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

EPMA Journal

Rostyslav V Bubnov¹  Mykola Ya Spivak²  Olga M Demchenko⁵  Olga V Kalenska³  Vasyl A Beniuk⁴  Vadym M Goncharenko³ 

[1] Center of Ultrasound Diagnostics and Interventional Sonography, Clinical Hospital ‘Pheophania’ of State Affairs Department, Zabolotny str., 21, Kyiv 03680, Ukraine;Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Zabolotny Str., 154, Kyiv 03680, Ukraine;Clinical Hospital ‘Pheophania’ of State Affairs Department, Zabolotny str., 21, Kyiv 03680, Ukraine;Third Department of Obstetrics and Gynecology, Bogomolets National Medical University, Kyiv 01601, Ukraine;JSC SPC ‘DiaprofMed’, Svitlycky str., 35, Kyiv 04123, Ukraine

关键词: Hysteroresection;    Endoscopic treatment;    Fertile age women;    Sonoelastography;    Transvaginal ultrasonography;    Endometrial receptors;    Endometrial hyperplasia;    Women’s health;    Personalized medicine;    Preventive;    Predictive;   

Others  :  801298
DOI  :  10.1186/1878-5085-4-24

 received in 2013-08-30, accepted in 2013-11-10,  发布年份 2013

【 摘 要 】

Introduction

Endometrial 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 methods

We 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.

Results

In 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.

Conclusions

The 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.

【 授权许可】

   
2013 Goncharenko et al.; licensee BioMed Central Ltd.

【 图 表 】

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