Oncogénesis del pólipo endometrial. Manejo clínico a través de marcadores biomoleculares / Oncogenesis of the endometrial polyp. Clinical management through biomolecular markers

La prevalencia de los pólipos endometriales se estima entre el 7,8 y el 35% de las mujeres, siendo mayor en el estado posmenopáusico. Los pólipos endometriales se asocian con hiperplasia endometrial y carcinogénesis, con una prevalencia informada de lesiones malignas y premalignas que puede llegar al 13%. La detección de pólipos endometriales en edad peri o posmenopáusica, en pacientes sintomáticas o asintomáticas, requiere un examen histeroscópico meticuloso. No está claro si la polipectomía debe realizarse de forma rutinaria en pacientes asintomáticas. El manejo expectante de pólipos pequeños y asintomáticos es razonable en muchos casos. Se necesitan estudios adicionales para dilucidar si los pólipos endometriales son precursores de cáncer, o simplemente marcadores de una enfermedad endometrial. Los biomarcadores capaces de detectar cambios a nivel molecular en los pólipos y el tejido endometrial nos ayudan a un mejor conocimiento y clasificación de los procesos malignos. Este conocimiento permite pasar de una medicina intervencionista a una medicina más conservadora, basada en la confianza de un conocimiento más preciso de los procesos biomoleculares. GynEC®-DX se basa en determinar la expresión de genes que se combinan en un algoritmo matemático diagnóstico para llegar a un diagnóstico negativo o positivo de cáncer de endometrio. La prueba molecular tiene un valor predictivo negativo del 99,6%, con una alta especificidad y sensibilidad. Esta prueba podría usarse para el diagnóstico diferencial del cáncer de endometrio en mujeres con pólipos endometriales sin requerir la exéresis de pólipos, limitando el riesgo iatrogénico y evitando intervenciones innecesarias

The prevalence of endometrial polyps is estimated between 7.8 and 35% of women, being more prevalent in postmenopausal women. Endometrial polyps are associated with endometrial hyperplasia and carcinogenesis, with an informed prevalence of malignant and premalignant lesions that may reach 13%. The detection of endometrial polyps in peri- or postmenopausal (status) age, in symptomatic or asymptomatic patients, requires a meticulous hysteroscopic examination. It is unclear if routine polypectomy should be performed in asymptomatic patients. The expectant management of small and asymptomatic polyps is reasonable in many cases. Additional studies are needed to elucidate whether endometrial polyps are precursors of cancer, or simply markers of an endometrial disease. Biomarkers capable of detecting changes at the molecular level in polyps and endometrial tissue help us to better understand and classify malignant processes. This knowledge allows to move from an interventional medicine to a more conservative medicine, based on the confidence of a more precise knowledge of the biomolecular processes. GynEC®-DX is based on determining the expression of genes that are combined in a diagnostic mathematical algorithm to arrive at a negative or positive diagnosis of endometrial cancer. The molecular test has a negative predictive value of 99.6%, with high specificity and sensitivity. This test could be used for the differential diagnosis of endometrial cancer in women with EPs and prevent the resection of polyps, limiting the iatrogenic risk and avoiding unnecessary interventions

Ambulatory MiniArc Precise Sling under Local Anesthesia for Stress Urinary Incontinence: Feasibility and Outcome.

AIMS: The aim of the study is to assess the feasibility of ambulatory stress urinary incontinence (SUI) surgery using the MiniArc Precise single-incision urethral sling without increasing the number of complications. SETTINGS AND DESIGN: This was a retrospective observational study of prospectively collected data carried out in a Tertiary Referral Hospital in Barcelona, Spain. MATERIALS AND METHODS: Forty patients diagnosed with SUI or stress predominant mixed urinary incontinence (MUI) treated surgically between November 2011 and November 2013. The MiniArc Precise® sling was inserted under local anesthesia in the ambulatory setting. STATISTICAL ANALYSIS USED: Descriptive statistics included frequencies and percentages for categorical variables and mean and range for quantitative variables. The statistical package used was SPSS version 17.0. RESULTS: Urodynamic studies showed SUI in 78% of cases and stress predominant MUI in 17%. Clinical findings included SUI in 56% of cases and MUI in 44%, with positive stress tests in all participants. The mean intraoperative pain (1-10 Visual Analog Scale) was 2. All patients were satisfied with the use of local anesthesia in the outpatient setting. Perioperative complications did not occur. One case of urinary retention and two cases of urinary tract infection (UTI) developed within this 1st month after operation and were successfully managed conservatively. Midterm complications included eight cases of UTI and four de novo urge incontinence. CONCLUSIONS: Placement of the MiniArc Precise sling under local anesthesia is a feasible and safe technique, which when carried out by an experienced surgeon allows to be done as an outpatient basis without increasing the rate of postprocedural complications.

