogenic HPV. Conclusion Eight‐type HPV restriction and Ct‐limit setting are promising strategies for improving the performance of primary HPV screening. A potential strategy to improve 8‐type HPV restriction would be to treat all with HPV 16/18/45; treat HPV 31/33/35/52/58 if below the type‐specific Ct limit and repeat HPV testing in 1‐year for other positive HPV results.

Yield of endocervical curettage in detecting cervical intraepithelial neoplasia grade 2 or higher during colposcopy: A prospective, cross‐sectional study

AbstractObjectiveThis study assessed the prevalence and factors associated with detecting cervical intraepithelial neoplasia grade 2 or higher (CIN2+) via endocervical curettage (ECC) during colposcopy.MethodsBetween December 2020 and September 2023, a prospective, cross‐sectional study involving women with abnormal cervical cancer screening results who underwent colposcopy was conducted. ECC was performed via a Kevorkian endocervical curette following colposcopy‐directed biopsy. The exclusion criteria were glandular cytology abnormalities, pregnancy, post‐hysterectomy status, and cervical cancer.ResultsThe study included 569 women, with a mean age of 41.6 ± 11.7 years. Among the participants, 78.9% presented with low‐grade cytology, whereas 21.1% presented with high‐grade cytology. All of the patients underwent ECC, with 0.4% (two patients) yielding inadequate samples. ECC detected CIN2+ lesions in 11.6% of the patients (95% confidence interval [CI], 9–14.3). Univariable analysis revealed that age, menopausal status, history of CIN2+, high‐grade cytology, and high‐grade colposcopy impression were significant factors for CIN2+ detection by ECC. Multivariable analysis confirmed high‐grade cytology as the sole independent factor (adjusted odds ratio [OR], 13.81 [95% CI, 4.60–41.42], P < 0.001). ECC added a diagnostic yield of 2.9% (95% CI, 1.5–4.3) for detecting CIN2+ lesions missed by colposcopy‐directed biopsy. Multivariable analysis demonstrated an independent association between human papillomavirus 16 (HPV‐16) infection and the additional diagnostic benefit of ECC, with an adjusted odds ratio (OR) of 6.26 (95% CI, 1.49–26.23, P = 0.012).ConclusionThis study highlights the critical role of ECC in detecting CIN2+ lesions, particularly in patients with high‐grade cytology or HPV‐16 positivity.

Primary squamous cell carcinoma of the uterine wall associated with adenomyosis: A rare case report and literature review

Abstract Primary squamous cell carcinoma (SCC) of the myometrium associated with adenomyosis is exceedingly rare. We present a case involving a 49‐year‐old female patient who experienced irregular menstruation for 3 months and was initially misdiagnosed with an anterior intramural uterine leiomyoma. The patient underwent a total abdominal hysterectomy with bilateral salpingectomy. Histopathological analysis revealed infiltrative moderately differentiated squamous cell carcinoma. Adenomyosis was also present, with no lesions detected in the cervix, endocervical canal, or uterine cavity. The lesion was localized within the intrinsic muscular layer of the anterior uterine wall. Postoperative diagnosis confirmed stage IIC squamous cell carcinoma of the uterine corpus. A subsequent whole‐body positron emission tomography‐computed tomography (PET‐CT) scan showed no abnormalities. A second surgery at another hospital revealed no abnormalities in the bilateral ovarian, greater omentum, and pelvic lymph nodes.

Laboratory practice in an oncology cryopreservation service: What and how?

AbstractIn humans, oocyte and embryo vitrification is a routinely used method for fertility preservation (FP). Sperm vitrification is currently applied to samples with low sperm concentration and volume, whereas slow freezing remains the preferred method for larger sperm volumes. Although ovarian tissue cryopreservation and testicular tissue cryopreservation are not yet routinely used for FP, the cryopreservation methods are a matter of debate. Slow freezing is the most commonly applied method for the ovarian cortex, while ovarian tissue vitrification remains clinically uncertain due to the limited number of successful births. It is important to underline that the guidelines for gametes, embryos, and tissue cryopreservation have a key role for both providers and patients, which is to minimize the risks associated with an unsafe FP choice and cryostorage.

Association of gestational trophoblastic disease with subsequent development of non‐trophoblastic cancer

Abstract Objective To evaluate the association between gestational trophoblastic disease and the subsequent risk of developing non‐trophoblastic cancer. Methods We conducted a retrospective cohort study of 3084 women with gestational trophoblastic disease and 1 415 812 women with obstetric deliveries in Quebec, Canada, between 1989 and 2021. The main exposure was gestational trophoblastic disease, including hydatidiform moles, invasive moles, and gestational choriocarcinoma. The outcome was development of non‐trophoblastic cancer during 33 years of follow‐up. We measured the association of gestational trophoblastic disease with non‐trophoblastic cancer using adjusted hazard ratios (HR) and 95% confidence intervals (CI), and tested whether associations were stronger for certain types of cancer or cancers with later onset. Results The incidence of non‐trophoblastic cancer was greater for women with invasive moles (47.1/10 000 person‐years) and gestational choriocarcinoma (59.3/10 000 person‐years) than hydatidiform moles (18.4/10 000 person‐years) and no gestational trophoblastic disease (22.4/10 000 person‐years). Gestational choriocarcinoma (HR 2.33, 95% CI: 1.35–4.01; P  = 0.002) and invasive moles (HR 1.97, 95% CI: 1.06–3.65; P  = 0.033) were associated with an elevated risk of non‐trophoblastic cancer compared with no gestational trophoblastic disease, while hydatidiform moles were not. Gestational choriocarcinoma and invasive moles were mainly associated with gynecologic cancer. However, risk of cancer was limited to the short‐term period after pregnancy and became similar to no gestational trophoblastic disease by the end of follow‐up. Conclusion While invasive moles and gestational choriocarcinoma appear to be associated with the subsequent development of non‐trophoblastic cancer, the absolute risk is small and limited to the short‐term.

Fertility after cancer

AbstractBoth chemotherapy and radiotherapy can cause infertility in a patient undergoing cancer therapy. As both the ovaries and uterus are involved in female patients, the effects are profound. Where cryopreservation is not used or is unavailable, reproductive options include spontaneous conception if fertility returns, donor gametes, adoption, and surrogacy. Semen, oocyte, embryo, and ovarian tissue cryopreservation all offer an opportunity for a pregnancy after cancer cure if natural fertility is not possible. The risks of fertility preservation are significant for women due to the risks of surgical procedures, ovarian hyperstimulation syndrome, and delay of cancer therapy. Pregnancies that establish in women after cancer cure have specific risks including premature labor, cesarean section, congenital anomalies, and the risk of transmitting disease associated with genetic history. Where ovarian reimplantation is considered, the risk of reimplantation of malignant cells must be considered particularly in hematological and breast disease.

Fertility stimulation protocols in women with cancer

AbstractAll female oncology patients undergoing controlled ovarian stimulation for fertility cryopreservation should be offered an antagonist protocol. Therapy can begin at the time of the first visit, providing consent is obtained. There is no need to delay until the next period. Stimulated patients should be monitored with ultrasound and estradiol levels as per normal clinic practice. For women with a diagnosis of breast cancer, and with the agreement of the treating oncologist, the stimulation protocol should include an aromatase inhibitor such as letrozole to reduce the circulating estradiol levels. All patients should have a gonadotropin‐releasing hormone trigger to eliminate the risk of ovarian hyperstimulation syndrome and facilitate timely return for cancer therapy.

Letter to the Editor: Second curettage versus conventional chemotherapy in avoiding unnecessary chemotherapy and reducing the number of chemotherapy courses for patients with gestational trophoblastic neoplasia: A systematic review and meta‐analysis

Review of triage strategies for atypical squamous cells of undetermined significance among young women

Abstract In the present study we reviewed the existing literature regarding management approaches for ASC‐US and highlight their pros and cons. The ASC‐US entity emerged from Bethesda classification 2001. We conducted this review using search words ASC‐US triage, ASC‐US management in young women, triage tests for ASC‐US, and ASC‐US outcome from the English literature. We included different cervical cancer policies (American, European and for WHO) and research articles published on ASC‐US in young women from the year 2001. We searched in Google Scholar, PubMed, MEDLINE (NCBI) library, Embase (Elsevier), Wiley online library as well as Cochrane library. We defined young women as aged 30 years and below. We identified 52 articles which focused on management approaches of ASC‐US, seven articles focused on young women aged <30 years. Five of these articles combined ASC‐US with low‐grade squamous intraepithelial lesions (ASC‐US/LSIL) while only two addressed ASC‐US as a standalone entity. The limited number of articles restricts the evidence base supporting the adoption of triage strategies. There is yet, no consensus in the literature regarding the management of ASC‐US, more so in young women below the age of 30 years. Researchers, however, agree on a few aspects, which include the necessity for applying a conservative strategy for managing ASC‐US in young women, avoiding direct referral for colposcopy at the initial detection of ASC‐US, and avoiding the use of human papillomavirus (HPV) testing on young women (unless living with HIV). Newer techniques such as HPV E6/E7 messenger RNA (mRNA), and dual staining p16/ki‐67, may serve as better triage to identify cases of HPV persistence and integration which may subsequently lead to preinvasive or invasive lesions.

Bevacizumab is associated with a higher gastrointestinal/genitourinary fistula or perforation risk in cervical cancer patients undergoing pelvic radiotherapy

Abstract Background Bevacizumab serves as an effective treatment in cervical cancer patients with metastatic, recurrent, or advanced disease. However, gastrointestinal (GI)/genitourinary (GU) toxicities have been observed after bevacizumab treatment. Radiotherapy (RT) is the mainstay of treatment of cervical cancer. Objectives To investigate the risk of GI/GU toxicities with bevacizumab plus RT compared with RT alone in cervical cancer patients. Search Strategy In this meta‐analysis, PubMed, Embase, Web of Science, and Cochrane databases were searched from inception to September 25, 2022. Selection Criteria Cohort studies evaluating the association between bevacizumab and GI/GU fistula or perforation in irradiated metastatic, recurrent, or advanced cervical cancer patients. Data Collection and Analysis Results are expressed as odds ratios (OR) with 95% confidence intervals (CI). The inconsistency test ( I 2 ) was used to assess heterogeneity. Egger's regression test with a two‐tailed P value was used to evaluate publication bias. Main Results Four cohort studies met the inclusion criteria with a total of 597 women included. There was a significant association between GI fistula/perforation and GU fistula/perforation in irradiated cervical cancer patients receiving bevacizumab (OR 4.03 [95% CI: 1.76–9.20] and OR 4.71 [95% CI: 1.51–14.70], respectively). Conclusions The bevacizumab‐containing regimen was associated with an increased risk of GI or GU toxicities in cervical cancer individuals undergoing pelvic RT. These results suggest the bevacizumab‐associated benefits and risk should be better weighted to reach an optimal treatment strategy. Further investigation on optimal dosage and timing of bevacizumab and RT is vital to minimize the adverse events and maximize the benefits.

A pilot study of upcycled smartphone‐based colposcopy for visual inspection of cervix performed by community healthcare workers in rural Vietnam

Abstract Objective This study assessed the feasibility of smartphone‐based colposcopy (SBC) for visual inspection of the cervix by community healthcare workers in low‐resource areas. Methods This was a retrospective study conducted in community villages in rural Vietnam, where 177 participants were enrolled for a cervical cancer screening. Cervical images were obtained by pre‐trained community healthcare workers using a portable, upcycled SBC (Samsung Galaxy Note 20). Images were taken before and after the visual inspection after acetic acid (VIA) examination. Captured images were stored on a web server through an Android‐based application and later reviewed independently by two experienced gynecologists. Image quality was assessed, and kappa statistics were calculated for the measurement of agreement in VIA findings. Results Cervical images of 177 women obtained between July and August 2020 were analyzed. The mean age of women was 42 ± 9.1 years, and 20.3% were postmenopausal. The percentage of adequate visibility of the squamocolumnar junction (SCJ) in the captured images was 83.1%. The kappa value for interobserver reliability was 0.61 for VIA positivity agreement between the two gynecologists. Image clarity was rated as average or above in 77.3%. The reasons for suboptimal clarity were poor focusing (15.3%), inadequate SCJ visibility (18%), and obscuring of the transformation zone due to blood (11.3%), discharge (14.7%), or artifacts such as intrauterine devices or polyps (5.1%). Conclusion Upcycled SBC was feasible when performed by pre‐trained healthcare workers in a low‐resource setting. VIA findings by SBC showed adequate agreement between two independent assessments, suggesting its potential as a method to aid cervical cancer screening.

Analyzing the performance of ChatGPT in answering inquiries about cervical cancer

Abstract Objective To analyze the knowledge of ChatGPT about cervical cancer (CC). Methods Official websites of professional health institutes, and websites created by patients and charities underwent strict screening. Using CC‐related keywords, common inquiries by the public and comments about CC were searched in social media applications with these data, a list of frequently asked questions (FAQs) was prepared. When preparing question about CC, the European Society of Gynecological Oncology (ESGO), European Society for Radiotherapy and Oncology (ESTRO), and European Society of Pathology (ESP) guidelines were used. The answers given by ChatGPT were scored according to the Global Quality Score (GQS). Results When all ChatGPT answers to FAQs about CC were evaluated with regard to GQS, 68 ChatGPT answers were classified as score 5, and none of ChatGPT answers for FAQs were scored as 2 or 1. Moreover, ChatGPT answered 33 of 53 (62.3%) CC‐related questions based on ESGO, ESTRO, and ESP guidelines with completely accurate and satisfactory responses (GQS 5). In addition, eight answers (15.1%), seven answers (13.2%), four answers (7.5%), and one answer (1.9%) were categorized as GQS 4, GQS 3, GQS 2, and GQS 1, respectively. The reproducibility rate of ChatGPT answers about CC‐related FAQs and responses about those guideline‐based questions was 93.2% and 88.7%, respectively. Conclusion ChatGPT had an accurate and satisfactory response rate for FAQs about CC with regards to GQS. However, the accuracy and quality of ChatGPT answers significantly decreased for questions based on guidelines.

Revolutionizing diffuse uterine leiomyomatosis treatment: A case report and literature review on “no‐distension” hysteroscopic myomectomy with thoracic tissue forceps

AbstractDiffuse uterine leiomyomatosis (DUL) is a prevalent leiomyoma variant in women of childbearing age, characterized by a uniformly enlarged uterus with numerous interconnected small myomas. Given that most DUL patients are in their reproductive years, treatments that preserve fertility are increasingly vital. This case report introduces an innovative hysteroscopic technique that forgoes uterine distension to remove multiple submucosal fibroids in a single procedure, maintaining endometrial integrity and fertility. A 27‐year‐old single woman experienced prolonged and heavier menstruation. Magnetic resonance imaging (MRI) scans showed an enlarged uterus with several round‐like masses in the uterine wall/submucosa. Addressing the patient's financial limitations and treatment preferences, a groundbreaking hysteroscopic surgery was performed using thoracic tissue forceps, alongside bedside ultrasonography, enabling fibroid excision without uterine distension. In total, 38 uterine fibroids were successfully excised without complications such as uterine perforation or hyponatremia. According to the FIGO classification system: three were type III, nine were type II, 15 were type I, and 11 were type 0. Postoperative follow‐up indicated normalized menstrual cycles, improved hemoglobin levels, and no recurrence of fibroids. A hysteroscopic examination 1 month after surgery revealed no significant fibroids or endometrial thickening. This case report underscores the effectiveness of a novel hysteroscopic surgical approach in treating DUL. This method eliminates the need for multiple staged surgeries and the risks of endometrial damage inherent in traditional techniques. It offers a minimally invasive, fertility‐preserving alternative for young DUL patients, marking a significant advancement in gynecologic surgery.

Searching for prognostic markers for Stage I epithelial ovarian cancer: A role for systemic inflammatory markers

AbstractObjectiveTo determine the prognostic role of systemic inflammatory markers for Stage I epithelial ovarian cancer (EOC).Materials and MethodsWe performed a retrospective, single‐center, observational study. We included patients with Stage I EOC cancer undergoing primary surgery between 1993 and 2016. Inflammatory markers were assessed by analyzing blood samples collected at initial diagnosis before EOC surgery. We evaluated these markers' association with disease‐free survival (DFS) and cancer‐specific survival (CSS).ResultsWe included 176 women in our study. The neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and systemic immune inflammation index (SII) were related to both DFS and CSS in the univariate analysis. In the multivariate Cox analysis, adjuvant chemotherapy (hazard ratio [HR] 0.17, 95% confidence interval [CI] 0.04–0.71, P = 0.02) and SII ≥730 (HR 6.84, 95% CI 1.30–35.9, P = 0.023) were independent predictors of DFS, while FIGO Stage IB–IC (HR 7.91, 95% CI 1.04–59.8, P = 0.04), NLR ≥3 (HR 56.8, 95% CI 7.46–433, P < 0.001) and PLR ≥169 (HR 49.1 95% CI 11.1–217.8, P = 0.005) were independent predictors of CSS.ConclusionsSystemic inflammatory markers are easily obtainable from patients' routine blood analyses and may represent inexpensive and reproducible prognostic markers in early‐stage EOC.

Efficacy of thermal ablation among women with cervical intraepithelial neoplasia grade 1 and high‐risk human papillomavirus genotypes: The first prospective study in Vietnam

Abstract Objective This study aimed to investigate the efficacy of thermal ablation (TA) for treating cervical intraepithelial neoplasia grade 1 (CIN 1) among women with positive high‐risk human papillomavirus (hr‐HPV). Methods This prospective study was conducted at Tu Du Hospital, Vietnam between August 2023 and February 2025. The study enrolled all the women aged greater than 30 years with CIN 1 and positive hr‐HPV test treated with TA. The primary outcome included evaluation of healed lesion on cytology, colposcopy combined with visual inspection of the cervix with acetic acid (VIA) and Lugol's iodine testing as well as HPV clearance rate. The secondary outcome included patient's satisfaction and undesirable effects during the treatment and follow‐up visits. Results Among 66 women eligible for inclusion in the study, the clearance rate of all hr‐HPV genotypes at 3 and 6 months was 62.1% and 84.6%, respectively. The clearance rates of HPV 16 and HPV 18 after undergoing TA treatment was highly achieved at 88.8% and 85.7%, respectively. Overall, the clearance rate of HPV 16, 12 other hr‐HPV genotypes, overall hr‐HPV genotypes and normal colposcopic findings were significantly improved following treatment compared to before treatment ( P  < 0.05). After 6 months, the overall cure rate of thermal ablation was observed at 60.6% (40/66 cases). The most common side effects included vaginal heat (43.1%), abdominal pain (34.8%), and vaginal pain (27.9%). On monitoring, patient's satisfaction was highly achieved at 93.9% on day 0 post‐treatment and for 95.5% at 3‐month control visit. No adverse effects as well as requirement of repeated ablation were reported. Conclusions Thermal ablation is an effective, safe, and well‐tolerated treatment for women with CIN 1 and positive hr‐HPV genotypes. This reliable modality shows a promising option for cervical cancer prevention in low‐resource settings. Further studies are required to strengthen these findings in different populations.

Endometrial sampling in the absence of hysteroscopy: Insights from more than 1000 dilatation and curettage cases

Abstract Objectives The aim of this epidemiological study is to present the distribution of histopathological results of endometrial biopsies performed for indications in women and their relationship with symptoms. Methods A retrospective analysis was conducted on patients with abnormal uterine bleeding (AUB) assessed by endometrial biopsy between January 2020 and July 2022. Analyzing the distribution and association of patients' demographic traits, biopsy motivations, and histopathologic findings was the main goal of the study. Results A total of 1216 patients were included in the study, and their average age was 48.48 ± 8.79 years. AUB was found to be the most common reason for biopsy ( n  = 616; 50.7%). The most common diagnosis among the histologic findings (320; 26.3%) was endometrial polyp. The most common symptoms among individuals with premalignant and malignant diseases were AUB, endometrial thickening, and postmenopausal hemorrhage. Additionally, it was determined that 21 (6.3%) postmenopausal patients had inadequate material. Conclusions The most common histologic diagnosis from the procedure was endometrial polyp. It is important to make sure that the sample taken includes the entire uterine cavity because postmenopausal women may have insufficient biopsy samples. This is especially true if a hysteroscopy with biopsy cannot be performed (for a variety of reasons). In fact, suspect endometrial cancers should be thoroughly evaluated by hysteroscopy in patients with postmenopausal bleeding, endometrial thickness, and atypical uterine bleeding.

Cesarean myomectomy for large uterine fibroids: Surgical outcomes from a single‐center case series

Abstract Objective To evaluate the safety and feasibility of cesarean myomectomy in patients with fibroids greater than 5 cm. Methods This was a retrospective case series of 45 patients undergoing cesarean delivery with concurrent myomectomy for fibroids >5 cm at a tertiary care center. Primary outcomes included operative time, estimated blood loss (EBL), hemoglobin drop, transfusion rates, and postoperative complications. Results Mean operative time was 74 min. On average, 2.5 fibroids were removed, with the largest averaging 10.1 cm in diameter. The mean hemoglobin drop was 2.5 g/dL, significantly associated with fibroid size. Average EBL was 827 mL. No patients required intraoperative transfusion, and only 4.4% required postoperative transfusion. Complication rates were comparable to standard cesarean delivery. Conclusion Cesarean myomectomy for larger fibroids is feasible and safe within experienced surgical programs, allowing patients to avoid additional surgery without significantly increased risk.

Knowledge, acceptance, uptake barriers and missed opportunities of human papillomavirus vaccine among female adolescents in Benin City, Nigeria: A mixed method study

Abstract Introduction The human papillomavirus (HPV) vaccine has shown efficacy against cervical cancer and HPV‐related malignancies. The vaccine was recently introduced in Nigeria as a routine immunization, free for young girls aged 9 to 14 years. This study aimed to determine the knowledge, acceptance, uptake barriers and missed opportunities of HPV immunization among adolescents in Benin City, Nigeria. Method A descriptive cross‐sectional study using mixed methods for data collection was carried out in four secondary schools in Benin City, Nigeria, over a 3‐month period, following ethical approval. Quantitative data were analyzed using SPSS 25.0, and qualitative data were analyzed using themes. P ‐values were set at less than 0.05. Results There were 801 students with a mean age group of 14.3 ± 1.85. Only 56.5% had heard of the HPV vaccine; 15.5% had good knowledge of HPV, 23.4% received the vaccine, while 25.8% were willing to receive the vaccine when available. The reasons for refusal were fear of side effects (56.3%), fear of needles (18.2%), and lack of adequate information (11.3%). The missed opportunity was 71.9%. Fathers with primary level education and an odds ratio of 0.181 (95% confidence interval: 0.034–0.947, P  = 0.043) and pupils of schools located in rural settings with an odds ratio of 0.369 (95% confidence interval: 0.205–0.665, P  < 0.001) were less likely to accept the HPV vaccine. The teachers agreed that HPV vaccination was a good idea, while the parents shared divergent views. Conclusion In this study, the knowledge and acceptance of HPV vaccine were found to be low, and there was a significant proportion of missed opportunities. An improved public awareness campaign is advocated.

Diagnosis and management of gestational trophoblastic disease: 2025 update

AbstractGestational trophoblastic disease (GTD) arises from abnormal placenta and comprises a spectrum of premalignant to malignant disorders. Changes in the epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow‐up with human chorionic gonadotropin (hCG) is essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duration of hCG monitoring varies depending on histological type and regression rate. Low‐risk GTN (International Federation of Gynecology and Obstetrics [FIGO] Stages I–III: score <7) is treated with single‐agent chemotherapy but may require additional agents. Although scores of 5–6 are associated with higher drug resistance, overall survival approaches 100%. High‐risk GTN (FIGO Stages II–III: score ≥7 and Stage IV) is treated with multi‐agent chemotherapy, with or without adjuvant surgery for excision of resistant foci of disease or radiotherapy for brain metastases, achieving a survival rate of approximately 90%. Gentle induction chemotherapy in ultra–high‐risk disease helps reduce early deaths in patients with extensive tumor burden, but late mortality still occurs from recurrent treatment‐resistant tumors. Immunotherapy can be considered in recurrence.

Comprehensive cross‐sectional study of CIN prevalence, HPV genotyping, genetic alterations, and microbiota as molecular biomarkers for early cervical cancer detection: A pilot clinical study among women in Russia

Abstract Objective To explore the relationships between HPV genotypes, vaginal microbiota, oncogenic mutations, and cervical intraepithelial neoplasia (CIN) to develop a risk assessment model for predicting CIN. Methods A cross‐sectional analysis was conducted on 264 women living in the Kaliningrad region, assessing CIN presence, HPV genotypes, vaginal microbiota composition, and mutations in key oncogenes. Results HPV genotypes 16, 31, 33, 35, 58, and 66 were identified as the most prevalent among patients with HPV infections. However, in a multifactorial model, only HPV genotypes 16 and 58 demonstrated a significant association with high‐grade squamous intraepithelial lesions and above. Genetic analysis revealed mutations in TP53 and ERBB2 genes in 20 and 17 patients, respectively, with TP53 mutations showing a notable correlation with CIN progression. Two patients with diagnoses of “Negative for Intraepithelial Lesion or Malignancy” carried the TP53 R248W mutation, a well‐established neoplasia‐related variant, highlighting its potential as a predictor of precancerous conditions. Increased copy numbers of human DNA and Enterobacteriaceae DNA correlated with low‐grade squamous intraepithelial lesions, though many DNA‐derived features displayed instability in logistic regression models, suggesting the need for further validation. Conclusion These findings suggest that although HPV genotypes, genetic mutations, and microbiota profiles may serve as markers for CIN, their predictive reliability requires further investigation. The present study represents the first large‐scale exploration of these factors conducted within the Russian female population.

How we treat relapsed refractory gestational trophoblastic neoplasms—An exciting case series

Abstract Objective Relapsed/refractory gestational trophoblastic neoplasia (RR‐GTN) presents a significant therapeutic challenge, with limited options available for patients who fail first‐line treatments. In the present study we describe a few unique cases of RR‐GTN and various options available for such situations. Methods We identified three cases of RR‐GTN between January 2021 and December 2022 who failed two or more lines of standard treatment. Clinical characteristics, therapeutic regimens, toxicities, and outcomes were collected from the case records. Results We present this case series of three patients with RR‐GTN treated with distinct therapeutic approaches: (1) Surgery for localized disease, (2) immunotherapy with pembrolizumab, and (3) tandem autologous stem cell transplantations. We also provide a detailed review of the available literature and guidance on managing RR‐GTN. Conclusion Intensified chemotherapy regimens, immune checkpoint inhibitors, and autologous stem cell transplantation offer promising avenues for improving outcomes in these high‐risk patients. Clinical trials are warranted to establish the optimal sequencing of these therapies in clinical practice, but it may not be possible due to the paucity of such clinical situations.

Measurement of thiol/disulfide homeostasis and ischemic modified albumin levels in patients with uterine leiomyomas

AbstractObjectiveThe aim is to contrast the serum levels of thiol‐disulfide homeostasis and ischemic modified albumin between patients with leiomyoma and healthy individuals and to assess the impact of oxidative stress on the etiopathogenesis of leiomyoma.MethodsIn this prospective case‐control study, a total of 154 participants were included, consisting of 77 cases diagnosed with leiomyoma and 77 healthy individuals without leiomyoma. The demographic characteristics and ultrasonographic findings of the participants were recorded, and parameters such as albumin, ischemia‐modified albumin, and thiol‐disulfide homeostasis were evaluated. The results obtained from the analyses were compared between the two groups.ResultsNo significant differences were observed in the demographic characteristics between the groups. A significant difference was observed between the leiomyoma and control groups regarding serum albumin parameters, serum ischemic modified albumin, and serum dynamic thiol‐disulfide parameters (P < 0.001). No significant difference was found in the ratios of disulfide/total thiol, disulfide/native thiol, native thiol/total thiol (P > 0.05).ConclusionThere was a notable contrast in the levels of albumin, ischemic modified albumin, albumin/ischemic modified albumin ratio, total thiol, native thiol, and disulfide between individuals with uterine leiomyomas and healthy individuals in the control group. Oxidative stress is believed to play a causative role in the etiopathogenesis of uterine leiomyomas.

Rapidly progressing ascites in a pregnancy with a massive fibroid: A case report and review of pseudo‐Meigs syndrome

Abstract Meigs syndrome is a classic triad of ascites, pleural effusions, and an ovarian fibroma with resolution following excision. Pseudo‐Meigs syndrome presents similarly but is caused by a pelvic mass other than an ovarian fibroma, such as a fibroid. We present a case report of a 33‐year‐old gravida 2 para 0‐0‐1‐0 woman with a massive, pedunculated fibroid who developed rapid onset of ascites and edema beginning at 5 weeks of gestation. Malignant, cardiac, renal, hepatic, and rheumatologic causes were ruled out. Her symptoms resolved following myomectomy and delivery via cesarean. Pseudo‐Meigs syndrome was suspected. Pseudo‐Meigs syndrome is a diagnosis of exclusion and requires surgical management for resolution. Pregnancy may be an inciting factor. Myomectomy may be done safely at the time of cesarean.

Pelvic lymph node involvement and risk of recurrence in HPV‐associated endocervical adenocarcinoma stage IA2‐IB1 according to Silva's system in two Colombian cancer centers

AbstractObjectiveTo compare the pelvic lymph node involvement and risk of recurrence in patients with human papillomavirus (HPV)‐associated endocervical adenocarcinoma stage IA2‐IB1 undergoing hysterectomy and/or trachelectomy plus lymphadenectomy, according to Silva's classification system.MethodsA retrospective cohort study was performed in two Colombian cancer centers. The cases were classified according to the Silva classification system. Clinical, surgical, and histopathological variables were evaluated. Recurrence risk was analyzed by patterns A, B, or C. A logistic regression model was performed for tumor recurrence. The Kaplan–Meier method was used to estimate overall survival and disease‐free survival (DFS). A weighted kappa was performed to determine the degree of concordance between pathologists.ResultsA total of 100 patients were identified, 33% pattern A, 29% pattern B, and 38% pattern C. The median follow‐up time was 42.5 months. No evidence of lymph node involvement was found in patients classified as A and B, while in the C pattern was observed in 15.8% (n = 6) of cases (P < 0.01). There were 7% of cases with recurrent disease, of which 71.5% corresponded to type C pattern. Patients with Silva pattern B and C had 1.22‐ and 4.46‐fold increased risk of relapse, respectively, compared with pattern A. The 5‐year DFS values by group were 100%, 96.1%, and 80.3% for patterns A, B, and C, respectively.ConclusionFor patients with early‐stage HPV‐associated endocervical adenocarcinoma, the type C pattern presented more lymph node involvement and risk of recurrence compared to the A and B patterns. The concordance in diagnosis of different Silva's patterns by independents pathologists were good.

Letter to the Editor: Analysis of adjuvant therapy in early staged endometrioid endometrial cancer—FIGO 2023 classification

Rates of genetic consultation in high‐grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population‐based study

AbstractObjectiveThe American Society of Clinical Oncology recommends all patients with high‐grade serous ovarian carcinoma (HGSC) undergo germline genetic testing. Genetic consultation rates in Ontario, Canada, only reached 13.3% in 2011. In 2016, PARP inhibitor maintenance therapy became available in Ontario for BRCA‐positive HGSC patients. Given expanding treatment options, we re‐examined genetic consultation rates among HGSC patients.MethodsThis retrospective cohort study identified patients diagnosed with HGSC between 2012 and 2019 using population‐based administrative data from Ontario. Genetics consultations were identified using Ontario Health Insurance Plan billing codes. Consultation rates over time were analyzed using Cochran–Armitage trend test and segmental regression analysis. Multivariable analysis identified factors associated with attending genetics consultation.ResultsThis study included 4645 HGSC patients. The mean age was 64.2 years (±SD 12.3); 56.3% had stage 3–4 disease. Overall, approximately 35% attended genetics consultations. The genetic consultation rate per year increased significantly from 21.6% to 42.6% (P < 0.001). Shorter times between diagnosis and genetics consult were observed after PARP inhibitors became available (68.1 vs 34.1 weeks, P < 0.001). Patients treated at designated cancer centers (odds ratio [OR] 2.11, P < 0.001), diagnosed in later years (OR 1.33, P < 0.001), and from higher income groups (P < 0.05) were more likely to attend genetics consultation; older patients were less likely (OR 0.98, P < 0.001). After PARP inhibitors became available, consultation rates plateaued (P < 0.001).ConclusionsBetween 2012 and 2019, genetic consultation rates improved significantly among HGSC patients; however, a large proportion of patients never attended consultation. Further exploration of barriers to care is warranted to improve consultation rates and ensure equitable access to care.

Implementation strategies of cervical cancer screening in South Asia: A systematic review

Abstract Background Cervical cancer is a preventable cancer by screening, vaccination and timely management of preinvasive cervical lesions. However, about 90% of the global burden of cervical cancer is reported from developing countries. Objective This systematic review aimed to analyze the strategies implemented for cervical cancer screening in South Asia. Search Strategy An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for articles published in English, evaluating the implementation of cervical cancer screening between December 2000 and June 2023 in South Asia using appropriate search terms. Selection Criteria Cross‐sectional studies, randomized control trials (RCTs) or non‐randomized controlled trials evaluating different cervical screening strategies were included. Data Collection and Analysis A three‐stage selection process was performed using a validated proforma including the title, author, year of publication, objective, country, study design, screening methods, strategies and outcomes, and results. The systematic review was designed based on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The risk of bias was evaluated with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Main Results Out of the initial 1135 articles reviewed systematically, 23 studies met the inclusion criteria and were included in the qualitative synthesis of results. The implementation outcomes measured were acceptability ( n  = 23 100%), feasibility ( n  = 22, 95.7%), fidelity ( n  = 14, 60.9%), sustainability ( n  = 7, 30.4%), coverage ( n  = 4, 17.4%) and cost ( n  = 1, 4.3%). Conclusion Cervical cancer screening can be effectively implemented by restructuring the ongoing programs.

Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

AbstractBackgroundFollowing the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low‐ and middle‐income countries (LMICs). A well‐integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task‐sharing and training of gynecologic oncologists (GynOncs).ObjectivesThis review aimed to explore existing literature on capacity‐building for surgical management of early‐stage gynecologic cancers.Search StrategyThe search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE.Selection CriteriaStudies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task‐sharing, or outcomes following operation by subspecialists compared to specialists were included.Data Collection and AnalysisResults were synthesized using narrative synthesis approach with emergence of key themes by frequency.Main ResultsThe scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non‐subspecialized care, and task‐shifting/−sharing.ConclusionsA multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity‐building and task‐sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost‐effectiveness.

Age‐stratified risk factors of re‐intervention for uterine fibroids treated with high‐intensity focused ultrasound

AbstractObjectiveTo estimate the rate and risk factors of re‐intervention for patients with uterine fibroids (UFs) undergoing high‐intensity focused ultrasound (HIFU) at different age distributions.MethodA retrospective cohort study was conducted in Nanchong Central Hospital, recruiting a total of 672 patients with UFs undergoing HIFU from June 2017 to December 2019. Using univariate and multivariate logistic regression, risk factors for re‐intervention were assessed.ResultsAmong 401 patients with UFs who completed the follow‐up visits (median 47 months, range 34–61), 50 (12.46%) patients underwent re‐intervention (such as high‐intensity focused ultrasound, uterine artery embolization, myomectomy and hysterectomy). In the different age distributions, the re‐intervention rate was 17.5% (34/194) in patients aged <45 years and 7.7% (16/207) in those aged ≥45 years. Regarding the younger patient group (aged <45 years), hypo‐ or iso‐intensive fibroids in T2‐weighted magnetic resonance imaging (T2WI) intensity may elevate the risk of re‐intervention for UFs (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.37–6.62; P = 0.007). Among the older patient group (aged ≥45 years), preoperative anemic patients had an increased risk of re‐intervention compared with those without anemia (OR 3.30, 95% CI 1.01–10.37; P = 0.041).ConclusionThe re‐intervention rate of HIFU decreased with increasing age. Among those aged <45 years, T2WI intensity was the independent risk factor for re‐intervention, and among those aged ≥45 years, preoperative anemic status may be related to re‐intervention outcome.

Response: Second curettage versus conventional chemotherapy in avoiding unnecessary chemotherapy and reducing the number of chemotherapy courses for patients with gestational trophoblastic neoplasia: A systematic review and meta‐analysis

Uncommon presentation of gestational trophoblastic disease: A case report of invasive mole with gingival metastasis and unique metastatic dissemination

SynopsisThis report sheds light on the extraordinary presentation of invasive mole with gingival metastasis. There are limited cases on this topic in the literature.

An unusual cause of small bowel obstruction: Case report of spontaneous uteroenteric fistula

SynopsisUteroenteric fistulae in the setting of degenerating leiomyomas may present with small bowel obstruction and require multidisciplinary surgical management to perform fertility‐sparing myomectomy.

Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: A systematic review and meta‐analysis

AbstractBackgroundDifferential diagnosis between uterine leiomyomas and sarcomas is challenging. Magnetic resonance imaging (MRI) represents the second‐line diagnostic method after ultrasound for the assessment of uterine masses.ObjectivesTo assess the accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas.Search StrategyA systematic review and meta‐analysis was performed searching five electronic databases from their inception to June 2023.Selection CriteriaAll peer‐reviewed observational or randomized clinical trials that reported an unbiased postoperative histologic diagnosis of uterine leiomyoma or uterine sarcoma, which also comprehended a preoperative MRI evaluation of the uterine mass.Data Collection and AnalysisSensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the curve on summary receiver operating characteristic of MRI in differentiating uterine leiomyomas and sarcomas were calculated as individual and pooled estimates, with 95% confidence intervals (CI).ResultsEight studies with 2495 women (2253 with uterine leiomyomas and 179 with uterine sarcomas), were included. MRI showed pooled sensitivity of 0.90 (95% CI 0.84–0.94), specificity of 0.96 (95% CI 0.96–0.97), positive likelihood ratio of 13.55 (95% CI 6.20–29.61), negative likelihood ratio of 0.08 (95% CI 0.02–0.32), diagnostic odds ratio of 175.13 (95% CI 46.53–659.09), and area under the curve of 0.9759.ConclusionsMRI has a high diagnostic accuracy in the differential diagnosis between uterine leiomyomas and sarcomas.

Risk‐reducing salpingo‐oophorectomy and breast cancer incidence among Jewish BRCA1/BRCA2‐mutation carriers—an Israeli matched‐pair study

AbstractObjectiveTo study the association of risk‐reducing bilateral salpingo‐oophorectomy (RRBSO) and breast cancer risk among BRCA pathogenic sequence variants (PSV).MethodsJewish Israeli BRCA carriers who underwent RRBSO were matched with those who did not—by the mutated gene and year of birth (±1 year). Breast cancer rates were compared.ResultsOverall, 127 pairs met the inclusion criteria, 79 (60.6%) pairs harbored BRCA1 PSV and 50 (39.4%) pairs harbored BRCA2 PSV. Median follow up was 8.7 years (interquartile range 4.6–16.1 years). Breast cancer rate for all BRCA carriers combined was not affected by RRBSO (RRBSO 21 [16.5%] versus no RRBSO 31 [24.4%], hazard ratio [HR] for breast cancer 0.61, 95% confidence interval [CI] 0.33–1.14, P = 0.127). No association between RRBSO and breast cancer incidence was noted among BRCA1 PSV carriers. In BRCA2 PSV carriers, RRBSO was associated with a decreased overall breast cancer incidence (HR 0.20, 95% CI 0.44–0.91, P = 0.038), as well as after 5, 10, 15, and 20 years. Hormone replacement therapy was used by 62 PSV carriers, 52 in the RRBSO group and 10 in the no‐RRBSO group and did not affect breast cancer risk (P = 0.463).ConclusionRRBSO is associated with breast cancer risk reduction in Jewish Israeli BRCA2 PSV carriers.Risk‐reducing bilateral salpingo‐oophorectomy was associated with breast cancer risk reduction in Jewish Israeli BRCA2 pathogenic sequence variant carriers.

Program organization rather than choice of test determines success of cervical cancer screening: Case studies from Bangladesh and India

AbstractThe call for elimination of cervical cancer as a public health problem by the World Health Organization has led to intense focus on the burden of disease, available resources, and the possibility of introducing efficient systems for screening and treatment that allow effective cancer control in limited‐resource settings. Presently, the focus is on the introduction of rapid, technologically less‐demanding, affordable HPV testing. However, until such tests become widely available, the momentum that has been gained using visual inspection with acetic acid (VIA) should not be lost. Countries with limited resources and a heavy burden of cervical cancer, such as Bangladesh and India, introduced and scaled up VIA‐based programs with varying degrees of programmatic organization and performance. Despite its limitations, VIA’s simplicity and affordability has allowed these countries to build infrastructure, increase numbers of trained healthcare personnel, and develop a system of multilevel coordination within the health system. Such efforts will have long‐term advantages provided that countries have access to an appropriate HPV test and build on their efforts to improve program organization through a strengthened health system, translating lessons learned in program implementation, logistics, and compliance with the new paradigm.

Systematic review and meta‐analysis on the impact of the levonorgestrel‐releasing intrauterine system in reducing risk of ovarian cancer

AbstractBackgroundOvarian carcinoma (OC) is one of the most widespread tumors in the world and is characterized by low survival rates.ObjectiveTo determine whether the levonorgestrel‐releasing intrauterine system (LNG‐IUS) can prevent OC.Search strategyThe literature until December 2020 were systematically reviewed according to the PRISMA Statement for Reporting Systematic Reviews (PROSPERO: CRD42019137957).Selection criteriaStudies assessing the impact of LNG‐IUS on the risk of OC were included.Data collection and analysisData were extracted independently by two authors to ensure accuracy and consistency.Main resultsA total of 34 323 records were obtained, of which three satisfied the inclusion criteria. In total, 1687 events of OC in a population of 20 461 311 person‐years were considered. Data pooling revealed that the use of LNG‐IUS did not confer a lower risk of OC relative to the never‐use of LNG‐IUS, with an estimated odds ratio of 0.66 (95% confidence interval 0.41–1.08; I2 = 84%; P = 0.002).ConclusionThe meta‐analysis did not demonstrate a preventive role of LNG‐IUS on OC. However, it was carried out on a few papers, and a definitive conclusion on the topic still cannot be drawn. Further studies are indicated in the future to define the impact of LNG‐IUS on OC.The meta‐analysis carried out on three papers did not demonstrate a preventive role of the levonorgestrel‐releasing intrauterine device on ovarian cancer.

Single ectopic ureter opening into a vaginal cyst associated with multiple urogenital tract malformation: A rare case report

SynopsisThis case presented a unique report of single ectopic ureter opening into a vaginal cyst associated with multiple congenital abnormalities in a prepubertal girl.

Association between ovarian and breast masses among Chinese women in Chongqing based on ultrasonography screening: A cross‐sectional study

AbstractObjectiveTo explore associations between breast and ovarian tumors among the general healthcare population.MethodsWe conducted a cross‐sectional retrospective study that enrolled 47 951 consecutive Chinese women who took health check‐ups between January 2015 and July 2018 and accepted both breast and gynecologic ultrasound scans during one healthcare examination in The Quality Control Center of Health Examination in Chongqing (China). Prevalence of breast and ovarian tumors was addressed. Multivariable logistic regressions were applied to assess the association between breast and ovarian lesions after adjusting for age, height, and body mass index, using ultrasonographic reports.ResultsAmong participants, 8481 (17.7%) had breast masses (BM), and 2994 (6.2%) had ovarian masses (OM). After adjusting for age, height and body mass index (BMI), women with OM had an increased risk of BM (odds ratio [OR] 1.139, 95% confidence interval [CI] 1.040–1.249, P = 0.005) than those without OM. Furthermore, subgroup analysis based on menopausal status revealed a positive association between the occurrence of OM and BM in premenopausal women (adjusted OR 1.155, 95% CI 1.052–1.269, P = 0.012) but this was not significant in perimenopausal or postmenopausal women. In subgroup analysis on BMI, positive correlations between OM and BM were found in women with an underweight BMI (OR 1.433, 95% CI 1.048–1.960, P = 0.024) and with a normal BMI (OR 1.130, 95% CI 1.018–1.253, P = 0.021), but this was not significant in overweight or obese cohorts.ConclusionA high prevalence of ultrasound‐revealed breast and ovarian tumors were found in Chinese women. Women with OM or BM have an increased prevalence of BM or OM, particularly among younger women and women with a lower BMI.

The impacts of neoadjuvant chemotherapy and of cytoreductive surgery on 10‐year survival from advanced ovarian cancer

AbstractObjectiveTo compare the long‐term survival outcomes for women with advanced ovarian cancer treated with chemotherapy either before or after surgery (neoadjuvant chemotherapy vs primary cytoreductive surgery) at a single tertiary cancer center.MethodsRetrospective cohort study of 326 patients with Stage IIIC or IV high‐grade serous ovarian cancer who received neoadjuvant chemotherapy or primary cytoreductive surgery between 2001 and 2011. Clinical treatments were recorded and 10‐year survival rates were measured.ResultsA total of 183 women (56.1%) underwent primary cytoreductive surgery and 143 women (43.9%) received neoadjuvant chemotherapy. Women who received neoadjuvant chemotherapy were more likely to have no residual disease than those who underwent primary cytoreductive surgery (51.4% vs 41.5%; P = 0.030) but experienced inferior 10‐year overall survival (9.1% vs 19.3%; P < 0.001). Among those who had primary cytoreductive surgery, those with no residual disease had superior 10‐year overall survival than those who had any evidence of residual disease (36.0% vs 7.2%; P < 0.001).ConclusionAmong women with advanced ovarian cancer, those who underwent primary cytoreductive surgery had better survival than those who received neoadjuvant chemotherapy. Neoadjuvant chemotherapy should be reserved for those in whom optimal primary cytoreductive surgery is not feasible.

Outcomes from 8 years of cervical cancer screening at a rural screen‐and‐treat site in northern Tanzania

AbstractObjectiveTo examine screening outcomes for a rural screen‐and‐treat site as well as the referral completion rate, outreach programming, and screening costs.MethodsA retrospective cross‐sectional analysis of demographic information and screening outcomes for all women screened at a rural screen‐and‐treat site between August 2011 and December 2018 was conducted. Referral completion rate for women with suspected cervical cancer was calculated for 2018.ResultsA total of 10 157 screenings were conducted during the study period. Median age was 35 years and median parity was 5. In all, 545 (5.35%) women were positive on visual inspection with acetic acid (VIA+), and 461 (91.1%) of 506 eligible women received cryotherapy. In 2018, 93 women were referred for suspected cancer to the zonal referral center, but only 10 (10.8%) presented for treatment. Mean screening cost was US$ 6.62 per person.ConclusionVIA+ rate was comparable to rates at urban sites in Tanzania, and outreach was an important component of screening. In contrast to other reports, few women suspected of having cancer reached treatment after being referred. Although the low cost of screening highlights the feasibility of rural screen‐and‐treat sites, additional research is needed to improve completion of referrals to a higher level of care.

