Treatment of Low-Risk Endometrial Cancer and Complex Atypical Hyperplasia With the Levonorgestrel-Releasing Intrauterine Device

Pal, Navdeep; Broaddus, Russell R.; Urbauer, Diana L.; Balakrishnan, Nyla; Milbourne, Andrea; Schmeler, Kathleen M.; Soliman, Pamela T.; Lu, Karen H.; Ramírez, Pedro T.; Ramondetta, Lois M.; Bodurka, Diane C.; Westin, Shannon N.

doi:10.1097/aog.0000000000002390

Cited by 155 publications

(134 citation statements)

References 22 publications

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“…Some patients cannot be operated on due to advanced age, morbid obesity, and/or medical comorbidities [2,17]. In addition, some young patients wish to preserve their fertility [2,28].…”

Section: Roc Curvementioning

confidence: 99%

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Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

et al. 2019

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Objectives:To examine the performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen sectioning in the assessment of myometrial invasion during the early stages of endometrial cancer. Material and methods:This retrospective study employed data from patients with endometrial cancer who were operated on between January 2013 and November 2018. Patients who underwent preoperative MRI and were of FIGO 2009 stage I were included in the study. Radiological staging and intraoperative staging by frozen sectioning were carried out. The data were analyzed to assess agreement of the overall results concerning myometrial invasion. Results:In total, 222 patients were enrolled. Their mean age was 58.3 ± 8.5 years. The accuracy of MRI for the detection of myometrial invasion was 88.7% and its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.6%, 82.1%, 92.2%, and 80.9%, respectively, with a kappa coefficient of 0.734 (95% confidence interval [CI], 0.684-0.784; p < 0.001). The accuracy of intraoperative frozen sectioning was 94.4%, and its sensitivity, specificity, PPV, and NPV were 97.7%, 85.7%, 94.7%, and 93.4%, respectively, with a kappa coefficient of 0.856 (95% CI, 0.812-0.900; p < 0.001). No significant difference in accuracy was observed between MRI and frozen sectioning (p = 0.057). MRI and frozen sectioning were sensitive for the detection of myometrial invasion, according to receiver operating curve analyses (areas under the curve, 0.869 and 0.917, respectively; p < 0.001). Conclusions:The assessment of myometrial invasion by preoperative MRI and intraoperative frozen sectioning during the early stages of endometrial carcinoma was highly accurate.

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“…Some patients cannot be operated on due to advanced age, morbid obesity, and/or medical comorbidities [2,17]. In addition, some young patients wish to preserve their fertility [2,28].…”

Section: Roc Curvementioning

confidence: 99%

“…In such situations, intraoperative frozen sectioning may play an important role. In addition, older patients and those with medical comorbidities, and younger patients who want to preserve their fertility, are not eligible for the operation [17]. Thus, preoperative evaluation is more important in these patients.…”

Section: Introductionmentioning

confidence: 99%

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

et al. 2019

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“…Conservative treatment modalities for EAH or early-stage endometrioid endometrial cancer (EEC) patients are mainly progestin therapies, including medroxyprogesterone acetate (MPA), megestrol acetate (MA), and levonorgestrel intrauterine system (LNG-IUS) [4][5][6]. Reports showed 75-85% of EAH and 50-75% of EEC patients could achieve complete response (CR) [7,8]. Dilatation and curettage (D&C) is a traditional diagnostic method in this fertility-sparing setting [9].…”

Section: Introductionmentioning

confidence: 99%

Treatment efficiency of comprehensive hysteroscopic evaluation and lesion resection combined with progestin therapy in young women with endometrial atypical hyperplasia and endometrial cancer

Yang

Zhu

et al. 2019

Gynecologic Oncology

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“…Pal et al reviewed 46 patients treated with LNG-IUD and found similar response rates of 75-80% among women treated for EAC and EHA. [41] Interestingly women with larger uterus size, and those with lack of exogenous progesterone effect in the pathology were found to have a lower likelihood to respond. Previous studies reported that the average time to response was six months.…”

Section: Recent Results and Pregnancy Outcomesmentioning

confidence: 98%

Challenges and controversies in the conservative management of uterine and ovarian cancer

Janda

McGrath

Obermair

2019

Best Practice & Research Clinical Obstetrics & Gynaecol

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Uterine cancer is the fifth most common cancer in women worldwide with an estimated 320,000 annual diagnoses. Its most common form, endometrioid adenocarcinoma of the endometrium (endometrial adenocarcinoma [EAC]), is thought to develop through excessive proliferation of endometrial glands, and then increasing steadily in incidence. The current standard treatment for EAC is hysterectomy, which is often curative. However, it may be unacceptably expensive for women with severe medical comorbidities, those who are at risk of intra- and postoperative adverse events and those who desire fertility. Ovarian cancer is the most malignant of all gynaecological cancers, but patients with disease limited to one ovary and patients with non-epithelial tumours may expect a good prognosis. A selected group of young patients who desire fertility may be well treated with conservative surgery. This chapter reviews patient selection, diagnosis, pre-treatment evaluation, treatment options, surveillance and risk of relapse.

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Treatment of Low-Risk Endometrial Cancer and Complex Atypical Hyperplasia With the Levonorgestrel-Releasing Intrauterine Device

Abstract: Levonorgestrel-releasing IUD therapy for the conservative treatment of complex atypical hyperplasia or early-grade endometrial cancer resulted in return to normal histology in a majority of patients.

Cited by 155 publications

References 22 publications

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

Treatment efficiency of comprehensive hysteroscopic evaluation and lesion resection combined with progestin therapy in young women with endometrial atypical hyperplasia and endometrial cancer

Challenges and controversies in the conservative management of uterine and ovarian cancer

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