Diagnóstico molecular del cáncer de endometrio / Molecular diagnosis of endometrial cancer

Mediante caracterización molecular se han identificado una combinación de biomarcadores fuertemente relacionados con la presencia de cáncer de endometrio. Concretamente, se ha desarrollado un test de diagnóstico molecular asociado a un algoritmo matemático que, con el análisis de una simple muestra de aspirado endometrial, permite mejorar el diagnóstico precoz del cáncer de endometrio. Este test, llamado GynEC(R)-DX, se basa en la interpretación de cambios moleculares que preceden las alteraciones morfológicas asociadas al cáncer de endometrio. La aplicabilidad del test GynEC(R)-DX, rápido y fiable, mejora por sí mismo la precisión diagnóstica de las pruebas convencionales de biopsia por aspirado o dirigida por histeroscopia, minimizando la posibilidad de resultados no concluyentes, y aporta una información de alto valor en determinados perfiles clínicos, que refuerza la confianza en la toma de decisión terapéutica y en el proceso de despistaje del cáncer de endometrio. Consecuentemente, se reduce el tiempo y el coste medio del diagnóstico de cáncer, especialmente en 5 perfiles específicos de pacientes característicos: hemorragia uterina anormal de repetición, ecografía con línea endometrial irregular sin dictamen claro histológico, diagnóstico de pólipo endometrial, hiperplasia endometrial sin atipias y Síndrome de Lynch. En el presente trabajo se describe el momento de aplicación del diagnóstico molecular, adaptado al algoritmo diagnóstico de la SEGO, para cada uno de los citados perfiles de alto riesgo, así como las ventajas clínicas derivadas (AU)

Through molecular characterization, a combination of biomarkers strongly related to the presence of endometrial cancer has been identified. Specifically, a molecular diagnostic test associated with a mathematical algorithm has been developed which, with the analysis of a simple sample of endometrial aspirate, allows improving the early diagnosis of endometrial cancer. This test, called GynEC(R)-DX, is based on the interpretation of molecular changes that precede the morphological alterations associated with endometrial cancer. The applicability of this test, called GynEC(R)-DX, fast and reliable, improves by itself the diagnostic accuracy of conventional aspiration or hysteroscopy-guided biopsy tests, minimizing the possibility of inconclusive results, and provides high value information in certain clinical profiles, which reinforces confidence in therapeutic decision- making and in the endometrial cancer screening process. The combination of GynEC(R)-DX with histological analysis on endometrial aspirate increases efficacy, sensitivity and Negative Predictive Value. Consequently, time and average cost of cancer diagnosis is reduced, especially in 5 characteristic profiles of abnormal patients: recurrent abnormal uterine bleeding, ultrasound with irregular endometrial line without clear histological opinion, diagnosis of endometrial polyp, endometrial hyperplasia without atypia and Lynch Syndrome. The present work describes the application of endometrial cancer molecular diagnosis, adapted to the SEGO diagnostic algorithm, for the high risk profiles mentioned above, as well as the derived clinical advantages (AU)

Preliminary results: ethanol sclerotherapy after ultrasound-guided fine needle aspiration without anesthesia in the management of simple ovarian cysts.

STUDY OBJECTIVE: To investigate the feasibility of ultrasound-guided, fine-needle aspiration and ethanol sclerotherapy of simple ovarian cysts in an office setting without anesthesia. We also describe the rate of cyst recurrence in patients treated with this technique and explore the associated risk factors. DESIGN: Prospective follow-up of patients after ethanol sclerotherapy of simple adnexal cysts in a single center trial (Canadian Task Force classification II-1). SETTING: The study was conducted at Bellvitge Teaching Hospital in Barcelona, Spain. PATIENTS: Ethanol sclerotherapy was performed on 60 simple adnexal cysts between 2009 and 2012. INTERVENTIONS: Ultrasound-guided fine-needle aspiration and ethanol sclerotherapy. MEASUREMENTS AND MAIN RESULTS: Patient demographics and cyst characteristics were collected for all patients. Potential risk factors for recurrence were analyzed by univariate and multivariate analyses. All the procedures, except 1, were performed without anesthesia. The only major complication was a case of self-limiting hem peritoneum that was managed expectantly. Moderate abdominal pain occurred in 26.7% of patients during the procedure. Fifty-five patients completed at least 6 months of follow-up and were included in the statistical recurrence analyses. Cyst recurrence was recorded in 9.1% of the patients and was managed in the usual manner in all the cases. Univariate analyses indicated that a larger cyst diameter and a higher estimated cyst volume were significantly associated with recurrence. In the multivariate analysis, recurrence was only significantly associated with estimated cyst volume. CONCLUSION: Ethanol sclerotherapy of simple ovarian cysts in an office setting without anesthesia is a feasible technique associated with a low rate of complications and recurrence, although larger randomized studies are necessary to assess the predictive factors for cyst recurrence.

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible

Guía de cribado del cáncer de cuello de útero en España, 2014 / No disponible

No disponible