Evaluation of external validity of the OVHIPEC‐1 trial in a real‐world population

AbstractObjectiveThe OVHIPEC‐1 trial (Phase III randomised clinical trial for stage III ovarian carcinoma randomising between interval cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy) showed improved survival when interval cytoreductive surgery (CRS) was combined with hyperthermic intraperitoneal chemotherapy in patients with stage III epithelial ovarian cancer (EOC). The authors compared the control arm of the trial with a real‐world population treated in the Netherlands during the same period to explore generalizability of the trial results.MethodsFor this nationwide comparative cohort study, all patients with EOC undergoing interval CRS between 2007 and 2016 were identified from the Netherlands Cancer Registry if they fulfilled the eligibility criteria of OVHIPEC‐1 (n = 1376). Patient and treatment characteristics, and overall survival (OS) were compared between trial and real‐world populations.ResultsAge, comorbidity, BRCA status, histologic subtype, and residual disease were similar in trial and real‐world patients. Trial patients had a better performance status, higher socioeconomic status, and underwent bowel surgery more often. In a real‐world setting, patients more often received more than six cycles. The difference in OS between the trial and the real‐world populations was not statistically significant (unadjusted hazard ratio, 1.09 [95% confidence interval, 0.87–1.37]; P = 0.44).ConclusionDespite differences in patient characteristics, OS of patients treated in the control arm of OVHIPEC‐1 was similar to patients treated outside the trial. The trial population accurately represents real‐world patients with stage III EOC undergoing interval CRS in terms of outcome.

Retroperitoneal recurrence of an ovarian juvenile granulosa cell tumor: A diagnostic challenge

SynopsisRetroperitoneal recurrence after excision of a juvenile granulosa cell tumor is rare and constitutes a diagnostic challenge, presenting with nonspecific symptoms and mimicking other conditions.

Laparoscopically assisted ovarian cystectomy with totally enclosed protective device for tumor isolation

AbstractObjectiveTo present a novel totally enclosed protective device for tumor isolation in laparoscopic ovarian cystectomy.MethodsA retrospective study was conducted of 16 patients with unilateral ovarian teratoma in the Department of Obstetrics and Gynecology of the China‐Japan Friendship Hospital. Laparoscopic surgery was performed with a totally enclosed protective device for tumor isolation, followed by a case series retrospective study. The indexes measured included size of cyst, rate of intraoperative rupture, duration of operation, amount of intraoperative blood loss, and postoperative length of stay in the hospital. An intact cyst resected in the device with no spillage seen indicated a successful surgery.ResultsA total of 16 operations were performed successfully. The mean diameter of the cysts was 7.2 ± 1.4 cm. Of them, 12 (75%) had an intraoperative cyst rupture without spillage. The mean duration of surgery was 1.3 ± 0.1 h and the mean amount of intraoperative blood loss was 12.5 ± 3.2 ml. All postoperative histology tests showed benign cysts. The mean length of stay after surgery was 2.4 ± 0.5 days. No peritonitis‐related symptoms or complaints were reported.ConclusionLaparoscopically assisted ovarian cystectomy with a totally enclosed protective device for tumor isolation was confirmed safe and feasible.

Five‐year recurrence pattern of mature cystic teratoma according to operation type in young women

AbstractObjectiveTo find cumulative recurrence rate and risk factors for recurrence in young women with mature cystic teratoma (MCT).MethodsPatients aged 10–29 years with MCT confirmed by their first ovarian surgery between 2000 and 2018 were included in the study. To rule out residual lesions, only patients with no MCT‐suspected lesions on imaging within 1 year after surgery were included in the study. Patients who had not undergone imaging tests from 1 year after surgery or had other findings on biopsy were excluded.ResultsThe present study included 372 (84.2%) patients with cystectomy and 70 (15.8%) patients with oophorectomy. The 5‐year cumulative recurrence rates for each patient group were 11.2% and 20.3%, respectively. The hazard rate of recurrence was higher in the oophorectomy group than the cystectomy group within 5 years after surgery. Large tumor size (hazard ratio [HR] 2.59; 95% confidence interval [CI] 1.11–6.08) and bilaterality (HR 2.65; 95% CI 1.27–5.52) were significant predictors of recurrence in the cystectomy group.ConclusionThe 5‐year cumulative recurrence rate after surgery in young women with ovarian MCT was 11.2% in the cystectomy group and 20.3% in the oophorectomy group. Risk factors for recurrence after cystectomy were large tumor size and bilaterality.

Screening for cervical cancer in Africa: A proposal of a different combination of VIA test and cervical smear in Uganda

AbstractObjectiveTo evaluate the efficacy of visual inspection with acetic acid (VIA) screening combined with a cervical smear in Uganda.MethodsNine screening campaigns were held in Uganda between January 2011 and October 2019. In the last three campaigns, a new approach was used: the cervical smear was performed before the VIA test and, in case of a positive VIA test, the slide was sent for examination. The data collected were divided into two groups: the first six campaigns and the last three campaigns.ResultsDuring the study period, 10 520 women were screened, of whom 911 had a positive VIA test. The VIA test showed 84.2% false positives. In the first group, the VIA test was positive in 516 women, of whom 93% were referred for further examinations. In the second group, the VIA test was positive in 395 women, but the cervical smear was positive in only 65 women. Thus, only 16.5% women were referred for further examinations.ConclusionCombining cervical smear, VIA test, and slide analysis in positive VIA tests may allow women who need treatment to be selected more effectively, while waiting for other more expensive solutions to become more affordable for this setting.

Do survivors of borderline ovarian tumors have susceptibility to secondary primary malignancies? A SEER population‐based study

AbstractObjectiveTo describe the risk of women who have survived borderline ovarian tumors (BOT) developing second primary malignancies (SPM).MethodsThis work employed the Surveillance, Epidemiology, and End Results (SEER) Program to conduct a retrospective study of patients diagnosed with BOT. The SEER stat software was used to calculate the standardized incidence ratio (SIR). Cases with pathologic diagnosis and for which information on prognostic factors were available were obtained and analyzed using the Fine and Gray model, with non‐SPM death as a competing event.ResultsThe risk of developing SPM among BOT survivors was not elevated compared with that expected in the general population (SIR 0.88, 95% confidence interval [CI] 0.80–0.96) between 1975 and 2017. Of 3661 patients with BOT diagnosed between 1977 and 2000, 477 patients (13.03%) experienced the development of SPM during the median follow up of 19.43 years and the cumulative incidence of SPM over a span of 25 years was 15.52%. Patients with mucinous BOT (P = 0.028), age older than 50 years (P < 0.001), or no lymph node dissection (P = 0.042), had a higher cumulative incidence of SPM in univariate analysis. In the multivariable competing risk analysis, performing lymphadenectomy (subdistribution hazard ratios [sdHR] 0.79, 95% CI 0.64–0.98), age (sdHR 1.03, 95% CI 1.02–1.03) could strongly predict the risk of SPM.ConclusionIn contrast to ovarian cancer, women with BOT were not more prone to develop SPM.

The awareness levels of women for gynecologic cancer in Turkey: A cross‐sectional study

AbstractObjectiveTo investigate the awareness levels of women for gynecologic cancers and the affecting factors.MethodsThis descriptive and cross‐sectional study was conducted with 321 women. Data were collected using a Personal Information Form and the Gynecologic Cancer Awareness Scale (GCAS).ResultsThe women's mean score (± standard deviation) on the GCAS was 151.08 ± 3.84. It was determined that the awareness of gynecologic cancer in the women who had undergone gynecologic examination and cervical smear test was higher than in other women. It was also determined that the level of education and income level, the status of having gynecologic examination and operation, and the wanting to get information about gynecologic cancer were not found to affect awareness of gynecologic cancers. The gynecologic cancer awareness of the women increased with the increase in age. It was found that there was no statistically significant relationship between the years of marriage, gravida, and the number of children, and the total GCAS score.ConclusionAlthough the gynecologic cancer awareness levels of the participants were high, they were not at the intended level. Education including early diagnosis, risk factors, and symptoms should be provided to women to increase their awareness of gynecologic cancer.

REBACIN® is an optional intervention for persistent high‐risk human papillomavirus infection: A retrospective analysis of 364 patients

Abstract Objective To evaluate the therapeutic efficacy of REBACIN® in patients with persistent high‐risk HPV (hrHPV) infection. Persistent hrHPV infection is a crucial cause of cervical cancer, for which optimal pharmacological intervention remains unavailable. Methods A retrospective analysis and a meta‐analysis were carried out. The retrospective analysis included 364 patients who were persistently infected with HPV for at least 12 months, between September 2015 and February 2019, and only received the REBACIN® intervention. HPV DNA typing, HC2 hrHPV DNA, and ThinPrep cytologic tests were performed before and after the REBACIN® intervention, to evaluate the therapeutic efficacy. The meta‐analysis included trials evaluating the therapeutic efficacy of interferons. Results After a follow‐up period of 3–6 months, the overall rate of efficacy of REBACIN® was 74.73% (272/364), which was higher than that of interferon (61.50%). The efficacy of REBACIN® was correlated with HPV type (odds ratio [OR] 0.549, 95% confidence interval [CI] 0.367–0.822, P =0.004) and pretreatment cytology (OR 0.358, 95% CI 0.173–0.739, P =0.005). Conclusion REBACIN® is potently efficacious at clearing persistent hrHPV infection; hence, it can serve as an optional intervention for persistent hrHPV infection.

A neglected disease relationship—“association of human immunodeficiency viral infection and vulvar cancer”: A retrospective, hospital‐based, case–control study

Abstract Introduction Vulvar cancer is one of the rare malignancies affecting women, but its incidence and younger age diagnoses are increasing through time. Because of its rarity, and low interest in medical society, limited research has been undertaken, especially on the risk factors. The aim of this study was to determine the effect of HIV infection and other factors on vulvar cancer. Methods A hospital‐based, case–control study was conducted. Data were collected by Kobotoolbox and analyzed using SPSS version 27. There were 110 study participants with a 1:4 cases to controls ratio, and descriptive and logistic regression analyses were utilized. Factors with P ‐value ≤0.25 on bivariate logistic regression and clinically relevant variables were included in multivariate analysis. The variables with P  ≤ 0.05 in multivariate analysis were taken as independent predictors of vulvar cancer. The adjusted odds ratio (aOR), and 95% confidence interval (CI) has been interpreted in the final result. Results The overall prevalence of HIV infection in the study participants was 11.8. HIV infection showed a statistically significant association with vulvar cancer ( P  = 0.011, aOR 37.41, 95% CI 2.275–615.064). Gravidity, menopausal status, history of vulvar wart, and lifetime number of sexual partners also showed a statistically significant association ( P  = 0.009, P  = 0.009, P  < 0.001, and P  = 0.047 respectively). Conclusion Vulvar cancer is common in women with HIV infection and is positively associated with the infection. Having low gravidity (≤4), a history of vulvar wart, being in a premenopausal state, and having a limited (<2) lifetime number of sexual partners are also positive associated with the disease.

Survival nomograms for vulvar squamous cell carcinoma based on the SEER database and a Chinese external validation cohort

AbstractObjectiveThe aim of study was to construct a nomogram to effectively predict the overall survival (OS) and cancer‐specific survival (CSS) for patients with vulvar squamous cell carcinoma (VSCC).MethodsThe training cohort consisted of 5405 patients with VSCC, extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Eighty‐four patients with VSCC were selected from the disease database of the Shengjing Hospital of China Medical University from 2014 to 2020, and enrolled as the external validation cohort. Significant independent prognostic factors were identified using Cox regression analysis and used to develop nomograms to predict 1‐, 3‐, and 5‐year OS and CSS in patients with VSCC.ResultsThe nomogram predicting OS was developed based on tumor size, histological grade, International Federation of Gynecology and Obstetrics (FIGO) stage, regional lymph node involvement, distant metastases, surgery, chemotherapy, age, and race. The nomogram for CSS was constructed using the similar factors, excluding race but including marital status. The nomogram for 1‐, 3‐, and 5‐year OS demonstrated robust performance with receiver operating characteristic curves (AUCs) exceeding 80% (0.86, 0.84, and 0.82), outperforming the FIGO staging alone (0.77, 0.75, and 0.72). Similarly, for CSS, our nomograms achieved larger AUCs of 0.89, 0.88, and 0.86 compared with FIGO staging alone (0.81, 0.79, and 0.78).ConclusionThe nomograms more accurately predict prognosis than simple FIGO staging. Moreover, the nomograms developed in this study provide a convenient, operable, and reliable tool for individual assessment and clinical decision‐making for patients with VSCC.

Effect of known pathological risk factors on the incidence of metastatic lymph nodes and survival in early‐stage vulvar cancer: SEER analysis

AbstractObjectiveThe current study was performed to evaluate the incidence of positive lymph nodes (LNs) in relation to known pathological risk factors, specifically among patients with apparent low‐grade, small tumors.MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) database to retrospectively identify patients with vulvar squamous cell carcinoma (SCC) diagnosed between January 1, 2000, and December 31, 2019, with known tumor size and regional LN examined. A comparison between patients who had positive and negative LNs was conducted to identify risk factors for LN metastases in relation to survival. Subgroup analysis was conducted in patients with diagnosed grade 1 vulvar SCC and tumor size up to 2 cm according to the status of LNs.ResultsMultivariate analysis found that both grade of disease and tumor size were significant factors in predicting LN status. Among patients with low‐grade small tumors up to 2 cm, the odds ratio for positive LNs was 2.5 for those with tumor size larger than 1 cm. In a multivariate survival analysis, older age, larger tumor size, and positive LNs were independently associated with decreased survival.ConclusionsThe current study confirms that among small tumors, those larger than 1 cm have a significantly increased risk for positive nodes compared with those smaller than 1 cm, and, among this specific group, patients with positive nodes have decreased survival. Future studies are needed to answer the question of whether, in the era of the sentinel node procedure, it is safe to omit LN evaluation altogether.

Vulvar ductal carcinoma in situ as a manifestation of ectopic breast tissue

SynopsisThe fourth known occurrence of ductal carcinoma in situ found in ectopic breast tissue of the vulva successfully treated with wide‐excision biopsy and anastrozole.

Cancer of the vulva: 2021 update

AbstractVulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. There is no specific screening and the most effective strategy to reduce vulvar cancer incidence is the opportune treatment of predisposing and preneoplastic lesions associated with its development. While vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain, or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma. Treatment of vulvar cancer depends primarily on histology and surgical staging. Treatment is predominantly surgical, particularly for squamous cell carcinoma, although concurrent chemoradiation is an effective alternative, particularly for advanced tumors. Management should be individualized and carried out by a multidisciplinary team in a cancer center experienced in the treatment of these tumors.

A rare case of primary small cell neuroendocrine carcinoma of the Bartholin gland

SynopsisPrimary small cell neuroendocrine carcinoma of the Bartholin gland is an extremely rare event with no treatment consensus. The present study reports a case of Bartholin gland carcinoma.

Development and validation of nomograms predicting cancer‐specific survival of vulvar cancer patients: based on the Surveillance, Epidemiology, and End Results Program

AbstractObjectiveTo explore potential prognostic factors and develop nomograms to predict the cancer‐specific survival of patients with vulvar squamous cell carcinoma (SCC) and patients with vulvar melanoma.MethodsCases of vulvar SCC and melanoma were retrieved from the Surveillance, Epidemiology, and End Results (SEER) Program, and randomly segregated into training and test sets. Based on the training set, univariate and multivariate Cox proportional hazard regressions evaluate the association between key demographic/clinical characteristics and vulvar cancer survival. Potential prognostic factors were included to construct nomograms for the prediction of 3‐year and 5‐year survival probabilities.ResultsAge, tumor size, stage, surgery, and chemotherapy were potential factors associated with vulvar cancer survival. The C‐indices for the training and test sets were 0.82 and 0.81 for SCC, and 0.73 and 0.70 for melanoma. Calibration curves revealed correlated agreements between nomogram‐based probability and actual survival status.ConclusionNomograms were developed to predict cancer‐specific survival of patients with vulvar cancer, accordingly identifying the subgroup at high risk of cancer‐specific mortality.

Comparison of cervical cancer screening results among public and private services in Brazil

AbstractObjectiveTo compare the frequency of cervical smear test results between women seen in private and public health services in a medium‐sized city in Brazil.MethodsThis was an observational analytical study analyzing cervical cytologic results over 16 years. Public data were collected from the Brazilian National Health System, and private refers to those collected at private clinics.ResultsThe overall frequency of unsatisfactory/rejected results was higher in public service examinations (odds ratio [OR] 0.05; 95% confidence interval [CI] 0.04–0.06). The same occurred for atypical squamous cells of undetermined significance (ASC‐US) (OR 0.90; 95% CI 0.85–0.95) and atypical squamous cells cannot exclude high grade intraepithelial lesions (ASC‐H) (OR 0.55; 95% CI 0.47–0.64) categories. For low‐grade squamous intraepithelial lesions, the frequency was higher among women from private services (OR 1.39; 95% CI 1.24–1.55). Among women aged 25–64 years, the frequency of high‐grade squamous intraepithelial lesions was higher among women seen in the public service (OR 0.81; 95% CI 0.66–0.99).ConclusionBrazilian public services showed higher frequencies of unsatisfactory/rejected results and higher rates of ASC‐US and ASC‐H. Focusing on pre‐analytical phases and establishing an internal quality control program can help improve these rates even though national protocols guide them.

Correlates of cervical cancer screening among women living with HIV in Kenya: A cross‐sectional study

Abstract Objective Cervical cancer is the leading cause of cancer‐related death among Kenyan women. It is important to identify how demographics and knowledge of cervical cancer are associated with screening to determine best practices for targeted screening efforts. Methods We conducted a sub‐analysis of women who were asked about cervical cancer from a cross‐sectional study of women attending large HIV care and treatment programs across Kenya between June and September 2016. Results 1671 of 3007 (56%) women reported ever being screened, 804 (48%) of whom were screened within the last 12 months. Prevalence of screening was highest among women who were older (adjusted prevalence ratio [APR] age 35–49 vs. 18–24: 2.26, 95% CI: 1.68–3.05, P  < 0.001), employed (APR: 1.55, 95% CI: 1.24–1.93, P  < 0.001), married (APR: 1.27, 95% CI: 1.01–1.59, P  = 0.047), had at least secondary education (APR: 1.45, 95% CI: 1.19–1.77, P  < 0.001), with longer time since HIV diagnosis (APR: 1.09/year average increase, 95% CI: 1.04–1.13, P  < 0.001). 36% knew cervical cancer is treatable. Conclusion Characteristics linked to social or economic capital are correlated with cervical cancer screening. Integrating cervical cancer screening into HIV care and educating patients on the need for annual screening and potential treatment are important strategies for increasing screening uptake.

Prevalence of high‐risk HPV among marginalized urban women in India and its implications on vaccination: A cross sectional study

AbstractObjectiveTo discover the prevalence and distribution of high‐risk human papilloma virus (HPV) subtypes in urban slums and their implications.MethodsA cross‐sectional study was performed to discover prevalence and distribution of high‐risk HPV subtypes. We screened 956 women. Data were analyzed using SPSS v.25. Inclusion criterion was married women between 30 and 45 years of age. Exclusion criteria were women with known cervical cancer at the time of the survey or those who had undergone hysterectomy.ResultsOf the women, 32.47% were HPV positive and of these, about 84.50% were positive for high‐risk HPV. HPV type 6 (HPV 6) and HPV 11 were not seen in the population. After HPV 16 and HPV 18, type 58 was the most common variant seen in our study. Currently‐used vaccines in India do not cover HPV 58.ConclusionKnowing and understanding the distribution of high‐risk HPV are necessary for an effective strategy to eliminate cervical cancer from India. Deoxyribonucleic acid‐based HPV screening is a useful method along with vaccination to prevent cervical cancer.

Effect of pre‐operative radiotherapy on long‐term outcomes among women with Stage IB1 to IIB cervical squamous cell carcinoma

AbstractObjectiveTo compare long‐term outcomes between pre‐operative radiotherapy followed by open surgery and direct open surgery among women with Stage IB1–IIB cervical squamous cell carcinoma.MethodsA multicenter retrospective cohort study among women with Stage IB1–IIB cervical squamous cell carcinoma who underwent open surgery either directly (SD group) or with pre‐operative radiotherapy (PR group) in China 2004–2016. Five‐year overall survival (OS) and disease‐free survival (DFS) between the two groups were compared by Kaplan–Meier methods and multivariate Cox regression.ResultsOverall, 8385 women with Stage IB1–IIB were included (PR group, n = 447; SD group, n = 7938). Five‐year OS and DFS was significantly lower in the PR than in the SD group (OS: 81.7% vs 91.6%, P < 0.001; DFS: 76.3% vs 86.7%, P < 0.001). As compared with direct surgery, pre‐operative radiotherapy was an independent risk factor for 5‐year OS (adjusted hazard raio [aHR], 1.75; 95% confidence interval [CI], 1.34–2.30) and DFS (aHR, 1.37; 95% CI, 1.09–1.73) by multivariate Cox regression. Sensitivity analyses confirmed the findings.ConclusionAmong women with Stage IB1–IIB cervical squamous cell carcinoma, outcomes were found to be worse for those undergoing pre‐operative radiotherapy followed by open surgery than for those undergoing direct open surgery.

HPV‐negative high‐grade cervical precancerous lesions or invasive cancer in China: A post hoc analysis of a multicentric clinical study

AbstractObjectiveTo evaluate HPV‐negative cervical high‐grade precancerous lesions or cancer in China.MethodsHistologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) were searched in a multicentric clinical study. All patients underwent cobas HPV testing, liquid‐based cytology, DNA ploidy analysis, and colposcopy‐guided biopsy. According to clinical practice, patients underwent p16ink4a staining and cone biopsy. Comparisons were made between HPV‐negative and ‐positive patients for clinical characteristics.ResultsThe study found 61 cases of cobas HPV‐negative CIN2+ among 797 cases of histologically confirmed CIN2+, including 38 CIN2, 20 CIN3, and 3 invasive cancers. The prevalence of HPV‐negative CIN2+ and CIN3+ was 7.7% (95% confidence interval [CI] 5.8–9.5) and 5.7% (95% CI 3.5–8.0), respectively. Among 24 cases with p16 staining, 20 showed p16 positivity. The proportions of normal or minor abnormalities in terms of colposcopy, cytology, and DNA ploidy were higher in HPV‐negative cases than in HPV‐positive cases. When adding cytology to the screening of symptomatic or previously HPV‐positive women, the prevalence of HPV‐negative CIN2+ or CIN3 would decrease by approximately 50%.ConclusionLess than one‐tenth of CIN2+ are missed by HPV‐only screening, and they have smaller lesions than HPV‐positive cases. Colposcopy should be considered for symptomatic or previously HPV‐positive women with HPV‐negative results.

Should attention be paid to the cone depth in the fully visible transformation zone? Retrospective analysis of 517 patients with cervical intraepithelial neoplasia grade 3

AbstractObjectiveThe predictors of positive endocervical margin (EM) and a cone‐depth cutoff value are not established in the fully visible transformation zone (TZ). The present study aimed to assess the independent variables associated with positive EM in women with high‐grade cervical intraepithelial neoplasia (CIN) and fully visible TZ.MethodsThe current investigation was a retrospective study including women with fully visible TZ and CIN 3 cone histology between 2014 and 2019. The sample was divided into women with positive versus those with negative EM. Univariate and multivariate analyses were performed. Finally, receiver operating characteristic curve analysis was also used.ResultsA total of 123 of 517 women (23.8%) showed positive EM at conization. Multivariate analysis found a positive association with type 2 TZ (odds ratio [OR], 2.17 [95% confidence interval (CI), 1.19–3.94]) and lesion extension ≥2 cervical quadrants (OR, 35.57 [95% CI, 17.96–70.45]). Cone depth was inversely related to positive EM (OR, 0.71 [95% CI, 0.63–0.80]). In women with type 2 TZ and lesion extension ≥2 cervical quadrants, the cutoff value was achieved at 8‐mm cone depth (area under the curve, 0.79 [95% CI, 0.67–0.90]).ConclusionIn women with high‐grade CIN and fully visible TZ undergoing conization, the lesion extension and the TZ subtype (1 or 2) should be considered. A no less than 9‐mm cone depth provided a fair predictive value in achieving free EM.

Study to determine efficacy of urinary HPV 16 & HPV 18 detection in predicting premalignant and malignant lesions of uterine cervix

AbstractObjectivesTo evaluate clinical performance and diagnostic accuracy of urinary HPV for non‐invasive screening of high‐grade precancerous and cancerous cervical lesions in a visual inspection under acetic acid (VIA) ‐positive cohort.MethodThe study included 180 women aged 35–65 years, who were VIA positive in a colposcopy clinic. All participants had the initial stream of a random urine sample tested for the presence of high‐risk HPV (hrHPV) types 16 and 18 and acetowhite lesions were biopsied per protocol. Concordance analysis was conducted to assess agreement between detection of hrHPV in urine and the presence of premalignant and malignant lesions in cervix on histopathology. Measures of diagnostic accuracy were estimated to evaluate the performance of urinary HPV against histopathology (reference standard).ResultsSubstantial agreement between urinary HPV detection and histopathology was found (Cohen's κ is 0.696, P ≤ 0.001), with an agreement in 88.9% of the cases and disagreement in 11.1%. The diagnostic performance of urinary HPV in predicting the presence of a high‐grade precancerous or cancerous lesion was as follows: sensitivity 67%, specificity 97%, positive predictive value 89%, and negative predictive value 88.8%.ConclusionHPV DNA detection from urine has good concordance with the histopathology for detection of precancerous and cancerous lesions of the cervix. Further studies on optimization of urine sampling and processing techniques are warranted.

Experiences of women with advanced cervical cancer before starting the treatment: Systematic review of qualitative studies

AbstractBackgroundAdvanced stage and high mortality are characteristics of cervical cancer in developing countries. Comprehension of the diagnosis itinerary is one of the main strategies to control the disease impact.ObjectivesTo identify reasons for the delay in diagnosing symptomatic cervical cancer according to the patient's perspectives reported in qualitative studies. We searched four databases (PubMed, Embase, CINAHL, and Web of Science).Selection criteriaWe included qualitative studies of women with advanced cervical cancer that explored their experiences before treatment. We excluded unoriginal, non‐qualitative, and duplicated studies.Data collection and analysisWe selected 39 articles for a full‐text reading and included 15 in the present review. We chose the Consolidated Criteria for Reporting Qualitative Research (COREQ) for quality assessment and The Model of Pathways to Treatment to guide the codifying process.Main resultsFour main themes emerged from the synthesis: (1) Health‐seeking motivators; (2) Obstacles to seeking medical care; (3) Diagnosis delay; and (4) Coping with the disease. These themes were derived from patients' personal knowledge and beliefs, social relationships, socioeconomic status, and healthcare system characteristics.ConclusionsIndividual behavior, social factors, and healthcare organization contribute to the delay in diagnosing advanced cervical cancer.

Feasibility of implementing cytology‐based cervical cancer screening national program in Lebanon: A pilot study

AbstractObjectiveTo review our national cervical cancer screening program using existing Ministry of Public Health primary healthcare centers (PHCs) and report the impact of women's knowledge, attitude, behavior, and practices on screening uptake and outcome.MethodsA cross‐sectional study on cervical cancer screening offered to sexually active Lebanese women aged 21 years and above visiting PHCs. Exclusions were history of complete hysterectomy, gynecologic cancers, and current pregnancy. Data were collected through a questionnaire and conventional cervical smear performed by trained healthcare providers and sent to one centralized cytopathology laboratory.ResultsOf 12 273 eligible women, 1.7% had an abnormal cervical smear test including 161 atypical squamous cells (ASC) of undetermined significance, 6 atypical glandular cells of undetermined significance, 16 low‐grade squamous intraepithelial lesion (SIL), 17 ASC—cannot rule out high‐grade SIL, 11 high‐grade SIL, and one invasive carcinoma. Knowledge and attitudes significantly affected participation in screening; women lacking awareness had rarely undergone a cervical smear.ConclusionIn Lebanon, cytology‐based cervical cancer screening is feasible within the PHCs. Positive screen incidence was low. Despite previous campaigns, a low level of knowledge persists, and affects women's com with the screening guidelines. Advocacy and awareness activities by key healthcare providers may help to improve participation.

Development of a nomogram for predicting pelvic lymph node metastasis in cervical squamous cell carcinoma

AbstractObjectiveTo develop and validate a nomogram for predicting pelvic lymph node metastasis (LNM) in cervical squamous cell carcinoma (SCC).MethodsThis was a retrospective study that included 715 patients with cervical SCC who underwent radical hysterectomy and bilateral pelvic lymphadenectomy between 2009 and 2018. Logistic regression analysis was used to identify independent risk factors for pelvic LNM. Based on these risk factors, a nomogram predicting LNM risk was constructed and internally validated using the bootstrapping resampling method.ResultsThe rate of LNM in FIGO (the International Federation of Gynecology & Obstetrics) Stage IA2–IIA2 cervical SCC was 24.2%. In multivariate analysis, FIGO Stage II, moderately differentiated or poorly differentiated histology, abnormally elevated serum SCC‐antigen, and triglyceride were identified as independent risk factors for LNM. Tumor size greater than 2 cm and parametrial involvement had borderline significance. Ultimately, the nomogram contained the six variables mentioned above, showing positive calibration and positive discrimination. The area under the receiver operating characteristic curvewas 0.827 and the bootstrap‐validated C‐index was 0.827. The Youden index of this paper was 0.540.ConclusionsWe developed and validated a nomogram to predict pelvic LNM in SCC based on clinical data, which can help physicians develop an optimal treatment strategy.

Prognosis determination of endocervical adenocarcinomas morphologically reclassified as HPV associated or HPV independent

AbstractObjectiveTo evaluate the prognosis of endocervical adenocarcinomas after reclassification according to the morphologic type based on the 2020 World Health Organization Classification.MethodsA retrospective longitudinal study with cases admitted at the University of Campinas, Brazil, from 2013 to 2020. The sample included 140 cases morphologically reclassified: 100 cases as adenocarcinoma HPV‐associated (HPVA), 17 as HPV‐independent (HPVI), and 23 non‐HPVA/HPVI. Clinic and pathologic variables were evaluated. Analyses were performed by χ2, Fisher exact, and Mann–Whitney U tests, Kaplan–Meier curves, Log‐rank test, and Cox regression.ResultsCompared with the HPVA group, advanced stage (FIGO Stage II+) was more frequent in the HPVI group (P = 0.009), which also showed older patients (P = 0.032), and a higher proportion of deaths (P = 0.006). The median overall survival (OS) differed between groups: 73.3 months in HPVA and 42.4 months in HPVI (P = 0.005). At the multivariate analysis, the risk of death was 6.7 (95% confidence interval 1.9–23.0) times higher in patients diagnosed in advanced stages.ConclusionHPVI cases were more frequent in older patients, presenting at more advanced stages and with worse OS. The morphology‐based approach of the new WHO classification appears to be prognostically valuable and applicable in lower‐ and middle‐income settings.

The social and economic impacts of cervical cancer on women and children in low‐ and middle‐income countries: A systematic review

AbstractBackgroundThere is limited knowledge on the social and economic impacts of a diagnosis of cervical cancer on women and children in low‐ and middle‐income countries (LMICs).ObjectivesTo determine the social and economic impacts associated with cervical cancer among women and children living in LMICs.Search strategyThe MEDLINE, PsychInfo, CINAHL, Pais International, and CAB Global Health databases were systematically searched to retrieve studies up to June 2021.Selection criteriaStudies were included if they reported on either the social or economic impacts of women or children in a LMIC.Data collection and analysisData was independently extracted by two co‐authors. The authors performed a quality assessment on all included articles.Main resultsIn all, 53 studies were included in the final review. Social impacts identified included social support, education, and independence. Economic impacts included employment and financial security. No study reported the economic impact on children. Studies that utilized quantitative methods typically reported more positive results than those that utilized qualitative methods.ConclusionsAdditional mixed‐methods research is needed to further understand the social support needs of women with cervical cancer. Furthermore, research is needed on the impact of a mother's diagnosis of cervical cancer on her children.

Implementation of visual inspection with acetic acid and Lugol's iodine for cervical cancer screening in rural China

AbstractObjectiveTo address the value of visual inspection where HPV‐based screening is not yet available, we evaluated the real‐world effectiveness of visual inspection with acetic acid (VIA) and with Lugol's iodine (VILI) as a primary screening method for cervical cancer in rural China.MethodsA total of 206 133 women aged 30–59 years received two rounds of VIA/VILI screening for cervical cancer in 2006–2010. Women with positive screening results underwent colposcopy and direct biopsy, and were treated if cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was diagnosed. Clinical effectiveness of VIA/VILI was evaluated by process and outcome measures.ResultsThe VIA/VILI positivity rate, biopsy rate and detection rate of CIN2+ in the second round were significantly lower than in the first round. The 2‐year cumulative detection rate of CIN2+ varied from 0.53% to 0.90% among the four cohorts initiated in 2006, 2007, 2008, and 2009. The first round of screening detected 60%–83% of CIN2, 70%–86% of CIN3, and 88%–100% of cervical cancer. Over 92% of CIN2+ were found at the early stage.ConclusionMultiple rounds of visual inspection with continuous training and quality assurance could act as a temporary substitutional screening method for cervical cancer in resource‐restricted settings.

Pretreatment lymphocyte count as independent prognostic factor in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy

AbstractObjectiveTo evaluate the association between pretreatment total lymphocyte counts (TLC) and survival outcome in locally advanced cervical cancer (LACC) patients treated with definite concurrent chemoradiotherapy (CCRT).MethodsWe retrospectively reviewed the data of 789 patients diagnosed with cervical cancer stage IIB to IVA treated with CCRT between January 2011 and December 2015. We assessed the association of pretreatment TLC with 5‐year disease‐free survival (DFS) and overall survival (OS) rates.ResultsFifty‐two patients had pretreatment TLC < 1000 cells/mm3. The median pretreatment TLC in TLC groups <1000 cell/mm3 and ≥1000 cell/mm3 were 573.9 cells/mm3 (range, 350.9–827.7 cells/mm3) and 2211.3 cells/mm3 (range, 1751.3–2785.8 cells/mm3), respectively. Patients in pretreatment TLC < 1000 cell/mm3 group had a lower number of treatment responses. The 5‐year DFS and OS rates were significantly higher in patients with pretreatment TLC ≥ 1000 cells/mm3 than their counterparts (67.7% vs. 35.4% [P < 0.0001] and 57.6% vs. 25.7% [P < 0.0001], respectively). In multivariate analysis, pretreatment TLC ≥ 1000 cells/mm3 was an independent predictor of DFS (HR, 0.39; 95% confidence interval [CI] 0.26–0.59, P < 0.001) and OS (HR, 0.59; 95% CI 0.42–0.84, P = 0.006).ConclusionPretreatment TLC was associated with treatment response and survival outcome in patients with LACC treated with definite CCRT.

Outcomes associated with different surgical approaches to radical hysterectomy: A systematic review and network meta‐analysis

AbstractObjectiveTo evaluate the efficacy and safety of five different approaches to cervical cancer surgery.MethodsWe conducted a systematic search for comparative studies on different radical hysterectomy types for cervical cancer in PubMed, Embase, the Cochrane Library, and Web of Science databases. All included observational studies used survival analyses to compare clinical outcomes of patients undergoing different radical hysterectomy types. All studies were assessed by the Newcastle‐Ottawa Scale with scores of at least seven points. We extracted the relevant data and conducted a network meta‐analysis to compare clinical outcomes among five surgical approaches.ResultsThirty studies (n = 11 353) were included. Robotic surgery had the lowest blood loss volume and hospitalization duration; open surgery had the shortest operative time. Vaginal assisted laparoscopic surgery was associated with the highest number of resected lymph nodes and lowest rate of perioperative complications. Survival outcomes and tumor recurrence outcomes were similar among the approaches.ConclusionThe current approaches to cervical cancer surgery have comparable efficacies.

Therapeutic strategy analysis of patients with advanced stage high‐grade neuroendocrine cervical cancer: A real‐world multicenter study

AbstractObjectiveTo explore the management of high‐grade neuroendocrine cervical cancer (HGNECC) since there has been no standard treatment for it.MethodsData on the management of HGNECC were retrospectively analyzed. Patients with FIGO stage IIB to IVB HGNECC from six hospitals were enrolled. The Kaplan–Meier method was used for survival analysis. Prognostic factors were determined using a Cox proportional‐hazards regression model.ResultsA total of 43 patients were included in the study. The multivariate analysis showed that chemotherapy was the preferred treatment as it improved progression‐free survival (PFS; P = 0.008) and overall survival (OS; P = 0.005). Distance metastasis was a significant negative prognostic factor for OS (P = 0.002), while radical surgery was a significant positive prognostic factor for PFS (P = 0.05). Compared with those who had received cisplatin and etoposide (≥5 cycles), patients who had received paclitaxel plus platinum‐based chemotherapy showed better PFS and OS. Five patients (two at stage IIB and three at stage IV) showed relatively long‐term survival. Of these patients, four had undergone radical surgery including tumor‐debulking, while three also received adjuvant chemotherapy.ConclusionPaclitaxel plus cisplatin or paclitaxel plus carboplatin may be more effective than etoposide plus cisplatin. Radical surgery followed by chemotherapy may be a favorable alternative intervention for selected patients with advanced stage cancer.

The willingness for cervical cancer screening among sexually active women in Indonesia: Lesson learned from two districts

AbstractObjectiveTo determine the factors that affect women’s willingness at childbearing age to detect/screen for cervical cancer.MethodsA cross‐sectional study was carried out on sexually active women, aged 30–50 years residing in Banyumas and Gunung Kidul Districts, Indonesia. There were 600 respondents. This study focused on the impact of knowledge, access to health information, and support of their husband on the willingness to undergo early detection of cervical cancer.ResultsThis study revealed that there was a statistically significant difference (P = 0.000) between the women who were willing and unwilling to do the screening in terms of higher knowledge (64.67% and 36.21%), obtained access to the information (80.43% and 54.74%), and supported by their husband (63.59% and 29.31%). This study also discovered that the willingness to be screened was significantly affected by spousal support (odds ratio [OR] 4.19, 95% confidence interval [CI] 2.81–6.27). Other factors, such as education level (OR 2.94, 95% CI 1.20–6.63), knowledge (OR 2.29, 95% CI 1.52–3.44), and access to information (OR 2.08, 95% CI 1.34–3.24), were also important drivers.ConclusionTo improve the coverage of cervical screening, several aspects could be treated, including education, knowledge, access to information, and spousal support.

Association between leiomyoma characteristics and perinatal complications: A retrospective cohort study

AbstractObjectiveTo evaluate the relationship of leiomyoma characteristics with perinatal outcomes.MethodsA retrospective cohort study was conducted. Women whose pregnancy was complicated with leiomyoma were recruited, and pregnant women without leiomyomas were enrolled as a control group. Demographic data, leiomyoma ultrasound characteristics, and pregnancy outcomes were collected. Subsequently, antepartum, intrapartum, postpartum, and neonatal complications were analyzed.ResultsThe overall rate of leiomyomas in pregnancy was 5.46% (4393/80510). Out of the 932 pregnancies studied, 632 were affected by leiomyoma. Women with leiomyomas exhibited significantly higher age, pre‐pregnancy BMI, gravidity, and in vitro fertilization‐embryo transfer rate. The occurrence of antepartum, intrapartum, and postpartum complications was influenced by different features of leiomyomas. Among leiomyoma with diameter of 9 cm or greater, cervical or submucous types were detrimental. In the multivariate linear regression analyses, a leiomyoma with diameter of at least 9 cm during pregnancy was independently associated with preterm birth, cesarean section, preterm premature rupture of membranes, and postpartum hemorrhage.ConclusionThe presence of leiomyoma of 9 cm or more increases the risk of antepartum, intrapartum, and postpartum complications; therefore, pre‐conception myomectomy can be considered. For leiomyoma 7–9 cm, extensive discussions between patients and clinicians should be conducted. In women with leiomyomas smaller than 7 cm, the risk of obstetric complications is similar to that in women without leiomyomas, except for those with cervical or submucous leiomyomas.

The prognostic value of tumor microenvironment in endometrioid type endometrial cancer: Effect of CD44 on oncologic outcome

AbstractObjectivesThe study aimed to evaluate the expression of CD44, CD47, interleukin‐1 (IL‐1), and tumor necrosis factor alpha (TNF‐α) in immunohistochemically stained (IHS) samples from endometrioid endometrial cancer (EEC) and to examine their correlation with clinicopathologic parameters.MethodsIHS was used to assess CD44, CD47, IL‐1, and TNF‐α expression in 53 EEC samples. Immunostaining was scored as negative (−), slightly positive (+), moderately positive (++), or strongly/diffuse positive (+++). The prognostic value of these markers was analyzed in relation to clinicopathologic features, including survival.ResultsIn endometrial cancer tissues, positivity rates were CD44 (81%), CD47 (81%), TNF‐α (40.5%), and IL‐1 (42.9%). Strong and diffuse CD44 staining was associated with improved survival and linked to endocervical invasion and stage. Patients with slightly positive CD47 had significantly higher rates of pelvic and para‐aortic lymph node metastases. Strong TNF‐α staining correlated with grade 3 EEC, while slightly positive IL‐1 staining was associated with increased endocervical invasion. No significant correlation was found between CD47, IL‐1, and TNF‐α expression and survival.ConclusionCD44 and CD47 were positive in most EEC specimens. CD44 expression was the only marker significantly correlated with overall survival and recurrence. TNF‐α showed a positive correlation with high‐grade tumors, and IL‐1 staining was inversely associated with endocervical invasion. These findings suggest that CD44 is a prognostic marker for survival, while TNF‐α and IL‐1 may have indirect prognostic roles in EEC.

Cachexia in gynecologic cancers: The role of biomarkers and cachexia index

Abstract Background Cancer cachexia, a metabolic syndrome causing muscle loss, inflammation, and malnutrition, adversely affects prognosis and treatment in cancer patients. Despite extensive studies in other malignancies, cachexia remains underexplored in gynecologic cancers, particularly in India. This study evaluates the cachexia index (CXI) in gynecologic cancer patients and its association with Activin A and Myostatin. Methods In this prospective observational study, 160 women with gynecologic malignancies were assessed for cachexia using Fearon's criteria, the global leadership initiative on malnutrition (GLIM) definition, and CXI, which integrates skeletal muscle index (SMI), albumin, and neutrophil‐to‐lymphocyte ratio (NLR). Serum Activin A and Myostatin were measured via enzyme‐linked immunosorbent assay. A subgroup of 30 ovarian cancer patients received nutritional and physical prehabilitation, with biomarker reassessment post‐intervention. Results Cachexia prevalence was 22.50% (Fearon's) and 56.25% (GLIM). The median CXI was 56.74, with 33.75% having CXI < 41, indicating severe cachexia. CXI < 41 was correlated with advanced disease ( P  = 0.000), lower body mass index ( P  = 0.034), reduced SMI ( P  = 0.000), and elevated inflammatory markers. Activin A was significantly higher in severe cachexia ( P  = 0.024), while Myostatin showed no correlation. Prehabilitation significantly improved CXI ( P  = 0.0001) and reduced Activin A and Myostatin ( P  = 0.0003, P  < 0.0001). In multivariable analysis, platelet‐to‐lymphocyte ratio emerged as the only independent predictor of low CXI (odds ratio 1.0145; 95% confidence interval 1.0081–1.0210; P  < 0.001), while Activin A showed a trend toward significance ( P  = 0.088). Conclusion CXI provides a comprehensive cachexia assessment in gynecologic cancers. Elevated Activin A is linked to muscle degradation. Prehabilitation improves CXI and reduces cachexia biomarkers, emphasizing its therapeutic potential. Further validation of CXI and biomarkers may enhance cachexia diagnosis and management.

Relationship between uterine fibroids and risk of cancers: Population‐based retrospective cohort study

Abstract Objective Numerous studies have assessed the relationship between estrogen and cancer, and an association between uterine fibroids and an increased risk of endometrial cancer and thyroid cancer has been found. However, previous studies are limited by small sample sizes and lack of information on patient characteristics. This population‐based retrospective cohort study aimed to confirm the association between uterine fibroids and cancer risk. Methods This population‐based retrospective cohort study used insurance information recorded in the Korea's Health Insurance Review and Assessment Service from January 1, 2009, to December 31, 2020. Patients with a diagnosis of uterine fibroids and uterine fibroid removal surgery code were included in the uterine fibroid group. Women who visited a clinic for a health checkup were included in the non‐uterine fibroid group. Results In total, 714 171 individuals were studied, 492 610 in the non‐uterine fibroids group and 221 561 in the uterine fibroids group. The all‐site cancer hazard ratio (HR) of the uterine fibroid group was higher than that of the non‐uterine fibroid group (all sites: HR, 1.399, confidence interval [CI]: 1.346–1.454), with HR for breast 1.263 (CI: 1.177–1.354), uterus 2.459 (CI: 2.009–3.010), ovary 1.349 (CI: 1.097–1.659), kidney 1.432 (CI: 1.014–2.022), thyroid 1.693 (CI: 1.591–1.800), and retroperitoneum and peritoneum 3.059 (CI: 1.263–7.414). Conclusion Surgically treated uterine fibroids are associated with increased cancer risk. They are associated with an increased risk of breast, uterine, ovarian, kidney, thyroid, peritoneal, and retroperitoneal cancers.

Risk of cancers in women with polycystic ovary syndrome: Cohort study based on health insurance database in South Korea

Abstract Objective To evaluate the risk of all cancer types associated with polycystic ovary syndrome (PCOS) in a Korean population‐based study. Methods This retrospective cohort study used national health checkups and insurance data between January 1, 2011, and December 31, 2020. Women aged 20–50 years who attended medical institutions for PCOS or underwent health checkups were included. In total, 774 811 participants were included. The PCOS and non‐PCOS groups comprised 127 980 and 563 850 patients, respectively. After 1:1 propensity score matching, each group consisted of 127 712 participants. Hazard ratios were evaluated for all types of cancers associated with PCOS across age groups. Results Demographic and clinical characteristics of women with and without PCOS were not significantly different. However, in the PCOS group, the total cancer risk increased (hazard ratio: 1.156, 95% confidence interval: 1.058–1.263, P  = 0.001), and the risk of uterine and ovarian cancers increased (hazard ratio: 4.963, 95% confidence interval: 3.282–7.504, P  < 0.001; hazard ratio: 1.774, 95% confidence interval: 1.142–2.755, P  = 0.011, respectively). The risk of thyroid cancer increased in the 20–29 years age group within the PCOS group (hazard ratio: 1.2, 95% confidence interval: 1.009–1.427, P  = 0.039). Conclusion PCOS is associated with an increased risk of uterine and ovarian cancers. An increased risk of thyroid cancer was associated with PCOS in the 20–29 years age group. However, no link was found between PCOS and breast cancer. This should be considered when treating patients with PCOS.

