Accuracy of endometrial sampling in the diagnosis of endometrial cancer: a multicenter retrospective analysis of the JAGO-NOGGO.

BACKGROUND: Accurate preoperative molecular and histological risk stratification is essential for effective treatment planning in endometrial cancer. However, inconsistencies between pre- and postoperative tumor histology have been reported in previous studies. To address this issue and identify risk factors related to inaccurate histologic diagnosis after preoperative endometrial evaluation, we conducted this retrospective analysis. METHODS: We conducted a retrospective analysis involving 375 patients treated for primary endometrial cancer in five different gynaecological departments in Germany. Histological assessments of curettage and hysterectomy specimens were collected and evaluated. RESULTS: Preoperative histologic subtype was confirmed in 89.5% of cases and preoperative tumor grading in 75.2% of cases. Higher rates of histologic subtype variations (36.84%) were observed for non-endometrioid carcinomas. Non-endometrioid (OR 4.41) histology and high-grade (OR 8.37) carcinomas were identified as predictors of diverging histologic subtypes, while intermediate (OR 5.04) and high grading (OR 3.94) predicted diverging tumor grading. CONCLUSION: When planning therapy for endometrial cancer, the limited accuracy of endometrial sampling, especially in case of non-endometrioid histology or high tumor grading, should be carefully considered.

Primary prevention of HPV-related diseases from the patients' perspective in Poland.

OBJECTIVES: This study aimed to assess the knowledge of human papillomavirus (HPV) and attitudes toward HPV vaccination (HPVv) among female patients in Poland, investigating the impact of sociodemographic factors on these aspects. The study also explored awareness of state-funded bivalent vaccination and gauged willingness to vaccinate children, especially in the aspect of the newly introduced nonavalent vaccine. MATERIAL AND METHODS: An 11-question questionnaire was administered to newly referred patients at a dysplasia consultation center in Kraków University Hospital between February and December 2022. Statistical analysis using IBM SPSS Statistics 25 evaluated sociodemographic characteristics, HPV knowledge, attitudes toward HPVv and correlations among responses. RESULTS: By December 2022, 187 completed forms were received, primarily from women aged 30-40 years, residing in large cities, and with higher education qualifications. While most were aware of HPV's association with cancer and abnormal cytology, over 40% were unaware of its asymptomatic nature. Higher education is correlated with better HPV awareness. Participants generally showed positive attitudes toward HPVv for themselves and their children, yet only a small fraction had received the vaccine. Education significantly influenced HPV knowledge, with higher education levels linked to better awareness and willingness to vaccinate children. Awareness of HPV is positively correlated with knowledge test performance and vaccination attitudes. CONCLUSION: The study revealed a lack of awareness regarding government co-financing for the bivalent vaccine. Campaigns endorsing reimbursed vaccination were found to be inadequate, highlighting the need for corrective measures to enhance awareness and improve vaccination rates, particularly for individuals outside the age range between 12 and 13 years relying on self-financing or sporadic government initiatives.

Postoperative gynecologic oncology admissions to intensive care unit in the tertiary care center: an eight-year retrospective study.

OBJECTIVES: The purpose of the study was to analyze the cohort of gynecologic oncology patients admitted to intensive care unit (ICU). MATERIAL AND METHODS: We conducted a retrospective study including all ICU postoperative admissions related to adult female patients with gynecological malignancies diagnosis treated in the tertiary care center between Jan 1, 2007, and Dec 31, 2014. RESULTS: A total of 666 women were admitted to ICU. It accounted for 2 % of all tertiary care center gynecology admissions. The mean age was 62.4 ± 12.7 years, and the mean length of stay was 8.9 ± 9.6 days. One hundred seventeen women (17.5%) required mechanical ventilation, and 220 women (33%) vasoactive drug infusion. The most common malignancy in the observed cohort of patients was ovarian cancer 326 (48.9%), followed by endometrial cancer 206 (30.9%). The patients with respiratory or circulatory insufficiency were older (mean age 64.9 ± 11.8 vs 60.8 ± 13; p < 0.001) and had longer mean ICU stay (13.1 ± 13.9 vs 6.3 ± 3.5 days; p < 0.001). We found a decrease in ICU admissions of patients without respiratory and circulatory failure after elective major surgery (Spearman: r = -1, p = 0.017). We report 21 patients' deaths (3.1% in the cohort; 0.06% of all admissions). CONCLUSIONS: Ovarian cancer patients were the largest group in the study, representing almost half of ICU admissions in the gynecology oncologic population. Older age was the risk factor of respiratory and circulatory insufficiency. Availability of intermediate care facilities could reduce ICU admissions after major surgery.

A survey of knowledge, attitudes and awareness of the HPV and HPV vaccine among obstetricians and gynecologists across Poland.

