Selection of suitable reference genes for gene expression studies in normal human ovarian tissues, borderline ovarian tumours and ovarian cancer.

The use of reference genes is the most common method of controlling the variation in mRNA expression during quantitative polymerase chain reaction, although the use of traditional reference genes, such as ß­actin, glyceraldehyde­3­phosphate dehydrogenase or 18S ribosomal RNA, without validation occasionally leads to unreliable results. Therefore, the present study aimed to evaluate a set of five commonly used reference genes to determine the most suitable for gene expression studies in normal ovarian tissues, borderline ovarian and ovarian cancer tissues. The expression stabilities of these genes were ranked using two gene stability algorithms, geNorm and NormFinder. Using geNorm, the two best reference genes in ovarian cancer were ß­glucuronidase and ß­actin. Hypoxanthine phosphoribosyltransferase­1 and ß­glucuronidase were the most stable in ovarian borderline tumours, and hypoxanthine phosphoribosyltransferase­1 and glyceraldehyde­3­phosphate dehydrogenase were the most stable in normal ovarian tissues. NormFinder ranked ß­actin the most stable in ovarian cancer, and the best combination of two genes was ß­glucuronidase and ß­actin. In borderline tumours, hypoxanthine phosphoribosyltransferase­1 was identified as the most stable, and the best combination was hypoxanthine phosphoribosyltransferase­1 and ß­glucuronidase. In normal ovarian tissues, ß­glucuronidase was recommended as the optimum reference gene, and the most optimum pair of reference genes was hypoxanthine phosphoribosyltransferase­1 and ß­actin. To the best of our knowledge, this is the first study to investigate the selection of a set of reference genes for normalisation in quantitative polymerase chain reactions in different ovarian tissues, and therefore it is recommended that ß­glucuronidase, ß­actin and hypoxanthine phosphoribosyltransferase­1 are the most suitable reference genes for such analyses.

The value of magnetic resonance imaging in investigating complex atypical hyperplasia of the endometrium.

BACKGROUND: Magnetic resonance imaging (MRI) has been recommended to rule out myometrial invasion or distant metastasis before treatment for complex atypical hyperplasia (CAH). This study aimed to evaluate whether preoperative MRI in patients diagnosed with CAH on initial biopsy will have any impact on their management. METHODS: A retrospective study of women diagnosed with CAH on initial endometrial biopsy that subsequently had hysterectomies. Definitive diagnosis was established at histology of the hysterectomy specimens and compared with preoperative MRI findings. RESULTS: Preoperative MRI scan was performed in 33 of 106 patients and myometrial invasion was reported in 12 patients with final histology diagnosing endometrial cancer in 10 patients. Twenty-one out of 33 cases were reported as no invasion on MRI but nine patients were confirmed with endometrial cancer on histology. Of the thirty-three patients diagnosed with endometrial cancer, twenty had stage 1a cancer, eight had stage 1b and five had stage 2 cancer. Twenty-seven patients had grade 1 and six patients had grade 2 cancer with no high-grade subtypes. CONCLUSIONS: In our series, we found that MRI had no value in the management of CAH. Thirty-three endometrioid endometrial cancers (31%) were identified and we found no high-risk subtypes, and simple hysterectomy and bilateral salpingo-oophorectomy would be performed and the few stage 2 cases diagnosed were microscopic and would not have been diagnosed on MRI.

Current management of endometrial hyperplasia-a survey of United Kingdom consultant gynaecologists.

OBJECTIVE: To determine current practice for the management of endometrial hyperplasia. STUDY DESIGN: We carried out a web-based survey of all UK consultant gynaecologists, from the Royal College of Obstetricians and Gynaecologists (RCOG) database, to evaluate the current practice and to enquire whether a trial between oral progestogens and LNG-IUS for endometrial hyperplasia is required. RESULTS: We sent 1090 email invitations and 411 (37.7%) responded to this survey. In total, 338 consultant gynaecologists, who manage patients with endometrial hyperplasia, responded to all items of the survey. The oral progestogens (33.2%) and the LNG-IUS (52.1%) were the most popular choices for managing complex endometrial hyperplasia. The majority of the gynaecologists would explore two conservative choices before embarking into performing a hysterectomy for this condition (130, 52.6%). However, for atypical hyperplasia, the majority of the gynaecologists would perform a hysterectomy (273, 83.2%) and would only consider LNG-IUS or oral progestogens as a second or third option. Two hundred forty-four (72.2%) responded that an RCT for oral progestogens versus LNG-IUS for the management of endometrial hyperplasia is required. There were 171 (50.6%) gynaecologists that would be willing to randomise in such an RCT. CONCLUSION: Our survey shows that complex endometrial hyperplasia is managed conservatively in UK, with oral progestogens or LNG-IUS, and atypical endometrial hyperplasia is managed with hysterectomy. An RCT, between oral progestogens and LNG-IUS for endometrial hyperplasia, is required to identify the optimum therapy.