Recurrent spontaneous ovarian hyperstimulation in a young nonpregnant Chinese woman with Rathke cleft cyst and a KISS1R variant: A rare case report and literature review

AbstractUnexplained spontaneous ovarian hyperstimulation syndrome (sOHSS) in a nonpregnant young woman is rare, with fewer than five cases documented in the literature. Although four distinct causative types of sOHSS have been identified, some cases remain beyond the scope of our current understanding. A young Chinese woman with sOHSS presented on multiple occasions with sOHSS between the ages of 18.6 and 20.6 years, with acute abdominal discomfort, ascites, hemoconcentration, and pronounced ovarian enlargement coinciding with minor ovulatory anomalies. During the most recent episode, concern regarding a malignant ovarian neoplasm led to emergent unilateral salpingo‐oophorectomy. Remarkably, her menstrual cycle normalized after surgery, with no subsequent recurrence of sOHSS. Subsequent diagnostic evaluations identified a Rathke cleft cyst (RCC) in the pituitary gland and a heterozygous mutation in the KISS1R gene. Neither of these findings corresponded with any of the four informally recognized causes of sOHSS, suggesting a hitherto unrecognized pathology. RCCs may cause OHSS by disrupting the endocrine system, while interactions between the kisspeptin system and estradiol may reach a critical threshold, culminating in sOHSS. This case provides important insights into sOHSS and will hopefully spearhead further research into pituitary anomalies and the intricacies of the kisspeptin system. Clinicians are urged to maintain a high level of vigilance for similar presentations and ensure timely and tailored therapeutic interventions.

Immune checkpoint inhibitors in gynecologic oncology: Current status and perspectives

AbstractImmune checkpoint inhibitors (ICIs) have transformed cancer treatment by leveraging the immune system's capacity to fight gynecologic cancer. This review summarizes the current status and future perspectives of ICIs in the treatment of cervical, endometrial, and ovarian cancers and rare tumors. ICIs have demonstrated significant efficacy in tumors with high tumor mutational burden and immune markers such as PD‐L1 expression and microsatellite instability. In cervical cancer, the integration of ICIs has shown promise at various stages of treatment, including advanced and recurrent settings. In endometrial cancer, molecular classification has facilitated targeted immunotherapy strategies, with notable success in mismatch repair‐deficient (dMMR) tumors. However, challenges remain in the treatment of microsatellite stable endometrial and epithelial ovarian cancers due to their relatively low immunogenicity. Combination therapies, including ICIs with angiogenesis inhibitors, poly (ADP‐ribose) polymerase (PARP) inhibitors, or chemotherapy, are being actively investigated to improve response rates. Several phase II and case series showed promising response to ICIs in vulvar/vaginal cancer and gestational trophoblastic neoplasia, though the efficacy in genital tract melanoma is still unclear. Despite these advances, the management of immune‐related adverse events and the identification of reliable biomarkers for patient selection remain critical. ICIs are poised to redefine the therapeutic landscape of gynecologic oncology, offering hope for improved outcomes and personalized treatment strategies.

Pseudo‐Meigs syndrome owing to a retained fibroid following total laparoscopic hysterectomy for multiple leiomyomas: A case report and review of the literature

Abstract Total laparoscopic hysterectomy (TLH) is the most common gynecologic procedure for fibroids. However, massive serous ascites has not yet been reported. For this reason, the management of ascites is challenging because it is an unexpected situation. We present the case of a 42‐year‐old woman complaining of menorrhagia who was diagnosed with multiple leiomyomas on ultrasound examination. No abnormal findings were observed in the endometrium or ovaries. TLH and bilateral salpingectomy were performed. Specimens were extracted via vaginal morcellation using a scalpel. No intraoperative complications were observed. The final pathologic examination of the uterus, which contained 25 fibroids and tubes, was benign. However, serous ascites began to enter the drain on the first day. The volume of the ascites was approximately 9000 mL over 3 days. There were no abnormalities in vital signs, liver test results, or serum albumin, electrolyte, or hemoglobin levels. Radiologic images excluded bowel and urinary tract injuries. However, an intra‐abdominal mass measuring 26 × 33 × 44 mm was detected on magnetic resonance imaging. Diagnostic laparoscopy revealed a myoma between the bowel loops, which was removed by placing it in an endobag. Thereafter, the ascites spontaneously resolved. Ascitic fluid is generally observed in gynecologic cancers. The basic treatment principles include close monitoring of vital signs, appropriate replacement of fluid deficits, drainage, and mobilization. Furthermore, treatment based on the etiopathology is crucial. In cases of multiple myomas, when extracting the uterus vaginally, a pedunculated myoma may break off or be missed in the abdomen. Leiomyomas have oncotic properties and can induce fluid flow from the intravascular to the peritoneal space. Rapid resolution of ascites after myoma removal indicates pseudo‐Meigs syndrome.

Comparative diagnostic performance of the early‐stage ovarian malignancy score versus other risk prediction models in early‐stage ovarian cancer: A Vietnamese prospective cohort study

Abstract Objective This study compares the diagnostic performance of the early‐stage ovarian malignancy (EOM) score against other risk prediction models for identifying early‐stage ovarian cancer. Methods This prospective cohort study involved 925 cases from the obstetrics and gynecology departments of two tertiary hospitals from May 2018 to December 2023. The data included gynecologic examination and/or ultrasound findings, menopausal status, ultrasonography features, serum CA125, and HE4 values, which were used to calculate the EOM score and compare it with other algorithms. Preoperative predictions were validated against postoperative histopathological data. Results In total, 792 cases (85.62%) were benign tumors, 74 cases (8.00%) were identified as early‐stage ovarian cancer, and 59 cases (6.38%) were classified as advanced‐stage ovarian cancer. With a cut‐off of ≥13, the EOM score achieved an area under the curve (AUC) value of 0.908 for distinguishing between cancer and non‐cancer, demonstrating sensitivity of 83.46% and specificity of 82.90%. For early‐stage cancer, the EOM score had an AUC value of 0.843. The EOM score outperformed the risk of malignancy index, the risk of ovarian malignancy algorithm, CPH‐I, CA125, and HE4 ( P  < 0.05). Conclusion The EOM score is a straightforward and effective tool for predicting early‐stage ovarian cancer, yielded performance similar to the IOTA Simple Rules combined with CA125.

Pediatric ovarian malignancies and outcomes in an urban tertiary care center

Abstract Objectives To describe the clinical characteristics, interventions, and outcomes of pediatric patients with ovarian cancer and borderline masses presenting to a large tertiary pediatric hospital. Methods A retrospective chart review of female patients who underwent surgery for an ovarian mass was performed. Patient characteristics, sociodemographics, presenting symptoms, and preoperative clinical assessment, surgical details, final pathology, and oncologic outcomes were reviewed and collected for further data analysis. Results Thirty‐one of 409 patients (7.6%) had a malignant or borderline mass. Germ cell tumors were the most common histology ( n  = 16, 51.6%) with immature teratoma ( n  = 8, 25.8%) being the most common subtype. Most patients were early stage at diagnosis (Stage I or II). The preoperative workup of patients was variable as 86 (21%) patients did not have any tumor markers drawn before surgery. Most patients were initially managed with unilateral salpingo‐oophorectomy and 13 (41.9%) underwent additional staging procedures. Thirteen patients (41.9%) received chemotherapy, four patients (12.9%) had a recurrence, and seven (22.6%) died. Conclusion Given the overall positive prognosis and recommended surveillance time for pediatric ovarian malignancies, most patients will age out of pediatrics during the surveillance period, making it essential that practicing gynecologists are familiar with these patients and the recommendations for their care.

Predictors of lymphocyst development following lymphadenectomy in patients with gynecologic cancer

Abstract Objective To evaluate the incidence of lymphocyst formation in patients undergoing pelvic and/or para‐aortic lymphadenectomy for gynecologic malignancies and identify associated factors. Methods A retrospective analysis was performed on 614 patients who underwent lymphadenectomy for primary endometrial, ovarian, or cervical cancer at Hacettepe University between 2014 and 2019. Results Of the 614 patients, 276 (45%) had endometrial cancer, 262 (42.6%) had ovarian cancer, and 76 (12.4%) had cervical cancer. Postoperative lymphocyst formation occurred in 187 patients (30.5%), predominantly in the pelvic region (91.4%). Lymphocyst incidence was not significantly influenced by primary cancer type. Factors such as age, menopausal status, the extent of surgery and the use of pelvic drains or absorbable hemostats did not significantly affect lymphocyst formation. However, para‐aortic lymphadenectomy, neoadjuvant therapy, adjuvant therapy, and the number of lymph nodes removed were identified as significant factors contributing to the development of lymphocysts. In multivariate analysis, only para‐aortic lymphadenectomy (OR 2.17, 95% CI: 1.26–3.73) and neoadjuvant therapy (OR 2.31, 95% CI: 1.28–4.19) were found to be independent parameters associated with lymphocyst development. Symptomatic or complicated lymphocysts requiring intervention occurred in 16 patients (8.6%), representing 2.6% of the total patient cohort. The most common reason for intervention was infection within the lymphocyst. Conclusion Lymphocyst formation is a frequent complication following gynecologic cancer surgery, often remaining asymptomatic and detected incidentally during routine follow‐ups. Lymphocysts are generally not a cause for concern, but they can lead to complications like infection, which requires intervention.

Epidemiological trends of gynecologic cancer burden in east Asian countries from 1990 to 2021 and projections to 2031

Abstract Objective This study aimed to estimate the incidence rates, deaths, and disability‐adjusted life‐years (DALYs) due to cervical, ovarian, and uterine cancers among females in East Asia (China, Democratic People's Republic of Korea, Mongolia, Japan, and Republic of Korea) between 1990 and 2021, and to predict the disease burden for the next decade. Methods The data were extracted from Global Burden of Disease (GBD) 2021 project. The joinpoint regression model was applied to reflect temporal trends. The age‐period‐cohort model investigated the effects of age, period, and birth cohort on mortality risk. The Bayesian age‐period‐cohort model was used to predict the disease burden for the next decade. Results In 2021, the incidence rates, deaths, and DALYs due to cervical, ovarian, and uterine cancers were rising in East Asia, but age‐standardized incidence rates (ASIRs) showed different heterogeneity. For cervical cancer, joinpoint regression results showed that the ASIR of cervical cancer decreased to 8.88% in 2021 in the Republic of Korea, with an annual percent change of −1.75% (95% CI –2.04 to −1.47, P  < 0.05). For ovarian cancer, the age‐standardized mortality rate (ASMR) and age‐standardized disability‐adjusted life‐year rate (ASDR) in Mongolia and Japan have been much greater than in other East Asian nations since 1990. For uterine cancer, the ASMR and ASDR in the Republic of Korea were lower than in other East Asian countries. In the next decade, the absolute numbers of deaths due to cervical, ovarian, and uterine cancers are expected to rise further in East Asia. Conclusion In East Asia, cervical, ovarian, and uterine cancers are a consistently increasing burden over time. These findings highlight the urgent need for targeted public health interventions to mitigate the impact of these cancers.

Efficacy of medical and surgical interventions to reduce blood loss during laparoscopic myomectomy: A systematic review and meta‐analysis

Abstract Objectives To compare the effectiveness of different medical and surgical interventions to reduce blood loss in milliliters during laparoscopic myomectomy and to assess the total operative time, as well as the need for conversion to hysterectomy or laparotomy. Search Strategy An exhaustive search was conducted across the following databases, MEDLINE, EMBASE, PubMed, Web of Science and Scopus, from the first year available until May 2022. Terms used were myomectomy, fibroid, fibroid resection, laparoscopy, endoscopy, gynecologic endoscopy, blood loss, hemorrhage, and transfusion. Selection Criteria Randomized controlled trials involving patients with uterine myomatosis who underwent laparoscopic myomectomy and received either a specific pharmacologic or surgical intervention to reduce blood loss, compared with another intervention or placebo, were included. Data Collection and Analysis Data extraction was performed by two authors using a previously designed form. Effect sizes for each treatment comparison reported were calculated as mean differences, and a frequentist network meta‐analysis was performed for the outcome of serum hemoglobin levels using the control group as the comparator. Main Results A total of 23 studies were included for the quantitative synthesis, with 2152 women. The combination of bupivacaine with epinephrine showed the most beneficial effect on hemoglobin decrease (in mg/dL) in the network meta‐analysis. Among the mechanical measures, the temporary uterine artery ligation with or without ovarian vessel ligation demonstrated the greatest reduction in blood loss (mean difference [MD] −122.61, 95% confidence interval [CI] −156.3 to −88.49; MD −95.14, 95% CI −113.17 to −77.10, with or without ligation, respectively). Conclusions Different interventions can reduce blood loss during laparoscopic myomectomy, the most effective were epinephrine plus bupivacaine and temporary uterine artery ligation. Using them is critical for minimizing complications during the procedure and so allowing fertility preservation. However, further randomized controlled trials are required to safely establish clinical recommendations. Clinical Registration Prospective Registry of Systematic Reviews (PROSPERO) ID: CRD42022324210.

Conservative hysteroscopic treatment of endometrial intraepithelial neoplasia and endometrial cancer in patients with high surgical risk with mechanical hysteroscopic tissue removal systems: A retrospective cohort study

Abstract Objective To compare surgical and oncologic outcomes between conventional resectoscopic surgery and mechanical hysteroscopic tissue removal (mHTR) systems in high‐risk patients not suitable for standard surgery undergoing conservative treatment for multifocal endometrial atypical hyperplasia/endometrial intraepithelial neoplasia (EAH/EIN) or early‐stage low‐grade endometrioid endometrial cancer (EEC). Methods We conducted a single‐center, retrospective cohort study at the Department of Gynecology and Physiopathology of Human Reproduction, S. Orsola‐Malpighi Hospital, University of Bologna, Italy. A total of 31 high‐surgical‐risk patients with EAH/EIN or early‐stage low‐grade EEC were included: 18 underwent conventional resectoscopic endo‐myometrial resection, while 13 were treated with mHTR systems. All patients received a levonorgestrel‐releasing intrauterine device (LNG‐IUD) postoperatively. After treatment, patients underwent an 18‐month follow up with endometrial biopsies every 6 months. Results The mHTR group had significantly shorter operative times (mean 12.3 ± 7.7 min) compared with the resectoscopic surgery group (mean 40.6 ± 11.8 min, P  < 0.001). Additionally, the incidence of intrauterine adhesions was lower in the mHTR group ( P  < 0.001). There were no significant differences between the two groups in terms of disease presence at 6, 12, or 18 months. Conclusions Hysteroscopic endo‐myometrial resection, with resectoscopic technique or with mHTR systems, combined with LNG‐IUD may represent a safe alternative for patients at high surgical risk with EAH/EIN or early‐stage low‐grade EEC. Moreover, mHTR demonstrated advantages such as shorter operative times and fewer adhesions. A large multicenter prospective study is needed to confirm our study findings.

Pathology results of risk‐reducing salpingo‐oophorectomy in BRCA1/2 carriers and long‐term clinical outcomes

AbstractIntroductionBRCA1/2 mutation carriers have a lifetime ovarian cancer risk of 40%–45% for BRCA1 and 15%–20% for BRCA2. The most effective risk‐reduction strategy for women with known BRCA mutations remains bilateral risk‐reducing salpingo‐oophorectomy (RRSO), which reduces the risk by 80%. The primary objective of this study is to assess the long‐term incidence of primary peritoneal carcinoma (PPC) following RRSO and to evaluate the occurrence of premalignant and malignant lesions.MethodsThis retrospective cohort study followed BRCA1/2‐positive patients who underwent RRSO, using data from two medical centers in Haifa Israel between 2002 and 2023. Data collected included demographic characteristics and pathology results post‐surgery. Outcomes included rates of occult cancer (OC), serous tubal intraepithelial carcinoma (STIC), and PPC.ResultsA total of 214 women underwent RRSO. Of these, 126 (58.8%) had a BRCA1 mutation, 76 (35.5%) had a BRCA2 mutation, and 12 (5.6%) carried both BRCA1 and BRCA2 mutations. During a mean follow‐up of 122.4 months (SD ± 84.0), three patients (1.5%) developed PPC. OC was identified in 13 patients (6.1%) during RRSO. Out of the 13 OC patients, eight (61.5%) were classified as stage 1. The overall survival for the OC population was 117.2 ± 55.9 months. STIC was detected in two patients.ConclusionIn this large retrospective analysis of BRCA carriers who underwent RRSO, we confirmed that long‐term follow‐up is crucial for BRCA mutation carriers undergoing RRSO, as malignancies can still arise over time. In our study, the incidence of PPC was 1.5%, highlighting the need for extended surveillance. These findings underscore the importance of meticulous surgical protocols, expert pathology review, and ongoing monitoring to optimize patient outcomes.

Oncological safety of fertility preservation treatment in ovarian cancer: A Spanish multicenter study

AbstractObjectiveTo assess the safety of fertility‐sparing treatments for early‐stage ovarian cancer in women younger than 40 years old.MethodsWe performed a retrospective multicenter study including women aged 18–40 years diagnosed with early‐stage (FIGO I–II) ovarian cancer in 55 Spanish hospitals, from January 2010 to December 2019. Benign and borderline tumors were excluded, as well as advanced stages (FIGO III–IV). All perioperative characteristics and follow‐up data were collected and analyzed. Standard staging surgery (SSS) was compared with fertility‐sparing surgery (FSS) in terms of oncological outcomes.ResultsIn all, 366 women were included; 327 (89.3%) were stage I. Among all patients, 216 (59%) underwent SSS and 150 (41%) FSS. Up to 208 (56.8%) patients did not have children, but only 12 (3.2%) had oocyte preservation before treatment. Patients in the FSS group compared with the SSS group showed a non‐significant difference in recurrences (8% vs. 9.3%, respectively; P < 0.711) and deaths (1.3% vs. 4.8%, respectively; P = 0.211) during the follow‐up. No significant differences were found between epithelial and non‐epithelial ovarian cancer both in recurrences (7.1% vs. 8.8%, respectively; P = 0.771) and in deaths (1.4% vs. 1.3%, respectively; P = 1) among patients who underwent FSS.ConclusionFSS seems a safe option for treatment of early‐stage ovarian cancer in patients who want to preserve fertility, either for epithelial and non‐epithelial histology.

The impact of hysterectomy for benign uterine tumors on subsequent ovarian reserve, lower urinary tract symptoms, and sexual function: A prospective multidirectional short‐term analysis

AbstractObjectiveTo evaluate the effects of hysterectomy for benign uterine tumors on subsequent ovarian reserve, sexual function, and lower urinary tract symptoms (LUTS).MethodsThe present study was a prospective longitudinal analysis that recruited patients aged 35–45 years who underwent simple hysterectomy without oophorectomy for symptomatic benign uterine tumors. Anti‐Müllerian hormone (AMH) and serum sex hormone profiles, including follicle‐stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and total testosterone, were measured at four timepoints: before hysterectomy, and 3, 6, and 12 months postoperatively. Participants completed the following questionnaires at these timepoints: Urinary Distress Inventory (UDI‐6), Incontinence Impact Questionnaire (IIQ‐7), and Pelvic Organ Prolapse/Urinary Incontinence and Sexual Function Questionnaire (PISQ‐12) short form.ResultsA total of 36 patients completed the study. Serum AMH levels significantly declined post‐hysterectomy compared with preoperative levels. Both UDI‐6 and IIQ‐7 scores significantly decreased post‐hysterectomy compared with preoperative scores. No differences were observed in serum FSH, LH, estradiol, progesterone, and testosterone levels before and after hysterectomy. No significant differences were found in the short form of PISQ‐12 before and after hysterectomy.ConclusionThe present study demonstrated that simple hysterectomy with ovarian preservation had detrimental effects on ovarian reserves, whereas LUTS showed improvement. Furthermore, sexual dysfunction was not likely to occur within the first postoperative year.

Fertility preservation in female cancer patients: Surgical procedures

AbstractThe surgical management of cancer patients wishing fertility preservation is multidisciplinary, involving surgeon, anesthetist, hematologist, and nursing and laboratory staff. Many oncology patients have a multitude of medical or surgical conditions that require careful planning of all therapy including surgical removal of reproductive material, either oocytes or ovarian tissue. The significant risks related to either transvaginal or abdominal surgery should be discussed and documented and the final decision to proceed must be balanced against the risks, including death. Multidisciplinary communication for individual case management is the safeguard for patient safe return to cancer therapy.

Unusual synchronous and metachronous association of hematologic neoplasms with gynecologic neoplasms: A case series and literature review

AbstractThe aim of the present study was to evaluate the occurrence of synchronous or metachronous hematologic and gynecologic malignancies. The medical database of the pathology department at a tertiary center was searched from 2016 to 2024 for cases involving both hematologic and gynecologic tumors. A literature search using Google Scholar and PubMed was also conducted between May and June 2024. Articles reporting surgical pathology data were included, while radiologic studies and those lacking pathology data were excluded. Cases involving one gynecologic cancer and one hematologic malignancy were analyzed. Three cases from our center and 25 cases from 15 English‐language articles were identified. The mean age of the cases at diagnosis was 61.4 ± 9.4 years. A total of 19 patients (68%) were diagnosed with synchronous cancers, while the rest had metachronous diagnoses. Endometrial cancer was seen in 20 cases (71.4%): 14 synchronous and five metachronous endometrioid adenocarcinomas, and one unspecified metachronous endometrial cancer. This was followed by five cases of ovarian cancer (17.9%): three synchronous serous ovarian carcinomas, one metachronous serous ovarian carcinoma, and one synchronous ovarian adenocarcinoma. Additionally, there were two cases of cervical cancer (7.1%): one synchronous adenosquamous carcinoma and one metachronous invasive squamous carcinoma, and one case of carcinosarcoma (3.6%). Involvement of more than one site is possible for hematolymphoid cancer, commonly affecting the pelvic or para‐aortic lymph nodes in 16 patients (57.1%), with other sites including the cervix (4 cases, 14.3%), ovary (4 cases, 14.3%), uterus (2 cases, 7.1%), iliac/inguinal lymph nodes (2 cases, 7.1%), fallopian tube (1 case, 3.6%), vagina (1 case, 3.6%), liver (1 case, 3.6%), abdomen (1 case, 3.6%), and appendix (1 case, 3.6%). Two cases were unspecified. Non‐Hodgkin lymphoma (NHL), primarily of B cell lineage, was the most common hematologic malignancy (25 cases, 89.3%, with 22 cases being B cell lineage). In contrast, Hodgkin lymphoma was observed in two cases (7.1%), and acute leukemia in one case (3.6%). Among 21 patients with available follow‐up data, eight died during the follow‐up period. The co‐occurrence of NHL, Hodgkin lymphoma, and acute leukemia with gynecologic cancers is rare. However, during surgery for gynecologic cancers, the potential of synchronous lymphoma should be considered, particularly in cases with unusual retroperitoneal lymphadenopathy.

Improved practical value of the FIGO 2023 staging system in evaluating prognosis of early stages endometrial carcinoma

AbstractObjectiveTo investigate the practical value of the International Federation of Gynecology and Obstetrics (FIGO) 2023 endometrial cancer (EC) staging system.MethodsData on clinicopathological characteristics of patients diagnosed with EC at Tianjin Central Hospital of Gynecology Obstetrics from January 2015 to December 2017 were collected. Initial staging was performed using the FIGO 2009 system, followed by revised staging with the 2023 FIGO system. The oncological outcomes of patients under the different staging systems were analyzed.ResultsA total of 671 patients with EC were included in this study, and after applying the 2023 FIGO staging system, the staging of 119 (17.73%) patients changed, with 11 (1.64%) patients experiencing downstaging and 108 (16.10%) patients experiencing upstaging; 5‐year progression‐free survival (PFS) and overall survival (OS) rates changed in stage I (97.75%–98.55% and 98.79%–99.38%, respectively) and stage II (91.39%–93.16% and 95.65%–95.72%, respectively) patients, and the differences in PFS (P = 0.060 and P = 0.001, respectively) and OS (P = 0.349 and P = 0.003, respectively) between stage I and stage II patients became statistically significant. After the restaging of FIGO 2009 stage I patients, there were statistically significant differences in PFS (P = 0.002 and P = 0.024, respectively) and OS (P = 0.002 and P = 0.002, respectively) between stage IIB and IA1 and IA2 patients, and significant differences in PFS (P = 0.022) and OS (P = 0.048) were observed between stage IIC and IA1 patients. In FIGO 2023 stage IIB and IIC patients, the differences in PFS (P = 0.39 and P = 0.39, respectively) and OS (P = 0.78 and P = 0.5, respectively) were not statistically significant among the various FIGO 2009 stages.ConclusionIn the FIGO 2023 EC staging system, stage I and II staging criteria are more reasonable, and the addition of stage IIB and IIC helps to better evaluate patient prognosis.

Prognostic impact of primary surgery in human papillomavirus‐independent, advanced or metastatic endocervical adenocarcinoma: A bi‐institutional retrospective study

AbstractObjectiveTo evaluate the prognostic impact of primary surgery on patients with HPV‐independent, advanced or metastatic endocervical adenocarcinoma (EAC) who typically exhibit poor survival outcomes and resistance to conventional therapies such as chemoradiotherapy.MethodsA bi‐institutional retrospective study was conducted at Samsung Medical Center and Taiwan National University Hospital. Between 2001 and 2023, 92 patients with HPV‐independent advanced or metastatic EAC were included. Patients were divided into two groups: 54 (58.7%) underwent primary surgery and 38 (41.3%) received non‐surgical treatments, including definitive radiotherapy or palliative chemotherapy. Kaplan–Meier analysis was used to compare progression‐free survival (PFS) and overall survival (OS) between groups. Multivariate analysis was performed to identify independent prognostic factors.ResultsThe surgery group demonstrated significantly improved outcomes, with a median PFS of 19.2 months, compared with 10.0 months in the non‐surgery group (P < 0.001). Median OS was not reached in the surgery group, whereas it was 24.1 months in the non‐surgery group (P = 0.002). Multivariate analysis showed that non‐surgical treatment was an independent predictor of poor PFS (hazard ratio [HR] 2.25; 95% confidence interval [CI] 1.18–4.29; P = 0.013) and OS (HR 3.25; 95% CI 1.37–7.73; P = 0.008). Additionally, the recurrence rate was significantly lower in the surgery group (55.6%) than in the non‐surgery group (84.2%; P = 0.006).ConclusionPrimary surgery significantly improves survival outcomes in patients with HPV‐independent advanced or metastatic EAC. These findings suggest that surgery should be considered as part of a multimodal treatment strategy for this aggressive subtype, highlighting the need for individualized therapeutic approaches beyond standard chemoradiotherapy protocols.

Characteristics and prognostic implications of a cohort of 50 Sertoli‐Leydig cell tumors at a single center

Abstract Objective The aim of the study was to investigate the clinical characteristics, therapy strategies and prognosis of Sertoli‐Leydig cell tumors (SLCTs). Methods A total of 50 cases of ovarian SLCTs were retrospectively analyzed. We performed descriptive statistics to describe baseline characteristics. Results A total of 70% of SLCT patients were below the age of 45 years. The dominant pathologic types were poor (40%) and moderate (40%) differentiation. Retiform variant tumor is more aggressive and tends to appear in children. According to the 2014 FIGO (the International Federation of Gynecology and Obstetrics) classification, tumors were classified as Stage I ( n  = 46: well differentiated, n  = 4; moderately differentiated, n  = 19; poorly differentiated, n  = 18; and retiform, n  = 5), Stage II ( n  = 1, moderately differentiated), Stage III ( n  = 1, poorly differentiated), and Stage IV ( n  = 2: poorly differentiated, n  = 1; and retiform, n  = 1). Median follow‐up was 58.1 months (2–132 months). A total of 45 patients (90%) achieved clinical remission. Four patients experienced a relapse (34.5 months, range: 7–58) and one patient died of the tumor at 10 months after initial treatment. All patients in grossly Stage IA achieved complete response, irrespective of the presence or absence of staging surgery or chemotherapy. After treatment, five patients successfully gave birth to healthy babies. Conclusion The prognosis for women diagnosed with early stage (I–II) SLCT is generally favorable, especially Stage IA. while those with advanced stages, poorly differentiated, retiform variant, or tumors containing heterologous components exhibit a more aggressive clinical course. Fertility sparing surgery appears to represent a feasible treatment approach for early stage SLCTs.

Enhancing the accuracy of preoperative and intraoperative evaluation of malignant ovarian germ cell tumors with a focus on fertility preservation in young women

Abstract Objective To analyze and improve the accuracy of preoperative assessment and intraoperative frozen‐section analysis (FSA) for malignant ovarian germ cell tumors (MOGCTs), especially in the context of fertility preservation. Methods A retrospective review of 48 women aged under 40 years, diagnosed with MOGCTs, and treated at Chonnam National University Hospital between July and December 2022 was conducted. The results of preoperative magnetic resonance imaging (MRI), measurement of serum tumor markers (α‐fetoprotein [AFP], β‐human chorionic gonadotropin, lactate dehydrogenase [LDH], cancer antigen [CA] 125, CA 19–9, CA 72–4, carcinoembryonic antigen), and intraoperative FSA were compared with the final pathology diagnosis. Results MRI demonstrated a sensitivity of 95.5%, whereas FSA showed a sensitivity of 72.9% for all MOGCTs. Sensitivities varied according to the subtype, but were consistently higher in MRI (100% for dysgerminoma, 88.9% for immature teratoma, 100% for endodermal sinus tumor, 100% for others). However, there were differences in FSA according to subtype (100% for dysgerminoma, 50.0% for immature teratoma, 100% for endodermal sinus tumor, 25.0% for others). Serum tumor markers also provided diagnostic insights, particularly LDH for dysgerminoma (82.4%) and AFP for immature teratoma (75.0%) and endodermal sinus tumor (100%). Conclusion Preoperative MRI and serum tumor marker measurement may be effective in guiding fertility‐sparing surgical decisions. MRI could outperform FSA in terms of accuracy, especially for immature teratoma.

An alternative for hysteroscopic myomectomy: Ultrasound‐guided single‐step myomectomy for submucous myoma uteri with ring forceps, a retrospective study

AbstractObjectiveHysteroscopic myomectomy is widely regarded as safe and feasible, although achieving single‐session results for larger myomas often requires alternative methods. This study introduces a novel approach: ultrasound‐guided myoma extirpation using ring forceps combined with hysteroscopy.MethodsThis retrospective, single‐center study includes patients who underwent ultrasound‐guided myoma extirpation between 2016 and 2024. Data were collected retrospectively, and myomas were classified according to the International Federation of Gynecology and Obstetrics leiomyoma subclassification system. Under ultrasound guidance, the myoma was extirpated using ring forceps. The pre‐, peri‐, and postoperative outcomes were recorded and analyzed.ResultsA total of 25 patients were included, with a mean age of 44.76 ± 8.09 years. Most patients (92%) were premenopausal, and the primary symptoms were irregular bleeding (76%) and menorrhagia (68%). The median myoma size was 3 cm (interquartile range [IQR]: 2–4 cm). The median operation time was 30 min (IQR: 20–42 min). There was no statistically significant correlation between the duration of the operation and the diameter of the myoma uteri. Most myomas were located in the fundus, left side, or anterior wall (20% each), with 60% classified as type 0. Postoperative assessments revealed no residual myomas in 84% of cases. Uterine perforation and cervical laceration occurred as complications in two cases, while four cases required an additional session. Two patients with infertility achieved full‐term pregnancies post‐surgery.ConclusionThis new, minimally invasive technique might be a feasible option for large myomas, particularly in low‐resource settings. It minimizes the need for multiple sessions, providing reassuring results for patients with suitable indications.

Personalized approach to malignant struma ovarii: Insights from a web‐based machine learning tool

AbstractObjectivesMalignant struma ovarii (MSO) is a rare ovarian tumor characterized by mature thyroid tissue. The diverse symptoms and uncommon nature of MSO can create difficulties in its diagnosis and treatment. This study aimed to analyze data and use machine learning methods to understand the prognostic factors and potential management strategies for MSO.MethodsIn this retrospective cohort, the Surveillance, Epidemiology, and End Results (SEER) database provided the data used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five machine learning algorithms to predict the 5‐year survival. A validation method incorporating the area under the curve of the receiver operating characteristic curve was used to validate the accuracy and reliability of the machine learning models. We also investigated the role of multiple therapeutic options using the Kaplan–Meier survival analysis.ResultsThe study population comprised 329 patients. Multivariate Cox regression analysis revealed that older age, unmarried status, chemotherapy, and the total number of tumors in patients were poor prognostic factors. Machine learning models revealed that the multilayer perceptron accurately predicted outcomes, followed by the random forest classifier, gradient boosting classifier, K‐nearest neighbors, and logistic regression models. The factors that contributed the most were age, marital status, and the total number of tumors in the patients.ConclusionThe present study offers a comprehensive approach for the treatment and prognosis assessment of patients with MSO. The machine learning models we have developed serve as a practical, personalized tool to aid in clinical decision‐making processes.

Response: Comment on searching for prognostic markers for stage I epithelial ovarian cancer: A role for systemic inflammatory markers

Contraceptive strategies for reducing the risk of reproductive cancers

AbstractReproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low‐resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low‐cost behavioral interventions to mitigate reproductive cancer risks.

A case report on the microcystic stromal tumor of the ovary: A rare type of ovarian tumor

Synopsis A microcystic stromal tumor (MCST) is considered a benign tumor. However, reported cases of recurrence and metastases indicate that it has got malignant features. Its recurrence is strongly linked to undertreatment.

Analysis of assisted reproductive outcomes in patients with atypical endometrial hyperplasia and early‐stage endometrial cancer after fertility‐sparing treatment

Abstract Objective To explore the assisted reproductive outcomes of patients with atypical endometrial hyperplasia (AEH) and early‐stage endometrial cancer (EEC) who achieved complete remission after conservative treatment and to provide reference for clinical selection of appropriate conservative treatment. Method This retrospective cohort study included seven patients with EEC and 62 patients with AEH who underwent in vitro fertilization or intracytoplasmic sperm injection at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University between August 2015 and October 2023. The authors divided the participants into two groups based on the type of fertility‐sparing treatment received: the oral medication group and the levonorgestrel‐releasing intrauterine system (LNG‐IUS) group. The primary outcome was the cumulative clinical pregnancy rate. Secondary outcomes included clinical pregnancy rate per transfer cycle, embryo utilization rate, and high‐quality embryo rate. Results The LNG‐IUS group had a significantly higher rate of usable embryos compared with the oral medication group (80.8% vs 91.1%, P  = 0.005) and also had a thinner endometrial thickness on the day of embryo transfer. The cumulative clinical pregnancy rate was higher in the LNG‐IUS group compared with the medication group (46.7% vs 78.9%, P  = 0.037), and the difference was statistically significant. Conclusion For patients with AEH and EEC with fertility needs, the conservative treatment method of LNG‐IUS can achieve better assisted reproductive outcomes.

Identification of vascular hotspots and analysis of micro‐vessel flow velocity waveforms in high‐grade squamous intraepithelial lesions of the cervix

AbstractObjectivesTo assess hotspot micro‐vessel flow velocity waveforms in human papillomavirus (HPV) cervical infections using transvaginal power Doppler ultrasound (TV‐PDU) and explore associations with high‐grade squamous intraepithelial lesions (HSIL, cervical intraepithelial neoplasia [CIN] II and III).MethodsIn all, 62 patients with confirmed HPV‐HSIL (14 CIN II, 48 CIN III) and 65 age‐ and parity‐matched women with neither HPV infection nor CIN were compared. Seven parameters by TV‐PDU were used to assess vascular classification and micro‐vessel flow velocity, including vascular grading (class I, II, III), lowest pulsatility index (PI), resistance index (RI), peak systolic velocity (PS), end‐diastolic velocity (ED), time average maximum velocity (TAMV), and the vascular index (VI = PS/ED).ResultsHSIL was primarily associated with vascular class I (75.8%), followed by class II (14.5%) and class III (9.7%). PI, RI, and VI in HSIL were significantly lower than the control group (P < 0.0001). Mean PI, RI, and VI values decreased progressively from the normal cervix to CIN II–III. At a PI cutoff of 1.03, sensitivity was 88.7%, specificity was 83.8%, and area under the curve (AUC) was 95.0. At an RI cutoff of 0.68, sensitivity was 96.8%, specificity 61.5%, and AUC 84.0. At a VI cutoff of 2.84, sensitivity was 85.5%, specificity 78.5%, and AUC 85.0.ConclusionBased on different patterns of hotspot vascular classification and micro‐vessel flow velocity waveforms, particularly PI between HSIL and the normal cervix, TV‐PDU may offer a potential role for aiding the planning for patients with suspicious HSIL. Further studies are needed to validate the findings.

Comparison of the clinical outcomes of patients with stage IA–IIA2 cervical adenocarcinoma and squamous cell carcinoma after radical hysterectomy: A propensity score‐matched real‐world analysis

AbstractObjectiveTo compare the pathological findings and survival outcomes of patients with 2009 FIGO stage IA–IIA2 cervical cancer between groups with adenocarcinoma (ADC) and squamous cell carcinoma (SCC) using the Chinese Cervical Cancer Clinical (FOUR‐C) study database.MethodsPatients from 2004 to 2018 with cervical ADC and SCC who underwent radical hysterectomy were identified through the FOUR‐C database. Propensity score matching (PSM) was conducted to balance baseline clinicopathological characteristics. The Kaplan–Meier method and Cox regression analysis were used to evaluate the prognostic effect of ADC on the 5‐year overall survival (OS).ResultsWe identified 1611 (9.8%) patients with ADC and 14 894 (90.2%) patients with SCC. Compared with SCC, ADC was significantly associated with an increased risk of death (odds ratio [OR] 1.40, 95% CI 1.12–1.74) and disease progression (OR 1.34, 95% CI 1.14–1.57). ADC had a greater propensity for lymph node metastasis, uterine corpus invasion, perineural invasion, and ovarian metastases than SCC (P < 0.05). After 1:2 PSM, significant differences were still observed between these two histology subtypes (OS: OR 1.43, 95% CI 1.10–1.86; DFS: OR 1.45, 95% CI 1.19–1.76). The subgroup analysis further showed a worse prognosis for patients with ADC than for patients with SCC among patients with any of the high‐ or intermediate‐ risk factors (OR 1.60, 95% CI 1.21–2.12), but no significant differences were observed for the patients with no risk factors (OR 0.71, 95% CI 0.32–1.58).ConclusionADC is an independent prognostic factor for shorter survival in surgically treated patients with cervical cancer presenting intermediate‐ or high‐risk factors but does not affect survival outcomes in patients without any risk factors.

Recurrent ovarian cancer in Africa: Rate and associated factors at a gynecologic oncology treatment center in Ethiopia—A cross‐sectional study

AbstractObjectiveTo determine the recurrence rate of epithelial ovarian cancer (EOC) and associated factors in an Ethiopian tertiary setting.MethodsA cross‐sectional study was conducted on recurrent ovarian cancer at St. Paul's College Millennium Medical College (Ethiopia). Data were collected through chart review using a structured questionnaire. SPSS version 26 was used to analyze the data. Descriptive analysis, bivariate, and multivariate regression analysis were performed as appropriate. Percentages, frequencies, odds ratio with 95% confidence interval (CI) were used to present the results' significance.ResultsA total of 202 patients with EOC were reviewed. The recurrence rate of ovarian cancer (OC) among these patients was 86.1% (a total of 173 patients developed recurrent disease). The commonest site of recurrence was the pelvis (89.1%, 180/202) and the majority of patients with recurrence were platinum sensitive, accounting for 63.8% (129/202) of cases. Age ≥40 years (adjusted odds ratio [AOR], 23.3, CI: 4.3–31.5), macroscopic residual disease (AOR, 5.2, CI: 1.96–17.68), and FIGO Stage III/IV (AOR, 22.11, CI: 8.3–39.13) were associated with recurrence.ConclusionThe recurrence rate of OC in this study was higher than previous reports. Advanced age at first presentation, extent of residual disease after surgery, and FIGO Stage III and IV disease were associated with disease recurrence.

Stage distribution and prognostic accuracy of the 2023 FIGO (the International Federation of Gynecology & Obstetrics) staging system for endometrial cancer: A retrospective cohort study

AbstractObjectiveTo assess the stage distribution and stage‐related disease‐specific survival rates for endometrial cancer using the FIGO (the International Federation of Gynecology & Obstetrics) 2009 and 2023 staging systems. Further, we sought to evaluate the prognostic utility of additional covariates beyond the FIGO 2023 stage.MethodsEndometrial carcinomas were molecularly classified by the Proactive Molecular Risk Classifier for Endometrial Cancer and staged according to FIGO 2009 and 2023 criteria. Disease‐specific survival was calculated as the time from surgery to death from endometrial cancer.ResultsData from 604 patients were analyzed. Median follow‐up time was 81 months. A total of 118 stage shifts (19.5%) occurred between the FIGO 2009 and FIGO 2023 systems, with upshifts accounting for 107 (90.7%) of these changes. Within the FIGO 2023 system, molecular classification resulted in restaging of 69 patients (11.4%). Shifts that could alter adjuvant therapy decisions were identified in 23 patients (3.8%). The FIGO 2023 system effectively categorized endometrial cancers into prognostic subgroups. The FIGO 2023 stage, tumor size, positive peritoneal cytology, and mismatch repair deficiency were associated with disease‐specific survival in a multivariable analysis, whereas age and adjuvant therapy were not.ConclusionThe FIGO 2023 staging system for endometrial cancer appears highly prognostic. Prognostic assessment of the patients can be further enhanced by readily accessible covariates. A stage shift between the FIGO 2009 and 2023 systems occurs in about one‐fifth of patients. The implementation of molecular classification within the FIGO 2023 system bears implications for decisions regarding adjuvant therapy.

A nomogram for predicting overall survival in patients with endometrial carcinoma: A SEER‐based study

AbstractObjectiveTo construct and validate a nomogram for patients with endometrial carcinoma to predict the 3‐ and 5‐year overall survival (OS) based on the Surveillance, Epidemiology, and End Results (SEER) database.MethodsDemographic and clinical pathologic characteristics of patients with endometrial carcinoma diagnosed between 1973 and 2015 were extracted from the SEER database. Univariate and multivariate Cox analyses were carried out to identify the independent characteristics and further included into the construction of a nomogram. Finally, concordance index and calibration curves were used to validate the nomogram.ResultsA total of 49 844 patients were enrolled into our analysis. The results of univariate Cox analysis showed that age, race, marital status, FIGO Stage, grade, and metastatic status to bone, brain, lung, or liver were significant factors. Multivariate Cox analysis was performed and it confirmed all factors as independent variables. Next, a nomogram was constructed using these independent variables in prediction of the 3‐ and 5‐year OS. Furthermore, results with concordance indices (0.852 in training set and 0.861 in validation set) and calibration curves closer to ideal curves indicated the accurate predictive ability of this nomogram.ConclusionsThe individualized nomogram demonstrated a good ability in prognostic prediction for patients with endometrial carcinoma.

Asymptomatic endometrial cancer with Lynch syndrome; in a woman with primary infertility—A case report and literature review

Abstract Lynch syndrome, also called hereditary non‐polyposis colorectal cancer, is an autosomal dominant disorder characterized by germline pathogenic mutations in DNA mismatch repair genes—resulting in increased susceptibility to colorectal, endometrial, and other tumors. This case report presents an incidental finding of endometrial cancer with Lynch syndrome during investigation for primary infertility. A 34‐year‐old woman presented to the fertility clinic with unexplained primary infertility. Investigations showed possible endometrial polyp, 13 × 11 mm in size. Hysteroscopic polypectomy and endometrial biopsy revealed complex endometrial hyperplasia amounting to endometroid adenocarcinoma. The case was discussed at the West of Scotland Gynecology‐Oncology MDT meeting—management options including fertility‐sparing treatment or radical surgery were presented to the patient and she opted for the latter. A total laparoscopic hysterectomy with bilateral salpingo‐oophorectomy was performed with pathology results consistent with well‐differentiated endometroid adenocarcinoma Stage 1A. Peritoneal washings showed no malignant cells. Genetic testing confirmed a diagnosis of Lynch syndrome. On further questioning, it was revealed that the patient had a strong family history of colon cancer but had not previously met the criteria for genetic testing. She was referred to colorectal surgeons and underwent colonoscopy. This showed no abnormality; she was therefore scheduled for 2‐yearly colonoscopic surveillance.

High prevalence of “non‐pathogenic” POLE mutation with poor prognosis in a cohort of endometrial cancer from South India

AbstractObjectiveThe Cancer Genome Atlas (TCGA) project identified favorable prognosis regarding the ultra‐mutated endometrial cancer (EC) subtype linked to polymerase epsilon gene (POLE) mutations. This study investigated POLE mutations in EC of Indian patients.MethodsThis retrospective analytical study was conducted between January 2016 and January 2023 at the Government Medical College, Kozhikode, and the MVR Cancer Center, Kozhikode, Kerala. Sanger sequencing of POLE gene exons 9 and 13 in 151 EC patients was carried out to analyze the relationship between mutations and epidemiological factors, clinicopathologic features, and treatment outcomes.ResultsAmong 151 cases enrolled, 39 were unique POLE‐mutated cases. Significant associations were high‐grade tumors, myometrial invasion >50%, and Lymph‐vascular space invasion (LVSI). The median follow‐up was 40 months (95% confidence interval [CI], 34–46). A lower mean disease‐specific survival (DSS) of 51.7 months (95% CI, 43.7–59.6) was noted in the POLE‐mutated group compared with 72.11 months (95% CI, 67.60–76.62) for the POLE wild‐type. A statistically significant hazard ratio (HR) of 2.683 for DSS in the POLE‐mutated group was noted. In advanced stages (FIGO stages II–IV), a nine‐fold HR for DSS and overall survival (OS) compared with POLE wild‐type was identified. After controlling for treatment effects using Cox proportional HR, advanced‐stage POLE‐mutated tumors had a significantly higher HR of 8.67 for DSS compared with POLE‐wild‐type tumors of the same stage.ConclusionThis study identified a unique set of POLE mutations in Indian EC patients associated with poor prognosis, which were particularly pronounced in advanced stages. Advanced stage of presentation, type of POLE mutations, and possibly ethnicity are predictors of adverse outcomes in POLE‐mutated EC. The present study highlights ethnicity as a determinant of phenotypic expression of genetic change.