OBJECTIVES: The objective of this study was to assess general knowledge regarding human papillomavirus (HPV) and the attitude to primary prevention in form of HPV vaccination (HPVv) among Polish obstetricians and gynecologists (OBGYNs). In addition, we wanted to study the willingness of physicians to promote the HPVv among patients, based on their general attitude to vaccinations as well as HPV-related knowledge. The gynecologists were also asked to assess their patients' awareness of HPV infection. MATERIAL AND METHODS: A questionnaire consisting of 25 questions was used to collect the data and with support of the Polish Society of Gynecologists and Obstetricians (PTGiP) and the Polish Society of Colposcopy and Cervical Pathology (PTKiPSM) sent via their mailing lists to all members and beyond. The total amount of 213 fully filled questionnaires were gathered and analyzed using descriptive statistics. RESULTS: Most of the surveyed OBGYNs showed a good knowledge of HPV and HPVv. They were able to correctly identify the high-risk oncogenic HPV types (hrHPV) and admitted to using HPV genotyping in their daily practice and actively promoting HPVv, being in majority supporters of mandatory vaccinations in general. Almost 90% confirmed the importance of informing patients about sexually transmitted diseases (STDs). On the other hand, there was a group of OBGYNs with clearly insufficient knowledge about the HPV and its prevention. CONCLUSIONS: General knowledge of Polish physicians about HPV is good, independent of gender and age. The acceptance of all vaccines is high, but the low availability of the HPV vaccines seems to be the biggest problem stopping patients from getting them.

Perioperative management of patients with gynecological cancers.

Oncological surgery is the primary treatment for gynecological malignancies and is inseparably linked with anesthesia. The modern approach to interdisciplinary and multidisciplinary perioperative care in gynecologic oncological patients improves the outcome. This paper presents a review of perioperative management of patients with gynecologic oncology related to enhanced recovery after surgery and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. We performed a literature search on MEDLINE, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, and Clinical Trials. The database search focused on selected topics related to perioperative gynecological oncology care. The authors also contributed through individual, independent literature searches.

Pregnancy status alters IL-21-mediated effects on murine B lymphocytes.

A favorable outcome of pregnancy depends greatly on an adequate balance of immune protection and fetal tolerance at the fetomaternal interface. IL-21 is a pro-inflammatory cytokine associated with altering immune responses in autoimmune diseases. IL-21 has pleiotropic functions, including induction of Th17 T cells, inhibition of Treg development, and modulation of antibody responses of B lymphocytes. Genetic polymorphisms of IL21 have been associated to poor pregnancy outcomes. However, the mechanism of IL-21 actions needs further evaluation. Here, we postulate that IL-21 affects splenic B cell function during pregnancy and shapes immune responses. We show that splenic B cells from CBA/J × BALB/c mice with favorable pregnancy outcome expressed lower IL21R levels than in CBA/J × DBA/2J mice, a mouse model for immune-induced bad pregnancy outcome. As a consequence, B cells from CBA/J × BALB/c mice reacted less sensitively to IL-21 than B cells from non-pregnant mice (NPM) or from CBA/J × DBA/2J mice. Also, LPS-induced apoptotic rates were altered in NPM and CBA/J × DBA/2J but not in CBA/J × BALB/c mice. This is accompanied by improved survival of B cells that produce the anti-inflammatory cytokine IL-10 upon stimulation with LPS. We also observed lower numbers of CD4+CXCR5+Bcl-6+ follicular T-helper cells (Tfh) in normal pregnant mice, compared to non-pregnant and mice with disturbed pregnancies. Our data indicate that alterations of the Tfh/IL-21/IL-10 axis may have important influence on pregnancy outcome.

Benign uterine mass-discrimination from leiomyosarcoma by a preoperative risk score: a multicenter cohort study.

PURPOSE: Discrimination of uterine leiomyosarcoma (LMS) and leiomyoma (LM) prior to surgery by basic preoperative characteristics and development of a preoperative leiomyosarcoma score. METHODS: A predominantly prospective cohort of 826 patients with LM from a clinical institution and an outpatient center was included in the study. Further a predominantly retrospective cohort of 293 patients with LMS was included from the counseling database of the German Clinical Center of Excellence for Genital Sarcoma and Mixed Tumors (DKSM, University Medicine Greifswald, Germany). We analyzed and compared anamnestic, epidemiological and clinical findings between both cohorts. Tenfold cross-validated logistic regression and random forest was performed on the 80% training set. The preoperative LMS score (pLMS) was developed based on logistic regression and independently evaluated by analyzing the area under the receiver operating characteristic curve (AUC) with the 20% test set. RESULTS: In the LMS cohort, 63.1% had initially surgery for presumed LM and only 39.6% of endometrial biopsies revealed LMS. Key features for LMS discrimination were found to be bleeding symptoms: intermenstrual bleeding [RRc = 2.71, CI = (1.90-3.49), p < 0.001], hypermenorrhea [RRc = 0.28, CI = (0.15-0.50), p < 0.001], dysmenorrhea [RRc = 0.22, CI = (0.10-0.51), p < 0.001], postmenstrual bleeding [RRc = 2.08, CI = (1.30-2.75), p < 0.001], suspicious sonography [RRc = 1.21, CI = (1.19-1.22), p < 0.001] and the tumor diameter (each centimeter difference: ß = 0.24, SD = 0.04, p < 0.001). pLMS achieved a mean cross-validated AUC of 0.969 (SD = 0.019) in the training set and an AUC of 0.968 in the test set. CONCLUSIONS: The presented score is based on basic clinical characteristics and allows the prediction of LMS prior to a planned surgery of a uterine mass. In case pLMS is between - 3 and + 1, we suggest subsequent diagnostics, such as endometrial biopsy, color Doppler sonography, LDH measurement, MRI and transcervical biopsy.