Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

Abstract

IntroductionEndometrial hyperplasia has a high risk for malignant transformation and relapses; existing mini-invasive treatments may lead to irrevocable endometrium destruction. The aims were to analyze receptor systems in endometrial hyperplasia, to evaluate the capabilities of ultrasonography, sonoelastography for diagnosis and treatment control, and to develop treatment algorithm.Materials and methodsWe included 313 women (20–45 years), assessed into the following: group 1 (n = 112) with glandular cystic hyperplasia, group 2 (n = 98) endometrial polyps, and group 3 (n = 103) atypical hyperplasia; and 82 controls who have undergone hysteroscopy before in vitro fertilization in tubal origin infertility were also included. Patients underwent clinical examination, transvaginal ultrasound, immunohistochemical study, and hormonal therapy/hysteroresectoscopy.ResultsIn patients with glandular hyperplasia, we registered increase of endometrium estrogen receptors (75.6% in the epithelium and 30.9% in the stroma; in controls, 43.3% and 29.6%, respectively); in polyps, there was a significant estrogen receptor increase in the stroma (48.2% vs 29.6% in controls), and in atypical hyperplasia, progesterone receptors significantly increased in the stroma. Ki-67 increased (40% to 50%) in the epithelium without changes in the stroma. Ultrasound has a sensitivity of 96% and a specificity of 85% for early detection of endometrial pathology and prediction outcome of intervention, and sonoelastography has a sensitivity of 91% and a specificity of 83% for polyp diagnosis. Personalized treatment was effective in 88.8%, relapse was diagnosed in 11.2% after 6 months, and conservative treatment of atypical hyperplasia was effective in 45%: in 25.8%, ablative hysteroresectoscopy was performed, while in 22.6% with comorbidities, hystero/oophorectomies were performed.ConclusionsThe evaluation of receptor status with ultrasound data in patients with endometrial hyperplasia allows for a clear definition of the treatment policy, avoidance of relapse, treatment optimization, and observation of such patients.

An estrogen‐induced endometrial hyperplasia mouse model recapitulating human disease progression and genetic aberrations

“…It is known that E2 increases the levels of both ER and PR within the endometrium. Since the expression of steroidal hormone receptors in our model occurred in response to E2, this may indeed reinforce the fact that EH is mainly hormonally driven . Expression of both ER and PR receptors in this study were consistent with results seen in hyperplastic human endometrial tissues.…”

Development of biomarker panel to predict, prevent and create treatments tailored to the persons with human papillomavirus-induced cervical precancerous lesions

“…Integrative women health care includes multimodal approach for gynaecologic pathology management with PPPM paradigm including the assessment in the following: breast [3], endometrial [4] precancers, etc. and collateral diseases as endocrine, autoimmunity, neurological, including neurodegenerative, vaccine-related disorders, pelvic pain management [44] in a point of view of predictive diagnosis for personalized treatment and tailored preventive measures.…”

“…The differences in immunohistochemical expression of p53, bcl-2, bax, estrogen receptor (ER), and progesterone receptor (PR), androgen receptor (AR), progesterone receptor antagonists (PA), etc. should be properly assessed to find the most common diagnostic pitfalls and helpful morphologic and immunohistochemical markers [4] . …”

“…Women health and gender-related pathology is among the priorities for predictive, preventive, personalized medicine (PPPM) [1-4] - an innovative approach towards gynecology cancer prevention that aims at detection of pre-malignant stages for novel integrative cancer management including development predictive schemes followed by tailored prevention with implementation of personalized treatment strategies [3]. Cancer of the cervix (cervical cancer, CC) is the second most common cancer in women worldwide, with about 500,000 new cases and 250,000 deaths each year [5].…”

Cyclic versus continuous medroxyprogesterone acetate for treatment of endometrial hyperplasia without atypia: a 2-year observational study

“…The response of endometrial hyperplasia to progestin therapy cannot be predicted as it is largely determined by hormone receptor status and degree of histological differentiation of endometria [14].…”