The association between endometrial cancer and subsequent diabetic retinopathy severity: A retrospective nationwide study

AbstractObjectiveThe endometrial cancer is a disorder with elevated oxidative stress. The high oxidative stress resulting from hyperglycemia can lead to diabetic retinopathy (DR) development which is a complication of type 2 diabetes mellitus. Accordingly, we aim to evaluate the potential relationship between the endometrial cancer and following DR development.MethodsA retrospective cohort study was conducted using the National Health Insurance Research Database (NHIRD) of Taiwan. Individuals diagnosed with endometrial cancer were matched to the non‐endometrial cancer patients in a 1:4 ratio. The major outcomes are the presence of DR, diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) according to diagnostic codes. Cox proportional hazard regression was used to show the adjusted hazard ratio (aHR) with 95% confidence interval (CI) of major outcomes between groups.ResultsThere were 99 (2.3%), 20 (0.5%), and 14 (0.3%) cases with DR, DME and PDR in the endometrial cancer group, respectively. Another 303 (1.8%), 35 (0.2%), and 27 (0.2%) with DR, DME and PDR were observed in the control group, respectively. The endometrial cancer group revealed a significantly higher incidence of DR compared with the control group (aHR 1.51, 95% CI 1.20–1.90, P < 0.001). The cumulative probability of DR was also higher in the endometrial cancer group than in the control group (P < 0.001). The relationship between endometrial cancer and DR was significantly higher in patients aged over 70 years (P = 0.008). In addition, a higher incidence of DR was found during the first 5 years after the endometrial cancer diagnosis (P < 0.001).ConclusionsThe endometrial cancer correlates to a higher incidence of subsequent DR, especially within first 5 years of endometrial cancer diagnosis.

Role of tumor volume in endometrial cancer: An imaging analysis and prognosis significance

AbstractObjectiveTo evaluate the prognostic value of tumor volume on preoperative MRI in endometrial cancer (EC) patients and its association with adverse prognostic factors and survival.MethodsA retrospective observational study with 127 consecutive patients with endometrioid EC was carried out between 2016 and 2021 at Juan Ramón Jiménez University Hospital, Huelva (Spain). All patients underwent preoperative magnetic resonance imaging (MRI) for local staging. The tumor volume was analyzed on MRI by two different methods: by measuring the three maximum diameters of the tumor according to an ellipse formula and by manual region of interest in different sections; the ratio between tumor volume and uterus volume was also calculated as a third tool. The relationships between volume, prognostic factors, and survival were analyzed.ResultsA total of 127 patients with endometroid EC underwent preoperative MRI and were included in the study. Tumor volume was significantly higher for deep myometrial invasion, cervical stromal involvement, infiltrated serosa, lymph node metastases, high‐grade EC, and lymphovascular space involvement, advanced FIGO stage, and High Recurrence Risk Group (P < 0.001). ROC curves showed that tumor volume greater than 25 cm3 predicts lymph node metastases. Volume index greater than 17 cm3 was associated with reduced disease‐free survival (P < 0.001) and overall survival (P < 0.003). Multivariate analysis showed that the greatest tumor volume had an independent impact on recurrence (odds ratio [OR]1.019, 95% confidence interval [CI] 1.005–1.032) and survival (OR 1.027, 95% CI 1.009–1.046).ConclusionsThis study shows an important correlation between tumor volume on MRI and poor prognostic factors. Preoperative tumor volume on MRI is a valuable biomarker to be considered for management of EC.

Worldwide barriers of optimal surgical care provision in advanced ovarian cancer

AbstractOvarian cancer (OC) remains one of the most challenging gynecological malignancies to cure, despite recent advances in treatment. Disparities in the diagnosis, management, and survival of OC exist worldwide and addressing them remains an ongoing challenge. The highest burden of OC is projected to be in women living in low‐ and middle‐income countries, where mortality rates are also disproportionately higher. Maximal effort cytoreduction paired with maximal effort systemic therapy followed by maintenance therapies remain the cornerstones of treatment for OC. Disparities are twofold: first, due to challenges with systemic therapy; and second, due to variations in surgical care, especially for advanced disease. While the goals of surgery remain unchanged, the radicality of cytoreductive resections and variation in practices worldwide have increased. The provision of surgical care for OC patients faces numerous challenges broadly categorized into three main areas: health system barriers; patient‐related barriers; and physician‐related barriers. Health system challenges include the lack of centralized cancer care, scarcity of resources, and inadequate funding. Patient‐related obstacles include disparities in patient education, comorbidities, socioeconomic factors, and underrepresentation of certain ethnicities in clinical trials. Physician‐related barriers encompass suboptimal surgical training, limited access to educational resources, inconsistent adherence to guidelines, limited use of a multidisciplinary team and overall differences in philosophy, ethos, and surgical tradition. Addressing and overcoming these barriers is essential to ensure equitable access to high‐quality surgical care for OC patients worldwide. The aim of the present review was to further explore these global challenges while also highlighting potential strategies to reduce disparities in women's health care.

Response: Prevalence and risk factors for malignancy in hysteroscopy‐resected endometrial polyps

Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi‐institutional cohort study

AbstractObjectiveTraditionally, the prognosis of patients with FIGO stage I endometrial cancer is determined by clinicopathological risk factors. In this study, we assessed the potential contribution of pretreatment carcinoembryonic antigen (CEA) and carbohydrate antigen‐125 (CA‐125) levels to estimating the prognosis of these patients and aimed to develop and validate a prognostic nomogram.MethodsThis retrospective study included patients with FIGO stage I endometrial cancer who underwent treatment between January 2009 and December 2021 in the four institutes of Chang Gung Memorial Hospital. To identify optimal cutoff values of CEA and CA‐125 for predicting survival, receiver operating characteristic (ROC) curves were generated, the Kaplan–Meier method was used to estimate survival, and a Cox regression model was used to analyze the independent prognostic factors. Finally, a nomogram and calibration curve were constructed to predict patient survival probability.ResultsOf the 1559 patients evaluated, the optimal cutoff values of CEA and CA‐125 were 1.44 ng/mL (area under the ROC curve [AUC] 0.601) and 39.77 U/mL (AUC 0.503), respectively. Multivariate Cox regression analysis showed that pretreatment CEA (hazard ratio [HR] 2.11, 95% confidence interval [95% CI] 1.35–3.28), CA‐125 (HR 2.07, 95% CI 1.31–3.27), age >70 years (HR 12.54, 95% CI 5.05–31.11), myometrial invasion >50% (HR 1.69, 95% CI 1.03–2.73), non‐endometrioid histology (HR 1.83, 95% CI 1.14–2.95), high‐grade tumor (HR 2.41, 95% CI 1.46–3.97), and lymphovascular space invasion (HR 2.32, 95% CI 1.26–4.25) were significant variables associated with overall survival. These factors were used to construct the nomogram model, which showed good concordance and accuracy.ConclusionsIntegration of pretreatment CEA and CA‐125 in a prognostic nomogram is feasible. Our prediction model has the potential to assist clinicians in guiding appropriate clinical practice.

Effect of time interval between surgery and the initiation of adjuvant therapy on the oncologic outcomes of early‐stage endometrial cancer

AbstractObjectiveTo identify the impact of time interval between surgery and initial adjuvant radiotherapy on oncologic outcomes in early‐stage endometrial cancer.MethodsThis retrospective cohort study included patients with stage I/II endometrial cancer who underwent surgical staging and adjuvant therapy at Songklanagarind Hospital from January 1, 2007, to December 31, 2017. Patients were categorized into two groups: TI <6 weeks and TI ≥6 weeks. The effects of TI and clinicopathological factors on recurrence‐free survival (RFS) and overall survival (OS) were analyzed using Cox proportional‐hazards regression.ResultsIn total, 177 patients were enrolled, with 52% receiving adjuvant radiotherapy at <6 weeks (overall median TI 5.7 weeks). The recurrence and death rates were 13% and 10.2%, respectively. The median follow‐up time was 46.6 months. The overall 3‐year RFS and OS rates were 88.2% and 85.2%, respectively. The TI significantly affected the 3‐year RFS (94.4% vs 81.2%; P = 0.008) and 3‐year OS (95.5% vs 83.2%; P = 0.012) in patients with TI <6 and ≥6 weeks, respectively. In multivariate analysis, the depth of myometrial invasion (MI), presence of lymphovascular space invasion, and TI were independent prognostic factors for both RFS and OS. Delaying the TI (≥6 weeks) was significantly associated with a worse RFS (hazard ratio [HR] 3.70; 95% confidence interval [CI]: 1.34–10.22; P = 0.012) and an inferior OS (HR 3.80; 95% CI: 1.23–11.69; P = 0.02).ConclusionA delay in the TI between surgery and the initiation of adjuvant radiotherapy of ≥6 weeks negatively affected the oncologic outcomes in early‐stage endometrial cancer.

Cancer of the corpus uteri: A 2025 update

AbstractEndometrial cancer comprises a heterogeneous group of neoplasms. Its incidence is increasing, as is mortality from endometrial cancer. This article updates many aspects surrounding endometrial cancer, covering histopathology, staging, surgical and non‐surgical management, follow‐up, and management of recurrent disease.

Integration of sentinel node mapping and molecular classification in endometrial cancer staging

Abstract Sentinel node mapping has gained popularity in surgical staging of endometrial cancer, providing a less invasive alternative to lymphadenectomy for staging purpose. Recent advances in molecular classification have deepened our understanding of endometrial cancer, leading to more personalized approaches in diagnosis and treatment. This review examined the interaction between sentinel node mapping and molecular classification in endometrial cancer, emphasizing the clinical implications. Surrogate molecular classification identified four distinct subtypes, each with different patterns of lymphatic spread and metastatic potential, overcoming the Bokhman's historic dualistic classification in type I (endometrioid) and type II (non‐endometrioid) endometrial cancer. Accumulating evidence supported that integrating molecular subtypes with sentinel node mapping, would improve the accuracy of lymph node staging, allowing for more tailored therapeutic strategies. The potential for artificial intelligence and machine learning to analyze molecular signatures in real‐time may further refine mapping accuracy and enable more individualized treatment plans. The development of novel molecular tracers and targeted therapies for sentinel node biopsy promises to enhance precision and minimize unnecessary lymphadenectomy. The aim of this review was to explore current methodologies, challenges, and future directions, highlighting the increasing role of molecular tools in sentinel node mapping and the personalized management of endometrial cancer.

Re‐evaluating prognostic indicators: The critical role of body composition and gene expression in endometrial cancer outcomes

AbstractObjectiveTo investigate the impact of body mass index (BMI), body composition (BC), and the expression of genes linked to obesity or lipid metabolism on the prognosis of endometrial cancer.MethodsWe conducted a comprehensive review of patients with confirmed endometrial cancer treated at the Pontificia Universidad Católica de Chile (PUC) and analyzed publicly available data from the endometrial cancer TCGA‐UCEC cohort. BC was assessed using computed tomography (CT) scans, and gene expression analysis was performed using RNA‐seq data. We evaluated the associations between BMI, BC, gene expression, and patient outcomes, including overall survival (OS) and progression‐free survival (PFS).ResultsOur study included 127 patients (67 from PUC and 60 from TCGA‐UCEC). BMI was not significantly associated with OS or PFS. However, BC metrics such as visceral adiposity and muscle mass were critical determinants of prognosis. We identified a 30‐gene risk score significantly associated with poorer PFS and OS, independent of other factors. Analysis of the tumor microenvironment (TME) revealed significant differences in immune cell composition and functional states between high‐ and low‐risk groups.ConclusionBMI alone is not a significant prognostic factor in endometrial cancer. Comprehensive assessments of BC, gene expression profiles, and the TME provide more accurate prognostic information and highlight potential therapeutic targets. These findings advocate for a shift towards personalized medicine, incorporating detailed phenotyping and molecular profiling to improve patient outcomes.

Prognostic significance of lymph node ratio in patients with endometrial cancer: A systematic review and meta‐analysis

AbstractBackgroundThe ratio of harvested lymph nodes to the number of metastatic nodes is known as the lymph node ratio (LNR) and its prognostic significance was investigated in many types of cancer.ObjectivesHowever, until now, the therapeutic role of lymphadenectomy in the management of endometrial cancer (EC) has remained controversial.Search StrategyThe search strategy involved the Medline, Scopus, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases.Selection CriteriaWe included prospective and retrospective observational studies.Data Collection and AnalysisThe current systematic review includes seven studies with a total of 6050 patients. From Cox regression analyses, pooled hazard ratios (HRs) were obtained to reduce the confounding effect of other factors that affect the survival outcomes.Main ResultsThe meta‐analysis revealed a significant difference in progression‐free survival in patients with LNR below the cut‐off point in comparison to individuals with LNR above the cut‐off point (HR 2.06, 95% CI 1.57–2.71, data from 6 studies). Similarly, a significantly smaller overall survival was observed among patients with LNR above the cut‐off value (HR 1.99, 95% CI 1.53–2.60; data from five studies).ConclusionsThe results of this systematic review provide strong evidence that LNR could be a prognostic factor for EC patients regarding the need for adjuvant therapy and survival rate. Further studies should focus on the specific cut‐off levels of LNR and the role of the molecular markers in assessing the prognosis of EC patients.

Meta‐analysis of the ability of mutational profiles on the cancer genome atlas to predict prognosis in endometrial carcinoma

AbstractBackgroundIn 2013, The Cancer Genome Atlas Research Network suggested that endometrial carcinoma patients may be reclassified into four molecular prognostic groups.ObjectiveTo compare survival of endometrial carcinoma patients with different mutational profiles.Search StrategyStudies reporting survival of endometrial carcinoma patients were identified through systematic searches of four databases.Selection CriteriaWe included relevant studies based on the literature type, data integrity and the methodological quality.Data Collection and AnalysisThe pooled survival data were compared among patients with different mutational profiles. Heterogeneity in the pooled data was assessed using the I2 statistic.Main ResultsData were meta‐analyzed from nine studies involving 4755 patients, who were classified into the following mutational profiles: p53abn, 745 patients (15.6%); MMRd, 1454 patients (30.6%); POLEmut, 351 patients (7.4%); and p53wt, 2205 patients (46.4%). Compared to the p53wt group, the p53abn group showed significantly worse overall survival (OS) (HR 2.31, 95% CI: 1.67–3.19), progression‐free survival (PFS) (HR 2.86, 95% CI: 1.45–5.64) and disease‐specific survival (HR 2.60, 95% CI: 1.41–4.79); and the MMRd group showed significantly worse OS (HR 1.30, 95% CI: 1.11–1.53) and PFS (HR 1.27, 95% CI: 1.01–1.59). The POLEmut group, in contrast, showed similar survival as the p53wt group.ConclusionsThe four mutational profiles for patients with endometrial carcinoma in the Cancer Genome Atlas for Endometrial Cancer are associated with worse to better survival in the trend: p53abn < MMRd < POLEmut ≈ p53wt. Mutational profiling may be useful for stratifying endometrial carcinoma patients by survival risk, which in turn may improve their management.

Letter to the editor—The new FIGO staging system for endometrial cancer: Is the paradigm shift clinically feasible?

Letter to the Editor: 2023 FIGO staging system for endometrial cancer

The accuracy of DNA methylation detection in endometrial cancer screening: A systematic review and meta‐analysis

AbstractObjectiveDNA methylation is the hallmark of early endometrial cancer and can be detected through non‐invasive methods. The present study systematically reviewed the efficacy of DNA methylation detection for endometrial cancer screening through exfoliative cytology.MethodsA systematic literature review was performed through the following databases from inception to October 7, 2024: PubMed, Embase, and the Cochrane Library. Studies on DNA methylation detection for endometrial cancer screening through exfoliative cytology were included. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The relevant variables included cytologic sample type, methylated genes, and marker performance (i.e., AUC value, sensitivity, specificity, and the corresponding 95% confidence interval [CI]), as well as the bias risk assessment according to the Cochrane Collaboration tool (Cochrane Intervention Systematic Review Guide 5.1.0).ResultsA total of 31 genes were selected from 20 studies as methylation markers for endometrial cancer detection in cytologic specimens. A total of 19 methylation markers for endometrial cancer detection with an area under the curve value from 0.80 to 0.97 were selected from 10 studies.ConclusionCytology‐based DNA methylation markers are feasible and accurate non‐invasive methods for the early detection of endometrial cancer screening in high‐risk populations.

Preoperative hysteroscopy shortened progression‐free survival in advanced FIGO stage in endometrial cancer: Ten year analysis

AbstractObjectiveTo investigate the impact of preoperative hysteroscopy on progression‐free survival (PFS) and disease‐specific survival (DFS), and to explore the factors which contribute to poor clinical outcomes between hysteroscopy and dilation and curettage (D&C) in endometrial cancer (EC).MethodsA retrospective study was designed by collecting data from women diagnosed with EC through hysteroscopy or D&C from January 2010 to December 2019 in a tertiary hospital in China. A propensity score was used for 1:1 matching of advanced stage patients. Univariate and multivariate analysis were conducted to determine whether hysteroscopy was a prognostic factor in EC and to identify factors associated with its impact on PFS and DFS in different subgroups.ResultsOverall, 543 and 272 women who underwent D&C and hysteroscopy, respectively were included. Compared to D&C, preoperative hysteroscopy was related to reduced PFS and DFS, with a hazard ratio (HR) of 1.904 and 3.905, respectively. Hysteroscopy contributed to an increased risk of positive wash cytology (48.27% vs 24.13%), recurrence (48.28% vs 20.69%) and shorter PFS after matching in FIGO Stage I–IV EC, while there was no significance in positive ascites cytology (14.04% vs 13.45%), PFS and DFS in FIGO Stage I EC.ConclusionsHysteroscopy was an independent predictive factor for poor prognosis in EC. Hysteroscopy appeared to be a safe diagnostic method as D&C in FIGO Stage I EC but was a risk factor for increased recurrence and reduced PFS in advanced stage disease. Its impact on DFS is uncertain.

Does repetitive dilatation and curettage or hysteroscopic biopsy in patients treated with progestins for endometrial hyperplasia or carcinoma affect subsequent fetomaternal outcomes? A population‐based study using the National Health Insurance Research Database of Taiwan

AbstractObjectiveTo investigate the impact of repeated dilatation and curettage or hysteroscopic biopsy on fetomaternal outcomes in patients receiving progestin treatment for endometrial hyperplasia or early‐stage carcinoma.MethodThis was a population‐based study using the Taiwan National Health Insurance Research Database between 2009 and 2017 of women who gave birth and had a history of endometrial hyperplasia and early‐stage carcinoma treated with progestins. Logistic regression analysis was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) reflecting the association between repeated procedures and fetomaternal outcomes.ResultsA total of 6956 women with 8690 deliveries were identified. Compared with those who had two or fewer procedures, women who received more than two procedures had a significantly higher risk for cervical insufficiency (aOR, 5.09 [95 CI, 2.31–11.24]). Furthermore, women who had more than two procedures were prone to have adverse neonatal outcomes, including Apgar score < 7 at 1 min (aOR, 1.97 [95% CI, 1.13–3.43]) and 5 min (aOR, 3.11 [95% CI, 1.33–7.23]) and preterm delivery <32 weeks (aOR, 2.86 [95% CI, 1.50–5.45]).ConclusionUndergoing more than two procedures was associated with subsequent maternal cervical insufficiency, preterm delivery <32 weeks, and low neonatal Apgar score. Health care providers should be aware of the potential risks and balance the benefits and harms of repeated procedures.

Triglyceride‐glucose index (TyG index) and endometrial carcinoma risk: A retrospective cohort study

AbstractObjectiveWe analyzed the association between the triglyceride‐glucose index (TyG index) and incident endometrial carcinogenesis, aiming to determine whether the TyG index is a promising predictive biomarker for endometrial carcinoma (EC).MethodsIn this retrospective cohort study, multiple logistic regression analysis was performed to evaluate the relationship between TyG index and EC incidence and progression. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC), as well as the cut‐off value of the TyG index for EC incidence.ResultsThe TyG index was significantly higher in patients with EC or endometrial atypical hyperplasia (EAH) than in those with normal endometrium (P < 0.001). A continuous rise was observed in the incidence of EC and EAH among the tertiles of the TyG index (P < 0.001). The multiple logistic regression analysis revealed that the TyG index was associated with EC and EAH risk after adjusting for potential confounding factors (EAH: odds ratio [OR] 2.54, 95% confidence interval [CI] 1.33–4.85, P = 0.005; EC: OR 2.65, 95% CI 1.60–4.41, P < 0.001). Moreover, high TyG index was positively associated with advanced pathological stage (OR 2.14, 95% CI 1.32–3.47, P = 0.002) and poorer differentiation (OR 2.53, 95% CI 1.36–4.72, P = 0.004).ConclusionThe TyG index might be a promising biomarker for endometrial carcinogenesis. Subjects with a higher TyG index should be aware of the risk of EC incidence and progression.

Depot medroxyprogesterone acetate and endometrial cancer: A multicenter case–control study

AbstractObjectiveTo assess the associations between depot medroxyprogesterone acetate (DMPA) and endometrial cancer.MethodsThis multicenter case–control study was conducted among tertiary hospitals in Thailand. Patients were women with endometrial cancer. Controls were women admitted for other conditions, matched for age within 5 years of the patients' age. The controls had to have no abnormal vaginal bleeding, history of hysterectomy, or cancers of the other organs. A standardized questionnaire was used to gather information. Conditional logistic regression was applied to calculate adjusted odds ratio (aORs) and 95% confidence intervals (CIs).ResultsDuring 2015 to 2021, 378 patients and 1134 controls were included. Ever use of DMPA was associated with a 70% decreased overall risk of endometrial cancer (aOR, 0.30 [95% CI, 0.21–0.42]). Endometrial cancer risk declined by 3% (aOR, 0.97 [95% CI, 0.96–0.98]) for every 3 months of DMPA use. The magnitude of the decline in endometrial cancer risk did not vary appreciably by cancer subtypes (aOR, 0.26 [95% CI, 0.17–0.41] and 0.38 [95% CI, 0.22–0.65] for low‐grade and high‐grade tumors, respectively).ConclusionsDepot medroxyprogesterone acetate use was inversely associated with endometrial cancer risk in a duration‐dependent manner. This association was independent of cancer subtype.

Endometrial cancer risk with menopausal hormone therapy: Health Insurance Database in South Korea‐based cohort study

AbstractObjectiveTo determine the risk of endometrial cancer according to the types of menopausal hormones used.MethodsThis retrospective cohort study recruited postmenopausal women older than 40 years from 2003 to 2011, utilizing data from the Korean national health insurance system from 2002 to 2019. The menopausal hormone therapy (MHT) group consisted of women who had been prescribed MHT for greater than 6 months between 2003 and 2011. The non‐MHT group consisted of women who had never used menopausal hormones between 2003 and 2011.ResultsA non‐MHT group of 1 000 550 women and a MHT group of 353 025 women were chosen. In comparison to never‐users, the risk of endometrial cancer was not higher in women who reported last using tibolone (adjusted hazard ratio [aHR] 1.08, 95% confidence interval [CI] 0.96–1.2), combined estrogen plus progestin by the manufacturer (aHR 0.83, 0.72–0.96), combined estrogen plus progestin by the physician (aHR 0.88, 0.7–1.12), and transdermal estrogen (aHR 1.13, 0.36–3.52).ConclusionsTibolone, combined estrogen plus progestin by the physician, and transdermal estrogen do not affect the risk of endometrial cancer. The combination of estrogen plus progestin by the manufacturer decreases the risk of endometrial cancer.

Letter to the editor: Prevalence and risk factors for malignancy in hysteroscopy‐resected endometrial polyps

Seven‐year survival analysis in women with unsuspected uterine malignancy after laparotomic versus laparoscopic hysterectomy: A national claim data retrospective cohort study

AbstractObjectiveThe primary aim was to compare the overall survival of women with unsuspected uterine malignancy (UUM) diagnosed after laparotomic versus laparoscopic hysterectomy for benign gynecologic diseases. The secondary aim was to evaluate the incidence of UUM.MethodsA national health insurance database was analyzed from 2006 to 2010.ResultsFrom the database (24 million women annually), 157 232 women who received hysterectomy for benign diseases were extracted. These women were divided into a laparotomic group (n = 103 631) and a laparoscopic group (n = 53 601). The overall incidences of UUM, unsuspected endometrial cancer, and unsuspected uterine malignancy other than endometrial cancer (UUMOEC) were 0.66%, 0.46%, and 0.19%, respectively. Kaplan–Meier survival analysis and Cox regression analysis showed that the laparoscopic group was associated with more favorable overall survival than the laparotomic group, especially in UUMOEC (P < 0.001).ConclusionIn women with UUM diagnosed after hysterectomy for benign diseases, overall survival up to 7 years favors laparoscopy over laparotomy, especially in UUMOEC and the incidence of UUM is relatively low. However, considering the devastating effect of intraperitoneal dissemination of UUM, surgeons should fully explain this issue to patients preoperatively and try to avoid intraperitoneal spread of tumor cells intraoperatively.

OPEC study: An international multicenter study of ovarian preservation in endometrial cancers

AbstractObjectiveTo evaluate the feasibility and oncological safety of ovarian preservation in early stage endometrial adenocarcinoma (EC) patients aged 40 and below.MethodsA total of 11 institutions from eight countries participated in the study. 169 of 5898 patients aged ≤40 years were eligible for the study. Patients with EC treated between March 2007 and January 2019 were retrospectively assessed.ResultsThe median duration of follow‐up after EC diagnosis was 59 months (4–187). Among 169 participants, ovarian preservation surgery (OPS) was performed in 54 (31.9%), and BSO was performed in 115 (68.1%) patients. Although patients younger than 30 years of age were more likely to have OPS than patients aged 30 to 40 years (20.4% vs. 9.6%, P = 0.021), there was no significant difference by the mean age. There were no other relevant baseline differences between OPS and BSO groups. The Kaplan–Meier analysis revealed no difference in either the overall survival (P = 0.955) or recurrence‐free survival (P = 0.068) among patients who underwent OPS, and BSO.ConclusionOPS appears to be safe without having any adverse impact on survival in women aged ≤40 years with FIGO Stage I EC.

Oncologic outcomes of conservative treatment of atypical polypoid adenomyoma of the uterus: A two‐center experience

AbstractObjectiveAtypical polypoid adenomyoma (APA) is a rare uterine premalignant lesion mainly occurring in premenopausal and nulliparous women. Although hysteroscopic resection (HR) has showed promising results, the conservative management of APA in young women is not standardized, and few data are available in the literature. We aimed to assess oncologic outcomes of the conservative treatment of APA.MethodsA multicenter observational retrospective cohort study was performed including all patients with APA who underwent conservative treatment from January 2006 to June 2020. Rates of each oncologic outcome (i.e. initial complete response, persistence, progression to cancer, recurrence, long‐term treatment success, and treatment failure) were calculated for all conservative treatment together and separately.ResultsTwenty‐five patients were included. Conservative treatments consisted of HR alone (n = 14) and HR + progestin (n = 11). Overall, 24 (96%) patients showed initial complete response, of which 21 (84%) showed long‐term treatment success; four (16%) patients had progression to cancer, of which two (8%) first recurred as APA. Long‐term treatment success was achieved in 13 of 14 (92.9%) patients with HR alone and 8 of 11 (72.3%) with HR + progestin.ConclusionConservative treatment appears to be a safe option in women with APA. The four‐steps HR might be considered as the first‐line conservative approach, while the addition of progestin does not seem to improve oncologic outcomes. However, the risk of progression to cancer highlights the need for a close and long‐term follow up with ultrasonography and hysteroscopic biopsies, and for hysterectomy in patients not desiring pregnancy.

Prospective study of fertility‐sparing treatment with chlormadinone acetate for endometrial carcinoma and atypical hyperplasia in young women

AbstractObjectiveTo confirm that the efficiency of the use of chlormadinone acetate for 6 months to obtain remission of atypical hyperplasia or endometrial carcinoma is comparable to that of the use of other fertility‐sparing treatments.MethodThe present study is based on the PREFERE prospective registry. All the patients received 3 or 6 months of chlormadinone acetate and were evaluated by hysteroscopic resection and pipelle sampling every 3 months.ResultsNinety‐four patients were included. Seventy‐nine patients achieved complete remission at 6 months (84%). No patients stopped treatment because of a lack of tolerance. Twenty‐four per cent of the patients achieved a live birth.ConclusionChlormadinone acetate is an effective and well‐tolerated fertility‐sparing treatment. Its benefits over other progestins are its tolerability, and its absence of contraindications, which make it a good choice for patients with thromboembolism and high vascular risk.

First case of intracaval recurrence of high‐grade endometrial stromal sarcoma: A case report

SynopsisThe present study reports the first case of high‐grade endometrial stromal sarcoma which occurred as tumor thrombus in the inferior vena cava. It was detected by chance during lymphadenectomy and radically resected.

Comparison of preoperative serum neopterin, periostin, indoleamine 2,3‐dioxygenase, YKL‐40, and tenascin‐C levels with current tumor markers for early‐stage endometrial cancer

AbstractObjectiveTo compare the predictive value of serum levels of neopterin, periostin, YKL‐40, tenascin‐C (TNC), and indoleamine 2,3‐dioxygenase (IDO) with current tumor markers for the primary diagnosis of early‐stage endometrial cancer.MethodsA prospective cross‐sectional study was conducted between January 2020 and November 2020. A total of 59 patients (38 women newly diagnosed with early‐stage endometrial cancer [study group] and 21 women with benign endometrial pathologies [control group]) were enrolled. Blood samples were collected prior to surgery and underwent immunoassay analysis.ResultsCarcinoembryonic antigen (CEA), periostin, and IDO levels were significantly higher in the study group than the control group (P = 0.008, P = 0.034, and P = 0.003, respectively). Receiver operating characteristic curve analysis revealed that IDO, periostin, and CEA were good predictors of early‐stage endometrial cancer (AUC = 0.733, 95% CI, 0.602–0.840, P < 0.002; AUC = 0.668, 95% CI, 0.533–0.785, P = 0.018; and AUC = 0.709, 95% CI, 0.576–0.820, P = 0.002, respectively). Correlation analysis revealed no significant correlation of any biomarker with age or body mass index in either the control or study group.ConclusionSerum CEA, periostin, and IDO levels were significantly higher in women with endometrial cancer than in those without cancer. These results may help identify new markers for diagnosing endometrial cancer.

Prevalence and risk factors for malignancy in hysteroscopy‐resected endometrial polyps

AbstractIntroductionTo determine the prevalence of malignant lesions in endometrial polyps by hysteroscopic polypectomy, and risk factors for malignant transformation. The secondary aim was to evaluate background endometrium of atypical hyperplasia in endometrial polyps, and the risk of coexisting endometrial carcinoma after hysterectomy.MethodsThis retrospective study included women who underwent hysteroscopic polypectomy between January 2015 and December 2019. Demographic characteristics, hysteroscopic findings, and histopathology results of the polyp and the uterus, in the case of a hysterectomy, were collected.ResultsIn all, 946 women were included in the study. Endometrial carcinoma in a polyp was found in 10 women (1.06%), and atypical hyperplasia was found in 11 women (1.16%). At the multivariate logistic regression model of risk factors, old age (P = 0.022) and obesity (P = 0.011) were significantly associated with (pre‐)malignant polyp. Five of the ten women (50%) with atypical hyperplasia confined to a polyp had coexisting endometrial carcinoma in the hysterectomy specimen.ConclusionWomen with risk factors should be offered hysteroscopic polypectomy to allow a reliable histologic evaluation. Furthermore, hysterectomy is recommended in women with atypical hyperplasia in endometrial polyps even after complete resection.

Intravenous leiomyomatosis: A case report and narrative literature review

Abstract In the present study, we report a case of intravenous leiomyomatosis with intracardiac extension. A subsequent extensive literature review was initiated in order to characterize this entity in terms of clinical manifestations, diagnosis and treatment strategies. We performed a literature search in PubMed, Webscience and Scopus using the MeSH term “intravenous leiomyomatosis” and included case reports, case series and retrospective studies published in the last 10 years. A total of 74 articles, with a total of 672 cases of intravenous leiomyomatosis were included. The average age at diagnosis was 45.5 years and 92% of the cases were reported in Asian countries. A total of 21% of the patients were asymptomatic. The most frequent symptoms included perception of pelvic mass, dyspnea, abnormal uterine bleeding and palpitations. In 55% of cases there was a preoperative suspicion of the diagnosis. In 61%, the lesion was confined to the pelvic cavity and in 35% there was extension beyond the renal veins (including intracardiac extension). When there was a preoperative diagnosis, the surgical team usually included elements from gynecology, vascular surgery and/or cardiac surgery. The treatment consisted of one‐stage surgery in 86% of cases, with complete resection in 90%. The recurrence rate was 12%. Intravenous leiomyomatosis can have a nonspecific presentation which, combined with its rarity, requires a high degree of suspicion. The challenges in its treatment and follow‐up arise from its surgical complexity and the absence of guidelines. The objective of this review was to compile the most recent cases reported to better characterize this rare entity thereby achieving optimal management.

Incorporation of pretreatment leukocytosis and thrombocytosis into the FIGO staging system for prognosis in surgically treated endometrial cancer

AbstractObjectiveTo investigate the impact of incorporating pretreatment leukocytosis and/or thrombocytosis in the FIGO staging system on prognostic prediction among women with surgically treated endometrial cancer.MethodsRetrospective review of clinical data from 900 women with endometrial cancer treated at Osaka University Hospital, Japan, between 2000 and 2016. The effect of concurrent leukocytosis and thrombocytosis on the prediction of recurrence and survival outcomes was evaluated via receiver operating characteristic (ROC) curve analysis and the Kaplan‐Meier method.ResultsAmong 678 women with Stage I–III disease, pretreatment leukocytosis or thrombocytosis alone were not prognostic indicators, but concurrent pretreatment leukocytosis and thrombocytosis was associated with significantly shorter survival (PFS, P<0.001; OS, P=0.004). In contrast, pretreatment leukocytosis, pretreatment thrombocytosis, and concurrent pretreatment leukocytosis and thrombocytosis did not provide any prognostic information for women with Stage IV disease. In ROC curve analysis, incorporation of concurrent pretreatment leukocytosis and thrombocytosis into the FIGO staging system resulted in a higher area under the curve for predicting recurrence for women with Stages I–III disease (0.770 vs 0.755; P=0.045).ConclusionIncorporating concurrent pretreatment leukocytosis and thrombocytosis into the FIGO staging system might improve predictive performance and allow additional risk stratification for women with Stage I–III endometrial cancer.

Genetic profile of borderline ovarian tumors in the Lebanese population by whole‐exome sequencing

AbstractObjectiveTo assess the molecular profile of borderline ovarian tumors (BOT) in the Lebanese population by whole‐exome sequencing and to correlate the results with the patients' clinical profiles.MethodsWe included in this retrospective study 33 tumors belonging to 32 Lebanese women presenting with BOT, diagnosed at Hôtel Dieu de France. A total of 234 genes involved in different germinal and somatic types of cancer were analyzed using next‐generation sequencing.ResultsMolecular analysis of these tumors allowed us to detect mutations in genes involved in the mitogen‐activated protein kinase cascade in 57.58% of BOT and to identify variants affecting the DNA repair mechanism in 63.89% of samples. Furthermore, our initial analysis revealed an association between defects in DNA double‐strand break repair and the occurrence of mucinous BOT, in 75% of the cases.ConclusionThis study reports the molecular profiles of BOT in the Lebanese population and compares them to the literature. This is the first study associating the DNA repair pathway to BOT.

Value of robotic surgery in endometrial cancer by body mass index

AbstractObjectiveTo compare perioperative outcomes and complications in robotically assisted laparoscopy (RAL) and standard laparoscopy (SLP) approaches in the treatment of endometrial cancer by body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters).MethodsA comparative study was carried out of women treated for endometrial cancer at the Hospital Clinico San Carlos from January 2012 to December 2016: 133 patients were operated by RAL and 101 by SLP. Demographic characteristics of the patients, perioperative outcomes and complications were compared in both approaches.ResultsHospital stay was significantly lower in patients with BMI ≤30 operated with RAL (2 days RAL vs 4 days SLP; P=0.002). Estimated blood loss was significantly lower in the group with BMI<25 (60 mL RAL vs 100 mL SLP; P=0.004) and in the group with BMI ≥30 (87.5 mL RAL vs 180 SLP; P=0.003) operated with RAL. RAL significantly reduced the conversion rate in patients with BMI ≥30 (2 [3.4%] patients RAL vs 6 [27.3%] patients SLP; P=0.004).ConclusionsRAL has demonstrated advantages in treating obese women with endometrial cancer by reducing blood loss and conversion to laparotomy.

Para‐aortic lymphadenectomy did not improve overall survival among women with type I endometrial cancer

AbstractObjectiveTo compare outcomes and prognosis among women with type I endometrial cancer undergoing hysterectomy and bilateral salpingo‐oophorectomy (H‐BSO) with or without systematic pelvic lymphadenectomy (PLD) or para‐aortic lymphadenectomy (PALD).MethodsRetrospective review of women postoperatively diagnosed with type I endometrial cancer who underwent H‐BSO at a university hospital in Chengdu, China (January 2010 to June 2012). Women were divided into no lymphadenectomy (PLD−/PALD−), systematic pelvic lymphadenectomy (PLD+/PALD−), or combined pelvic and para‐aortic lymphadenectomy (PLD+/PALD+) groups. Follow‐up was by telephone. Postoperative outcomes and prognosis were compared and risk factors were analyzed.ResultsIn total, 333 women met the inclusion criteria: 121 underwent PLD+/PALD−, 166 underwent PLD+/PALD+, and 46 underwent PLD−/PALD−. There were no differences in pre‐operative characteristics among the groups (all P>0.05). The PLD+/PALD+ group had a higher laparotomy rate (P=0.001), the PLD−/PALD− group had shorter operation time (P=0.001) and lower blood loss (P<0.001). There were no differences between the PLD+/PALD− and PLD+/PALD+ groups. Overall, 291 women had sufficient follow‐up data; there was no difference in overall survival, and PALD was not a predictor of survival.ConclusionPostoperative outcomes were similar among all surgical groups; a survival benefit of PALD was not demonstrated.

Diagnosis and management of a case of gestational trophoblastic neoplasia with lumbosacral metastases

AbstractGestational trophoblastic neoplasia (GTN) with spinal metastasis is rare with few documented cases worldwide. Few studies have explored chemotherapy combined with radiotherapy in the treatment of such cases. However, because of its rarity, there is still no standardized treatment regimen. A 34‐year‐old Gravida 1 Para 0 (0010) was diagnosed with GTN with metastasis to the lumbosacral spine, resulting in conus medullaris syndrome with lumbar radiculopathy. She presented with a 14‐month history of amenorrhea, left lower extremity pain, and urinary and bowel retention. On examination, there was a 10.0 × 7.0 cm lumbosacral mass and atrophy of the left lower extremity. Transvaginal ultrasound showed a cul de sac mass, and diluted β‐human chorionic gonadotropin (β‐hCG) titer was markedly elevated at more than 1000 000 mIU/mL. Magnetic resonance imaging (MRI) of the lumbosacral spine showed an ill‐defined sacral mass measuring 13.3 × 11.5 × 6.3 cm with spinal canal, bone, muscle, and nerve root involvement. She was treated with 10 cycles of EMACO and palliative radiotherapy with 10 sessions of 30 Gy of external beam radiation therapy directed toward the lumbosacral mass. Repeat MRI showed a decrease in size of the mass to 6.6 × 8.2 × 4.1 cm with concurrent decrease in β‐hCG to 1.30 mIU/ml, and resolution of leg pain and urinary and bowel symptoms. She was declared to be in remission 3 months after the last cycle of EMACO.

Medicaid expansion and overall mortality among women with cervical cancer

Abstract Objective To assess the association between Medicaid expansion under the Affordable Care Act (ACA) and overall mortality among women with cervical cancer, specifically evaluating changes in stage at diagnosis and treatment utilization and emphasizing differences in survival between early expansion states (implemented by 2014) and non‐expansion states. Methods Researchers conducted a retrospective cohort study using data from the National Cancer Database for the period 2006–2021, involving individuals aged 18–64 years. Medicaid expansion served as the primary explanatory variable, classifying states that implemented Medicaid expansion before January 2014 as early expansion states and states that did not expand as non‐expansion states. The Difference‐in‐Differences (DID) analytical method assessed the effects of Medicaid expansion on survival, cancer stage at diagnosis, and treatment utilization, adjusting for demographics, cancer stage, treatment modalities, and incorporating state and year fixed effects. Robust standard errors were clustered at the state level. Results The analysis included 77 774 women aged 18–64 years diagnosed with cervical cancer, with 37 901 (48.7%) diagnosed pre‐ACA and 39 873 (51.3%) diagnosed post‐ACA. In early expansion states, Medicaid expansion correlated with a 3.12% increase in early‐stage cervical cancer diagnoses (95% confidence interval [CI] 1.74%–4.53%) and a 1.44 percentage point reduction in distant metastatic disease at presentation (95% CI –2.52% to −0.30%). Additionally, there was a 3.24% increase in surgical treatment utilization (95% CI 1.83%–4.62%) compared with non‐expansion states. Furthermore, early expansion states demonstrated a 29.12% reduction in overall mortality hazard (95% CI –56.41% to −1.63%), with these survival improvements consistent across racial groups and disease stages. Conclusion Medicaid expansion was associated with earlier diagnosis, increased surgical treatment utilization, and significantly reduced overall mortality among women with cervical cancer.

Management of invasive cervical carcinoma in three oncology centers in Latin America: A historical cohort study

Abstract Objective To describe clinical and sociodemographic characteristics of patients with invasive cervical cancer treated at three oncology centers in Latin America, as well as their risk factors, and management based on the FIGO stage 2009. Methods This is a descriptive historical cohort study of patients with invasive cervical cancer recruited between January 2010 and June 2016. The study describes demographic characteristics, risk factors, treatments, and oncological outcomes at 1 and 5 years. Results A total of 717 patients were included: 433 (60.39%) from INC Colombia, 174 (24.26%) from INCAN Mexico, and 110 (15.34%) from INEN Peru. Most patients were at FIGO Stage 2009 IIB 213 (29.70%), and the most common histologic subtype was squamous cell carcinoma 550 (76.71%). Concurrent chemo‐radiotherapy was the most frequent approach 334 (46.48%), followed by surgical treatment 261 (36.40%) patients. Regarding oncological outcomes, the 5‐year disease‐free survival (DFS) for all patients was 76.72% (95% CI: 73.34%–80.18%), with worse outcomes observed for Stages III and IV compared to early stages. The 5‐year overall survival (OS) for the general group was 83.76% (95% CI: 81.00%–86.73%), with statistically significant differences showing better outcomes for Stage I, with an OS of 94.52% (95% CI: 91.68–97.44). Conclusion In this descriptive historical cohort, most patients received treatment according to their clinical stage. Survival rates, both overall and disease‐free, were better for early‐stage disease compared to advanced stages.

Pyomyoma outside of pregnancy—Case report and systematic review of the literature

Abstract Background Pyomyoma is a rare but potentially life‐threatening phenomenon with a high mortality rate reaching up to 20%–30%. It can present in women during the antenatal or postpartum period as well as after uterine artery embolization or even spontaneously. Common presenting symptoms include abdomino‐pelvic pain and fever in the presence of uterine leiomyoma. Objectives To assess the different presentations of pyomyoma in a non‐pregnant population, and review the treatment modalities. Search Strategy This systematic review was conducted following the PRISMA guidelines. We performed a comprehensive search of PubMed, Scopus, Google Scholar and Embase during the years 1945–2024. Selection Criteria Included case reports assessed the types of intervention (hysterectomy, myomectomy, or other forms of treatments) to treat pyomyoma. All case studies confirming diagnosis of pyomyoma on either operative and/or histologic findings were eligible. Data Collection and Analysis A total of 121 studies were initially screened and after a full text evaluation, 52 articles were included in this systematic review. Main Results Pyrexia and abdominal pain were the commonest presenting symptoms found in 72% and 57% of patients, respectively. The most common causative organism was E‐coli (23%). A total of 61% of patients underwent hysterectomy, and 27% patients had a myomectomy performed. A total of 12% of patients were treated with conservative management. Conclusions Given the considerable mortality risk of approximately 20%–30%, the benefits of surgical treatment tend to outweigh the potential risks. Where future fertility is a concern, it may be possible to eliminate the source of infection by performing myomectomy instead of hysterectomy in conjunction with antimicrobials.

Interaction between the level of human papillomavirus integration and human papillomavirus type on the risk of grade 3 cervical intraepithelial neoplasia or more severe in human papillomavirus integration positive women: A cross‐sectional study

Abstract Background The human papillomavirus (HPV) integration test is a novel cervical cancer screening technique. This study aimed to explore the effect of HPV integration level on the risk of grade 3 cervical intraepithelial neoplasia (CIN) or more severe CIN (3+) in HPV integration‐positive women, as well as the interaction between HPV type and HPV integration level on CIN3+. Method The HPV integration test was conducted using high‐throughput viral integration detection. The number of HPV integration reads (NHIR) is used to represent the level of HPV integration. Multivariable logistic regression models were used to examine the independent and interaction of the NHIR and the HPV type on CIN3+. Results A total of 1053 HPV integration‐positive women enrolled in this study. The percentage of CIN3+ in participants was 32.7%. The risk of CIN3+ increased by 0.9% (odds ratio [OR]: 1.009, 95% confidence interval [CI]: 1.006–1.012) per 10 increases in the NHIR. The risk of CIN3+ in the HPV16/18 group was higher than in the other 12 high‐risk HPV group (OR: 2.875, 95% CI: 2.034–4.064). However, with the elevated NHIR, the risk gap between the two groups gradually narrowed until it disappeared. There is multiplicative ( P  = 0.031) and additive interaction between the NHIR and the HPV type on CIN3+. Conclusion There was an interaction between HPV type and NHIR on CIN3+. HPV integration can further assess a patient's risk based on HPV genotyping detection, which is conducive to reducing missed diagnoses. The NHIR might be a potential biomarker for early warning and precise identification of high‐risk CIN lesions.

Image‐guided therapies for uterine fibroids

Abstract Uterine fibroids (leiomyomas) and adenomyosis are among the most common benign gynecological conditions affecting women of reproductive age. These disorders are frequently associated with abnormal uterine bleeding, pelvic pain, pressure symptoms on adjacent pelvic organs, and potential infertility. The incidence of fibroids increases as women enter their third and fourth decades of life. In parallel, recent trends in delayed childbearing have further emphasized the need for fertility‐preserving treatment options. Notably, fibroids have a higher prevalence in African‐American women, highlighting a significant disparity in health needs compared to white women. Historically, hysterectomy and myomectomy were considered definitive treatments. However, these procedures carry inherent surgical risks, longer recovery periods, and, in the case of hysterectomy, a complete loss of reproductive potential. Consequently, there is increasing demand for uterus‐sparing, minimally invasive alternatives that provide effective symptom control with lower morbidity and preservation of fertility. Among the evolving treatment options, three image‐guided, minimally invasive therapies have gained particular attention: Uterine Artery Embolization (UAE), Radiofrequency Ablation (RFA), and High‐Intensity Focused Ultrasound (HIFU). Uterine Artery Embolization (UAE), also known as uterine fibroid embolization (UFE), is a well‐established endovascular procedure in which embolic agents are introduced via catheterization of the uterine arteries, inducing ischemia and infarction of fibroids. Performed under conscious sedation or regional anesthesia, UAE has demonstrated significant reductions in fibroid volume and symptom relief in over 80% of appropriately selected patients. All image‐guided techniques are especially beneficial for women who desire uterine preservation, have contraindications to surgery, or wish to avoid major operative interventions. In comparison with UAE, Radiofrequency Ablation (RFA) uses targeted thermal energy to induce coagulative necrosis within fibroid tissue. This approach can be delivered via laparoscopic, transcervical, or transvaginal routes, depending on the platform. The Sonata® System integrates intrauterine ultrasound guidance with energy delivery, enabling precise fibroid targeting with minimal myometrial damage. RFA is associated with shorter recovery and less intraoperative blood loss, though it is more suitable for smaller or fewer fibroids and may be less ideal for extensive disease. Together, these advancements reflect a paradigm shift in fibroid management—driven by demographic trends, racial disparities, patient preferences, and technological innovations—toward evidence‐based, uterus‐preserving therapies tailored to individual patient needs. This article discusses details of each technique including the procedure, benefits and complications and also the impact on particular situations such as pregnancy. Some key points common to each technique are also mentioned.

