PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) study, pre-operative recognition of high risk endometrial carcinoma: a multicentre prospective cohort study

Abstract

BackgroundEndometrial carcinoma is the most common gynaecologic malignancy in industrialised countries and the incidence is still rising. Primary treatment is based on preoperative risk classification and consists in most cases of hysterectomy with bilateral salpingo-oophorectomy. In patients with serous and clear cell histology a complete surgical staging is mandatory. However, in routine clinical practice final histology regularly does not correspond with the preoperative histological diagnosis. This results in both over and under treatment.Methods/DesignThe aim of this multicentre, prospective cohort study is to select a panel of prognostic biomarkers to improve preoperative diagnosis of endometrial carcinoma in order to identify those patients that need extended surgery and/or additional treatment. Additionally, we will determine whether incorporation of cervical cytology and comorbidity could improve this preoperative risk classification. All patients treated for endometrial carcinoma in the participating hospitals from September 2011 till December 2013 are included. Patient characteristics, as well as comorbidity are registered. Patients without preoperative histology, history of hysterectomy and/or endometrial carcinoma or no surgical treatment including hysterectomy are excluded. The preoperative histology and final pathology will be reviewed and compared by expert pathologists. Additional immunohistochemical analysis of IMP3, p53, ER, PR, MLH1, PTEN, beta-catenin, p16, Ki-67, stathmin, ARID1A and L1CAM will be performed. Preoperative histology will be compared with the final pathology results. Follow-up will be at least 24 months to determine risk factors for recurrence and outcome.DiscussionThis study is designed to improve surgical treatment of endometrial carcinoma patients. A total of 432 endometrial carcinoma patients were enrolled between 2011 and 2013. Follow-up will be completed in 2015. Preoperative histology will be evaluated systematically and background endometrium will be classified. This is the first study incorporating immunohistochemistry, cervical cytology and comorbidity to define the optimal panel of prognostic biomarkers that contribute in clinical decision making in the management of endometrial carcinoma.Trial registrationNetherlands Trial Register number NTR3503

Endometrial adenomyoma polyp caused postmenopausal bleeding mimicking uterine malignancy

“… 14 However, the final diagnosis of these cases following hysterectomy was endometrial cancer. 15 The Pipelle may have diagnostic pitfalls in EAPs such as in our case. One report revealed that the sensitivity of Pipelle and curettage was 93.8% and 97%, respectively, in patients with low-grade cancer, and 99.2% and 100%, respectively, in patients with high-grade cancer.…”

L1CAM is an independent predictor of poor survival in endometrial cancer — An analysis of The Cancer Genome Atlas (TCGA)

“…This may require confirmation of a similar correlation between serum L1CAM expression and positive lymph node metastases in EC patients, or feasibility of preoperative expression levels in endometrial biopsies. The results of the currently ongoing Pipelle Prospective endometrial carcinoma (PIPENDO) study which includes preoperative and postoperative L1CAM expression analyses, will thus be eagerly awaited [24]. Secondly, increased expression in advanced, high-risk ECs of this transmembrane protein may offer potential novel therapeutic strategies to target the extracellular portion of L1CAM in EC patients, and simultaneously allow for biomarker selection of these patients by IHC.…”

Preoperative risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model: A development and validation study

“…Performance was validated using 2 prospective multicenter external data sets: the Molecular Markers in Treatment in Endometrial Cancer (MoMaTEC) cohort (n = 446), including patients treated between May 2001 and 2010, and the PIpelle Prospective ENDOmetrial carcinoma (PIPENDO) cohort (n = 384), including patients treated between September 2011 and December 2013 [8,22]. Patients from these cohorts were only included if they had a minimal subset of variables: preoperative tumor grade, at least 3 molecular biomarkers, at least one of the clinical preoperative markers, and information on outcome.…”