Lymphovascular Space Invasion in Early-Stage Endometrial Cancer (LySEC): Patterns of Recurrence and Predictors. A Multicentre Retrospective Cohort Study of the Spain Gynecologic Oncology Group.

The main aim is to compare oncological outcomes and patterns of recurrence of patients with early-stage endometrioid endometrial cancer according to lymphovascular space invasion (LVSI) status. The secondary objective is to determine preoperative predictors of LVSI. We performed a multicenter retrospective cohort study. A total of 3546 women diagnosed with postoperative early-stage (FIGO I-II, 2009) endometrioid endometrial cancer were included. Co-primary endpoints were disease-free survival (DFS), overall survival (OS), and pattern of recurrence. Cox proportional hazard models were used for time-to-event analysis. Univariate and multivariate logistical regression models were employed. Positive LVSI was identified in 528 patients (14.6%) and was an independent prognostic factor for DFS (HR 1.8), OS (HR 2.1) and distant recurrences (HR 2.37). Distant recurrences were more frequent in patients with positive LVSI (78.2% vs. 61.3%, p < 0.01). Deep myometrial invasion (OR 3.04), high-grade tumors (OR 2.54), cervical stroma invasion (OR 2.01), and tumor diameter ≥ 2 cm (OR 2.03) were independent predictors of LVSI. In conclusion, in these patients, LVSI is an independent risk factor for shorter DFS and OS, and distant recurrence, but not for local recurrence. Deep myometrial invasion, cervical stroma invasion, high-grade tumors, and a tumor diameter ≥ 2 cm are independent predictors of LVSI.

Intrauterine contraceptive device rupture. Follow-up of a retrospective cohort and clinical protocol. RUDIUS study.

OBJECTIVE: Intrauterine device fracture, as we know it today, is an infrequent event, usually described as isolated cases. The purpose of this study was to look for factors influencing intrauterine fragment retention after device rupture. STUDY DESIGN: Retrospective cohort study. A total of 135 patients were recruited, and the cohort follow-up ran for three full years from 2018 to 2020. RESULTS: Thirty-three percent of patients had a retained intrauterine fragment compared to 82 of 123 (66.7%) who had expelled it spontaneously. In the group of patients who had at least one intercurrent period between device fracture and confirmatory fragment persistent test, we found persistence of intrauterine fragment in 18 of 71 (25.4%) patients compared to 53 of 71 (74.6%) who did not (p = 0.047). A total of 6 of 39 (15.4%) of the patients with spontaneous rupture of the device presented with persistence of the intrauterine fragment compared to 32 of 81 (39.2%) of the group with fracture after manipulation (p = 0.006). The mean time elapsed from the fracture to the confirmatory test in the patients who had persistence of the fragment was 26.97 days (range from 0 to 116), while in those who expelled it spontaneously, a mean of 45.59 days (range 7-267) had elapsed (p = 0.003). CONCLUSIONS: The main factors positively influencing complete expulsion of the fragmented IUD were elapsed time of 45 days or more, intercurrent menstruation or spontaneous fracture. Therefore, the proposed protocol calls for expectant management for at least 1.5 months after fracture, allowing at least one intercurrent period to elapse prior to any therapeutic manoeuvre.

Preoperative sampling in endometrial cancer: evaluation of the histopathological agreement with definitive surgical specimen.

PURPOSE: The main goal of this study is to assess the diagnostic agreement between preoperative biopsy and definitive histology of the surgical specimen to determine which sampling method is most suitable for diagnosis of early-stage endometrial cancer. METHODS: We performed a retrospective multicentric study to assess the correlation between three endometrial sampling methods (hysteroscopy, pipelle and D&C) in patients who had undergone preoperative endometrial biopsy and received primary surgical treatment for endometrial cancer. The primary objective was the agreement rate between hysteroscopy (HSC), endometrial biopsy (pipelle) and dilatation and curettage (D&C). RESULTS: A total of 1833 women who underwent preoperative sampling at 15 centers were included: 1042 biopsies were performed by HSC, 703 by pipelle and 88 by D&C. All three methods presented a moderate diagnostic concordance (κ = 0.40-0.61) with the definitive specimen's histology: HSC (κ = 0.47), pipelle sampling (κ = 0.48) and D&C (κ = 0.48). Likewise, a subgroup analysis was performed by histological subtype comparing HSC and endometrial biopsy, showing that neither is superior as a diagnostic method. CONCLUSIONS: According to this study, the use of pipelle sampling could become an adequate diagnostic method in endometrial cancer due to its similar agreement to HSC, ease of use and affordability.

Prenatal diagnosis of cor triatriatum sinister associated with early pericardial effusion: A case report.

BACKGROUND: Cor triatriatum sinistrum or cor triatriatum sinister is a rare congenital heart disease that accounts for approximately 0.1% of all cardiac abnormalities. It is defined as the presence of an anomalous septum that divides the left atrium into two cavities, and in most cases, it can be asymptomatic or less frequently very severe. CASE SUMMARY: A 37-year-old pregnant woman visited our hospital. In the first trimester scan, we detected signs of fluid in the pericardium (pericardial effusion) that reached the atriums. In the third trimester, an anomalous septum in the left atrium suspicious of cor triatriatum sinister was detected. Expectant management was decided, the pregnancy evolved normally and resulted in uncomplicated delivery of a healthy child. The findings in the prenatal scan were confirmed by echocardiography and the diagnosis of cor triatriatum sinister was confirmed. The newborn was asymptomatic at all times. CONCLUSION: We show expectant management of cor triatriatum sinister and suggest an association between this entity and early pericardial effusion.