Endometriosis and malignancy: The intriguing relationship

AbstractObjectiveTo determine the prevalence and study the association of ovarian, uterine, and breast cancers with endometriosis.MethodsA cross‐sectional study of all women with a tissue‐proven diagnosis of endometriosis postoperatively in a tertiary care hospital between January 1, 2010, and December 31, 2019, was conducted to determine the prevalence of coexistent malignancy. Patient details were obtained from electronic clinical records. Univariate analysis followed by multivariate analysis was done to find independent risk factors associated with malignancy.ResultsOut of 800 patients, 104 (13.0%) were found to have coexistent malignancy: ovarian (50, 6.2%); endometrial (33, 4.1%); synchronous ovarian and endometrial (7, 0.9%); and breast (14, 1.8%). Increasing age (odds ratio [OR] 1.13; 95% confidence interval [CI] 1.09–1.16), higher levels of cancer antigen 125 (CA 125) (OR 1.002; 95% CI 1.001–1.005), postmenopausal status (OR 6.2; 95% CI 2.0–19.2), duration of endometriosis over 5 years (OR 4.7; 95% CI 2.5–9.0), and endometriomas larger than 8 cm (area under the curve 0.83) were predictive of coexistent malignancy.ConclusionEndometriosis is associated with an increased risk of ovarian, endometrial, and breast malignancy. Increasing age, postmenopausal status, higher levels of CA 125, larger endometrioma, and long‐standing disease are predictive risk factors.

Application of P16 /Ki‐67 dual‐staining for the detection of high‐grade cervical lesions in the triage of patients with minor abnormal cytology: A meta‐analysis

Abstract Background The p16/Ki‐67 dual‐staining is increasingly applied to increase diagnostic accuracy in detecting high‐grade cervical lesions, including cervical intraepithelial neoplasia Grade 2 (CIN2+) and CIN3+. Objectives To compare the diagnostic performance of p16/Ki‐67 dual‐staining with the human papillomavirus (HPV) tests in the triage of women with atypical squamous cells of undetermined significance (ASC‐US) and low‐grade squamous intraepithelial lesions (LSIL) cytology results. Search Strategy Publications before April 27, 2024, were identified through PubMed, Embase, Web of Science, and Cochrane Library. Selection Criteria The studies have head‐to‐head comparison of p16/Ki‐67 dual‐staining and HPV testing in detecting high‐grade cervical lesions. Data Collection and Analysis Two researchers independently screened articles by title, abstract, and full text. The GRADE and QUADAS‐2 tool was used for quality evaluation. The pooled sensitivity and specificity for CIN2+ and CIN3+ were estimated using random effects models, with results and heterogeneity assessments presented in forest plots. Pretest‐posttest probability (PPP) plots were constructed to evaluate the detection rates of CIN3+ in ASC‐US and LSIL patients. Main Results Twenty‐one studies with 6394 participants were included. The pooled specificity of p16/Ki‐67 dual‐staining was higher than that of HPV tests (CIN2+: 0.73 [95% confidence interval [CI] 0.65–0.80] versus 0.41 [95% CI 0.33–0.50]; CIN3+: 0.61 [95% CI 0.53–0.69] versus 0.33 [95% CI 0.23–0.45]). Summary receiver operating characteristic curve analysis demonstrated p16/Ki‐67 dual‐staining had better diagnostic accuracy for CIN2+ than HPV tests (area under the curve: 0.88 [95% CI 0.85–0.90] versus 0.79 [95% CI 0.75–0.82]). Pretest‐posttest probability (PPP) plots highlighted the superior performance of p16/Ki‐67 dual‐staining for colposcopy referrals in LSIL patients. Conclusions P16/Ki‐67 dual‐staining offers greater specificity for detecting CIN2+/CIN3+ in ASC‐US and LSIL triage, particularly for LSIL. It holds potential as an alternative to HPV tests in resource‐limited settings or LSIL cases, warranting further research to refine its application in diverse populations.

Effect of low‐dose vitamin D supplementation on uterine fibroid size in women with hypovitaminosis D: A nonrandomized pilot study

Abstract Objective To evaluate the effect of low‐dose vitamin D supplementation on uterine fibroid (UF) size in patients with hypovitaminosis D. Methods This was a single‐center observational study including a prospective interventional cohort and a retrospective comparative cohort. The control group ( n  = 16) included retrospective data from patients without vitamin D supplementation who attended two gynecological consultations 6 months apart. The interventional cohort ( n  = 15) prospectively received low‐dose vitamin D supplementation (25 000 IU every 2 weeks for 6 months) and serum 25‐hydroxyvitamin D levels, UF size and vascularization, and patients' symptoms and quality of life were evaluated at baseline and 3 and 6 months. Results In untreated controls, UFs grew significantly in 6 months (67.1 ± 20.2 mm versus 79.4 ± 29.7 mm, P  < 0.001). Vitamin D supplementation significantly reduced UFs from 56.9 ± 14.5 mm at baseline to 53.3 ± 13.3 mm after 3 months ( P  = 0.03) and 52.2 ± 13.6 mm after 6 months ( P  = 0.001). UF vascularity index (5.5 ± 7.5%) and vascularization flow index (2.2 ± 3.4) was significantly lower at month 6 compared with baseline (7.6 ± 9.9% [ P  = 0.01] and 3.3 ± 5.4 [ P  = 0.009], respectively). Conclusion Low‐dose vitamin D supplementation effectively reduced UF size in women with hypovitaminosis D within 6 months, suggesting vitamin D is a promising solution for patients with UFs and hypovitaminosis D. Clinical Trial Registration This study was registered on June 17, 2019, and the date of initial participant enrollment was July 9, 2019. NCT03991078, https://clinicaltrials.gov/study/NCT03991078 .

Cost‐effectiveness analysis of 9‐valent human papillomavirus vaccine combined with screening for cervical cancer in Japan

AbstractObjectiveIn Japan, the current coverage rate of human papillomavirus (HPV) vaccination is only 30%, and the rate of biennial cervical screening is 40%. The Japanese Government has attempted to increase the coverage of HPV vaccination and cervical screening. We analyzed the cost‐effectiveness of the 9‐valent HPV vaccine and cervical screening in Japan.MethodsA yearly cycle Markov model with 15 health states was created to evaluate the cost‐effectiveness of the 9‐valent HPV vaccination and cervical screening in women aged 12–75 years. We considered four scenarios: 30% coverage of vaccination with 40% coverage of biennial screening (Scenario 1 representing the current Japanese situation), 70% (the highest proportion in 2013 in Japan) and 90% coverage of vaccination with 40% coverage of biennial screening (Scenarios 2 and 3, respectively), and 90% coverage of vaccination with 70% coverage of biennial screening (Scenarios 4). The incremental cost‐effectiveness ratio (ICER) was calculated as costs per quality‐adjusted life year (QALY) based on the perspective of the healthcare payer and compared with the benchmark for willingness to pay in Japan (41 700 USD per QALY). The cumulative morbidity and mortality in each scenario were analyzed using the Markov model.ResultsCompared with Scenario 1, the ICERs of Scenarios 2, 3, and 4 were 5382, 5321, and 8524 USD/QALY, respectively, which were lower than the benchmark for willingness to pay. As the coverage of HPV vaccination and cervical screening increased, the cumulative morbidity and mortality decreased.ConclusionIncreasing the coverage of the 9‐valent HPV vaccination and cervical screening is cost‐effective in Japan.

Plexiform neurofibroma infiltrating uterine cervix and parametrium, causing hydronephrosis: A case report and review of the literature

Abstract Neurofibromatosis Type 1 is a genetic disorder resulting in RAS pathway activation. As a result, risk of developing both benign and malignant neoplasms is higher, compared with the general population. Plexiform neurofibromas are benign tumors of the peripheral nerve sheath affecting 40%–50% of patients with neurofibromatosis Type 1. Cervical‐parametrial plexiform neurofibroma is a very rare neoplasm. Here we present the ninth case in the literature. A 37‐year‐old woman presented with chronic pelvic pain and a pelvic mass that was 73 × 33 mm in size. Most of the mass was located between the proximal vagina‐cervix and the bladder. It was infiltrating the bilateral parametrium and the pararectal tissues. There was hydronephrosis on the right side and her right kidney was atrophic. The tumor would likely also cause obstruction on the left side. We performed a type B radical hysterectomy, right salpingo‐oophorectomy, left salpingectomy, cystoscopy, left ureterorenoscopy, and left ureteral double‐j catheterization, in addition to resection of the tumor, which was located between the cervix and bladder. She was followed for 11 months without any tumor relapse. The left kidney remained normal in the follow‐up period. To our knowledge, this is the first publication reporting the neurofibromatosis Type1 mutation c.7615 + 6 T>C as a pathogenic variant. In this case, we showed that plexiform neurofibromas and neurofibromatosis should be taken into account, when a pelvic mass adjacent to the uterine cervix is diagnosed, particularly if the tumor tends to accompany the peripheral nerve tracts. Surgical treatment of cervical‐parametrial plexiform neurofibromas is recommended in certain circumstances and a multidisciplinary approach may help to determine the optimal management.

Do myomectomies alter third‐trimester complications compared with women without myomectomies and uterine fibroids in situ: A retrospective cohort study of an American population database

Abstract Objective To evaluate population characteristics and pregnancy, delivery, and neonatal complications in women with myomectomy prior to pregnancy versus intramural fibroids in situ. Methods Retrospective cohort study using hospital discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2004 to 2014 included. A population of 14 206 pregnancies post‐myomectomy and 81 517 with fibroids in situ were analyzed, performing multivariate logistic regression with adjustment. Results Post‐myomectomy patients were younger, with lower body mass index, higher in vitro fertilization use, more commonly Caucasians or Hispanics, and had higher rates of pregestational diabetes, smoking, illicit drug use, previous cesarean delivery, and multiple gestations, compared with the in‐situ fibroid (ISF) group. Post‐myomectomy patients had decreased rates of gestational hypertension (adjusted odds ratio [aOR] 0.87, 95% confidence interval [CI] 0.77–0.97), eclampsia (aOR 0.76, 95% CI 0.32–0.81), gestational diabetes (aOR 0.83, 95% CI 0.77–0.90), spontaneous vaginal deliveries (aOR 0.09, 95% CI 0.08–0.11), postpartum hemorrhage (aOR 0.77, 95% CI 0.68–0.88), and intrauterine fetal death (aOR 0.64, 95% CI 0.43–0.97). Conversely, they had increased risks of placenta previa (aOR 1.40, 95% CI 1.20–1.64), preterm delivery (aOR 1.16, 95% CI 1.07–1.24), cesarean section (aOR 8.64, 95% CI 7.71–9.69), uterine rupture (aOR 2.21, 95% CI 1.31–3.74), transfusions (aOR 1.79, 95% CI 1.59–2.02), and congenital anomalies (aOR 2.35, 95% CI 2.01–2.75). Conclusions The ISF group experienced different complications than the post‐myomectomy group. Pregnancies post‐myomectomy could benefit from additional screening or interventions during pregnancy to reduce complications from malplacentation and ensure delivery in specialized centers to mitigate risks. Patients should be counseled regarding these potential risks. Increased understanding of the role of myomectomies on reproductive outcomes requires further prospective studies.

Association of HPV16 /18 genotype infection with the Silva pattern classification system in human papilloma virus‐associated endocervical adenocarcinomas

Abstract Objective Persistent high‐risk human papillomavirus (HR‐HPV) infection is an essential risk factor for HPV‐associated adenocarcinomas (HPVA). A three‐tier pattern system (the Silva pattern) for endocervical adenocarcinoma (ECA) associated with tumor metastasis and recurrence was described by Elvio G. Silva nearly 10 years ago. However, there are no studies on the association between HPV genotypes and Silva patterns. Methods The Silva pattern classification was performed on 240 surgical HPVA specimens according to the 2020 World Health Organization classification of female genital tract cancers. HPV DNA was detected using the SPF 10 ‐DEIA‐LiPA 25 assay for all specimens and an attribution algorithm was used to calculate the attribution rate of HPV16/18. Results Out of all HPVA cases, 29 patients (12.1%) were found to have tumors with Silva pattern A, 122 (50.8%) had pattern B tumors, and 89 (37.1%) had pattern C (representing the worst morphological behavior, poorest prognosis and highest risk of mortality). The crude prevalence of HPV16 and 18 was 46.9% and 44.7%, respectively. The attribution of HPV16 in Silva patterns A, B, and C was 58.0%, 51.7%, and 33.8%, respectively ( P  = 0.123). Similarly, the attribution of HPV18 was found to be 29.8%, 39.7%, and 49.5% in patterns A, B, and C, respectively. Notably, there was a statistically significant positive linear relationship between the prevalence of HPV18 and the Silva pattern from A to C ( P  = 0.002). Conclusion HPV16 and 18 are the most prevalent HPV subtypes in patients with HPVA. HPVA patients who are infected with HPV18 exhibit worse morphological behavior compared to those with the HPV16 genotype.

The association between additional radiotherapy after systemic chemotherapy and the prognosis of stage FIGO 2018 IVB cervical cancer

Abstract Objective Systemic platinum‐based chemotherapy is the first‐line treatment of choice for metastatic cervical cancer. While subsequent radiotherapy after primary chemotherapy is a potential option, its benefit remains unclear. This multicenter retrospective study aimed to evaluate whether post‐chemotherapy radiotherapy improves the prognosis of metastatic cervical cancer. Methods We retrospectively analyzed 46 eligible patients, including 22 patients receiving chemotherapy‐alone and 24 patients receiving chemotherapy followed by subsequent radiotherapy. Medical records were retrospectively reviewed for patient characteristics, subsequent treatment modality, adverse events during the treatment course, metastasis site, recurrence or progression, and recurrence sites. Fisher exact test or chi‐squared test, the Mann–Whitney U test, log‐rank test, and Cox proportional hazards model were used. Results The 2‐year overall survival (OS) rate for all patients was 47%, with the median OS of 24.8 months. Patients receiving chemotherapy alone (chemotherapy‐alone group) had a 2‐year OS rate of 23%, while those receiving subsequent radiotherapy (chemotherapy‐radiotherapy group) had a significantly higher OS rate of 67% (HR = 2.83, P  = 0.006). The 2‐year progression‐free survival (PFS) rates were 9% and 33%, respectively (HR = 3.25, P  = 0.010). Serious adverse events occurred in 46.2% of the chemotherapy‐alone group and 29.2% of the chemotherapy‐radiotherapy group during subsequent treatment ( P  = 0.249). Conclusion Post‐chemotherapy radiotherapy may improve the prognosis of metastatic cervical cancer without increasing serious adverse events. Further prospective studies are warranted to validate these findings.

Predictors of surgical outcomes in transcervical resection of myoma

Abstract Objective To verify identified predictors of surgical outcomes in transcervical resection of myoma (TCRM) in Filipino women. Methods A retrospective analytical cross‐sectional study was done on 474 women who underwent TCRM between 2010 and 2020, in St Luke's Medical Center, Philippines. Ethical exemption was granted by the Institutional Ethics Committee. Identified predictors of prolonged operative time (>60 min)—increased blood loss (>70 mL), fluid overload, uterine perforation, and incomplete resection—in published research studies were analyzed. Results Univariate analysis revealed that European Society for Gynecological Endoscopy (ESGE) type 2, and myoma size ≥5 cm, myoma number ≥3 were associated with prolonged operative time. ESGE type 2 and myoma size ≥5 cm were associated with increased blood loss and incomplete resection. Myoma size ≥5 cm, an intraoperative fluid deficit of 1000 mL (hypotonic) or 2500 mL (isotonic), and prolonged operative time were correlated with fluid overload. ESGE type 2 is associated with uterine perforation. Only a Lasmar score ≥5 was significantly associated with all the aforementioned unfavorable surgical outcomes. Multivariate analysis showed that a Lasmar score ≥5 (odds ratio [OR] 6143.26; 95% confidence interval [CI] 456–82 680; P  < 0.001) and myoma size ≥5 cm (OR 21.56; 95% CI 1.67–277; P  = 0.019) were independent predictors of adverse surgical outcomes. Conclusion This study verified that the Lasmar classification can predict TCRM complexity with cut‐off values of 5 for both Lasmar score and myoma size. We recommend that the use of the Lasmar scoring classification preoperatively may be beneficial in TCRM in Filipino women.

Feasibility of opportunistic salpingectomy at the time of a vNOTES hysterectomy: A retrospective cohort

SynopsisThe vNOTES approach has a high feasibility of performing a salpingectomy at the time of a hysterectomy.

Efficacy of chitosan powder in reducing vaginal bleeding following a loop electrosurgical excision procedure: A randomized control trial

AbstractObjectiveTo evaluate the efficacy of topical chitosan powder in reducing postoperative vaginal bleeding following a loop electrosurgical excision procedure (LEEP).MethodsIn this randomized controlled trial, patients who underwent LEEP were randomly assigned (1:1) to the chitosan group, in which the wound area was sprayed with chitosan powder using a spray pump, or the control group. The primary outcome was the median quantity of vaginal blood lost in the early postoperative period (defined as within 6 h of the procedure).ResultsThe 124 women enrolled in the study were randomly divided into control (n = 61) and chitosan (n = 63) groups. The median amount of vaginal blood loss during the early postoperative period was significantly lower in the chitosan group than in the control group (198.85 [64.4–388.57] mL vs. 250.60 [67.7–552.87] mL; P < 0.001). The rate of late postoperative bleeding requiring hemostatic intervention was also lower in the chitosan group than in the control group (3.2% vs. 16.4%; P = 0.013). Superior cervical wound healing in the chitosan group compared to the control group was also observed.ConclusionThe application of chitosan powder to the cervical wound bed can improve surgical outcomes by decreasing post‐LEEP vaginal bleeding and facilitating the healing of cervical wounds.

HPV E6/E7 mRNA screening alone can be used as a screening method for cervical cancer in premenopausal women in China: A retrospective study

AbstractBackgroundThis study aimed to assess the value of a HPV E6/E7 mRNA assay (Aptima® HPV [AHPV]) for primary cervical cancer screening combined with menopausal status.MethodsA total of 16 917 women underwent AHPV testing and had complete histopathological results at the Affiliated Hospital of Jining Medical University China between January 1, 2017 and March 31, 2022. We evaluated the performance of different screening strategies and combined strategies, as well as evaluations of different menopausal states.ResultsWhen identifying LSIL+ (includes low‐ and high‐grade squamous intraepithelial lesions and invasive cervical cancer [ICC]), the sensitivity (91.2%) and negative predictive value (NPV; 96.6%) were significantly higher for AHPV than for liquid‐based cytology assay (LBC; 33.2% and 84.7% for sensitivity and NPV, respectively). Furthermore, the co‐testing strategy (cytology combined with AHPV), when compared with AHPV, achieved a slightly higher sensitivity (93.6% vs. 91.2%, respectively, P < 0.001), a similar specificity (61.3% vs. 62.7%, respectively, P = 0.014), a similar positive predictive value (PPV; 37.5% vs. 37.8%, respectively, P = 0.709) and a similar NPV (97.5% vs. 96.6%, respectively, P = 0.001). Moreover, AHPV (when compared with menopausal women) achieved a higher sensitivity (93.5% vs. 77.7%, respectively, P < 0.001), a higher NPV (97.3% vs. 93.9%, respectively, P < 0.001), a similar PPV (37.8% vs. 37.0%, respectively, P = 0.618) and a slightly lower specificity (60.7% vs. 72.1%, respectively, P < 0.001) in premenopausal women. These results were similar when identifying HSIL+ (includes high‐grade squamous intraepithelial lesion and ICC).ConclusionThe present study suggests that initial screening with HPV E6/E7 mRNA testing rather than combined screening is a suitable candidate for cervical cancer screening in China (especially for premenopausal women) based on economic reasons.

Roles of probiotics against HPV through the gut‐vaginal axis

AbstractHuman papillomavirus (HPV) is a sexually transmitted virus, whose persistent infection is the main reason for invasive cervical cancer (ICC), which is the fourth most common type of cancer in women, with more than 500 000 new cases every year. After infection, various alterations occur in the host, facilitating the virus's evasion of immune system clearance and promoting its proliferation. Oral probiotic consumption can influence the whole body's immunity, inflammatory reflection, neural, endocrine humoral, metabolic pathways and other organs by adjusting the components of gut microbiota (GM). Some evidence shows there is a tight connection between GM and vaginal microbiota (VM), which is referred to as the gut‐vaginal axis. This review investigates the potential role of probiotics in clearing HPV via the gut‐vagina axis, emphasizing the effectiveness of Lactobacillus in preventing vaginal diseases and suggesting its potential for HPV clearance. Understanding the role of probiotics in the gut‐vagina axis could pave the way for new strategies to reduce and eliminate HPV and related diseases.

Working towards health: A model of cervical cancer screening and treatment for factory employees in Haiti

Abstract Objective In Haiti, cervical cancer continues to cause high levels of mortality and morbidity due to lack of resources and political unrest. Haitian women employed in factories are especially vulnerable because they are unable to take time away from work to access health resources. We aimed to describe a low‐cost intervention which successfully addressed this need. Methods We present a retrospective review of data gathered through a public–private partnership, in which women working in garment factories near Port‐au‐Prince, Haiti, were offered health education, clinical breast exam, and free human papillomavirus (HPV) self‐swab testing at their place of employment. Women testing positive for HPV were subsequently tested using visual inspection with acetic acid (VIA) to inform treatment referrals, and treated with mobile thermocoagulation in factory infirmaries. Factory‐employed healthcare workers were trained on cancer screening, including VIA and clinical breast exam. Results A total of 6843 out of 6983 (98%) female factory employees attended free reproductive health education sessions, and 4005 out of 4153 eligible women (97%) were screened using HPV self‐swab testing; 5176 women received a clinical breast exam. Of the women screened for HPV, 1001 (25%) tested positive and 905 (90%) of HPV‐positive women received VIA testing and thermocoagulation. The intervention had a total cost of US$76 000, over half of which was spent on an HPV testing machine. Conclusions Innovative approaches to the prevention of cervical cancer are especially necessary in very low‐resource, politically unstable environments like Haiti. Self‐swab and screen‐and‐treat programs in the workplace were acceptable to employees and factory owners. This low‐cost model was reached vulnerable women through a public‐private partnership, and tracked them through screening and treatment. It could be implemented elsewhere or extended to include other health services.

HPV 16/18 E7 oncoprotein detection as a promising triage strategy for HPV 16/18‐positive patients: A prospective multicenter study with a 2‐year follow up

Abstract Objective To explore the effectiveness of HPV 16/18 E7 oncoprotein in detecting high‐grade cervical intraepithelial neoplasia (CIN) and predicting disease outcomes in HPV 16/18‐positive patients. Methods The present study was a cross‐sectional study with a 2‐year follow up. We collected 915 cervical exfoliated cell samples from patients who tested positive for HPV 16/18 in gynecologic clinics of three tertiary hospitals in Beijing from March 2021 to October 2022 for HPV 16/18 E7 oncoprotein testing. Subsequently, 2‐year follow up of 408 patients with baseline histologic CIN1 or below were used to investigate the predictive role of HPV 16/18 E7 oncoprotein in determining HPV persistent infection and disease progression. Results The positivity rate of the HPV 16/18 E7 oncoprotein assay was 42.06% (249/592) in the inflammation/CIN 1 group and 85.45% (277/324) in the CIN2+ group. For CIN2+ detection, using the HPV 16/18 E7 oncoprotein assay combined with HPV 16/18 testing, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.45%, 57.94%, 52.57%, and 87.95%, respectively. During the 2‐year follow up, the sensitivity, specificity, PPV, and NPV for predicting persistent HPV infection were 48.44%, 58.21%, 34.64%, and 71.18% in the baseline inflammation and CIN1 group. Conclusions As a triage method for high‐grade CIN screening in HPV 16/18‐positive patients, HPV 16/18 E7 oncoprotein demonstrated a relatively high NPV, making it suitable for clinical use in triaging HPV 16/18‐positive cases and potentially reducing the colposcopic referral rate. HPV 16/18 E7 oncoprotein exhibited a preferably predictive value in determining HPV infection outcomes and disease progression.

Response: Age‐stratified risk factors of re‐intervention for uterine fibroids treated with high‐intensity focused ultrasound

Investigating the healthcare‐seeking behaviors of mobile phone users to improve cervical cancer screening in rural Uganda

Abstract Objective Cervical cancer is the leading cause of cancer in low‐ and middle‐income countries, despite being preventable. Uganda, which lacks an effective screening program, has one of the highest global cervical cancer incidence rates. Mobile health (mHealth) technology has the potential to improve healthcare‐seeking behaviors and access. The present study describes the connection between mobile phone access and healthcare‐seeking behaviors in rural Uganda. Methods Women were eligible for this cross‐sectional study if they had no prior screening or treatment for cervical cancer in the past 5 years, were aged 30 to 49 years old, and were residents of the South Busoga Forest reserve. Survey data was analyzed using descriptive statistics and chi‐square tests. Results Of the 1434 participants included in the analysis, 91.4% reported having access to a mobile phone. Most respondents were aged 30–40 years, had a partner, had ≤primary education, and were farmers. Participants with mobile phone access were significantly more likely to report attending a healthcare outreach visit (access = 87.3%, no access = 72.6%, P  < 0.001) or visiting a health center (access = 96.9%, no access = 93.5%, P  < 0.001). Participants in both groups had largely positive attitudes around and good knowledge of cervical cancer screening. Conclusion While attendance to healthcare services was high amongst participants, those with mobile phone access were more likely to seek healthcare services. Further inquiry into this association between mobile phone access and healthcare‐seeking behavior is needed to optimize the improvements to cervical cancer screening when implementing interventions such as mHealth technology.

Severe hemoperitoneum from spontaneous rupture of uterine tumor resembling ovarian sex‐cord tumor: A very rare case

SynopsisA case of uterine tumor resembling ovarian sex‐cord tumor with an unfamiliar presentation. Management was performed based on the clinical findings and the literature recommendations.

Fertility‐sparing approach to malignant ovarian germ cell tumors – Oncologic and obstetric outocome: A retrospective study

AbstractObjectiveTo evaluate oncologic (such as disease‐free and overall survival) and obstetric outcomes in patients diagnosed with malignant ovarian germ cell tumors (MOGCTs).MethodsPatients diagnosed with MOGCTs between March 2007 and February 2022 were evaluated and patients who underwent fertility sparing surgery were included in this retrospective study. The obstetric and oncologic outcomes were evaluated by collecting data up until the patient's last follow‐up visit from the hospital records and patient files. The study was approved by Başkent University Institutional Review Board (KA23/124).ResultsSeventy FSS patients were included in this study. The median age of the patients was 22.5 years (range: 11–37). The median follow‐up time was 92.0 months (10–189). Immature teratoma was the most common histological subtype (32.9%). Bilateral involvement was detected in only one patient with immature teratoma (1.4%). The 5‐year DFS rates of immature teratoma, dysgerminoma, yolk sac, and mixed germ cell histologic types were 91.1%, 94.1%, 82.4%, and 88.9%, respectively (P: 0.716).The 5‐year OS rates of the same histologic types were 95.7%, 100%, 88.2%, and 88.9%, respectively (P = 0.487). All patients (100%) had a regular menstrual cycle after the completion of adjuvant treatment. The mean time between the last chemotherapy and menstruation was 4.38 months. To date, a total of 34 patients tried to conceive after the completion of disease treatment. A total of 23 (67.6%) patients conceived, resulting in 27 live births in 22 (100%) patients.ConclusionFertility preservation should be the first treatment option in MOGCTs in young patients due to the unilateral involvement of the disease and its chemosensitive nature.

Scarless preventive surgery

SynopsisOncogenetic risk‐reduction surgeries could be better accepted if innovation allowed the scars to be hidden. Adnexectomies, vNotes, and endoscopic mastectomies presented here are examples.

Impact of 2 years of COVID‐19 pandemic on ovarian cancer treatment in IRCCS‐AUSL of Reggio Emilia

AbstractObjectiveTo assess compliance with the 2019 regional recommendation to centralize epithelial ovarian cancer (EOC) patients and to assess whether the COVID‐19 pandemic has affected the quality of care for EOC patients.MethodsWe compared data from EOC patients treated before the introduction of the 2019 regional recommendation (2018‐2019) with data obtained from EOC patients treated after the regional recommendation was adopted during the first 2 years of the COVID‐19 pandemic (2020‐2021). Data were retrieved from the Optimal Ovarian Cancer Pathway records. R software version 4.1.2 (the R Foundation for Statistical Computing, Vienna, Austria) was used for the statistical analysis.Results251 EOC patients were centralized. The number of EOC patients centralized increased from 2% to 49% despite the COVID‐19 pandemic. During the COVID‐19 pandemic, there was an increase in the use of neoadjuvant chemotherapy and interval debulking surgery. There was an improvement in the percentage of Stage III patients without gross residual disease following both primary and interval debulking surgery. The percentage of EOC cases discussed by the multidisciplinary tumor board (MTB) increased from 66% to 89% of cases.ConclusionDespite the COVID‐19 pandemic, centralization has increased and the quality of care has been preserved thanks to the MTB.

Prognostic nomogram for predicting the overall survival rate of patients with uterine clear‐cell carcinoma: Based on SEER database

Abstract Objective To evaluate the risk factors for uterine clear‐cell carcinoma (UCCC) and construct nomograms predicting 1‐, 3‐, and 5‐year overall survival rates of patients with UCCC. Methods The demographic and clinical information of 1674 patients diagnosed with UCCC between 2004 and 2015, including age, race, marital status, tumor size, American Joint Committee on Cancer (AJCC) stage, and details of surgery and radiotherapy/chemotherapy, was collected from the Surveillance, Epidemiology, and End Results (SEER) database. After excluding patients with unknown AJCC stage, race, marital status, or lymph node information, 1469 patients remained. Risk factors were determined using univariate and multivariate analyses, and nomograms were developed to predict 1‐, 3‐, and 5‐year overall survival of UCCC. Various indicators were used to evaluate the performance of the nomogram, such as the C‐index, net classification improvement (NRI) and decision curve analysis (DCA). Results Age, log odds of positive lymph nodes, AJCC stage, surgery status, and chemotherapy status were independent risk factors for UCCC. The C‐indexes of the training group and AJCC stage groups were 0.771 and 0.697, respectively. The results for the area under the receiver operating characteristics curve, NRI, and calibration curves indicated that the nomogram had good predictive ability. DCA revealed that the nomogram had greater clinical applicability than AJCC stage alone. Internal validation using the validation cohort also demonstrated that this nomogram had good predictive performance. Conclusion A new nomogram comprising a combination of demographic and clinical characteristics provided better survival predictions than the AJCC staging system alone, which will facilitate prognostic assessments and clinical decision‐making.

Prediction of high‐risk factors for ovarian metastasis in patients with endometrial cancer: A large‐sample retrospective case–control study

AbstractObjectiveTo determine the high‐risk factors of ovarian metastasis of endometrial cancer and their impact on prognosis.MethodsA retrospective case–control study was conducted on a large cohort of patients with endometrial cancer.ResultsA total of 1240 patients with endometrial cancer were eligible for analysis, of whom 120 (9.7%) had ovarian metastasis. The patients with endometrial cancer with ovarian metastasis were more likely to have deep myometrial infiltration, lymph node metastasis, and elevated levels of CA125. The median survival was 39 months in patients with ovarian metastasis and 111 months in those without ovarian metastasis (P < 0.001). According to the stratified analysis, the progression‐free survival (PFS) and overall survival in the low‐risk group and PFS in the high‐risk group of patients with endometrial cancer with ovarian metastasis were significantly shorter than those without ovarian metastasis (P < 0.0001, P = 0.0034, and P < 0.0001, respectively).ConclusionDeep myometrial invasion, lymph node metastasis, and elevated levels of CA125 may be independent high‐risk factors for ovarian metastasis in patients with endometrial cancer. Ovarian metastasis has a greater impact on the prognosis of patients with low‐risk endometrial cancer.

Feasibility of 5‐fluorouracil and imiquimod for the topical treatment of cervical intraepithelial neoplasias (CIN) 2/3

AbstractObjectivesTo determine the feasibility (as measured by tolerability and safety) and efficacy of topical 5‐fluorouracil (5‐FU) and imiquimod for the treatment of cervical intraepithelial neoplasia (CIN) 2/3.MethodsThis pilot prospective study was conducted in women aged 18–45 years with p16+ CIN 2/3. Participants underwent an 8‐week alternating regimen of self‐applied 5% 5‐FU on weeks 1, 3, 5, and 7 and physician‐applied imiquimod on weeks 2, 4, 6, and 8. Adverse events (AEs) were collected by symptom diary and clinical exam. Feasibility was measured by tolerability and safety (AEs) of the study intervention. Tolerability was assessed as the number of participants able to apply 50% or more of the treatment doses. The safety outcome was calculated as the number of participants who experienced “specified AEs” defined as possibly, probably, or definitely related grade 2 or worse AE or grade 1 genital AEs (blisters, ulcerations, or pustules) lasting more than 5 days. The efficacy of the intervention was determined by histology and high‐risk human papillomavirus (hrHPV) testing was done after treatment.ResultsThe median age of the 13 participants was 27 ± 2.9 years. Eleven (84.61%) participants applied 50% or more of the treatment. All participants reported grade 1 AEs; 6 (46.15%) reported grade 2 AEs; and 0 reported grade 3/4 AEs. Three (23.08%) participants had specified AEs. Histologic regression to normal or CIN 1 among those completing 50% or more of the treatment doses was observed in 10 (90.91%) participants, and 7 (63.63%) tested negative for hr‐HPV at the end of the study.ConclusionsTopical treatment for CIN 2/3 with 5‐FU/imiquimod is feasible, with preliminary evidence of efficacy. Topical therapies need further investigation as adjuncts or alternatives to surgical therapy for CIN 2/3.

Impact of HIV infection on access to cancer care and survival among women with invasive cervical cancer in Côte d'Ivoire: A prospective cohort study

AbstractObjectiveTo assess the impact of HIV on access to invasive cervical cancer (ICC) care and overall survival (OS) in a time of universal access to antiretroviral therapy (ART).MethodsA cohort of women prospectively diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private cancer centers in Côte d'Ivoire. Follow‐up data were collected through facility‐ and phone‐based approaches. Logistic and Cox regression models allowed analysis of factors associated with access to cancer care and OS, respectively.ResultsOverall, 294 women with ICC aged 50 years (interquartile range [IQR] 43–60) were enrolled, including 21.4% of women living with HIV (WLHIV), 87% being on ART. An advanced ICC clinical stage (III–IV) was less frequent in WLHIV (63.5% vs. 77.1% in HIV‐uninfected women; P = 0.029). Cancer care was initiated in 124 (42.2%) women (54.0% in WLHIV; 39.0% in HIV‐uninfected; P = 0.030). Factors independently associated with access to cancer care were International Federation of Gynecology and Obstetrics (FIGO) stage I–II (adjusted odds ratio [aOR] 3.58, 95% CI 2.01–6.38) and no treatment by traditional healers prior to ICC diagnosis (aOR 3.69, 95% CI 1.96–6.96). The 2‐year OS was 37.9% (95% CI 30.0–47.9). HIV status was not predictive of mortality (adjusted hazard ratio [aHR] 0.98, 95% CI 0.60–1.69). An advanced clinical stage was the only measured predictor of death (aHR 1.59, 95% CI 1.02–2.47).ConclusionIn a time of universal access to ART, HIV infection was not associated with OS among women with ICC in Côte d'Ivoire. Higher access to cancer care in WLHIV might be mediated by enhanced access to ICC screening services, supporting the need to expand these services to other types of healthcare facilities.

Cancer of the vagina: 2021 update

AbstractDiagnosis of a primary vaginal cancer is rare, as most vaginal tumors are metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This is associated with persistence of high‐risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, as with cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer.

Exploring the potential of AI ‐powered applications for clinical decision‐making in gynecologic oncology

Abstract Objective The rise of artificial intelligence (AI) and large language models like Llama, Gemini, or Generative Pretraining Transformer (GPT) signals a promising new era in natural language processing and has significant potential for application in medical care. This study seeks to investigate the potential of GPT‐4 for automated therapy recommendations by examining individual patient health record data with a focus on gynecologic malignancies and breast cancer. Methods We tasked GPT‐4 with generating independent treatment proposals for 60 randomly selected patient cases presented at gynecologic and senologic multidisciplinary tumor boards (MDTs). The treatment recommendations by GPT‐4 were compared with those of the MDTs using a novel clinical concordance score and were reviewed both qualitatively and quantitatively by experienced gynecologic oncologists. Results GPT‐4 generated coherent therapeutic recommendations for all clinical cases. Overall, these recommendations were assessed by clinical experts as moderately sufficient for real‐word clinical application. Deficiencies in both accuracy and completeness were especially noted. Using a quantitative clinical concordance score, GPT‐4 consistently demonstrated superior performance in managing the senologic cases compared with the gynecologic cases. Iterative prompting substantially enhanced treatment recommendations in both categories, increasing concordance with MDT decisions to up to 84% in senologic cases. Conclusion GPT‐4 is capable of processing complex patient cases and generates detailed treatment recommendations; however, differences persist in surgical approaches and the use of systemic therapies, and there is a tendency toward recommending excessive genetic testing. As AI‐powered solutions continue to be integrated into medicine, we envision the potential for automated therapy recommendations to play a supportive role in human clinical decision‐making in the future.

Cancer of the vulva: 2025 update

AbstractVulvar cancer is an uncommon gynecological malignancy primarily affecting postmenopausal women. No specific screening exists and the most effective strategy to reduce the incidence of vulvar cancer is the opportune treatment of predisposing and preneoplastic lesions associated with its development. Although vulvar cancer may be asymptomatic, most women present with vulvar pruritus or pain or have noticed a lump or ulcer. Therefore, any suspicious vulvar lesion should be biopsied to exclude invasion. Once established, the most common subtype is squamous cell carcinoma. The treatment of vulvar cancer depends primarily on histology, clinical, radiological, or surgical staging. Treatment is predominantly surgical and/or adjuvant radiation therapy, particularly for squamous cell carcinoma, although definitive concurrent chemoradiation is an effective alternative, particularly for advanced tumors. In those cases where vulvar cancer presents with distant metastases, systemic therapy is modeled after cervical cancer, a more common cancer where there is more robust data to guide treatment. Management should be individualized and carried out by a multidisciplinary team in a cancer center experienced in the treatment of these tumors.

FIGO staging for carcinoma of the vulva: 2021 revision

AbstractTo revise the FIGO staging for carcinoma of the vulva using a new approach that involves analyses of prospectively collected data. The FIGO Committee for Gynecologic Oncology reviewed the recent literature to gain an insight into the impact of the 2009 vulvar cancer staging revision. The Committee resolved to revise the staging with a goal of simplification and actively collaborated with the United States National Cancer Database to analyze prospectively collected data on carcinoma of the vulva. Many tumor characteristics were collected for all stages of vulvar cancer treated between 2010 and 2017. Statistical analysis was performed with SAS software. Overall survival was estimated based on tumor characteristics. Log‐rank and Wilcoxon tests were used to analyze overall survival similarities between and within groups of tumor characteristics. Characteristics with similar survivals were then grouped into the same stages and substages. Kaplan–Meier overall survival curves were generated for the resulting stages and substages. There were 12 063 cases with available data. The resulting new staging for carcinoma of the vulva has two substages in Stage I, no substage in Stage II, three substages in Stage III, and two substages in Stage IV. The Kaplan–Meier overall survival curves showed clear separation between stages and substages. The 2021 vulvar cancer staging is the first from the FIGO Committee for Gynecologic Oncology to be derived from data analyses. This revision has a new definition for depth of invasion, uses the same definition for lymph node metastases utilized in cervical cancer, and allows findings from cross‐sectional imaging to be incorporated into vulvar cancer staging. The 2021 FIGO staging for carcinoma of the vulva is data‐derived, validated, and much simpler than earlier revisions.

Comparison of two 3D reconstruction models for understanding of complicated female pelvic tumors

Abstract Objective Three‐dimensional (3D) reconstructed models have been shown to improve visualization in complex female pelvic tumors. Cinematic rendering (CR) is a 3D imaging technique for computed tomography (CT) images, which creates more realistic images with the ability to enhance imaging of anatomical features for diagnosis. This study was set up to compare two types of 3D models and to validate the use of 3D anatomical techniques for the diagnosis of complex female pelvic tumors. Methods The preclinical, randomized, two‐sequence crossover investigation was performed from December 2022 to January 2023 at First Affiliated Hospital of Chongqing Medical University. Sixteen residents and 10 attending surgeons assessed the cases of 23 patients with two types of 3D model images. The surgeons were randomly assigned to two assessment sequences (CR‐3D model group and CT‐3D model group). For each case, participants selected one question that probed fundamental questions about the tumor's genesis throughout each assessment period. Following a 4‐week washout period, case assessments were transferred to the other image modality. Results The main result assessment was the accuracy of the answers. The time to answer the questions and the case assessment questionnaire was added as a secondary outcome. The mean scores in the CR‐3D models (19.35 ± 1.87) varied significantly from those in the CT‐CR group (16.77 ± 1.8) ( P  < 0.001), and solving the questions in the CT‐3D model sequence (41.96 ± 6.31 s) varied significantly from that in the CR‐3D model sequence (52.88 ± 5.95 s) ( P  < 0.001). Subgroup analysis revealed that there were statistically significant variations in the scores of female reproductive tumors, pelvic tumors other than the reproductive system, and retroperitoneal tumors ( P  = 0.005). Analysis of the assessment questionnaire showed that more surgeons choose CR 3D reconstruction (8.31 ± 0.76 vs 7.15 ± 1.19, P  < 0.001). Conclusions The results suggest that each 3D reconstruction method has its own advantages. Surgeons feel that CR reconstruction models are a useful technique that can improve their comprehension of complex pelvic tumors, while traditional 3D models have an advantage in terms of speed to diagnosis.

Progress in the pathological arena of gynecological cancers

AbstractThis review covers the significant new developments in the pathological classification of gynecological tumors. Many of these were included in the updated World Health Organization Classification of Female Genital Tract Tumours, published in 2020. Topics include the compelling evidence that a large majority of extrauterine high‐grade serous carcinomas arise from the fallopian tube; the Cancer Genome Atlas (TCGA) Classification of endometrial carcinomas; the discovery that most so‐called synchronous endometrial and ovarian endometrioid carcinomas represent metastasis from the endometrium to the ovary; and the division of cervical, vaginal, and vulval carcinomas into clinically meaningful HPV‐associated and HPV‐independent types. Newly described tumor types are covered, including endometrial and ovarian mesonephric‐like adenocarcinoma, uterine sarcoma types associated with specific molecular abnormalities, and gastric (gastrointestinal)‐type adenocarcinomas of the endometrium and vagina. Important molecular events in ovarian sex cord–stromal tumors are also discussed.

FIGO Cancer Report 2021

Multifactorial construction of low‐grade and high‐grade endometrial cancer recurrence prediction models

Abstract Objective To analyze independent risk factors for endometrial cancer (EC), a common female cancer globally, and construct individualized prediction models for EC recurrence. Methods The EC patients from the medical record system were divided into low‐grade ( n  = 392) and high‐grade ( n  = 183) groups. Immunohistochemical expression of estrogen receptor, progestin receptor, Ki67, and L1 cell adhesion molecule (L1CAM) was detected. Univariate Cox regression, LASSO regression, and stepwise Cox regression were applied for identifying independent risk factors for EC recurrence. The predictive value of the model was verified by using receiver operating characteristics curves, bootstrap method, calibration curves, and decision curve analysis curves. Results Multivariate Cox analysis revealed that FIGO (the International Federation of Gynecology & Obstetrics) Stage, progestin receptor, lymphovascular space invasion (LVSI), and tumor size were independent risk factors for low‐grade EC recurrence‐free survival (RFS), and FIGO Stage, L1CAM, LVSI, and pelvic lymph node status were independent risk factors for high‐grade EC. The areas under the curves at 1‐, 3‐, and 5‐year RFS in low‐grade and high‐grade groups were 0.881/0.825, 0.888/0.853, and 0.807/0.832, respectively. Calibration curves were close to the diagonal, and the decision curve analysis curves were located mostly above the All and None lines in both groups. Conclusion The prediction model demonstrates accurate discriminative ability and strong calibration capability. It has high clinical application value and provides decision making information regarding RFS for both low‐grade and high‐grade EC patients. This may assist in formulating personalized treatment plans, monitoring follow‐up strategies, and implementing lifestyle intervention measures.

Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta‐analysis

AbstractBackgroundAlthough robotics has been shown to improve outcomes in some high‐difficulty surgical category patients, it is unclear if such an approach may improve outcomes in elderly patients with endometrial carcinoma (EC).ObjectiveTo compare robotic and laparotomic surgery in the treatment and staging of elderly EC patients.Materials and methodsA systematic review and meta‐analysis was performed assessing the risk of overall, intra‐operative, and peri‐operative complications associated with the surgical approach (laparotomic vs robotic) for elderly patients with EC by relative risk (RR). Pooled means ± standard deviation of length of stay were compared with the unpaired t test. Subgroup analyses for overall complications were performed based on different age cut‐offs (>70, >65, and >75 years) and severity of complications (minor and major). A value of P less than 0.05 was considered significant.ResultsFive studies with 7629 EC patients were included. Pooled RR for robotic compared with laparotomic surgery was 0.40 (P < 0.001) for overall, 0.46 (P = 0.18) for intra‐operative, and 0.43 (P < 0.001) for peri‐operative complications. Pooled difference between means ± standard deviation of length of stay for robotic versus laparotomic surgery was −3.34 (P < 0.001). At subgroup analyses, pooled RR of overall complications for robotic surgery versus laparotomic surgery was 0.34 (P < 0.001) in the >70 years, 0.51 (P < 0.01) in the >65 years, 0.20 (P = 0.12) in the >75 years groups. Pooled RR was 0.50 (P = 0.1) in the minor complications subgroup, and 0.42 (P = 0.002) in the major complications subgroup.ConclusionRobotics might be a viable alternative to the laparotomic approach for EC in elderly patients because it significantly decreases the risk of overall and peri‐operative complications (mainly major complications), and the length of stay when compared with laparotomy. The decrease in risk of overall complications is greater with increasing patient age.

Risk assessment for endometrial cancer in women with abnormal vaginal bleeding: Results from the prospective IETA‐1 cohort study

AbstractObjectiveTo investigate the association between personal history, anthropometric features and lifestyle characteristics and endometrial malignancy in women with abnormal vaginal bleeding.MethodsProspective observational cohort assessed by descriptive and multivariable logistic regression analyses. Three features—age, body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), and nulliparity—were defined a priori for baseline risk assessment of endometrial malignancy. The following variables were tested for added value: intrauterine contraceptive device, bleeding pattern, age at menopause, coexisting diabetes/hypertension, physical exercise, fat distribution, bra size, waist circumference, smoking/drinking habits, family history, use of hormonal/anticoagulant therapy, and sonographic endometrial thickness. We calculated adjusted odds ratio, optimism‐corrected area under the receiver operating characteristic curve (AUC), R2, and Akaike's information criterion.ResultsOf 2417 women, 155 (6%) had endometrial malignancy or endometrial intraepithelial neoplasia. In women with endometrial cancer median age was 67 years (interquartile range [IQR] 56–75 years), median parity was 2 (IQR 0–10), and median BMI was 28 (IQR 25–32). Age, BMI, and parity produced an AUC of 0.82. Other variables marginally affected the AUC, adding endometrial thickness substantially increased the AUC in postmenopausal women.ConclusionAge, parity, and BMI help in the assessment of endometrial cancer risk in women with abnormal uterine bleeding. Other patient information adds little, whereas sonographic endometrial thickness substantially improves assessment.

Uterine carcinosarcoma vs endometrial serous and clear cell carcinoma: A systematic review and meta‐analysis of survival

AbstractBackgroundIt is unclear whether uterine carcinosarcoma (UCS) is more aggressive than endometrial serous carcinoma (SC) and clear cell carcinoma (CCC).ObjectivesTo compare the prognosis of UCS to that of endometrial SC and CCC, through a systematic review and meta‐analysis.MethodsFour electronic databases were searched from January 2000 to October 2020. All studies assessing hazard ratio (HR) for death in UCS vs SC and/or CCC. HRs for death with 95% confidence interval were extracted and pooled by using a random‐effect model. A significant P‐value <0.05 was adopted.ResultsSix studies with 11 029 patients (4995 with UCS, 4634 with SC, 1346 with CCC and 54 with either SC or CCC) were included. UCS showed a significantly worse prognosis than SC/CCC both overall (HR = 1.51; P = 0.008) and at early stage (HR = 1.58; P < 0.001). Similar results were found for UCS vs SC (HR = 1.53; P < 0.001) and UCS vs CCC (HR = 1.60; P < 0.001).ConclusionsCompared to SC and CCC, UCS has a significantly worse prognosis, with a 1.5–1.6‐fold increased risk of death. This might justify a more aggressive treatment for UCS compared to SC and CCC. Further studies are necessary to define the prognostic impact of different molecular subgroups.

Cancer of the corpus uteri: 2021 update

AbstractEndometrial cancer is the most common gynecological malignancy in high‐ and middle‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Since The Cancer Genome Atlas defined four molecular subgroups of endometrial cancers, the molecular factors are increasingly used to define prognosis and treatment. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (and increasingly sentinel node biopsy) enables identification of lymph node‐positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant therapy is used for Stage I–II patients with high‐risk factors and Stage III patients; chemotherapy is especially used in non‐endometrioid cancers and those in the copy‐number high molecular group characterized by TP53 mutation. In advanced disease, a combination of surgery to no residual disease and chemotherapy with or without radiotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval.

Obesity and gynecological cancers: A toxic relationship

AbstractDespite the evidence supporting the relevance of obesity and obesity‐associated disorders in the development, management, and prognosis of various cancers, obesity rates continue to increase worldwide. Growing evidence supports the involvement of obesity in the development of gynecologic malignancies. This article explores the molecular basis governing the alteration of hallmarks of cancer in the development of obesity‐related gynecologic malignancies encompassing cervical, endometrial, and ovarian cancers. We highlight specific examples of how development, management, and prognosis are affected for each cancer, incorporate current knowledge on complementary approaches including lifestyle interventions to improve patient outcomes, and highlight how new technologies are helping us better understand the biology underlying this neglected pandemic.

Prognostic value of the TCGA molecular classification in uterine carcinosarcoma

AbstractBackgroundThe TCGA molecular groups of endometrial carcinoma are “POLE‐mutated” (POLEmut), “microsatellite‐instable/mismatch repair‐deficient” (MSI/MMRd), “TP53‐mutated/p53‐abnormal” (TP53mut/p53abn), and “no specific molecular profile” (NSMP).ObjectivePrognostic assessment of the TCGA groups in uterine carcinosarcoma (UCS).Search strategySystematic review from January 2000 to January 2021.Selection criteriaStudies assessing the TCGA groups in UCS.Data collection and analysisProgression‐free survival (PFS) and overall survival (OS) were assessed by Kaplan–Meier and Cox analyses (reference: TP53mut/p53abn group) and compared with endometrioid and serous carcinomas (original TCGA cohort), with a significant P < 0.050.Main resultsFive studies with 263 UCS were included. Compared with TP53mut/p53abn UCS, MSI/MMRd UCS showed significantly better PFS (P < 0.001) but similar OS (P = 0.788), whereas NSMP UCS showed similar PFS (P = 0.936) and OS (P = 0.240). Compared with their endometrioid/serous counterparts, NSMP and TP53mut/p53abn UCS showed significantly worse PFS (P < 0.001 and P = 0.004) and OS (P < 0.001 and P < 0.001), while MSI/MMRd UCS showed similar PFS (P = 0.595) but significantly worse OS (P < 0.001). The POLEmut group showed neither recurrences nor deaths in both the UCS and the endometrioid/serous carcinoma cohorts.ConclusionPOLEmut UCS show excellent prognosis, whereas TP53mut/p53abn and NSMP UCS show a prognosis even worse than that of TP53mut/p53abn endometrioid/serous carcinomas. The prognosis of MSI/MMRd UCS remains to be defined.

Impact of adenomyosis on the prognosis of patients with endometrial cancer

AbstractBackgroundDespite the high prevalence of adenomyosis in hysterectomy specimens of endometrial carcinoma (EC) patients, the relationship between adenomyosis and EC prognosis appears unclear.ObjectiveTo assess the prognostic value of coexistent adenomyosis in patients with EC.MethodsA systematic review and meta‐analysis was performed by searching six electronic databases for studies reporting data on prognosis of EC patients with and without coexistent adenomyosis. Studies with patient selection based on prognostic factors were excluded. Pooled univariate hazard ratio (HR) analyses for overall survival (OS) and disease‐free survival (DRF) were performed, using EC patients without adenomyosis as a control group. For DFS, pooled multivariate HR analysis was also evaluable.ResultsThree studies of 2505 EC patients (553 with and 1952 without adenomyosis) were included. Compared with EC patients without adenomyosis, EC patients with coexistent adenomyosis showed a pooled HR of 0.533 (CI 95%, 0.329–0.864) for OS at univariate analysis; 0.536 (CI 95%, 0.334–0.859) for DFS at univariate analysis; and 0.875 (CI 95%, 0.331–2.315) for DFS at multivariate analysis.ConclusionIn EC patients with coexistent adenomyosis, the risk of death is halved compared with EC patients without adenomyosis. However, the independence of this association needs to be verified in future studies.

Is routine frozen section analysis necessary in patients with non‐endometrioid cancer or grade 3 endometrioid cancer?

AbstractObjectiveTo explore the accuracy related to type and subtype between frozen section (FS) results and final pathology results in patients with endometrial cancer and to suggest whether it should be routinely performed.MethodsRetrospective data were collected from 184 patients with endometrial cancer who underwent surgery at a single center (January 2014–December 2018). FS results were compared with the final pathology results with respect to histotype, tumor grade, and depth of invasion to define the accuracy of FS analysis.ResultsFrozen section analysis was performed in 141 (76.6%) patients. The accuracy rates and κ values between the FS and final pathology results with respect to histotype, tumor grade, and depth of invasion were 87.23%, 81.15%, and 98.2% and 0.41, 0.7, and 0.9, respectively (P < 0.001). Among the 18 patients with preoperative non‐endometrioid cancer (non‐EC), six underwent FS analysis, and final pathology confirmed EC in three, of whom 75% were detected by FS analysis. Eight of 19 patients with preoperative grade 3 EC underwent FS analysis and the accuracy rate was 87.5%.ConclusionIntraoperative FS analysis is a reliable method that can help intraoperative decision making. It should be performed routinely in patients with non‐EC and grade 3 EC.

Cancer of the ovary, fallopian tube, and peritoneum: 2021 update

AbstractIn 2014, FIGO’s Committee for Gynecologic Oncology revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high‐grade serous carcinomas (HGSC). Stage IC is now divided into three categories: IC1 (surgical spill); IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface); and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension), and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now “microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node” metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, and the treatment of ovarian germ cell and stromal malignancies.

Intraoperative predictors of appendiceal abnormalities in patients with mucinous ovarian neoplasms

AbstractObjectiveTo evaluate intraoperative factors predicting appendiceal pathology during gynecologic oncology surgery for suspected mucinous ovarian neoplasms.MethodsWe conducted a retrospective study on 225 patients with mucinous ovarian neoplasms who underwent surgery for an adnexal mass with concurrent appendectomy between 2000 and 2018. Regression analyses were used to evaluate intraoperative factors, such as frozen section of the ovarian mass and surgeon's impression of the appendix in predicting appendiceal pathology.ResultsMost patients (77.8%) had a normal appendix on final pathology. Abnormal appendix cases (n = 26) included: metastasis from high‐grade adenocarcinoma of the ovary (n = 1), neuroendocrine tumor of the appendix (n = 4), and low‐grade appendiceal mucinous neoplasms (n = 26; 23 associated with a mucinous ovarian adenocarcinoma, 2 with a benign mucinous ovarian cystadenoma, and 1 with a borderline mucinous ovarian tumor). Combining normal intraoperative appearance of the appendix with benign or borderline frozen section yielded a negative predictive value of 85.1%, with 14.9% of patients being misclassified, and 6.0% having a neuroendocrine tumor or low‐grade appendiceal neoplasm.ConclusionBenign or borderline frozen section of an ovarian mucinous neoplasm and normal appearing appendix have limited predictive value for appendiceal pathology. Appendectomy with removal of the mesoappendix should be considered in all cases of mucinous ovarian neoplasm, regardless of intraoperative findings.

Comparison of transvaginal or transumbilical tissue extraction at laparoscopic gynecologic surgery: A 12‐year experience

Abstract Objective To present our surgical outcomes by comparing the transumbilical and transvaginal methods for the removal of specimens in laparoscopic surgery of fibroids and adnexal masses during our 12 years of experience. Methods A retrospective cohort study was conducted at our referral center between January 2012 and April 2024. We evaluated surgical outcomes, patients' clinical‐demographic characteristics, cosmetic‐pain scores and dyspareunia by comparing the two methods that we use routinely. Results We retrospectively reviewed 285 patients. Visual analog scale (VAS) scores at 24 h were lower in the transvaginal group than in the transumbilical group (0.4 ± 0.6 vs. 0.8 ± 0.8, P  < 0.001). The 3‐month postoperative cosmetic score (CS) was higher in the transvaginal group than in the transumbilical group (4.5 ± 0.5 vs. 4.1 ± 0.6, P  < 0.001). Furthermore, myomectomy and transumbilical were independent risk factors for lower VAS scores 24 h post surgery (myomectomy: odds ratio [OR] 3.42, P  = 0.001, transvaginal route: OR 0.41, P  = 0.005). Finally, the transumbilical extraction route and extension of the umbilical incision were independent risk factors for lower CS ( P  = 0.035 and P  = 0.028). Conclusion Removal of the specimen via the transvaginal route in laparoscopic adnexal mass and fibroid surgeries may lead to less pain in the early postoperative period and better cosmetic results without increasing the duration of the operation, the rate of intraoperative complications, and the rate of dyspareunia.

FIGO position statement on opportunistic salpingectomy as an ovarian cancer prevention strategy

AbstractEpithelial ovarian cancer, with the highest mortality rate among gynecologic malignancies, often goes undetected until advanced stages due to non‐specific symptoms. Traditional prevention strategies such as bilateral salpingo‐oophorectomy (BSO) are limited to high‐risk women and induce surgical menopause, often leading to significant health concerns. Recent findings suggest that many serous epithelial ovarian cancers originate in the fallopian tubes rather than the ovaries. This has led to the hypothesis that salpingectomy, with preservation of the ovaries, may reduce the risk of ovarian cancer while avoiding the adverse effects of early menopause. Studies show that bilateral salpingectomy (BS) significantly reduces ovarian cancer incidence even in average‐risk women. Bilateral salpingectomy has been demonstrated to be safe with minimal added operative time, no adverse effects on ovarian function and is also cost effective. Opportunistic salpingectomy (OS), at the time of non‐gynecologic surgeries, is a promising strategy for reducing ovarian cancer risk, especially among average‐risk women who have completed childbearing. It offers a safe and cost‐effective alternative to traditional methods. Emerging data supports incorporating OS into standard surgical practices for benign gynecologic conditions and considering it during unrelated abdominal/pelvic surgeries after adequate patient counseling and informed consent. Further training of non‐gynecologic surgeons in OS is recommended to expand its preventive benefits.

FIGO guidance for sustainable implementation of vaccination programs for women: Pregnancy and HPV

Cancer of the cervix uteri: 2021 update

AbstractSince the publication of the 2018 FIGO Cancer Report, giant strides have been made in the global effort to reduce the burden of cervical cancer, with the World Health Organization (WHO) rolling out a global strategy for cervical cancer elimination, aiming for implementation by 2030. In over 130 countries, including low‐ and middle‐income countries, HPV vaccination is now included in the national program. Screening has seen major advances with wider implementation of HPV testing. These interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. FIGO’s revised staging of cervical cancer (2018) has been widely implemented and retrospective analyses of data based on the new staging have been published. Minimally invasive surgery has been shown to be disadvantageous in women with cervical cancer. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.

Worldwide initiatives to eliminate cervical cancer

AbstractIn 2020, more than 600 000 women were diagnosed with cervical cancer and 342 000 women died worldwide. Without comprehensive control, rates of cervical cancer incidence and mortality are expected to worsen. In 2020, the World Health Organization adopted the global strategy to eliminate cervical cancer to the threshold of four cases per 100 000 women within the 21st century, using a triple pillar intervention strategy comprising 90% of girls fully vaccinated by the age of 15 years, 70% of women screened by the age of 35 years and again by 45 years, and 90% of women with precancer treated and 90% of women with invasive cancer managed. In countries with high cervical cancer incidence, a tremendous effort will be needed to overcome the challenges. This article discusses the efforts in place to accelerate achievement of this ambitious goal.

Reaching the women with the greatest needs: Two models for initiation and scale‐up of gynecologic oncology fellowship trainings in low‐resource settings

AbstractWomen in low‐ and middle‐income countries (LMICs) are significantly more likely to develop and die from invasive cervical cancer, while rates of other gynecologic malignancies are comparable to those faced by women in high‐income countries. Despite this increased need, there are few specialist physicians in LMICs available to treat women with gynecologic cancers. Training specialists in low‐resource settings faces multiple challenges, including ensuring protected time from other clinical demands, access to best practice guidelines, training that is tailored to the specific challenges faced in the trainee's environment, and isolation from other fully trained professionals and securing support services. In addition, training specialists from LMICs in high‐resource settings is costly and return of trainees to their own country is not guaranteed. Here we describe two approaches to gynecologic oncology training in LMICs. The International Gynecologic Cancer Society (IGCS) developed the Global Curriculum Mentorship and Training Program (Global Curriculum) to support gynecologic oncology fellowships in regions of the world that do not currently have formal training in gynecologic oncology. In India, on the other hand, leaders in world‐class gynecologic oncology centers must find a way to meet the training needs of a vast and disparate country.

Artificial intelligence in the diagnosis and management of gynecologic cancer

AbstractGynecologic cancers affect over 1.2 million women globally each year. Early diagnosis and effective treatment are essential for improving patient outcomes, yet traditional diagnostic methods often encounter limitations, particularly in low‐resource settings. Artificial intelligence (AI) has emerged as a transformative tool that enhances accuracy and efficiency across various aspects of gynecologic oncology, including screening, diagnosis, and treatment. This review examines the current applications of AI in gynecologic cancer care, focusing on areas such as early detection, imaging, personalized treatment planning, and patient monitoring. Based on an analysis of 75 peer‐reviewed articles published between 2017 and 2024, we highlight AI's contributions to cervical, ovarian, and endometrial cancer management. AI has notably improved early detection, achieving up to 95% accuracy in cervical cancer screening through AI‐enhanced Pap smear analysis and colposcopy. For ovarian and endometrial cancers, AI‐driven imaging and biomarker detection have enabled more personalized treatment approaches. In addition, AI tools have enhanced precision in robotic‐assisted surgery and radiotherapy, and AI‐based histopathology has reduced diagnostic variability. Despite these advancements, challenges such as data privacy, bias, and the need for human oversight must be addressed. The successful integration of AI into clinical practice will require careful consideration of ethical issues and a balanced approach that incorporates human expertise. Overall, AI presents significant potential to improve outcomes in gynecologic oncology, particularly in bridging healthcare gaps in resource‐limited settings.

Cervical dysplasia among migrant women with female genital mutilation/cutting type III: A cross‐sectional study

AbstractObjectiveTo assess the rate of cervical dysplasia in a population of migrant women with female genital mutilation/cutting (FGM/C) type III who attended a specialized clinic for FGM/C.MethodsDescriptive retrospective cross‐sectional study reviewing electronic medical records of all infibulated women who attended a specialized clinic for women and girls with FGM/C at Geneva University Hospitals (2010–2016). We examined sociodemographic characteristics, parity, FGM/C subtypes, presence/grade of cervical dysplasia, colposcopy follow up/treatment, infections, and history of sexual violence.ResultsOut of 360 women reviewed, 188 women with FGM/C type III were included. Mean age of the women was 37.7 (±5.14) years. They were mostly from East Africa (n = 116, 61.7%). A total of 113 (60%) had undergone defibulation, the majority (105; 92.9%) without undergoing re‐infibulation. Cervical dysplasia was found in 20 (10.6%): 16 (8.5%) had a low‐grade grade squamous intraepithelial lesion or HPV‐positive atypical squamous cells of undetermined significance, Four (2.1%) had a high‐grade squamous intraepithelial lesions, of which one was a carcinoma in situ. Seven (35%) of the women with dysplasia underwent colposcopies regularly, five (25%) irregularly, and eight (40%) dropped out of colposcopy follow up.ConclusionCervical dysplasia is frequent among women with FGM/C type III and efforts should be made to guarantee follow up for migrant women.

A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis

AbstractBackgroundVisualization of the lesions in the lower genital tract is the mainstay for diagnosis of the four lesions found in female genital schistosomiasis (FGS), but colposcopes are generally not available in low‐resource settings.ObjectiveWe sought to review handheld devices that could potentially be used for FGS diagnosis.Search strategyWe searched Medline and Embase 2015–2019 for handheld devices used in cervical cancer screening and FGS diagnosis.Selection criteriaWe excluded studies that did not compare the device to standard‐of‐care colposcopes or histopathology.Main results and conclusionIn 11 studies, four handheld colposcopes, two smartphones, and one compact digital camera were evaluated. Two handheld colposcopes were found to be potentially adequate for FGS diagnosis, namely Gynocular and Mobile ODT. The smartphones and digital camera did not have sufficient magnification to diagnose grainy sandy patches, one of the FGS lesion types. Customized software should be made to support the diagnosis of both FGS and cervical neoplasia. Real‐time postgraduate training and quality control should be considered in future studies of handheld colposcopes. For patients from schistosomiasis endemic areas, we recommend that handheld devices are used for FGS. Studies are needed to determine which of the two devices is most adequate for FGS diagnosis in schistosomiasis endemic areas.

Acting on the call: A framework for action for rapid acceleration of access to the HPV vaccination in low‐ and lower‐middle‐income countries

AbstractCervical cancer, caused by HPV infection, is responsible for more than 311  000 preventable deaths every year. A global call to accelerate efforts to eliminate this disease has generated a new global strategy proposing ambitious, but achievable, targets for HPV vaccination of girls, and screening and treatment of women. The present paper addresses the suboptimal access to HPV vaccination in low‐income and lower‐middle‐income countries (LICs/LMICs), where the burden of disease weighs most heavily, in part through co‐infection with HIV. A proposed framework for action was formulated by first reviewing the reasons underlying gaps in HPV vaccine coverage. Good practices from recent introductions of HPV vaccine at scale in LICs/LMICs were then assessed based on targeted literature reviews and the experience and views of the authors. Difficulties in uptake and coverage of the HPV vaccine relate to the costs of the vaccine and service delivery, lack of prioritization, the challenges of vaccinating adolescents, and shortage of vaccines as the supply failed to keep pace with the rapid expansion in global demand, including from LICs/LMICs. The framework for action calls for new strategic thinking to consolidate global learning and invigorate operationalization at a country level.

Combination of transvaginal ultrasound with cervical cancer screening contributes to early detection of ovarian cancer: Clinical trial

Abstract Objective Early detection of ovarian cancer at stage I is important to improve patients‘ prognosis. The goal of this study was to examine if transvaginal ultrasound (TVU) performed at the same time as cervical cancer screening can facilitate early detection of ovarian cancer. Methods From 2014 to 2022, 483 269 women underwent TVU examinations during cervical cancer screening. The criteria for abnormal findings on TVU were ovarian enlargement ≥3 cm in long diameter (≥2 cm in postmenopausal women). Results Of the 483 269 women who underwent TVU, 3294 (0.68%) were selected for detailed examination. Of these women, 550 underwent surgery and 80 cases of ovarian cancer were found (positive predictive value: 2.43%). Pathologic review in 76 of these cases showed 70 cases of epithelial ovarian cancer (type I: 54 [77.1%], Type II: 16 [22.9%]) and six cases of non‐epithelial malignant tumors. Clinical staging analysis showed that 81.6% (62 cases) were at stage I. Significantly more type I than type II tumors were detected at stage I (87.3% ( n  = 46) vs. 56.3%, P  = 0.0068 ( n  = 9)). Notably, 95.7% (22/23) of clear cell carcinoma cases were detected at stage I. Discussion The high rate of early detection of type I ovarian cancer might be due to its slow progression. In Asia, where type I is common, the benefits of screening for ovarian cancer are particularly great. However, screening with TVU has generally been considered to have little benefit. The results of this study suggest a need for reassessment of this view.

Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi‐institutional study

AbstractObjectiveTo analyze the clinical management, the outcomes, and the trend in hysterectomy rates (HR) in patients who underwent this procedure for cervical intraepithelial neoplasia (CIN).MethodsMulticentric retrospective observational study conducted on 242 patients who underwent hysterectomy for CIN between 2010 and 2020 in nine Italian institutions. Hysterectomy for invasive or micro‐invasive neoplasia, sub‐total hysterectomy, or trachelectomy were excluded.ResultsA significant increase in the trend of HR for CIN was recorded (P = 0.002, r = 0.81; C.I. 95%: 0.415–0.949); HR increased from 0.46% in the year 2010 to 3.32% in 2020. The mortality rate was 0.4%, and 5% had operative complications. On definitive histopathology examination, a CIN of any grade was recorded in 71.5% of cases, and an occult invasive cancer in 1.24%. No pathology or CIN1 was found in 26.8% of cases, suggesting over treatment. During follow‐up, a vaginal lesion was recorded in 5% of cases.ConclusionA significant increase in the number of hysterectomies performed for CIN in the last 10 years was recorded. Hysterectomy for CIN can lead to complications, risk of the onset of vaginal lesions, and risk of overtreatment, and remains, in the first instance, an unacceptable treatment, to be proposed only after adequate counseling.

Cancer of the ovary, fallopian tube, and peritoneum: 2025 update

AbstractIn 2014, FIGO's Committee for Gynecologic Oncology revised the staging of ovarian cancer, incorporating ovarian, fallopian tube, and peritoneal cancer into the same system. Most of these malignancies are high‐grade serous carcinomas (HGSCs). Stage IC is now divided into three categories: IC1 (surgical spill), IC2 (capsule ruptured before surgery or tumor on ovarian or fallopian tube surface), and IC3 (malignant cells in the ascites or peritoneal washings). The updated staging includes a revision of Stage IIIC based on spread to the retroperitoneal lymph nodes alone without intraperitoneal dissemination. This category is now subdivided into IIIA1(i) (metastasis ≤10 mm in greatest dimension) and IIIA1(ii) (metastasis >10 mm in greatest dimension). Stage IIIA2 is now “microscopic extrapelvic peritoneal involvement with or without positive retroperitoneal lymph node” metastasis. This review summarizes the genetics, surgical management, chemotherapy, and targeted therapies for epithelial cancers, including the treatment of ovarian germ cell and stromal malignancies.

New histopathological and molecular findings in gynecological cancers

AbstractThis review covers significant developments in the pathological classification of gynecological tumors in recent years. Topics covered include The Cancer Genome Atlas (TCGA) Classification of endometrial carcinomas and how to incorporate this into routine reporting, the fact that most synchronous endometrial and ovarian endometrioid carcinomas represent metastasis from the endometrium to the ovary, and the important subject of lymphovascular space invasion in endometrial carcinomas. The categorization of cervical squamous cell carcinomas (SCCs) and adenocarcinomas and vulval and vaginal SCCs into prognostically meaningful HPV‐associated and HPV‐independent types is also discussed. Some “newly” described tumor types are covered, including endometrial and ovarian mesonephric‐like adenocarcinomas, STK11 adnexal tumors, and a number of uterine mesenchymal neoplasms associated with specific molecular abnormalities. Important molecular events in ovarian sex cord–stromal tumors and other rare adnexal neoplasms are also discussed.

HPV vaccination coverage rate in women undergoing conization for cervical intraepithelial neoplasia in Spain: The  COVAR study

Abstract Objective Females subjected to cervical excisional therapy (conization) due to high‐grade squamous intraepithelial lesions/cervical intraepithelial neoplasia HSIL/CIN have a higher risk of developing cervical lesions compared to the general population. Research suggests that HPV vaccination may reduce post‐treatment HSIL/CIN risk. Since 2014, HPV vaccination is recommended and funded in Spain at regional level for women who had undergone treatment for cervical precancerous lesions (HSIL/CIN2‐3 or any other potentially tumoral cytohistological alteration). In 2018, the Ministry of Health standardized the recommendations but the vaccination coverage rate (VCR) for this population has not been published. The COVAR Study aimed to estimate the annual HPV VCR among women undergoing conization for SIL/CIN in Spain and assess sociodemographic and COVID‐19 pandemic influence. Methods This was a multicentric, cross‐sectional retrospective study conducted in six Spanish public hospitals from January 1, 2019, to December 31, 2021. Results Annual HPV VCR was 87.3% (1135/1300), increasing to 89.8% (983/1095) in women with a conization for high‐grade SIL (HSIL)/CIN. Among vaccinated women, 30.2% (343/1135) were vaccinated after SIL/CIN diagnosis but before conization and 58.3% (662/1135) were vaccinated after conization; the remaining 11.5% (130/1135) received at least one dose before SIL/CIN diagnosis. Of the conizations, 32.4% (517/1594) were performed during the pre‐pandemic period, decreasing to 19.6% (312/1594) during the first COVID‐19 restriction period; the annual HPV VCR also decreased (30% [259/865] to 20.7% [179/865], P  < 0.001), for women vaccinated after conization. Conclusion The annual HPV VCR in our population was 87.3%, reflecting effective vaccination strategies. The COVID‐19 pandemic substantially impacted the annual percentage of conizations and HPV vaccination.

Barriers in the prevention and early detection of human papillomavirus in Latin America

AbstractObjectiveTo evaluate the individual, social, cultural, health system, and structural barriers related to the human papillomavirus (HPV) in women from eight Latin American countries.MethodsA prospective, relational, and analytical study was conducted from July to August 2024 in women from eight Latin American countries: Argentina, Colombia, Mexico, Nicaragua, Peru, Dominican Republic, Uruguay, and Venezuela. Spanish‐speaking adult women who had a history of having undergone cervicovaginal cytology were included. An online survey of 34 items was designed that evaluated the different barriers to HPV medical care.ResultsOverall, 1930 women were surveyed. There is a lack of education on issues related to sexual and reproductive health, as 57.3% of the participants considered HPV infection to be a sexually transmitted disease. A correlation was observed between a higher level of education and the acceptability of vaccination, as well as the taking of screening tests. It was found that 39.1% were vaccinated, which reflects the lack of resources in hospitals, where the vaccine is not available to all women, a similar situation to the screening test.ConclusionThere are still many barriers to HPV medical care due to the cultural roots that exist in the region. It is important to identify them and create strategies that allow equality and accessible medical care for all women, in order to eradicate cervical cancer, which is one of the great pending issues on the gynecologist's agenda.

Low uptake of Pap test as a cervical cancer screen among Saudi women: Findings from a national survey

Abstract Objective The present study aimed to assess the current knowledge and uptake of Papanicolaou (Pap) tests for cervical screening among Saudi women, including barriers to undergoing the test and the availability of related services. Methods A cross‐sectional study was conducted using a health questionnaire administered through the Absher portal between April 1, 2019, and March 31, 2020. The questionnaire consisted of five questions and took less than 5 min to complete. Descriptive and inferential statistics were employed to analyze demographic variables, and chi‐square tests were used to examine the association between these variables and Pap test uptake. Results The questionnaire included 8194 Saudi women, with the majority from Makkah (24.40%), Riyadh (21.92%), and Eastern (14.44%) regions. Only 22.52% of respondents had ever received a Pap test, and among them, 17.48% did so based on their physician's recommendation. Private clinics accounted for 10.73% of Pap test locations, while public clinics accounted for 8.97%. The primary reasons for not undergoing the test were lack of knowledge regarding its importance (40.24%) and lack of information from physicians (16.96%). Knowledge of the Pap test as a cervical screening method was significantly associated with marital status, Saudi region, and age group. Conclusions This study revealed low awareness of the Pap test for cervical screening among Saudi women, particularly in younger age groups. Targeted educational initiatives are essential to increase awareness and emphasize the significance of regular screenings, especially among younger individuals, to enhance early detection and reduce the burden of cervical cancer in Saudi Arabia.

Quality of life improvements in women with uterine fibroids treated with relugolix combination therapy during the LIBERTY long‐term extension study: A descriptive subgroup analysis in women with anemia at baseline

AbstractObjectiveTo investigate the effects of 52 weeks of treatment with relugolix combination therapy (relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) on symptoms of uterine fibroids (UF) and quality of life (QoL) in women with heavy menstrual bleeding associated with UF and anemia (hemoglobin ≤10.5 g/dL) at baseline.MethodsThis post hoc analysis included women from the LIBERTY long‐term extension study with anemia (hemoglobin concentration ≤10.5 g/dL) at pivotal study baseline and documented hemoglobin values at week 52 (anemia‐evaluable population). Treatment responders: women achieving a menstrual blood loss volume of <80 mL and a ≥50% reduction over the last 35 days of treatment. Anemia responders were women achieving a hemoglobin increase of >2 g/dL from baseline to week 52. Least squares (LS) mean changes from baseline in uterine fibroid symptom (UFS)‐QoL symptom severity, fatigue, and health‐related QoL total (HR‐QoL) and (sub)scale scores were calculated.ResultsIn total, 115 women were included in the anemia‐evaluable population. Of 39 anemia‐evaluable women who received continuous treatment with relugolix combination therapy for 52 weeks, 34 (87.2%) met treatment responder criteria and 23 (59.0%) were anemia responders. LS mean hemoglobin concentration increased by 29.4% at week 52. LS mean UFS‐QoL symptom severity and fatigue scores decreased by 38.5 and 31.9 points, respectively, and HR‐QoL total score increased by 41.6 points.ConclusionIn women with UF and a high disease burden due to anemia, relugolix combination therapy substantially improved hemoglobin levels, decreased distress due to symptoms, especially fatigue, over 52 weeks.

Expression of netrin‐1 in uterine serous carcinoma and its association with prognosis

AbstractBackground/ObjectivesAt present, there are few biomarkers used to predict the prognosis of uterine serous carcinoma (USC). Netrin‐1 may be a promising biomarker candidate. We investigated netrin‐1 expression in USC tissues and healthy endometrial tissues to determine its relevance to disease prognosis.Materials and MethodsNetrin‐1 expression was examined in the tissues of 48 patients with USC and 30 patients with healthy benign endometrial tissues via immunohistochemistry.ResultsNone of the healthy tissues were stained with netrin‐1. In tumor tissues, the overall positivity rate of netrin‐1 was 75%, detected as high expression in 17 patients (35%) and low in 19 (40%). Patients who had tumors with no netrin‐1 expression (n = 12) had a median overall survival (OS) of 60.0 months (95% confidence interval [CI], 47–98), whereas patients who had tumors with low to strong netrin‐1 expression (n = 33) had a lower median OS of 50 months, but the difference was not statistically significant (95% CI, 58–108; P = 0.531). Disease‐free survival (DFS) was not statistically significant between the groups (95% CI, 67.7–115.9; P = 0.566). Patients with a tumor diameter ≥2 cm had higher netrin‐1 expression than those with a tumor diameter of 2 cm (P = 0.027). We did not find any difference in overall and DFS when age, tumor stage, histology, tumor diameter, p53 status, lymphovascular space invasion, myometrial invasion, and lymph node metastasis were compared according to netrin‐1 expression (P > 0.05).ConclusionNetrin‐1 was expressed in USC but not in healthy tissues. Its expression was not associated with OS or DFS.

Myomectomy with ArtiSential fully articulating laparoscopic instruments: A prospective multicenter study

Abstract Background ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°‐unrestricted movement of the wrist joint, as in robotic surgery. Objective The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. Methods A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. Results The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m 2 ; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. Conclusions Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy.

Synchronous ovarian and Bartholin gland carcinoma: Case report and review of literature

AbstractTo our knowledge, this is the first reported case of synchronous ovarian and vulva (Bartholin gland) cancer. A postmenopausal woman presented with a complex multiloculated left adnexal mass and 2‐cm right Bartholin gland mass. CA 125 was 59 IU/mL. Computed tomography of chest, abdomen, and pelvis showed a very large (32 × 13.5 × 22.5 cm) complex mass arising from the pelvis and extending to the level of the T12/L1 disk space. A right Bartholin mass with suspicious right inguinal nodes was seen. Midline laparotomy, total abdominal hysterectomy, bilateral salpingo‐oophrectomy, infracolic omentectomy, pelvic peritoneal biopsies, and peritoneal washings were carried out. Wide local excision of the right Bartholin gland mass was carried out in the same setting. Histopathology came back as Stage 2B left ovarian clear‐cell carcinoma and synchronous right Bartholin gland adenoid cystic carcinoma with lymphovascular invasion, incompletely excised, staged at least FIGO Stage 1B. Following local multidisciplinary team discussion and positron emission tomography scan review, the local committee agreed to start three cycles of adjuvant chemotherapy then proceed with Bartholin gland scar re‐excision and bilateral groin lymph node dissection. After the three cycles, the groin lymph nodes came back as metastatic adenocarcinoma with overall morphologic and immunohistochemical features consistent with metastatic ovarian clear‐cell carcinoma. Postoperative adjuvant chemotherapy was given. Initial follow‐up period over 9 months was uneventful.

Anti‐NMDA receptor autoimmune encephalitis associated with ovarian teratoma: A case series and literature review

AbstractAutoimmune encephalitis is a group of disorders characterized by symptoms of dysfunction of the limbic and extra‐limbic systems that occur in association with antibodies against intracellular antigens, synapses, or proteins located on the surface of nerve cells. Anti‐NMDA (N‐methyl‐D‐aspartate) receptor encephalitis was first described in 2007 and has become one of the most commonly recognized autoimmune encephalitides. The disease is predominantly female (81%) and affects young patients (37% <18 years old, 95% <45 years old), with up to 58% of women over 18 years old having ovarian teratoma. Clinical symptoms of anti‐NMDA receptor encephalitis include psychiatric disorders (anxiety, agitation, bizarre behavior, hallucinations, delusions, and memory impairment); seizures and epileptic states; and other neurologic symptoms (muscle tone abnormalities, eye movement disorders, and central ventilatory disorders). Diagnosis of this condition can be difficult due to the non‐specific nature of the symptoms, often leading to delays in appropriate treatment. Early diagnosis and timely treatment of anti‐NMDA receptor encephalitis, especially in young women with ovarian teratoma, has significantly improved the chances of full recovery and improved reproductive health outcomes for patients.

A case of postoperative non‐invasive mucosal implantation of early‐stage cervical adenocarcinoma to the clitoris

SynopsisPostoperative non‐invasive mucosal implantation of cervical adenocarcinoma on the clitoris is rare. Surgical resection is appropriate for local recurrence in the vulva.

High acceptability of point‐of‐care HIV testing at the colposcopy outpatient clinic in hospitals in the Netherlands

AbstractObjectiveCervical cancer and its precursor are labeled as HIV indicator conditions, justifying the recommendation of HIV testing for all patients. This study aimed to assess the acceptance and patients' and gynecologists' perceptions on HIV testing in patients with cervical dysplasia at the colposcopy outpatient clinic in hospitals in the Netherlands.MethodsA cross‐sectional study was conducted between May 2021 and February 2023 to implement point‐of‐care HIV testing in five hospitals in the Rotterdam region, the Netherlands. We included patients aged 18 years and older, without documented HIV, presenting with cervical dysplasia. The primary outcome was the HIV test acceptance rate. Secondary outcomes were the HIV positivity rate and the association between dysplasia severity and test acceptance. We also assessed patients' and gynecologists' perspectives on this testing strategy with a questionnaire.ResultsOf 563 patients, 523 accepted HIV testing, resulting in a test acceptance rate of 92.9% (95% confidence interval, 90.45%–94.88%). Testing rates were consistent among participating hospitals (91.6%–100.0%) None of the patients tested positive for HIV. Severity of dysplasia was not associated with test acceptance (P = 0.768). Most patients (n = 500, 96.0%) reported good or higher experience with this testing strategy. The main barriers for gynecologists to offer HIV testing were lack of time (n = 22, 33.9%) and fear to offend a patient (n = 7, 12.5%). Less than half (n = 19, 39.3%) of gynecologists believed an HIV test should be offered to all patients with cervical dysplasia.ConclusionPoint‐of‐care HIV testing at colposcopy outpatient clinics was well accepted by patients. The data indicate that the primary barrier lies with the physicians to offer such testing.

Oncologic and obstetric outcomes of early‐stage epithelial ovarian cancer patients who underwent fertility‐sparing surgery: A retrospective study

AbstractObjectiveThis study aimed to assess the long‐term oncologic and obstetric outcomes of women with epithelial ovarian cancer who underwent fertility‐sparing surgery.MethodsA total of 68 patients observed between March 2007 and July 2021 were included in this retrospective study. Unilateral salpingo‐oophorectomy and uterine preservation with staging surgery were the main procedures for fertility‐sparing surgery. Disease‐free, overall survival, and obstetric outcomes were measured as primary outcomes.ResultsThe median age of the patients was 30.5 years. The median follow‐up time was 60.5 months. Disease recurrence occurred in 15 (22.1%) of the patients. Five‐year disease‐free survival and overall survival (OS) percentages were 75.6% and 83.3%, respectively, for all stages. The FIGO (International Federation of Gynecology & Obstetrics) stage was the only significant factor that affected OS (P = 0.001). Twenty‐three patients tried to conceive, and 15 (65.2%) patients became pregnant. Twelve (80%) pregnancies reached term and resulted in 15 live births. Chemotherapy administration and surgical intervention (cystectomy or unilateral salpingo‐oophorectomy) showed no difference in pregnancy results (P = 0.806 and P = 0.066, respectively).ConclusionFertility preservation is safe for invasive epithelial ovarian cancer at early stages for women in the reproductive era. Disease recurrence and OS results are similar to standard treatment at early stages with decent obstetric outcomes.

A long‐term retrospective analysis of management of cervical cancer during pregnancy

AbstractObjectiveThis study aims to describe cervical cancer during pregnancy (CCP) and investigate factors associated with survival outcomes.MethodsThis retrospective matched study included CCP patients from May 2007 to August 2021 and matched non‐pregnant cervical cancer patients (1:2) based on age (±5 years), year at diagnosis (±2 years), histological type and stage (2018 FIGO). The Kaplan–Meier method and multivariate Cox regression analyses were used to assess the impact of pregnancy and clinicopathologic factors on prognosis.ResultsThirty‐eight CCP patients (stage IA to IIIC) and 76 non‐pregnant patients were included. Most CCP patients were diagnosed in the first (31.6%) or second (47.4%) trimester. CCP patients had a longer waiting time than non‐pregnant patients. Pregnancy continued in 42.1% (continuation of pregnancy [COP] group) and was terminated in 57.9% (termination of pregnancy [TOP] group) of patients. Survival analysis showed no significant differences in recurrence‐free survival (RFS) or overall survival (OS) between pregnant and non‐pregnant patients or between the COP and TOP groups. At the end of the follow‐up period (range 12–178 months), 23 children born to CCP patients exhibited normal development.ConclusionPregnancy does not impact cervical cancer prognosis. The oncologic outcomes of the TOP and COP groups were comparable. A pregnancy‐preserving strategy could be considered for managing CCP patients.

Chromocolposcopy with fluorescein sodium for detection of premalignant and malignant lesions of the cervix: A cross‐sectional study

AbstractObjectiveThe aim of the study was to explore the utility of fluorescein sodium (FNa) as a contrast agent for colposcopy to detect premalignant and malignant lesions of cervix. The primary objective was to determine and compare the percentage detection of premalignant and malignant lesions of FNa and acetic acid (AA) positive areas.MethodsThis study included 120 screen positive women who underwent colposcopy using both 3% AA and FNa (0.06%). Observations for FNa staining were made under blue filter and directed biopsies were taken from acetowhite and fluorescent green areas. Benign lesions were considered as disease‐negative and low grade squamous intraepithelial lesions (LSIL), high grade SIL (HSIL), and invasive cancer were considered as disease‐positive. Correlation between histopathology and FNa and AA was determined by Kappa statistics.ResultsThe mean age was 39.59 ± 10.73 years and median parity was 2. Out of 120 patients, 57 had benign lesions, 18 had LSIL, 33 had HSIL and 12 had invasive carcinomas. Sensitivity was 98.41% versus 64.91% respectively and specificity was 85.71% versus 35.09% respectively with FNa and AA. Diagnostic accuracy of FNa and AA was 82.50% versus 61.60%. There was good agreement between FNa staining and final histopathology and fair agreement between AA application and HPE (κ = 0.643 vs 0.213, P < 0.001).ConclusionUsing FNa as a contrast agent during colposcopy results in greater accuracy for detection of premalignant and malignant lesions of the cervix as compared to AA.

Whole‐tumor apparent diffusion coefficient histogram analysis for preoperative risk stratification in endometrial endometrioid adenocarcinoma

AbstractObjectiveTo investigate the application of whole‐tumor apparent diffusion coefficient (ADC) histogram metrics for preoperative risk stratification in endometrial endometrioid adenocarcinoma (EEA).MethodsPreoperative MRI of 502 EEA patients were retrospectively analyzed. Whole tumor ADC histogram analysis was performed with regions of interest drawn on all tumor slices of diffusion‐weighted imaging scans. Risk stratification was based on ESMO‐ESTRO‐ESP guidelines: low‐, intermediate‐, high‐intermediate‐, and high‐risk. Univariable analysis was used to compare ADC histogram metrics (tumor volume, minADC, maxADC, and meanADC; 10th, 25th, 50th, 75th, and 90th percentiles of ADC [recorded as P10, P25, P50, P75, and P90 ADC, respectively]; skewness; and kurtosis) between different risk EEAs, and multivariable logistic regression analysis to determine the optimal metric or combined model for risk stratifications. Receiver operating characteristic curve analysis with the area under the curve (AUC) was used for diagnostic performance evaluation.ResultsA decreasing tendency in multiple ADC values was observed from the low‐ to high‐intermediate‐risk EEAs. The (low + intermediate)‐risk EEAs and low‐risk EEAs had significantly smaller tumor volumes and higher minADCs, meanADCs, P10, P25, P50, P75, and P90 ADCs than the (high‐intermediate + high)‐risk EEAs and non‐low‐risk EEAs (all P < 0.05), respectively. The combined models of the (meanADC + volume) and the (P75 ADC + volume) yielded the largest AUCs of 0.775 and 0.780 in identifying the (low + intermediate)‐ and the low‐risk EEAs from the other EEAs, respectively.ConclusionWhole‐tumor ADC histogram metrics might be helpful for preoperatively identifying low‐ and (low + intermediate)‐risk EEAs, facilitating personalized therapeutic planning.

Nomograms for predicting overall survival and cancer‐specific survival of endometrioid ovarian carcinoma: A retrospective cohort study from the SEER database

AbstractObjectiveEndometrioid ovarian cancer (EnOC) accounts for approximately 10%–15% of epithelial ovarian cancer cases. There are no effective tools for predicting the prognosis of EnOC in clinical work. The aim of this study was to construct and validate a nomogram to predict overall survival and cancer‐specific survival (CSS) in patients with EnOC.MethodsData regarding patients diagnosed with primary EnOC between 2004 and 2019 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. LASSO Cox regression and Cox regression analyses were performed to screen for prognostic factors, which were used to construct nomograms. In addition, we performed subgroup analyses of the prognostic value of chemotherapy and lymph node surgery.ResultsIn total, 3957 patients with primary EnOC were included in the analysis: 2770 in a training cohort and 1187 in a validation cohort. Age, stage, grade, lymph node surgery, and race were significantly and independently correlated with overall survival and CSS. Nomograms were constructed to predict 3‐ and 5‐year overall survival and CSS. Nomograms have good predictive ability and clinical practicability. Subgroup analysis showed that lymph node surgery improved the prognosis of patients with EnOC (P < 0.05) except for patients with grade III–IV and Stage I disease (overall survival P = 0.272, CSS P = 0.624). Chemotherapy did not improve survival time in most patients (P > 0.05) except for patients with grade I–II and Stage II–IV disease (overall survival P = 0.008, CSS P = 0.046).ConclusionWe constructed predictive nomograms and a risk classification system to evaluate overall survival and CSS in EnOC patients. For most patients with EnOC, chemotherapy did not improve the prognosis. In contrast to chemotherapy, lymph node surgery improved prognosis in most patients with EnOC.

Adenomyosis and coexisting gynecologic pathologies: How often do they coexist?

Abstract Objective To evaluate the presence of gynecologic pathologies accompanying adenomyosis among the hysterectomy specimens performed for various gynecologic indications. Methods This multicenter retrospective cohort study included women who underwent hysterectomy for various gynecologic indications and were diagnosed with adenomyosis at tertiary care centers. Eligible women were classified into two groups based on histopathologic results: Group 1—patients with only adenomyosis ( n  = 102) and Group 2—patients with adenomyosis and other gynecologic pathologies ( n  = 1353). Demographic and clinical characteristics, ultrasound examinations, and pathology reports were collected from medical records, and differences between the groups were assessed regarding clinical and demographic data, preoperative evaluations, and surgical characteristics. Results A total of 1455 patients were included. The adenomyosis‐only group was significantly older than the group with other gynecologic pathologies. The most common coexisting condition was myoma uteri, found in 586 patients (43.3%), followed by cancer and endometrial polyp. Myoma uteri was the most common comorbidity in premenopausal women, but cancer was more prevalent in postmenopausal patients. The mean endometrial thickness was less in the adenomyosis‐only group (6.5 ± 4.7 versus 8.0 ± 7.1 mm, P  = 0.032). Adenomyosis was more frequent in patients with menstrual irregularities compared with pelvic pain and postmenopausal bleeding. Conversely, cancer was significantly more common in patients with postmenopausal bleeding. Overall, 351 (24.1%) patients were diagnosed with cancer, with endometrial cancer being the most common ( n  = 218, 62.1%). Conclusions Our findings suggest that adenomyosis is frequently associated with conditions such as myoma uteri, endometrial polyps, and endometrial cancer.

Impact of optimal secondary cytoreductive surgery on survival outcomes in women with recurrent endometrial carcinoma: A systematic review and meta‐analysis

AbstractBackgroundManagement of recurrent endometrial carcinoma (EC) represents a challenge. Although a complete resection of visible disease at secondary surgery (R0) is recommended, the impact of R0 on survival outcomes is unclear and pooled data are lacking.ObjectiveTo quantitatively assess the impact of R0 on survival outcomes in women with EC recurrence.Search StrategyA systematic review and meta‐analysis was performed searching eight electronic databases from their inception up to January 2024.Selection CriteriaAll peer‐reviewed studies that assessed quantitatively the impact of R0 on survival outcomes in women at first EC recurrence were included.Data Collection and AnalysisHazard ratio (HR) with 95% confidence interval (CI) for death of any cause and secondary recurrent or progressive disease in women with EC recurrence who underwent R0 compared to non‐optimal secondary surgical cytoreduction (R1) were pooled and assessed at both univariable and multivariable analyses.Main ResultsThree studies with 442 patients were included. At univariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.451 (95% CI: 0.319–0.638) for death from any cause, and 0.517 (95% CI: 0.298–0.895; p = 0.019) for recurrent or progressive disease.At multivariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.447 (95% CI: 0.255–0.783; p = 0.005) for death from any cause, and 0.585 (95% CI: 0.359–0.952; p = 0.031) for recurrent or progressive disease.ConclusionIn women with EC recurrence, R0 is an independent prognostic factor, decreasing the risk of death from any cause by approximatively 55%, and of recurrent or progressive disease by approximatively 40%, compared to R1.

Artificial intelligence for cervical cancer screening: Scoping review, 2009–2022

AbstractBackgroundThe intersection of artificial intelligence (AI) with cancer research is increasing, and many of the advances have focused on the analysis of cancer images.ObjectivesTo describe and synthesize the literature on the diagnostic accuracy of AI in early imaging diagnosis of cervical cancer following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR).Search StrategyArksey and O'Malley methodology was used and PubMed, Scopus, and Google Scholar databases were searched using a combination of English and Spanish keywords.Selection CriteriaIdentified titles and abstracts were screened to select original reports and cross‐checked for overlap of cases.Data Collection and AnalysisA descriptive summary was organized by the AI algorithm used, total of images analyzed, data source, clinical comparison criteria, and diagnosis performance.Main ResultsWe identified 32 studies published between 2009 and 2022. The primary sources of images were digital colposcopy, cervicography, and mobile devices. The machine learning/deep learning (DL) algorithms applied in the articles included support vector machine (SVM), random forest classifier, k‐nearest neighbors, multilayer perceptron, C4.5, Naïve Bayes, AdaBoost, XGboots, conditional random fields, Bayes classifier, convolutional neural network (CNN; and variations), ResNet (several versions), YOLO+EfficientNetB0, and visual geometry group (VGG; several versions). SVM and DL methods (CNN, ResNet, VGG) showed the best diagnostic performances, with an accuracy of over 97%.ConclusionWe concluded that the use of AI for cervical cancer screening has increased over the years, and some results (mainly from DL) are very promising. However, further research is necessary to validate these findings.

The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties

AbstractUterine leiomyomas (ULs) are non‐cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a “paradoxical disease” where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification “subserosal, intramural and submucosal”, facilitating a detailed examination of individual ULs impact on the female reproductive system. The “type 3 UL” is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique “hybrid” between a submucous and an intramural UL, that may exert a detrimental “double hit” mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.

Survival outcomes of 2018 FIGO stage IIIC versus stages IIIA and IIIB in cervical cancer: A systematic review with meta‐analysis

AbstractObjectiveTo assess the difference in survival outcomes between stage IIIC and stages IIIA and IIIB in the 2018 FIGO cervical cancer staging system.MethodsThe PubMed, EMBASE, MEDLINE and Web of Science were searched for articles published from November 1, 2018 to January 31, 2023. Articles published in English were considered. The included studies compared the survival outcomes of patients with cervical cancer in FIGO 2018 stage IIIC with those in stages IIIA and IIIB. Studies focused on rare histopathological types were excluded. The statistical analyses were performed using Stata 17 software. The endpoints were overall survival (OS) and progression‐free survival (PFS).ResultsTen retrospective cohort studies were eligible, involving 2113 (6.2%), 9812 (28.6%), 44 (0.1%), 10 171 (29.7%), 11 677 (34.1%) and 445 (1.3%) patients in stage IIIA, IIIB, IIIA&B, IIIC, IIIC1, and IIIC2, respectively. In the OS group, stage IIIC/C1 was significantly associated with superior survival compared with stage IIIA (hazard risk [HR] 0.62, 95% confidence interval [CI] 0.41–0.93, P = 0.022; I2 = 92.9%) and stage IIIB(A&B) (HR 0.56, 95% CI 0.44–0.71, P < 0.001; I2 = 94.0%). The FIGO 2018 stage IIIC2 was not associated with an increased mortality risk compared with stage IIIA and stage IIIB(A&B). In the PFS group, the outcome of FIGO 2018 stage IIIC/C1 was similar to stage IIIA (HR 0.66, 95% CI 0.27–1.64, P = 0.371; I2 = 65.6%), but better than stage IIIB(A&B) (HR 0.75, 95% CI 0.68–0.83, P < 0.001; I2 = 0.0%). The FIGO 2018 stage IIIC2 has similar PFS outcomes to stage IIIA and stage IIIB(A&B).ConclusionOur findings demonstrate that survival outcomes of stage IIIC are no worse than those of stage IIIA and stage IIIB in the 2018 FIGO cervical cancer staging system. In cervical cancer, FIGO 2018 stage IIIC1 has significantly better OS outcomes than stage IIIA and stage IIIB.

Triage of HPV positivity in a high HIV prevalence setting: A prospective cohort study comparing visual triage methods and HPV genotype restriction in Botswana

AbstractObjectiveGuidelines for effective triage following positive primary high‐risk human papillomavirus (HPV) screening in low‐ and middle‐income countries with high human immunodeficiency virus (HIV)‐prevalence have not previously been established. In the present study, we evaluated the performance of three triage methods for positive HPV results in women living with HIV (WLHIV) and without HIV in Botswana.MethodsWe conducted baseline enrollment of a prospective cohort study from February 2021 to August 2022 in South‐East District, Botswana. Non‐pregnant women aged 25 or older with an intact cervix and no prior diagnosis of cervical cancer were systematically consented for enrollment, with enrichment of the cohort for WLHIV. Those who consented completed a questionnaire and then collected vaginal self‐samples for HPV testing. Primary HPV testing for 15 individual genotypes was conducted using Atila AmpFire® HPV assay. Those with positive HPV results returned for a triage visit where all underwent visual inspection with acetic acid (VIA), colposcopy, and biopsy. Triage strategies with VIA, colposcopy and 8‐type HPV genotype restriction (16/18/31/33/35/45/52/58), separately and in combination, were compared using histopathology as the gold standard in diagnosing cervical intraepithelial neoplasia (CIN) 2 or worse (CIN2+).ResultsAmong 2969 women enrolled, 1480 (50%) tested HPV positive. The cohort included 1478 (50%) WLHIV; 99% were virologically suppressed after a mean of 8 years on antiretroviral therapy. In total, 1269 (86%) women had histopathology data for analysis. Among WLHIV who tested positive for HPV, 131 (19%) of 688 had CIN2+ compared with 71 (12%) of 581 in women without HIV. Screening by 8‐type HPV genotype restriction was more sensitive as triage to detect CIN2+ in WLHIV 87.79% (95% CI: 80.92–92.85) and women without HIV 85.92% (95% CI: 75.62–93.03) when compared with VIA (WLHIV 62.31% [95% CI: 53.39–70.65], women without HIV 44.29% [95% CI: 32.41–56.66]) and colposcopy (WLHIV 70.77% [95% CI: 62.15–78.41], women without HIV 45.71% [95% CI: 33.74–58.06]). However, 8‐type HPV genotype restriction had low specificity in WLHIV of 30.88% (95% CI: 27.06–34.90) and women without HIV 37.06% (95% CI: 32.85–41.41). These results were similar when CIN3+ was used as the outcome. When combining 8‐type HPV genotype restriction with VIA as the triage strategy, there was improved specificity to detect CIN2+ in WLHIV of 81.65% (95% CI: 78.18–84.79) but dramatically reduced sensitivity of 56.15% (95% CI: 47.18–64.84).ConclusionsEight‐type HPV genotype restriction is a promising component of effective triage for HPV positivity. However, novel triage strategies in LMICs with high HIV prevalence may be needed to avoid the trade‐off between sensitivity and specificity with currently available options.Clinical trials registrationThis study is registered on Clinicaltrials.gov no. NCT04242823, https://clinicaltrials.gov/ct2/show/NCT04242823.

Cervical carcinosarcoma, report of some cases and a literature review

SynopsisMost data come from case series, so diagnosis and management may pose a challenge. Further investigations are needed to determine HPV's role in this pathology.

Local treatment strategies in Stage IVB cervical squamous cell carcinoma and adenocarcinoma

AbstractObjectiveTo evaluate the effect of different local treatment strategies on survival outcomes in patients with Stage IVB cervical squamous cell carcinoma (SCC) and adenocarcinoma.MethodsPatients diagnosed with Stage IVB cervical SCC and adenocarcinoma between 2004 and 2015 were included from the Surveillance, Epidemiology, and End Results (SEER) database. Subgroup analysis was performed in those diagnosed between 2010 and 2015 and available for the sites of distant metastases.ResultsIn total, 706 patients were identified in this study, including 378 (53.5%) and 328 (46.5%) diagnosed in 2004–2009 and 2010–2015, respectively. There were 525 (74.4%) and 181 (25.6%) patients with SCC and adenocarcinoma, respectively. Moreover, 274 (38.8%) and 432 (61.2%) patients received hysterectomy and primary radiotherapy, respectively. The results of the multivariate Cox regression analysis showed that histology and local treatment strategies were not related to cause‐specific survival (CSS) and overall survival. In the SCC patients, patients who received primary radiotherapy had similar CSS (P = 0.312) and overall survival (P = 0.390) compared with those treated with surgery. In the adenocarcinoma patients, those who received primary radiotherapy had inferior CSS (P = 0.003) and overall survival (P < 0.001) compared with those treated with surgery. Similar results were found in those diagnosed 2004–2015 and 2010–2015 after propensity score matching.ConclusionsFor patients with Stage IVB cervical cancer who received local therapy, surgery, and primary radiotherapy had similar survival in cervical SCC, whereas surgery had better survival outcomes compared with primary radiotherapy in those with cervical adenocarcinoma.

Cervical assessment certification and its impact on performance quality in the context of universal cervical screening

AbstractObjectiveTo assess the impact of the introduction of universal transvaginal cervical screening and certification on the quality of cervical length ultrasound images.MethodsThe present study included a retrospective cohort of singleton pregnancies that underwent transvaginal cervical length measurement at the anatomical scan (180/7 and 236/7 weeks) before (period A, 2015–2017) and after (period B, 2017–2019) the introduction of universal transvaginal cervical length screening. Independent observers blindly evaluated the images obtained for cervical length using a qualitative scoring method based on five criteria, according to the Fetal Medicine Foundation.ResultsIn all, 6013 patients met the inclusion criteria, 3333 in period A and 2680 in period B. Maternal characteristics and risk factors for preterm birth were similar between the two periods. The acceptance of transvaginal cervical length measurement in period B was 95.5% in the overall cohort and 100% in the subgroup of high‐risk patients. The quality score was significantly higher in period B than in period A. Among the image quality criteria, the anterior/posterior ratio, the correct magnification of the images, and the calipers' placement contributed significantly to the improved quality score in period B. Most of the sonographers performed better in period B, irrespective of the years of experience, but certificate holders obtained higher scores than non‐certified sonographers, particularly those in mid‐career. The identification of short cervix was significantly higher in period B than in period A.ConclusionThe implementation of universal transvaginal cervical length screening and the certification process are associated with improved quality of cervical length images, even among expert sonographers and in the presence of anatomical pitfalls.

Validation of single‐photon emission computed tomography with computed tomography and lymphoscintigraphy for sentinel lymph node identification in cervical cancer

AbstractObjectiveTo compare single‐photon emission computed tomography with computed tomography (SPECT/CT) and lymphoscintigraphy (LSG) for the detection of sentinel lymph nodes (SLNs) in patients with early‐stage cervical cancer.MethodsThis hospital‐based, single‐center, retrospective study included 128 patients with cervical cancer (aged >18 years) treated between 2014 and 2022. Injection of 99 m Technetium‐labeled phytate into the uterine cervix was used to detect pelvic SLNs. SNL identification rates and locations were analyzed for preoperative LSG and SPECT/CT.ResultsMedian age and body mass index of patients were 40 years (range, 20–78 years) and 21.7 kg/m2 (range, 16–40 kg/m2), respectively. There was no significant difference in overall identification rates (identification of at least one SLN) of SLNs between SPECT/CT (91%) and LSG (88%). There was no significant difference in bilateral SLN identification rates between SPECT/CT (66%) and LSG (65%). A total of 219 pelvic SLNs (110 right and 109 left hemipelvis) were identified by SPECT/CT; the most frequent locations were the obturator (122 SLNs, 56%) and external iliac (67 SLNs, 30%).ConclusionSPECT/CT and LSG showed high SLN identification rates in patients with cervical cancer, and there was no significant difference in overall or bilateral SLN identification rates between the two techniques.

Diagnostic study of human papillomavirus DNA detection in cervical and vaginal samples using the filter paper card

AbstractObjectiveTo determine the accuracy of high‐risk human papillomavirus (HPV) DNA samples on filter paper in comparison to specimen transport medium (STM).MethodsThis was a cross‐sectional diagnostic study of 42 consecutive women who were prospectively recruited. Each had self‐collected vaginal samples on filter paper, physician‐collected cervical samples on filter paper, and physician‐collected cervical samples in STM. HPV DNA testing was performed with a Hybrid Capture 2 system (Qiagen). Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and agreement of filter paper methods with the standard procedure were calculated.ResultsThe overall prevalence of HPV in STM was 67.5%. Detection of HPV DNA in the physician‐collected cervical samples on filter paper had a sensitivity of 77.8%, a specificity of 100%, a PPV of 100%, and an NPV of 68.4%. The patient's self‐sampling on filter paper had a sensitivity of 66.7%, a specificity of 100%, a PPV of 100%, and an NPV of 59.1%. The agreement between STM method and physician‐collected sample on filter paper was substantial, (κ = 0.695, P < 0.001), while the agreement between STM and self‐collected samples on filter paper was moderate (κ = 0.565, P < 0.001). Most patients reported that self‐collection was acceptable (100%), painless (95%), and not embarrassing (95%).ConclusionFilter paper, with dried self‐collected vaginal samples, can be used to detect high‐risk HPV with acceptable accuracy.

Postoperative management of FIGO 2018 stage IIA1 cervical squamous cell carcinoma with only one intermediate‐risk factor: Is radiotherapy needed?

AbstractObjectiveTo investigate whether postoperative radiotherapy is required for FIGO 2018 stage IIA1 cervical squamous cell carcinoma patients with only one intermediate‐risk factor.MethodsThis was a multicenter retrospective study. The selected patients were classified into no postoperative adjuvant therapy and postoperative radiotherapy groups. The 5‐year overall survival (OS) and disease‐free survival (DFS) rates were compared.ResultsIn total, 159 patients with no postoperative adjuvant therapy and 179 patients with postoperative radiotherapy were included, with the former group showing a lower OS but no difference in DFS. No postoperative adjuvant therapy was an independent risk factor for patient mortality. Patients were also stratified by tumor diameter: 56 patients had a tumor diameter ≤2 cm, comprising 32 patients with postoperative radiotherapy and 24 patients without (no between‐group difference was found); 272 patients had a tumor diameter >2 cm, comprising 122 patients with postoperative radiotherapy and 150 patients without, with the former group showing a higher OS, and no postoperative adjuvant therapy was an independent risk factor for patient mortality.ConclusionFor FIGO 2018 stage IIA1 cervical squamous cell carcinoma patients with only one intermediate‐risk factor and a tumor diameter >2 cm, postoperative radiotherapy is likely beneficial to improve prognosis.

Pelvic organ prolapse and vaginal cancer: A systematic literature review

AbstractBackgroundPrimary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment.ObjectivesTo investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions.Search StrategyWe performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by “pelvic organ prolapse”, “genital prolapse”, and “vaginal cancer”, “vaginal carcinoma”.Selection CriteriaNo article type restrictions were applied.Data Collection and AnalysisTwenty‐one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients.Main ResultsManagement usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed.ConclusionA multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.

Clinical characteristics and serum CA19‐9 combined with HE4 are valuable in diagnosing endometriosis‐associated ovarian cancer

AbstractObjectiveEndometriosis‐associated ovarian cancer (EAOC) is difficult to diagnose because of its low incidence, uncertain risk factors, and the absence of effective markers. This study aimed to investigate the clinical characteristics of EAOC and identify useful serological markers.MethodsWe retrospectively studied the clinical characteristics of patients with EAOC and ovarian endometriosis, obtained between January 1, 2011 and October 31, 2021. Univariate and multivariate logistic regression analyses were used to explore the relationship between clinical characteristics and EAOC. Receiver operating characteristic curves were applied to access the diagnostic value of serological markers in EAOC.ResultsIn total, the clinical characteristics of 220 patients were obtained; 44 with EAOC and 176 with ovarian endometriosis. EAOC patients were older (46.20 vs. 36.26 years, P < 0.001) and had larger tumors (9.10 vs. 6.73 cm, P = 0.003) together with higher CA19‐9 (21.44 vs. 4.72 U/mL, P < 0.001) and HE4 levels (62.35 vs. 44.19 pmol/L, P < 0.001) when compared with ovarian endometriosis patients. Multivariate analysis showed that HE4 greater than 59.7 pmol/L, CA19‐9 greater than 8.5 U/mL, age 42 years or older, and tumor length 9.2 cm or longer were independent risk factors for EAOC. Significantly, CA19‐9 combined with HE4 had high sensitivity (72.73%) and specificity (78.41%) in diagnosing EAOC.ConclusionAge over 42 years, large ovarian tumor, serum CA19‐9 and HE4 are valuable in the diagnosis of EAOC.

Impact of appendectomy of a grossly normal appendix on the survival outcomes of mucinous ovarian carcinomas in a tertiary hospital

AbstractObjectiveTo evaluate the survival outcomes of appendectomy for a grossly normal appendix in patients with mucinous ovarian carcinomas.MethodsRetrospective cohort study. Patients with mucinous ovarian carcinomas with grossly normal appendices who underwent primary surgery between 2002 and 2022 were enrolled. The overall survival (OS) and progression‐free survival (PFS) of appendectomy and non‐appendectomy groups were analyzed using the Kaplan–Meier method and compared using the log‐rank test. Univariate and multivariate Cox regression analyses were used to determine the independent factors associated with OS and PFS.ResultsOf 192 patients, appendectomy was performed in 138 (71.9%). Three (1.6%) patients had primary appendiceal tumors and two (1.0%) had appendiceal metastases of ovarian origin. The median follow‐up time was 68.8 months. The OS and PFS were better in patients in the appendectomy group than in those in the non‐appendectomy group (5‐year OS: 80.72% vs. 65.05%, P = 0.012; 5‐year PFS: 76.32% vs. 58.60%, P = 0.020). Independent factors associated with poor OS and PFS were no omentectomy, peritoneal seeding, and advanced International Federation of Gynecology and Obstetrics (FIGO) stage.ConclusionAppendectomy of a grossly normal appendix was not an independent prognostic factor for OS and PFS in patients with mucinous ovarian carcinomas.

Prognostic nomogram and treatment efficacy analysis for vaginal cancer: A SEER database and external validation study

AbstractObjectivesTo analyze the prognosis and treatment decisions for patients with vaginal cancer through a large retrospective cohort study, in order to assist clinicians to evaluate the condition and choose treatment methods.MethodsThis was a retrospective study analyzed with Cox regression, nomogram, and external validation. The Kaplan–Meier curve was used for comparative analysis of various treatment modalities.ResultsA total of 6650 cases of vaginal cancer diagnosed between 2000 and 2018 from the Surveillance, Epidemiology, and End Results database and 106 cases diagnosed between 2006 and 2021 from Fujian Cancer Hospital were identified. Young age, early FIGO (the International Federation of Gynecology and Obstetrics) stage, well‐differentiated, squamous and adenocarcinoma, first primary malignancy, married, undergoing surgery, and chemoradiotherapy were good independent prognostic factors (P < 0.001). The internal and external validation concordance indices were 0.7102 and 0.7785, respectively. The Kaplan–Meier curves indicated that surgery, radiotherapy, and chemotherapy significantly improved survival in patients with vaginal cancer. Forest plots suggest that radiotherapy combined with surgery was superior to radiotherapy alone (P < 0.001).ConclusionWe established a specific nomogram to predict vaginal cancer prognosis. Surgery combined with external beam radiation plus brachytherapy may be the most recommended treatment option.

Small‐cell neuroendocrine carcinoma of the vagina: A case report

SynopsisManagement of a small‐cell neuroendocrine carcinoma of the vagina presented in a woman on a distant Greek island.

Adnexal masses: Diagnostic performance of contrast‐enhanced ultrasound using the simple rules from the International Ovarian Tumor Analysis group

AbstractObjectiveTo evaluate the role of the Simple Rules (SR) from the International Ovarian Tumor Analysis group in contrast‐enhanced ultrasound (CEUS) of for the differential diagnosis of benign and malignant adnexal tumors.MethodsA total of 180 patients with suspected malignant adnexal masses admitted to Lanzhou University Second Hospital were included, all of whom received conventional ultrasound (US) and CEUS examination before surgery. All masses were assessed using SR in US and SR in CEUS. To compare the diagnostic performance, the sensitivity, specificity, negative and positive predictive values, Youden index, and area under the curves values of SR in US and SR in CEUS were obtained.ResultsSensitivity, negative predictive values, Youden index, and area under the curves were better for SR in CEUS than SR in US. The specificity and negative predictive value of SR in CEUS were lower than that of SR in US. Compared with SR in US, SR in CEUS significantly reduced the number of uncertain masses (21, 36.7% vs. 66, 11.7%).ConclusionWe concluded that SR in CEUS performed well in the diagnosis of malignant adnexal masses. SR in CEUS is a supplement to SR in US.

Ten‐year follow‐up study of long‐term outcomes after conservative surgery for early‐stage ovarian cancer

AbstractObjectiveTo evaluate long‐term outcomes after surgery for apparent early‐stage ovarian cancer (OC).MethodsRetrospective analysis of women who underwent staging surgery for apparent early‐stage OC at a single center in Milan, Italy, from 1990 to 2008, and had a follow‐up longer than 10 years (living women with no recurrence). Univariate and multivariate analyses and propensity score matching were carried out.ResultsOverall, 182 women underwent radical (n=148, 81.3%) or conservative (n=34, 18.7%) procedures for early‐stage OC. Ten‐year disease‐free and overall survival were 82.9% (n=151) and 87.9% (n=160), respectively. Conservative or radical surgery had similar disease‐free (log‐rank test, P=0.783) and overall (log‐rank test, P=0.783) survival. These data were confirmed after the application of propensity score matching. High‐risk features correlated with non‐significant worse disease‐free survival (P=0.080). In the high‐risk group (≥Grade 3 or ≥ Stage IC), type of surgical approach (conservative vs radical) did not affect survival (hazard ratio, 0.81; 95% confidence interval, 0.18–3.56; P=0.781).ConclusionWomen with early‐stage OC had encouraging long‐term survival. The presence of high‐risk disease had detrimental effects on survival, regardless of surgical approach. High‐risk disease should not be considered a contraindication to conservative surgery.

Recurrent mucinous neoplasm arising in cesarean scar: A case report and review of literature

AbstractOvarian mucinous tumors are one of the common epithelial tumors in the ovary, but their recurrence is extremely rare. In a 37‐year‐old female patient who had had five operations in 7 years due to recurrent mucinous neoplasms, a mass extending to the umbilicus was recently detected during a routine examination. With this finding the patient underwent cystectomy, total abdominal hysterectomy, and left salpingo‐oophorectomy. Two of the five operations were performed during cesarean delivery. In the recent surgical procedure, two cysts were removed. A 20 cm cyst in the pelvic region was diagnosed as a mucinous cystadenoma. The other cyst located in the myometrium was a mucinous cystadenoma with focal borderline change and arose in the previous cesarean scar. The authors present what is believed to be the first case of recurrent mucinous neoplasm arising within a cesarean scar. A review of the literature concerning the topic is also presented.

Effect of barbed suture versus conventional suture in laparo‐endoscopic single‐site cystectomy for ovarian mature cystic teratoma: An ambispective cohort study

AbstractObjectiveTo compare the effects of barbed suture (BS) and conventional suture (CS) on perioperative conditions and ovarian function in the excision of ovarian mature cystic teratoma (MCT) by laparo‐endoscopic single‐site surgery (LESS).MethodsThe present study is an ambispective cohort study conducted in an affiliated tertiary hospital between May 2019 and October 2020. Women treated by LESS cystectomy for unilateral ovarian MCT were included. BS or CS were applied in the surgery.ResultsBS and CS groups were matched 1:1 for age, body mass index and ovarian cyst volume (40 women per group). There were no significant differences in baseline characteristics. Mean operating time (53.89 ± 14.80 versuss 67.93 ± 19.23 min, P = 0.004) and suturing time (11.85 ± 6.68 versus 19.76 ± 12.75 min, P = 0.006) were significantly shorter in the BS group than the CS group. No significant differences were found in serum anti‐Müllerian hormone (AMH) levels between groups at baseline, postoperative day 1, 3 months, and 12 months. However, serum AMH was significantly lower than baseline at postoperative day 1, 3 months, and 12 months in both groups.ConclusionBS provides shorter operating and suturing time than CS, without increasing damage to ovarian function in LESS cystectomy for ovarian MCT.

Sex cord stromal tumor presenting with hair loss in postmenopausal women

Male pattern baldness is abnormal in menopause and a possible sign of hyperandrogenism. Bilateral salpingo‐oophorectomy is necessary to rule out an androgen‐secreting ovarian tumor.

Detection of high‐risk human papillomavirus infection and treatment of high‐grade vaginal intraepithelial neoplasia: A single‐institution study

AbstractObjectiveTo identify high‐risk HPV (hrHPV) genotypes associated with high‐grade vaginal intraepithelial neoplasia (VaIN), and evaluate the efficacy of various treatments for high‐grade VaIN.MethodsA retrospective review of outcomes among women diagnosed with VaIN after vaginal punch biopsy conducted due to an abnormal Papanicolaou smear or positive test for hrHPV at a hospital in Seoul, Korea, from 2013 to 2018. Logistic regression was used to identify variables associated with abnormal pathologic outcomes.ResultsAmong 389 women included in the study, 58 were diagnosed with high‐grade VaIN, including VaIN stage 2 (n = 37), VaIN stage 3 (n = 16), carcinoma in situ of the vagina (n = 3), and squamous carcinoma of the vagina (n = 2). In multivariate logistic regression analysis, risk of high‐grade VaIN and cancer was higher among women with abnormal cytology (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.47–2.47), any hrHPV infection (OR, 8.75; 95% CI, 1.14–67.31), HPV16 infection (OR, 5.71; 95% CI, 2.57–12.68), or HPV31 infection (OR, 4.37; 95% CI, 1.45–13.11).ConclusionThe findings suggest that infection with hrHPV, especially HPV16 and HPV31, is significantly associated with high‐grade VaIN. Regarding treatment modalities, ablative or excisional treatments showed good efficacy against pathologic regression of high‐grade VaIN.

Effects of HIV infection on metastatic cervical cancer and age at diagnosis among patients in Lusaka, Zambia

AbstractObjectiveTo examine the association between the duration of HIV infection and the stage of cervical cancer in Lusaka, Zambia.MethodsThis retrospective case‐case study included 1583 cervical cancer patients from the Cancer Diseases Hospital in Lusaka, Zambia. A sub‐population of HIV‐positive patients with additional clinical HIV information was identified following linkage of cancer and HIV databases. Logistic regression models examined the relationship between HIV status and early‐onset cervical cancer diagnosis, and between HIV infection duration and initial diagnosis of metastatic cervical cancer.ResultsThe study population had an average age of 49 years and 40.9% had an initial diagnosis of metastatic cancer. HIV‐positive women were more than twice as likely to be diagnosed at early‐onset cervical cancer compared with HIV‐negative women. Among the sub‐population of HIV‐positive patients, a longer duration of HIV infection was associated with 20% lowered odds of initial metastatic cancer diagnosis.ConclusionThe availability, accessibility, and impact of the cervical screening program in this population should be further examined to elucidate the relationship between cervical screening, age, and duration of HIV infection and the the stage of diagnosis of cervical cancer.

Value of the Copenhagen index in the diagnosis of malignant adnexal tumors: A meta‐analysis

AbstractOvarian cancer is a common gynecological malignant tumor. Early diagnosis is important for the prognosis of patients with ovarian cancer. To evaluate the accuracy of the Copenhagen Index (CPH‐I) in detecting malignant adnexal tumors and to compare the diagnostic accuracy of CPH‐I and the Risk of Ovarian Malignancy Algorithm (ROMA). PubMed, Web of Science, and Cochrane Library databases were used to retrieve eligible studies. The overall sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the (summary receiver operating characteristic) curve (AUC) were 0.81, 0.88, 6.61, 0.22, 30.43, and 0.91, respectively, in diagnosing malignant adnexal tumors. In addition, using ROMA, the sensitivity, specificity, and AUC were 0.83, 0.85, and 0.90, respectively. CPH‐I showed high accuracy in diagnosing malignant adnexal tumors, which could be an alternative method with similar efficacy to ROMA. CPH‐I was more advantageous in diagnosing adnexal tumors in postmenopausal women.

Clinicopathologic features of pregnancy luteoma

AbstractObjectiveThis study aimed to explore the clinicopathological characteristics, immunophenotype, histological occurrence, diagnosis, and differential diagnosis of ovarian luteoma tumor of pregnancy.MethodsThe clinical features, histomorphology, immunohistochemistry, and reticular fiber staining results of 18 cases of luteoma tumors of pregnancy were analyzed, and related published studies were reviewed.ResultsThe 18 cases of luteoma tumors were all women who had undergone multiple pregnancies. The tumors were 1.3–15 cm in size and brownish yellow or reddish brown in color, with a soft texture. Microscopic examination revealed the eosinophilic cytoplasm of tumor cells and diffuse hyperplasia. The results of the immunohistochemical analysis were as follows: α‐inhibin, AE1/AE3, CD99, and vimentin were positive, while epithelial membrane antigen, S‐100, HMB45, and MelanA were negative. One case was positive for MelanA. The staining results of reticular fibers showed that the argyrophilic reticular fibers were black surrounding the tumor cell nests.ConclusionsLuteoma tumor of pregnancy is a rare tumor‐like lesion mostly appearing in late pregnancy. The gross, immunohistochemical staining, and reticular fiber staining results may help diagnose this disease. The disease needs to be differentiated from other diseases.

Appropriateness of hysterectomies at the time of surgical removal of presumed benign adnexal masses

AbstractObjectiveTo evaluate factors that affect a gynecologist’s decision to remove an asymptomatic uterus at the time of removal of a presumed benign adnexal mass.MethodsRetrospective chart review of hysterectomies conducted when removing presumed benign adnexal masses at a tertiary‐care academic center. Primary outcome was the final pathology of the adnexal mass to determine whether the hysterectomy was medically indicated. Secondary outcomes included the rate of postoperative complications.ResultsWe included 185 out of 1415 charts. Most hysterectomies were performed by gynecologic oncologists (68.8%); 113 (61%) had a frozen section and of those, 76 (67.3%) were benign. Final adnexal pathology was benign in 135 (73%) cases. Using a bivariate analysis, menopausal status (P = 0.019), parity (P = 0.047), sonographic appearance of the mass (P = 0.049), and the physician’s preoperative suspicion for malignancy (P < 0.001) were significantly associated with the final adnexal pathology. At the multivariate level, only the physician’s suspicion for malignancy was significantly associated with the final adnexal pathology (P < 0.0001) with an odds ratio of 7.28 (95% confidence interval 3.11–17.02).ConclusionDespite gynecologists' capacity to predict the malignant nature of an adnexal mass, 135 of 185 (73%) hysterectomies were performed without a clear medical indication, at the time of removal of benign adnexal masses.

Prognosis of bulky pTIIB cervical cancer treated by radical hysterectomy comparing adenocarcinoma with squamous cell carcinoma using propensity score matching

Abstract Objective To investigate whether radical hysterectomy (RAH) can effectively treat true Stage IIB (pTIIB) cervical adenocarcinoma (AC) because FIGO (clinical) Stage IIB cervical cancer is rarely treated with RAH and radiotherapy has unfavorable effects on AC. Methods We retrospectively analyzed data for 82 patients with Stage pTIIB cervical cancer who underwent RAH at our institution between January 1997 and December 2017. The end points were disease‐free survival (DFS) and overall survival (OS) among squamous cell carcinoma (SCC) (n = 60) and AC (n = 22) patients. Kaplan–Meier survival analysis with and without propensity score matching was conducted to identify the impact of RAH. Results Para‐aortic lymph node metastasis and tumor diameter were significant factors for recurrence, and adjuvant chemotherapy prevented recurrence on multivariate analysis. After propensity score matching, there was no significant difference in DFS and OS between the groups. Five‐year DFS and OS of the SCC group were 0.505 (95% confidence interval [CI] 0.268–0.702) and 0.619 (95% CI 0.351–0.803), respectively, and those of the AC group were 0.444 (95% CI 0.232–0.638) and 0.602 (95% CI 0.351–0.782), respectively. Conclusion Bulky Stage pTIIB cervical cancer is hard to cure, but RAH plus adjuvant therapy might be an option for radio‐resistant pTIIB cervical AC.

Mapping the cervical cancer screening cascade among women living with HIV in Johannesburg, South Africaa

AbstractObjectiveTo map the cervical cancer screening cascade among women living with HIV attending a public‐sector cytology screening program in Johannesburg, South Africa.MethodsWe conducted a retrospective cohort study of routinely collected clinical data captured in an electronic medical record system. Women (≥18 years) living with HIV with an abnormal Pap result between January 2013 and May 2018 were included. The proportion of women who received follow‐up consistent with extant clinical guidelines, stratified by their initial Pap smear result, was examined.ResultsThe study included 2072 women: 1384 (66.8%) with a low‐risk Pap result, 681 (32.9%) with a high‐risk Pap result, and 7 (0.3%) with suspected cancer. Only 174 (25.6%) women with a high‐risk Pap result underwent guideline‐indicated management within 18 months. Among women with a low‐risk Pap result, 375 (27.1%) received follow‐up within 1 year; the cumulative incidence of follow‐up increased to 63.1% at 3 years. All women with suspected cancer either received a colposcopic biopsy or were referred for further treatment.ConclusionAttrition among South African women living with HIV who attended cervical screening in an urban public‐sector program was high. Developing tailored interventions to address bottlenecks in the care cascade and improve cervical screening outcomes will be central to eliminating cervical cancer.

Snapshot of symptoms of advanced cervical cancer patients referred to the palliative care service in a cancer center in Mexico

AbstractObjectiveTo report the clinical and demographic characteristics of patients with advanced cervical cancer referred to the palliative care service (PC) at a major cancer center in Mexico.MethodsThis is a retrospective cohort study of patients with advanced cervical cancer referred to the PC of INCan, between January 2011 and December 2015. Demographic and clinical characteristics at the time of admission to the INCan, time to referral to PC, initial Edmonton Symptom Assessment System evaluation, and follow up were recorded.ResultsIn all, 359 patients were included, median age 51 years, predominantly poor with low education. Most patients 322 (90%) received tumor‐specific treatment; presence of nephrostomies and other tumor‐related complication was frequent. Median time to referral was 335 days, more than 180 (50%) had five or more symptoms, pain and fatigue were the most prevalent.ConclusionWomen with advanced cervical cancer have a high burden of symptoms; PC is only considered at the end of life. Efforts for an early referral to PC should be made.

The importance of the pseudocapsule in the management of uterine myoma: State of the art and expert recommendations

Abstract The pseudocapsule corresponds to specialized myometrium that surrounds and nourishes the fibroid. This entity has a neurovascular structure and particular fibrotic tissue and has gained recognition as a critical factor in the management of these prevalent tumors. This article provides a comprehensive review of the current understanding of the pseudocapsule's anatomy, function, and implications for clinical practice. By synthesizing current literature and considering expert opinions, this article emphasizes the need to incorporate the pseudocapsule into the clinical framework for uterine fibroids, ultimately aiming to improve patient care.

Laparoscopic sentinel lymph node dissection followed by open radical hysterectomy for early stage cervical cancer: A pilot study

AbstractObjectiveTo propose a treatment algorithm, after the LACC trial, of laparoscopic sentinel lymph node biopsy with frozen section, followed by immediate open radical hysterectomy in node‐negative cases, for early stage cervical cancer.MethodsWe retrospectively collected all cases of cervical cancer that were surgically treated between 2019–2020. In all cases, surgery began with laparoscopic sentinel lymph node biopsy ± ovarian transposition. Node‐negative cases continued with open radical hysterectomy. In node‐positive cases, surgery was discontinued, sparing the patient a laparotomy incision.ResultsNine patients with cervical cancer were referred for surgery. Laparoscopic bilateral lymph node identification was achieved in all. In two cases, sentinel lymph nodes were positive for metastatic cancer and surgery was discontinued. For the other seven, node‐negative patients, open radical hysterectomy was completed. Four patients had laparoscopic ovarian transposition. There were no cases where nodes were negative on frozen section but positive on final pathology.ConclusionLaparoscopic sentinel lymph node biopsy before open radical hysterectomy may spare a considerable number of laparotomies on the one hand and bi‐modal treatment with surgery and radiation on the other, for node‐positive patients. The oncological safety of this approach is yet to be determined.

The rising relative and absolute incidence of uterine cancer in specific populations

AbstractObjectiveTo assess the contemporary incidence of cancers using American Samoa as a learning set for insights into similar populations.MethodsA retrospective observational analysis of de‐identified data held in public‐access databases (2004–2014) and data on uterine cancer from a hospital, both in American Samoa (2015–2016).ResultsThere were 341 new cases of cancer in 2004–2014 (111 per 100 000 women/year), including breast (20.2%), uterine (19.4%), and cervical (5.0%); and 287 in 2011–2015 (103 per 100 000 women/year), including uterine (24.0%), breast (18.5%), and cervical (5.2%). Uterine cancer increased from 21.4 to 60.3 per 100 000 women/year, becoming the most common cancer in American Samoa. In 2011–2015, the incidence‐rate ratio of uterine cancer to other cancers in American Samoa was 1.3‐, 3.8‐, 4.6‐, 7.7‐, and 23‐fold higher than breast, colon, cervical, ovarian, and lung cancer, respectively. Among the most recent cases (n=33), median age was 55 years (10 [30.3%] <50 years), median BMI was 38.2; and 11 (33.3%) cases had grade 3 histology.ConclusionThe pattern of cancers in American Samoa differs from that in the US mainland. The findings reflect significant changes in cancer incidence. Cancer control programs should evaluate the potential of uterine screening in accordance with their community's needs and characteristics.

A systematic review and meta‐analysis of diagnostic accuracy of HPV tests for the screening of cervical cancer in low‐resource settings

AbstractBackgroundHPV tests for the screening of cervical cancer in low‐income countries (LICs) might improve early detection and preventive efforts.ObjectivesTo determine the diagnostic accuracy of HPV tests for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) in LICs.Search strategyThe Cochrane Library, MEDLINE, and CINAHL databases were searched on June 1, 2020. References of relevant studies were hand‐searched.Selection criteriaDiagnostic test accuracy studies were included if women had an HPV test for cervical cancer screening, followed by verification with colposcopy and colposcopy‐directed biopsy. The primary target was CIN2+.Data collection and analysisTwo authors independently screened studies, extracted data, and assessed methodological quality. Bivariate diagnostic random‐effects meta‐analysis was used.Main resultsEleven studies including 82 556 women were eligible, most of which were at low risk of bias. The pooled diagnostic odds ratio of hybrid capture test of samples collected from the cervix by healthcare providers for detecting CIN2+ and CIN3+ was 42.0 (95% confidence interval [CI] 20.7–76.3) and 97.1 (95% CI 35.3–215.0), respectively.ConclusionsEvidence indicates that hybrid capture tests can be used for screening of cervical cancer in LICs. Future studies are warranted for self‐sampling and for low‐cost HPV tests.

Loop electrosurgical excision procedure (LEEP) plus top hat for HIV‐infected women with endocervical intraepithelial neoplasia in Kenya

AbstractObjectiveTo determine the utility of detecting endocervical cervical intraepithelial neoplasia (CIN) 2+ with endocervical curettage (ECC) and treating with loop electrosurgical excision procedure (LEEP) plus top hat (+TH) among women with HIV.MethodsCytology was followed by coloscopy‐directed biopsy if participants had HSIL or ASC‐H and biopsy plus ECC if there were glandular cells present. CIN2/3 on ECC and/or inadequate colposcopy (ENL) was treated with LEEP+TH, while CIN2/3 on ectocervix (ECL) received LEEP alone. Recurrent CIN2+ were compared over a 2‐year follow‐up.ResultsOf 5330 participants, 160 underwent ECC, 98 were CIN2/3 on ECC, and 77 received LEEP+TH. ECC detected 15 (9%) more women with CIN2/3 than biopsy alone. Women were more likely to have ENL if they were older (≥45 vs <35 years) (adjusted relative risk [aRR] 2.14; P = 0.009) and on antiretroviral treatment longer (≥2 vs <2 years) (aRR 3.97; P < 0.001). Over the 2‐year follow‐up, 35 (29%) ENL had recurrent CIN2+ after TH compared to 19 (24%) ECL after LEEP (hazard ratio 1.32; 95% confidence interval 0.75–2.31; P = 0.338).ConclusionAmong HIV‐infected women, adding ECC did not increase detection of pre‐cancerous disease significantly and treatment with LEEP+TH for ENL was comparable to treatment with LEEP for ECL.

Association of pretreatment SUVmax of cervix and SCC‐antigen with FIGO2018 stage in Stage IIB–IVB squamous cervical cancer and relationship to prognosis

AbstractObjectiveTo evaluate the association of pretreatment maximum standardized 18F‐fluorodeoxyglucose uptake value (SUVmax) of cervix and serum squamous cell carcinoma antigen (SCC‐ag) with FIGO2018 stage and prognosis among women with Stage IIB–IVB squamous cervical cancer.MethodsRetrospective study of 116 women with FIGO2018 Stage IIB–IVB cervical cancer treated in Hangzhou, China, 2013–2015. The relationship between pretreatment SUVmax or SCC‐ag and prognostic factors was evaluated by univariate and multivariate analyses.ResultsWomen were stratified by mean SUVmax and mean SCC‐ag. There was a significant difference between low (<12.9) and high (≥12.9) SUVmax groups in menopause (P = 0.004), FIGO2018 stage (P = 0.015), and survival rate (P < 0.001). The low group had better overall and progress‐free survival by Kaplan–Meier evaluation (both P = 0.022). High SCC‐ag (≥14.6 ng/mL) was associated with FIGO2018 stage (P = 0.038) and distant metastasis (P = 0.011). There was a significant correlation between SUVmax and serum SCC‐ag (P = 0.026). In multivariate Cox regression analyses, FIGO2018 stage (P = 0.019) and SUVmax of cervix (P = 0.015) were independent predictors of poor outcome in squamous cervical cancer.ConclusionBoth SUVmax of cervix and SCC‐ag were associated with FIGO2018 stage in squamous cervical cancer. Pretreatment high SUVmax of cervix and advanced FIGO2018 stage might indicate a poor prognosis.

Elimination of cervical cancer in low‐ and middle‐income countries: Inequality of access and fragile healthcare systems

AbstractIn 2018, WHO called for global action to eliminate cervical cancer. The complexity of the processes involved in terms of prevention is often underestimated. Low‐ and middle‐income countries do not have a robust healthcare framework to ensure high‐quality programs. The present article discusses how fragile healthcare systems are barriers to eliminating cervical cancer, and also reports the experience of a Brazilian prevention program. The article considers how cervical cancer can be interpreted as an indicator of inequality: how women's attitudes and access to care determine an early or late diagnosis, and how strategies combining vaccine and DNA‐HPV tests are crucial. New vaccine schemes, the critical analysis of local data, strengthening communication, managing sentinel events, and integrating vaccination and screening data for the health information system are some of the key activities to sustainable improvement in both access and quality of care.

Attendance for diagnostic colposcopy among high‐risk human papillomavirus positive women in a Brazilian feasibility study

AbstractObjectiveTo investigate factors associated with colposcopy attendance in HPV‐positive women in São Paulo, Brazil.MethodsWe analyzed data from a prospective cohort of women positive for high‐risk HPV (hr‐HPV) undergoing cervical cancer screening in primary care services in São Paulo, Brazil. Non‐pregnant women attending routine screening between December 2014 and March 2016 were offered an hr‐HPV test, and those testing positive and aged 25 years or older were invited for colposcopy. Sociodemographic information was recorded at study enrollment. We compared variables between women who did and did not attend colposcopy within a logistic regression framework.ResultsOf 1537 hr‐HPV‐positive women, 1235 (80.4%) attended for colposcopy, with a median time from primary test to colposcopy of 132 days. Younger age (P<0.001) and concurrent negative cytology results (P=0.025) were associated with lower attendance. Women registered at units providing both the primary test and colposcopy were more likely to attend than those at units making external referrals (788/862 [91.4%] versus 447/675 [66.2%], P<0.001).ConclusionNon‐attendance for colposcopy may limit the success of future screening programs based on hr‐HPV testing in Brazil. Transfer of colposcopy services to primary care is a simple and effective facilitator of attendance.

Factors related to completion of referral among women with suspected cervical cancer and dysplasia in Tanzania

AbstractObjectiveTo investigate completion of referral among women with suspected cervical cancer in Tanzania.MethodsRetrospective cohort study of 196 women referred from two healthcare clinics to Ocean Road Cancer Institute, Dar es Salaam, between March 2016 and June 2018. Women with precancerous lesions or suspected cancer were interviewed about their knowledge and perception of cervical cancer and referred for follow‐up.ResultsMost participants were unable to name symptoms (55.1%), prevention methods (88.3%), or treatments (59.0%), although 79.1% rated the disease as severe. Women who came for routine early detection were less likely to complete referral than those who did not (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.05–0.70). Women who knew someone who died from cervical cancer were 5.40 times more likely to complete referral than those who did not. Knowing someone with cervical cancer was a predictor of referral completion in three multivariate models: OR, 5.62 (95% CI, 2.20–14.38); 4.34 (1.64–11.47); and 4.61 (1.72–12.36). Having severe symptoms was a predictor of non‐completion in two models: 0.30 (0.12–0.75) and 0.35 (0.14–0.87).ConclusionPatient‐directed interventions should include education involving survivors of cancer and dysplasia, whereas system‐directed interventions should utilize reminders to increase referral completion.

Cervical cancer in low‐income countries: A Bangladeshi perspective

AbstractCervical cancer is the fourth most common cancer among women worldwide, with approximately 70% of cases involving infection with human papillomavirus (HPV) genotypes 16 and 18. According to International Agency for Research on Cancer, more than 50 million Bangladeshi women are at risk of developing cervical cancer, and 17 686 new cases and 10 362 deaths occur annually. If diagnosed at the precursor stage, however, cervical cancer is a condition that can be successfully treated. As a result, screening programs are necessary to identify the disease before it progresses to invasive cancer. In the present review, we discuss the overall situation of cervical cancer in Bangladesh, summarizing the sociodemographic status of affected women, associated risk factors, screening approaches, and treatment options. We emphasize the potential of visual inspection with acetic acid (VIA) as a cost‐effective screening approach for detecting cervical lesions among poor women in the community. In a resource‐limited country such as Bangladesh, VIA may represent an ideal model to build an effective awareness campaign through urban and rural hospitals, community‐based clinics, and other health facilities available in industry.

Performance of the Swede score to predict cervical intraepithelial neoplasia in women with HIV‐1 in Johannesburg, South Africa

AbstractObjectiveTo evaluate the performance of the Swede score to detect cervical intraepithelial neoplasia (CIN) in women with HIV‐1 in Johannesburg, South Africa.MethodsA cross‐sectional study using secondary data analysis from the HPV in Africa Research Partnership (HARP) study that compared the performance of three different screening tests to detect CIN. Colposcopy was performed on any woman who screened positive and findings were recorded using the Swede score. A biopsy of any lesion and a four‐quadrant biopsy was taken. The score was evaluated against a histological diagnosis of >CIN1. The sensistivity, specificity, PPV and NPV for each score was calculated.ResultsMedian age and CD4+ count of the 576 women eligible from the Johannesburg cohort was 34 years (IQR, 30–39) and 427 cells/mm3 (IQR, 323–579), respectively. Almost two‐thirds (64%) were on ART and about 21% had CIN 2+ on histology. A Swede score of 5 or greater had the best combination of sensitivity and specificity for CIN 2+ with an AUC of 0.72 (95% CI, 0.68–0.76) corresponding to a sensitivity of 72.1 (95% CI, 63.5–79.6) and specificity of 71.8 (95% CI, 67.4–75.9).ConclusionThe Swede score can assist in determining whether women with HIV/AIDS should have treatment at the first colposcopy visit versus those who may be followed up, thereby individualizing treatment.

Diffuse peritoneal inclusion cysts masquerading as disseminated gynecologic malignancy in post‐menopausal females: Two cases and a review of the literature

Abstract Peritoneal inclusion cysts are an important and underrecognized cause of benign pelvic and abdominal masses in post‐menopausal patients. Diffuse peritoneal cysts in this population can be difficult to distinguish from disseminated gynecologic malignancy on imaging and laboratory evaluation and will often be managed by gynecologists and gynecologic oncologists. Preoperative diagnosis may be suspected in the setting of findings of thin‐walled cystic lesions on imaging with indicative surgical or clinical history; however, given the risk of malignancy in this population, tissue diagnosis is necessary to exclude more serious diagnoses. Once the diagnosis of peritoneal inclusion cysts has been made, both diagnostic biopsy and complete resection of disease are reasonable treatment strategies, depending on patient goals and symptoms. There is no evidence supporting adjuvant therapy in the treatment or prevention of recurrence of peritoneal inclusion cysts in the post‐menopausal population. We present two cases that demonstrate these diagnostic and treatment principles for the gynecologic audience and summarize the existing evidence base for management these lesions.

Detection of types of HPV among HIV‐infected and HIV‐uninfected Kenyan women undergoing cryotherapy or loop electrosurgical excision procedure

AbstractObjectiveTo assess the baseline types of HPV infection among HIV‐positive and HIV‐negative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia.MethodsA prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV‐positive and HIV‐negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array.ResultsOf 175 participants, 86 (49.1%) were HIV‐positive and had a higher prevalence of low‐risk HPV types (odds ratio [OR] 5.28, P=0.005) compared with HIV‐negative women. The most common high‐risk (HR)‐HPV types in HIV‐positive women were HPV 16 (13.9%) and HPV 18 (11.1%). HIV‐positive women requiring LEEP were more likely to have HR‐HPV types (OR 6.67, P=0.012) and to be infected with multiple HR‐HPV types (OR 7.79, P=0.024) compared to those undergoing cryotherapy.ConclusionHIV‐positive women requiring LEEP versus cryotherapy had a higher prevalence of any HR‐HPV type and multiple HR‐HPV types. There were no such differences in HPV types identified among HIV‐negative women.

Prevalence and predictors of precancerous cervical lesions among HIV‐positive women in Jos, north‐central Nigeria

AbstractObjectiveTo determine the prevalence and predictors of precancerous cervical lesions among HIV‐positive women in Jos, Nigeria.MethodsA cross‐sectional study was conducted from October 2017 to January 2018 among 326 HIV‐positive women. Cervical smears were collected for examination at the AIDS Preventive Initiative of Nigeria clinics of Jos University Teaching Hospital (JUTH) and Bingham University Teaching Hospital (BhUTH), Jos, Nigeria. Demographic characteristics of participants were documented using a structured questionnaire. Data were entered and analyzed using SPSS version 21.ResultsOf the 326 participants, precancerous cervical lesions were present in 40 (12.2%) women: 4 (1.2%) had atypical squamous cells of undetermined significance, 19 (5.8%) had low‐grade squamous intraepithelial lesions, 1 (0.3%) had atypical squamous cells cannot exclude high‐grade squamous intraepithelial lesions, 13 (4.0%) had high‐grade squamous intraepithelial lesions, and 3 (0.9%) had high‐grade squamous intraepithelial lesions, suspected for invasion. The multivariate logistics regression model showed that parity (odds ratio 3.4, 95% confidence interval 1.3–9.5, P=0.043) was a significant predictor of precancerous cervical lesions.ConclusionThe prevalence of precancerous cervical lesions among HIV‐infected women is relatively low compared to earlier reported prevalence in an HIV population in Jos. Increasing parity was a significant predictor.

Primary conization overcomes the risk of developing local recurrence following laparoscopic radical hysterectomy in early stage cervical cancer

AbstractObjectiveTo investigate whether primary conization might overcome the risk of local dissemination in patients undergoing laparoscopic radical hysterectomy.MethodsConsecutive data of 262 patients with early stage cervical cancer were retrieved: 88 women had conization followed by radical hysterectomy. A propensity‐matched comparison (1:1) was carried out in order to compare laparoscopy and open surgery. Accumulating data highlighted that minimally invasive surgery has been associated with higher recurrence rates and worse overall survival than open surgery in women with early stage cervical cancer.ResultsData of 35 paired patients (total 70 patients) were analyzed. No between‐group differences in baseline, disease, and pathological variables were observed. Patients undergoing laparoscopy correlated with lower blood loss (50 [range 30–100] vs 150 [range 50–500] mL; P<0.001) and shorter length of stay (3 ± 0.8 vs 5.4 ± 1.4 days; P<0.001) compared to open surgery. One local recurrence was observed per group (P=1.00). Type of surgical approach did not influence site of recurrence (P=1.00) or survival outcomes, in terms of 10‐year disease‐free (P=0.549, log‐rank test) and overall survivals (P=0.615, log‐rank test).ConclusionsThe data show that primary conization might overcome the risk of local recurrence after laparoscopic radical hysterectomy in early stage cervical cancer. Further prospective evidence is needed.

Evaluation of folate receptor‐mediated tumor detection as a triage tool in cervical cancer screening

AbstractObjectiveTo evaluate the efficacy of folate receptor‐mediated tumor detection (FRD) for identifying high‐grade intraepithelial squamous lesions (HSIL) in the triage of women who are positive for human papillomavirus (HPV), and those with cytology findings of atypical squamous cells of undetermined significance (ASCUS).MethodA secondary analysis of prospectively collected data from 1504 women who had abnormal results during primary cervical cancer screening at 13 hospitals in Beijing, China, between November 2014 and August 2015. The detection accuracy of FRD was evaluated among HPV‐positive women and women with ASCUS referred for colposcopy examination.ResultsAmong 1338 women with HPV, the percentage coincidence with pathology findings was higher for FRD (66.7%) than for cytology of ASCUS or higher (51.5%). The rate of colposcopy referral for cytology and FRD as a triage tool was 969 (72.4%) and 736 (55.0%), respectively. Thus, 233 (17.4%) fewer women would be referred for colposcopy by FRD. Among 476 women with cytology of ASCUS, the percentage coincidence with pathology findings was higher for FRD (63.4%) than for HPV (35.9%).ConclusionFRD was found to be a promising triage tool for women who are HPV‐positive and those with cytology findings of ASCUS.

Does the trend toward less deep excisions in LLETZ to minimize obstetric risk lead to less favorable oncological outcomes?

AbstractObjectiveTo analyze the relationship between large loop excision of the transformation zone (LLETZ) depth and the persistence of disease and human papillomavirus (HPV) infection in patients with cervical intraepithelial neoplasia grades 2 and 3.MethodsA cross‐sectional observational retrospective study included women with cervical intraepithelial neoplasia grades 2 and 3 who underwent LLETZ at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 1, 2011, to December 31, 2016. Follow‐up of cytology and HPV detection were performed at 6 and 12–18 months after surgery.ResultsIn this study of 256 women, multivariate analysis revealed that conization depth of 10 mm or less did not indicate an increase of persistence/recurrence of pathological cytology at 6 months (P=0.094) and after 12–18 months (P=0.234), or infection by HPV at 6 months (P=0.675) and 12–18 months (P=0.938) after LLETZ. The affected endocervical margin at 6 months is the sole independent risk factor for persistence, both in the lesion (P=0.003) and HPV (P=0.004).ConclusionConization depth lower than 10 mm at LLETZ did not increase disease persistence or infection by HPV in an 18 month monitoring period. Therefore, higher depth conizations would not be justified to ensure favorable oncological results.

Scaling up cervical cancer prevention in Western Kenya: Treatment access following a community‐based HPV testing approach

AbstractObjectiveTo evaluate access to treatment after community‐based HPV testing as testing within screen‐and‐treat programs has the potential to lower mortality from cervical cancer in low‐resource settings.MethodsA prospective cohort study was conducted in western Kenya in 2018. Women aged 25–65 years underwent HPV self‐testing. HPV‐positive women were referred for cryotherapy. Participant data were obtained from questionnaires during screening and treatment. The proportion successfully accessing treatment and variables associated with successful treatment was determined.ResultsOf the 750 women included, 140 (18.6%) tested positive for HPV. Of them, 135 were notified of their results, of whom 77 (59.2%) sought treatment and 73 (52.1%) received cryotherapy. Women who received treatment had a shorter time from screening to result notification (median 92 days, interquartile range [IQR] 84–104) compared to those who did not (97 days, IQR 89–106; P=0.061). In adjusted analyses, women with a history of cervical cancer screening (odds ratio [OR] 11, 95% confidence interval [CI] 1.42–85.20) and those electing result notification through a home visit (OR 4, 95% CI 1.23–14.17) were significantly more likely to acquire treatment at follow‐up.ConclusionLinkage to treatment after community‐based HPV screening in this population was low, highlighting the need for strategies aimed at strengthening treatment linkage in similar settings.

Prevalent and persistent oncogenic HPV types in a cohort of women living with HIV prior to HPV vaccination

AbstractObjectiveTo describe prevalent and persistent oncogenic human papillomavirus (HPV) types detected in women living with HIV (WLWH) in Canada, including women with cervical dyskaryosis, and to determine predictors of type‐specific HPV persistence.MethodsWomen and girls living with HIV, recruited from 14 sites of HIV care across Canada, were included in a sub‐analysis of a prospective vaccine immunogenicity cohort study (two HPV DNA results, at least one cervical cytology result pre‐vaccination). Demographic and clinical data were collected alongside cervical samples for cytology and HPV DNA typing between November 25, 2008, and May 19, 2015.ResultsPre‐vaccination, HPV16 and HPV52 were the most prevalent oncogenic HPV types. Of the 252 women and girls who met the eligibility criteria, 45% were infected with at least one oncogenic HPV type and one‐third of participants had a persistent oncogenic infection. HPV16, 45, and 52 were the most frequently persistent types. Seventeen percent of women had persistent infections with oncogenic HPV types not within currently available vaccines (HPV35/39/51/56/59/68/82). Lower CD4 count significantly predicted HPV persistence (P=0.024). Cervical cytology results were normal for 82.9% of participants, atypical squamous cells of undetermined significance for 2.4%, low‐grade squamous intraepithelial lesions for 11.5%, and high‐grade squamous intraepithelial lesions for 2.8%.ConclusionUnvaccinated WLWH were infected with a wide range of oncogenic HPV types. The findings highlighted the importance of optimal treatment of HIV and continued cervical cancer screening as key steps toward the global elimination of cervical cancer.

Comparison of no adjuvant treatment and radiotherapy in early‐stage cervical carcinoma with intermediate risk factors

AbstractObjectiveTo evaluate the results of receiving no adjuvant treatment (NAT) or radiotherapy after radical hysterectomy in patients with International Federation of Gynecology and Obstetrics 2018 Stage IB1–IB3 cervical cancer with intermediate risk factors.MethodsA retrospective cohort study was conducted at Baskent University School of Medicine's Department of Gynecology and Obstetrics in Ankara, Turkey between January 1, 2008, and December 31, 2016. In total, 134 women with at least two intermediate risk factors (positive LVSI, deep stromal invasion, and tumor size ≥4 cm) were included in the study. Patients were divided into two groups: NAT and radiotherapy.ResultsThere were 66 patients in the NAT group and 68 in the radiotherapy group. The median follow‐up time was 61.05 months. The 5‐year overall survival (OS) rates were similar in both groups (84.1% vs 82.9%, respectively; P=0.57), while the 5‐year disease‐free survival (DFS) rates were 80.2% and 78.2% in the NAT and radiotherapy groups, respectively (P=0.25). Most importantly, both groups had similar local recurrence rates: 8 (12.1%) in the NAT group and 9 (13.2%) in the radiotherapy group (P=0.82). Multivariant analyses showed that the only independent risk factor for recurrence was tumor size ≥4 cm with a hazard ratio of 2.4 (95% confidence interval 1.12–5.24; P=0.02).ConclusionAdjuvant treatment improved neither DFS nor local recurrence rates.

FIGO stage IIB cervical cancer prognostication in low‐resource settings

A systematic review of self‐sampling for HPV testing in Africa

AbstractBackgroundHuman papillomavirus (HPV) testing may be feasible for primary cervical cancer screening in low‐resource countries.ObjectiveTo compare self‐sampling by women with clinician‐performed sampling for HPV testing in Africa.Search strategyMEDLINE, Google scholar, EMBASE, and several journals were searched from 2000 until 2015 using relevant terms.Selection criteriaSelected studies compared self‐sampled and clinician‐sampled HPV tests.Data collection and analysisData extraction forms included description of the type of HPV screening, description of any additional intervention components, study design, sample size, follow‐up periods, analytic approach, reported numerical outcomes, results, and limitations.ResultsTwenty‐five studies were identified. Women of a wide age range were successful at self‐sampling in many African countries. More than 95% of self‐samples yielded HPV DNA results. The concordance in test results between self‐collected samples and clinician‐collected samples was reasonably high in most studies. In all studies, the quality of cytology from self‐sampling matched that of clinician‐sampling. Women were generally positive about self‐collection, but noted some concerns.ConclusionSelf‐sampling for HPV DNA testing seems to represent a feasible alternative to the Pap test. Further research is needed to provide a solid evidence base to inform using of self‐sampling for HPV DNA testing for primary cervical cancer screening.

Human papillomavirus prevalence and distribution in self‐collected samples from female university students in Maputo

AbstractObjectiveTo characterize human papillomavirus (HPV) prevalence and distribution among female university students in Maputo, Mozambique, and evaluate the determinants of HPV infection.MethodsA cross‐sectional study among 504 female university students between February and April 2017. Cervicovaginal self‐collected samples were analyzed for HPV genotypes by polymerase chain reaction‐restriction fragment length polymorphism and AnyplexTM II HPV28 Detection kit (Seegene®).ResultsThe prevalence of any HPV genotype was 28.6% (144/504). Single and multiple HPV infections were detected in 76 (15.1%) and 68 (13.5%) participants, respectively. Prevalence of high‐risk HPV was significantly higher than that of low‐risk HPV (P<0.001). HPV16 was the most frequent genotype, followed by HPV58, HPV66, HPV52, HPV18, HPV56, HPV61, and HPV70. The prevalence of genotypes covered by the bivalent, quadrivalent, and nonavalent vaccine was 14.3%, 15.9%, and 23.4%, respectively. Number of sexual partners over lifetime and in the past 12 months was associated with HPV infection (P<0.001 and P=0.039, respectively).ConclusionsKnowledge of HPV genotype‐specific prevalence among young women is important to set up strategies for HPV vaccination. The findings suggest that introduction of the nonavalent HPV vaccine might be the way forward in the present low‐resource setting. In addition, self‐sampling was useful for HPV detection and genotyping.

Diagnostic accuracy of self‐collected vaginal samples for HPV DNA detection in women from South India

AbstractObjectivesTo assess the efficacy of self‐collected vaginal samples compared with physician‐collected cervical samples for the detection of HPVDNA.MethodsA hospital‐based cross‐sectional study was carried out among patients with newly diagnosed cervical cancer attending the Gynecologic Oncology Division, Department of Obstetrics and Gynecology and Radiation Oncology Department at Government Medical College, Kozhikode, Kerala between March 2017 and April 2019. Consenting patients collected their vaginal samples, followed by cervical sample collection by the clinician. The paired samples were transported at 4–8 °C to the laboratory. Amplification of LCR/E6/E7 regions of the HPV genome was done by polymerase chain reaction (PCR). The agreement level between paired samples was assessed by the Kappa index.ResultsAmong the 114 cervical cancer patients enrolled in the present cross‐sectional study, the prevalence of HPV DNA was 78.1% (95% confidence interval [CI] 69.2%–85%) in cervical samples and 77.2% in vaginal samples (95% CI 68.7%–83.9%). The overall agreement between the two sampling methods was 93.9% and the kappa value was 0.82 (P<0.001). The sensitivity of HPV detection using vaginal samples was 98.9% (95% CI 93.9%–99.8%) and the specificity was 100% (95% CI 86.7%–100%) with cervical sampling as the gold standard. By Kappa index, an almost perfect agreement for HPV DNA detection between self‐collected and physician‐collected samples was observed.ConclusionSelf‐collection of vaginal samples ensures equity of cervical cancer screening in low‐income countries such as India.

HPV‐based cervical cancer screening in low‐resource settings: Maximizing the efficiency of community‐based strategies in rural Kenya

AbstractObjectiveTo characterize the efficiency of screening through high‐volume community health campaigns (CHCs) by comparing the costs and population reach and identify factors associated with gains in efficiency. Access to effective cervical cancer screening remains limited in low‐resource settings, especially in rural areas. Periodic CHCs are a novel method of offering screening for HPV at lower costs and higher population coverage than health facilities.MethodsA micro‐costing study was conducted within a cervical cancer screening trial to measure efficiency (cost per woman screened) and population uptake of HPV‐based screening offered through CHCs in Migori County, Kenya between January and September 2016. Regression analysis assessed relationships between population size and efficiency. Structured observations and qualitative interviews identified implementation factors that affected efficiency in individual campaigns.ResultsCommunities screening through CHCs had costs per woman screened ranging from US $22.06 to $30.21. Efficiency was directly correlated to overall numbers of women screened, but not to proportion of population screened. Modifiable factors that acted as context‐specific facilitators and barriers with a potential impact on efficiency were identified.ConclusionThere was substantial variation in efficiency among CHCs. Cultural factors, health beliefs, and poor coordination among implementation partners as potential key barriers to screening uptake were identified.

CO 2 laser therapy versus topical imiquimod for the treatment of vulvar high‐grade intraepithelial lesions: A retrospective cohort study

Abstract Objectives To compare topical imiquimod with CO 2 laser therapy for the treatment of a first episode of vulvar high‐grade squamous intraepithelial lesions (vHSIL), to identify serious adverse effects of both treatment modalities, and to examine risk factors for treatment failure. Methods This retrospective chart‐based cohort study included 47 patients initially treated with topical imiquimod or CO 2 laser therapy between 2017 and 2021. The primary outcome was treatment failure, defined as the need for repeat treatment. Cumulative incidence curves were used to compare the probability of treatment failure over time by treatment group. Potential risk factors for treatment failure, including age, treatment type, lesion focality, and smoking, were examined using Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). Results Sixty‐six percent (31/47) of patients were initially treated with topical imiquimod and 34% (16/47) with CO 2 laser. Both groups were similar in age, lesion focality, human papillomavirus vaccination, and smoking status. During a follow‐up of 62.3 person‐years, 52% (16/31) of patients treated with imiquimod and 56% (9/16) of patients treated with CO 2 laser experienced treatment failure. Age over 52 years was associated with a higher risk of treatment failure (aHR 3.07, 95% CI 1.25–7.53). The association was positive but not significant for multifocal versus unifocal lesions and for smokers versus non‐smokers. No serious adverse effects were observed with either treatment modality. Conclusion Topical imiquimod has similar efficacy and safety to CO 2 laser therapy for initial the treatment of vHSIL. Older age is associated with an increased risk of treatment failure.

Association between body mass index, obesity, and vulvar cancer recurrence

AbstractObjectiveThe objective of this paper is to study the association between obesity and tumor recurrence in patients with vulvar cancer.MethodsThis is a retrospective study including vulvar cancer patients from 2003 to 2022. Our primary outcome was progression‐free survival (PFS) stratified by status of obesity, defined as body mass index (BMI) >30.0 kg/m2.ResultsOverall, 48 patients were included in the study, with 32 (66.7%) diagnosed at early stages (I–II). The median BMI was 28.0 kg/m2 [interquartile range 24.9–32.3 kg/m2]. There were 13 obese patients (27%), and the median follow‐up time was 55 months [interquartile range 14–102]. Most patients (80%) were HPV‐independent of human papilloma virus. Surgical intervention was the primary treatment modality for 88% (n = 42) of the cohort, and 26 patients (54%) received adjuvant chemoradiation. Disease recurrence was identified in 28 patients (58%). The median PFS was 68 months, and the median overall survival was 109 months. There was no difference in the median PFS between obese patients and non‐obese patients (P = 0.370). In a Cox regression analysis, after adjusting for patient age, margin‐free distance, and stage of disease, BMI was not associated with PFS hazard ratio 1.06 (0.99–1.12).ConclusionObesity is not associated with PFS in patients with vulvar cancer, and BMI might not be considered a risk factor for recurrence.

Topical imiquimod and in situ vulvar melanoma: A promising therapy?

Abstract Objectives Vulvar melanoma is a rare type of cancer that affects mainly postmenopausal women. There are no established protocols for the treatment of vulvar melanoma. From data extrapolated from the literature on cutaneous melanoma, surgical excision remains the best option for the resectable disease. Imiquimod, a topical immunomodulator, has been used in selected cases of in situ vulvar melanoma. Methods and Results We reported two cases of in situ vulvar melanoma treated with topical imiquimod 5%, either as first‐line therapy or adjuvant treatment, that showed a complete clinical response to topical treatment. Conclusion Imiquimod's beneficial and adverse effects in in situ vulvar melanoma treatment are examined.

Kin17 high expression as a potential biomarker for high‐grade cervical intraepithelial neoplasia

Letter to the editor: Searching for prognostic markers for stage I epithelial ovarian cancer: A role for systemic inflammatory markers

Immunohistochemical expression of ErbB/HER family proteins in patients with vulvar cancer

AbstractObjectiveTo investigate the immunohistochemical (IHC) expression of the ErbB/HER family in primary vulvar squamous cell carcinoma (VSCC).MethodsWe analyzed a series of 125 patients who were surgically treated for VSCC from January 1980 to June 2016. All cases had lymph node (LN) staging and 80 had LN metastasis. A tissue microarray was built for epidermal growth factor receptor (EGFR), HER2, HER3, and HER4 IHC staining.ResultsIn the primary tumor we found positive expressions for EGFR, HER2, HER3, and HER4 in 5%, 0.9%, 0.9%, and 22.8%, respectively. For the LN metastasis, expressions of EGFR and HER4 were positive in 22.2% and 39.1%, respectively. No cases had positive staining for HER2 and HER3 in the LN metastasis. For HER4, positive expression correlated with smaller tumor sizes (P = 0.02). However, positive HER4 was related to adverse prognostic factors such as: histological grade (P = 0.012), presence of lymphovascular space invasion (40.9% vs 16.2%; P = 0.035), and perineural invasion (57.1% vs 16.7%; P = 0.006). Notably, all cases with LN metastasis had positive HER4 in the primary tumor (P < 0.001). ErbB/HER family expression was not related to worse survival.ConclusionEGFR, HER2, and HER3 were infrequently expressed in VSCC by IHC. HER4 IHC expression was found in 22.8% of cases and was related to adverse prognostic factors.

The V‐Y gluteal fold advancement flap: Outcomes following radical surgery for vulvar malignancies

AbstractObjectiveTo evaluate the feasibility and complication rate of the V‐Y gluteal fold flap in surgery for vulvar cancer.MethodsFrom June 2015 to June 2018, 62 patients surgically treated for vulvar cancer were included in the study. Twenty‐three (37.1%) underwent plastic reconstructive surgery with V‐Y advancement flaps.ResultsThe mean surgical time was longer for patients undergoing V‐Y flap surgery. The margins were positive in six patients (9.7%), close (<8 mm) in 10 (16.1%), and adequate (>8 mm) in 46 (74.2%). Six (9.7%) patients had dehiscence and two (3.2%) patients suffered from necrosis. In patients undergoing V‐Y flap reconstruction, two (8.7%) had a wound dehiscence, no patients had necrosis. In patients undergoing direct closure, four (10.3%) had wound dehiscence and two (5.1%) had necrosis.ConclusionsV‐Y gluteal fold advancement technique is a safe procedure, performed in a single surgical session with minimal increase in surgical time and low wound healing complications. Use of this technique was correlated with an increased rate of adequate surgical margins (<8 mm) and reduced need for adjuvant radiotherapy.

Highlighting strengths and resources that increase ownership of cervical cancer screening for Indigenous communities in Northern British Columbia: Community‐driven approaches

AbstractObjectiveTo examine the unique and diverse strengths held by rural and remote Indigenous communities in northern British Columbia, including multi‐generational support systems in health and wellness, profound connections to the land, and strong cultural foundations, and harness these strengths, allowing communities to engage in innovative and empowering health and wellness programs.MethodsBuilding on these pre‐existing and fundamental strengths, an alternative option to cervical cancer screening was introduced to nine Carrier Sekani health centers located in northern interior British Columbia in response to disparities in screening rates. Introduced in 2019, CervixCheck uses a self‐collection approach that is private, safe, convenient, and offered at local community health centers by trained and supportive health staff.ResultsUsing a strengths‐based and community directed and descriptive approach, the process was outlined for a successful and ongoing health screening opportunity that is put into the hands of community members within Indigenous communities in the region of northern British Columbia.ConclusionThrough collaborative partnerships, in‐person engagement sessions, and the utilization of pre‐existing infrastructure and health and wellness teams, this project was successfully integrated into primary care centers using culturally safe and community‐based approaches.

Prognostic impact of erythropoietin‐stimulating agent use during front‐line chemotherapy in patients with ovarian cancer: A Korean multicenter cohort study

Abstract Objective To evaluate whether treatment with erythropoiesis‐stimulating agents (ESAs) for chemotherapy‐induced anemia affects progression‐free survival (PFS) in patients receiving front‐line chemotherapy following surgery for ovarian cancer (OC). Methods We retrospectively reviewed all consecutive patients who received front‐line chemotherapy after surgery between 2013 and 2019 at six institutions. The patients were divided according to the use of ESAs during front‐line chemotherapy. The primary endpoint was PFS. The secondary endpoint was the occurrence of thromboembolism. Propensity score matching (PSM) analysis was used to compare survival between matched cohorts. Results Overall, 2147 patients (433 receiving ESA and 1714 for no‐ESA) were identified, with a median follow‐up of 44.0 months. The ESA group showed a significantly higher proportion of stage III/IV disease (81.8% vs 61.1%; P  < 0.001) and postoperative gross residual disease (32.3% vs 21.2%; P  < 0.001) than the no‐ESA group. In the multivariable Cox regression analysis, the use of ESAs did not affect PFS (adjusted hazard ratio, 1.03; 95% confidence interval [CI]: 0.89–1.20; P  = 0.661). The incidence of thromboembolism was 10.2% in the ESA group and 4.6% in the no‐ESA group (adjusted odds ratio, 6.58; 95% CI: 3.26–13.28; P  < 0.001). When comparing the well‐matched cohorts after PSM, PFS did not differ between the ESA (median PFS 23.5 months) and no‐ESA groups (median PFS 22.2 months) ( P  = 0.540, log‐rank test). Conclusions The use of ESAs during front‐line chemotherapy did not negatively affect PFS in patients with OC after surgery but increased the risk of thromboembolism.

A case of unilateral sclerosing stromal tumor of the ovary in a postmenopausal female

SynopsisAlthough SSTs predominantly affect young women, postmenopausal women with pelvic masses should not be overlooked. A comprehensive approach is necessary for diagnosis of this tumor.

High‐risk HPV positivity is a long‐term risk factor for recurrence after cervical excision procedure in women living with HIV

AbstractObjectiveTo evaluate the risk factors for recurrence of high‐grade disease after cervical excision in women living with HIV (WLWH), with a specific interest in the role of high‐risk (HR‐) HPV positivity.MethodsMulticentric retrospective study conducted on WLWH who underwent cervical excision between January 1987 and June 2017 in six Italian institutions. The rate of high‐grade recurrence was determined. Risk factors for recurrence and HR‐HPV positivity were determined with the Log‐rank test and Cox proportional hazards regression models.ResultsA total of 271 WLWH were included in the final analysis. A high‐grade recurrence was found in 58 (21.4%) patients. Age 41 years or more at inclusion and HR‐HPV positivity during follow up were independently associated with a higher risk of disease recurrence with relative risks of 4.15 (95% confidence interval [CI] 2.01–8.58, P < 0.001) and 5.18 (95% CI 2.12–12.67, P < 0.01), respectively. Age 41 years or more (relative risk 1.75, 95% CI 1.01–3.04, P = 0.047) resulted as a risk factor for HR‐HPV positivity during follow up.ConclusionHR‐HPV positivity is a risk factor for recurrence after cervical excision in WLWH. Women older than 41 years may benefit from a long‐term yearly follow up. Future studies regarding HPV vaccination after treatment in WLWH may be useful, considering the protective role of the higher probability of HPV negativity in vaccinated women.

Utilizations and characteristics of ovarian conservation at hysterectomy for cervical carcinoma in situ

AbstractObjectiveTo examine the trends and characteristics of ovarian conservation at time of hysterectomy in cervical carcinoma in situ.MethodsThis is a retrospective cohort study examining the Healthcare Cost and Utilization Project's National Inpatient Sample, January 2016 to December 2019. The study population included 6605 patients aged less than 65 years with cervical carcinoma in situ who underwent hysterectomy. Exposure allocation was the adnexal procedure status (ovarian conservation vs. oophorectomy). Main outcome measures were temporal trends of ovarian conservation over time and per patient age. A classification‐tree was constructed to examine utilization patterns of ovarian conservation.ResultsOvarian conservation was performed in 57.2% of patients. Ovarian conservation rates were unchanged over time (P‐trend = 0.219). Ovarian conservation rates remained stable until age 40 years, ranging from 88.0% to 78.6% (P‐trend = 0.236), after which time the rate sharply decreased from 78.6% to 19.1% (P‐trend <0.001). In a multivariable analysis, younger age, fewer comorbidities, higher household income, vaginal hysterectomy, and surgery at small bed capacity non‐rural hospitals were associated with ovarian conservation (all, P < 0.05). There were 17 utilization patterns of ovarian conservation for which the rate ranged from 17.2% to 94.4% (absolute rate difference 77.2%, P < 0.001).ConclusionDecrease in the utilization of ovarian conservation at hysterectomy for cervical carcinoma in situ occurred at age 40 years, which is earlier than expected.

Endometrial microbial dysbiosis and metabolic alteration promote the development of endometrial cancer

AbstractObjectiveEmerging evidence suggests that the endometrial microbiome plays important roles in the development of endometrial cancer (EC). Here, we evaluate stage‐specific roles of microbial dysbiosis and metabolic disorders in patients with EC, patients with endometrial hyperplasia (EH), and patients afflicted with benign uterine conditions (CK).MethodsThis prospective cohort study included 33 women with EC, 15 women with endometrial EH, and 15 women with benign uterine conditions (CK) from November 2022 to September 2023. Different typical endometrial samples were imaged with a scanning electron microscope and a transmission electron microscope. The endometrial microbiome was assessed by sequencing the V3–V4 region of the 16S rRNA gene and the ITS1 to fill the gap in relation to the study of the uterine fungal microbiome. Moreover, liquid chromatography‐mass spectrometry‐based metabolomics was used to identify and quantify metabolic changes among these groups.ResultsThe endometrial microbiome revealed that there is a structural microbiome shift and an increase in the α‐diversity in the EC and EH cases, distinguishable from the benign cases, especially the fungal community structure. The fungal microbiome from patients with EC and EH was altered relative to controls and dominated by Penicillium sp. By contrast, Sarocladium was more abundant in controls. Significant differences were observed in the composition and content of compounds between benign cases and EC, especially estradiol‐like metabolism‐related substances. Altered microbiota was correlated with the concentrations of interleukin‐6 (IL‐6), IL‐11, transforming growth factor‐beta, and β‐glucuronidase activity especially the relative abundance increase of Penicillium sp.ConclusionsThis study suggested that the endometrial microbiome is complicit in modulating the development of EC such as estrogen activity and a pro‐inflammatory response. Our work provides a new insight into the endometrial microbiome from a perspective of stages, which opens up new avenues for EC prognosis and therapy.

Response: FIGO staging of endometrial cancer: 2023

The positive threshold of the immunohistochemical parameter Ki67 for predicting the recurrence of cervical cancer

AbstractObjectiveTo find the optimal threshold of Ki67 and evaluate its significance in predicting recurrence of stage I–II cervical cancer.MethodsA total of 1130 patients were included after screening. Univariate and multivariate Cox regression analysis were used to select factors associated with recurrence of cervical cancer. The receiver operating characteristic (ROC) curve was used to assess the optimal threshold of Ki67. The differences of clinicopathological parameters and the survival analysis between the two groups divided based on the optimal threshold of Ki67 were compared.ResultsMultivariate Cox regression analysis showed that Ki67 (p < 0.001) was significant prognostic predictor for recurrence of cervical cancer. The optimal threshold of Ki67 was 42%. The recurrence‐free survival (RFS) and the overall survival (OS) of cervical cancer patients in the high‐Ki67 group (Ki67≥42%) were much lower than those in the low‐Ki67 group (Ki67<42%) (p < 0.001, p < 0.001). Among the 380 patients with low‐risk cervical cancer, the RFS and OS of patients in the high‐Ki67 group were also lower than those in the low‐Ki67 group (p < 0.001, p < 0.001).ConclusionThe Ki67 was a useful prognostic factor in patients with stage I–II cervical cancer, and the Ki67 labeling index 42.0% was optimal threshold for predicting recurrence.

A predictive model for endometrial cancer recurrence based on molecular markers and clinicopathologic parameters: A double‐center retrospective study

AbstractObjectiveThe purpose of this study was to establish a predictive model for endometrial cancer (EC) recurrence based on commonly used molecular markers and clinicopathologic parameters.MethodsThis was a double‐center retrospective study. The data of patients were retrospectively collected from two tertiary hospitals in Chongqing, China. The patients were divided into training and validation cohorts according to the ratio of 7:3. In the training cohort, the factors related to the recurrence were screened through uni‐ and multivariate Cox regression analysis, and a nomogram was constructed based on this. Internal and external validation of the model was performed in two cohorts, respectively. In the training cohort, the optimal risk threshold of the model was determined by using the receiver operating characteristic (ROC) curve and the maximum value of the Youden index.ResultsA total of 1348 patients were included, including 944 in the training cohort and 404 in the validation cohort. Multivariate analysis suggested that ER expression, P53 expression and other clinicopathologic parameters, were significantly related to recurrence. On this basis, a nomogram was constructed to predict 1‐, 3‐, and 5‐year recurrence‐free survival (RFS) rate. The model had good predictive accuracy in both cohorts through the validation. The ROC curve and Youden index suggested that the optimal risk threshold of 3‐year RFS rate predicted by the model was 0.83, and there was a significant survival difference between the high‐ and low‐risk groups.ConclusionCompared to traditional prediction models, the model proposed in this study that combined molecular indicators and clinicopathologic parameters can better predict the prognosis of EC patients.

Response: FIGO staging of endometrial cancer 2023

Dusp6 immunohistochemistry is associated with the response of atypical endometrial hyperplasia and early endometrial cancer to conservative treatment

AbstractObjectiveDual‐specificity phosphatase 6 (Dusp6) was proposed as a predictive marker of response of atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC) to conservative treatment. However, its predictive accuracy has never been calculated. We aimed to define it in conservatively treated AEH and EEC.MethodsAll patients <45 years with AEH or EEC and conservatively treated with hysteroscopic resection + LNG‐IUD insertion from 2007 to 2018 were retrospectively assessed. Dusp6 immunohistochemical expression was assessed and dichotomized as “strong” vs “weak”. Relative risk (RR) for “no regression” and “recurrence” or AEH/EEC was calculated. Predictive accuracy was calculated as sensitivity, specificity, positive and negative predictive values (PPV, NPV) and area under the curve (AUC) on receiver operating characteristic curve.ResultsThirty‐six women were included. Weak Dusp6 immunohistochemical expression was significantly associated with increased risk of resistance to treatment, with a RR = 16 (P = 0.0074); predictive accuracy analysis showed sensitivity = 80%, specificity = 90%, PPV = 57.1%, NPV = 96.4%, AUC = 0.85. A weak Dusp6 expression was not significantly associated with the risk of recurrence after an initial regression (RR = 0.4; P = 0.53).ConclusionWeak Dusp6 expression appears as a significant predictor of resistance of AEH/EEC to fertility‐sparing treatment, with moderate predictive accuracy.Weak Dusp6 expression is significantly associated with resistance of atypical endometrial hyperplasia or early endometrial cancer to fertility‐sparing treatment, with moderate predictive accuracy.

FIGO staging of endometrial cancer: 2023

AbstractIntroductionMany advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies.MethodsThe FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system.ResultsBased on the existing evidence, the substages were defined as follows:Stage I (IA1): non‐aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non‐aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low‐grade endometrioid carcinomas limited to the uterus with simultaneous low‐grade endometrioid ovarian involvement; (IB) non‐aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous, high‐grade endometrioid, clear cell, carcinosarcomas, undifferentiated, mixed, and other unusual types without any myometrial invasion.Stage II (IIA): non‐aggressive histological types that infiltrate the cervical stroma; (IIB) non‐aggressive histological types that have substantial LVSI; or (IIC) aggressive histological types with any myometrial invasion.Stage III (IIIA): differentiating between adnexal versus uterine serosa infiltration; (IIIB) infiltration of vagina/parametria and pelvic peritoneal metastasis; and (IIIC) refinements for lymph node metastasis to pelvic and para‐aortic lymph nodes, including micrometastasis and macrometastasis.Stage IV (IVA): locally advanced disease infiltrating the bladder or rectal mucosa; (IVB) extrapelvic peritoneal metastasis; and (IVC) distant metastasis.The performance of complete molecular classification (POLEmut, MMRd, NSMP, p53abn) is encouraged in all endometrial cancers. If the molecular subtype is known, this is recorded in the FIGO stage by the addition of “m” for molecular classification, and a subscript indicating the specific molecular subtype. When molecular classification reveals p53abn or POLEmut status in Stages I and II, this results in upstaging or downstaging of the disease (IICmp53abn or IAmPOLEmut).SummaryThe updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence‐based context for treatment recommendations and for the more refined future collection of outcome and survival data.

The role of sarcopenic obesity in high‐grade endometrial cancer

AbstractObjectiveTo investigate the relationship between obesity and sarcopenia in relation to overall survival (OS) and disease‐specific survival (DSS) in high‐grade endometrial cancer patients.MethodsWe conducted a retrospective study in women diagnosed with high‐grade endometrial cancer (EC) between February 2006 and August 2017 in the Royal Cornwall Hospital who had abdominal computerized tomography (CT)‐scan as part of routine staging work‐up. Sarcopenia was assessed by measuring psoas‐, paraspinal‐ and abdominal wall muscles on CT and defined by skeletal muscle index ≤41 cm2/m2. Sarcopenic obesity was defined as sarcopenia combined with body mass index (BMI) ≥30 kg/m2.ResultsA total of 176 patients with median age of 70 years and median BMI of 29.4 kg/m2were included in the study. The majority of patients (38%) had endometrioid type histology. Sarcopenia was not associated with OS (P = 0.951) or DSS (P = 0.545) However, in multivariate analysis, sarcopenic obesity was associated with reduced OS in endometrioid endometrial cancer (EEC) patients (P = 0.048).ConclusionSarcopenic obesity is associated with OS in high‐grade EEC patients, while sarcopenia without obesity is not related to OS or DSS in high‐grade EC. In non‐endometrioid endometrial cancer, there is no association between sarcopenic obesity and survival.

The optimal cut‐off value of immunohistochemical parameter P53 for predicting recurrence of endometrial cancer

AbstractObjectiveTo explore the optimal cut‐off value of immunohistochemical parameter P53 for predicting the recurrence of Stage I–III endometrial cancer.MethodsA total of 473 patients who were treated between October 2013 and May 2018 were retrospectively studied. Receiver operating characteristic (ROC) curves and the Youden index were used to calculate the optimal cut‐off value of P53. Cox regression analysis was used to detect the association between the threshold of P53 and recurrence of endometrial cancer. Recurrence‐free survival (RFS) and overall survival (OS) were exhibited by Kaplan–Meier curve.ResultsThe study showed that 67% was the optimal cut‐off value of P53 to predict the recurrence of endometrial cancer. P53 above 67% was an independent predictor for relapse of endometrial cancer (p < 0.001). The 3‐year RFS was 89.7% in the low‐value group and 66.6% in the high‐value group (p < 0.001), while the 3‐year OS was 93.9% and 76.4%, respectively (p < 0.001). Furthermore, the 3‐year RFS of patients who did not receive adjuvant chemotherapy or radiotherapy was 95.7% and 78.2% between the two groups (p < 0.001).ConclusionThe optimal cut‐off value of immunohistochemical parameter P53 for predicting recurrence was confirmed as 67% and a P53 index above 67% was an independent prognostic factor.

High‐grade endometrial stromal sarcoma of the endocervix: An extremely rare case report

Nulliparity and postmenopausal status are independent factors of malignancy potential of endometrial intraepithelial neoplasia in polyps

AbstractObjectiveTo estimate the risk of concurrent endometrial cancer in endometrium when endometrial intraepithelial neoplasia (EIN) is found within an endometrial polyp and to identify the possible predictive factors for concurrent endometrial cancer.MethodsHistopathologic data of women who underwent hysteroscopy for resection of endometrial polyps at Ankara Baskent University Hospital, between 2011 and 2019 were screened. Patients whose polypectomy report was EIN in a polyp, and who had a final report of the hysterectomy specimen were included. Patients were divided into two groups according to the presence of concurrent cancer in the hysterectomy material: group 1, concurrent cancer present and group 2, concurrent cancer absent. Statistical analyses were performed using SPSS.ResultsA total of 4125 women underwent hysteroscopy for the resection of endometrial polyps. Of those women, 161 (3.9%) were diagnosed as having EIN and 115 met the criteria. The rate of concurrent endometrial cancer was 28.6% (33/115). According to multivariate analysis, nulliparity (odds ratio [OR] 0.38; 95% confidence interval [CI] 1.04–3.67; p = 0.036) and postmenopausal status (OR 0.64; 95% CI 0.42–0.98; p = 0.042) were found to be independent factors significantly associated with concurrent endometrial cancer.ConclusionThe incidence of concurrent cancer is higher in postmenopausal or nulliparous women when EIN is detected in a polyp.

Risk factors for cervical stromal involvement in endometrioid‐type endometrial cancer

Abstract Objective The aim of this study was to identify predictors of cervical stromal involvement in women with endometrioid‐type endometrial cancer (EEC). Methods A total of 795 patients with EEC who underwent comprehensive surgical staging including pelvic and para‐aortic lymph node dissection between January 2007 and December 2018 were retrospectively analyzed. Data including age, menopausal status, serum CA‐125 levels, tumor size, lymphovascular space invasion (LVSI), depth of myometrial invasion, positive peritoneal cytology, cervical stromal involvement, histologic grade, recurrence, and follow‐up duration were recorded. Results Median follow up was 49 months. Cervical stromal invasion was found in 88 patients. Multivariate analysis revealed that presence of LVSI (hazard ratio [HR] 2, 95% confidence interval [CI] 1.02–4.25, P  = 0.045), a primary tumor diameter of at least 3 cm (HR 3, 95% CI 1.31–7.25, P  = 0.010), and at least 50% deep myometrial invasion (HR 2.7, 95% CI 1.37–5.41, P  = 0.004) were independent risk factors for cervical stromal involvement in patients with EEC. Conclusion Our study results suggest that presence of LVSI, a primary tumor diameter of at least 3 cm, and LVSI of at least 50% seem to be independent predictors of cervical involvement in women with EEC.