2019, Vol 17, No 1
Evaluation of the effectiveness of histopathological verification of the endometrium by means of an outpatient aspiration biopsy
Curr Gynecol Oncol 2019, 17 (1), p. 3–9
DOI: 10.15557/CGO.2019.0001

Objectives: 1) Examining the effectiveness of an outpatient aspiration biopsy from the uterine cavity in the context of satisfactory sampling. 2) Assessing risk factors of obtaining a non-diagnostic sample. 3) Search for ultrasound image patterns according to the International Endometrial Tumor Analysis that may indicate potential ineffectiveness of the biopsy. 4) Assessment of effectiveness of an outpatient biopsy in detection of endometrial cancer. Methods: Observational prospective study on a non-selected population of women suspected of endometrial pathologies. Results: 116 endometrial aspiration biopsies have been analyzed. Diagnostic histopathological samples were obtained in 100 cases (86.2%). There was no statistical significance in obtaining a non-diagnostic result of a biopsy in terms of the menopausal status, presence of uterine fibroids, occurrence of abnormal uterine bleeding, age, endometrial thickness and the number of deliveries. A large variety of ultrasound images were obtained according to the International Endometrial Tumor Analysis parameters. There were no clearly dominant patterns of endometrial ultrasound parameters in patients with non-diagnostic biopsy results. 100% of endometrial cancer cases were reported in postmenopausal patients with the history of abnormal uterine bleeding. The mean thickness of the endometrium was statistically the largest in this group: 16.2 mm (4–22.3 mm) (p = 0.025). Conclusions: An outpatient endometrial aspiration biopsy is an effective, low-impact procedure in case of indications for histopathological assessment of the endometrium.

Keywords: endometrial cancer, endometrial biopsy, abnormal uterine bleeding, suction curette, endometrium sampler
An update of the cervical cancer staging system as of 2019
Curr Gynecol Oncol 2019, 17 (1), p. 10–18
DOI: 10.15557/CGO.2019.0002

Staging systems for malignant neoplasms are basic tools needed for correct assignment to oncological therapy, proper decision-making about adjuvant treatment, comparison of therapy outcomes and for ensuring consistency of clinical studies. The International Federation of Gynecology and Obstetrics (FIGO) was the first to develop their own principles of staging for malignant cancers of the female genital organs. Over the years, together with the progress in diagnosis and therapy of gynecologic cancers, the staging systems for all malignant neoplasms have been revised several times. The goal of this article is to compare the latest FIGO staging system for cervical cancer from 2019 with the previous version from 2009 and to discuss the most important clinical implications that its implementation into daily clinical practice will ensue. The new FIGO staging system for cervical cancer is no longer a purely clinical classification. For the first time, it also involves imaging and/or pathological findings. In the staging system from 2019, tumor size ceases to be a significant parameter in stage IA, but it merely depends on the depth of invasion. Stage IB has been divided into three substages depending on tumor size: IB1: depth of stromal invasion ≥5 mm and greatest dimension <2 cm, IB2: greatest dimension ≥2 cm to <4 cm and IB3: ≥4 cm. Stage II takes into account the possibility of using imaging and/or pathology for evaluating tumor size and extension. Stage IIA1 includes tumors with the diameter <4 cm, while stage IIA2 includes tumors with the size of ≥4 cm. Moreover, stage IIIC has been introduced. It involves patients with involvement of the retroperitoneal lymph nodes with a proper notation (“r” or “p”) depending on the technique employed to verify the lymph node status (imaging or pathology, respectively). The implementation of the new staging system will allow more accurate association of the FIGO stage with the actual clinical situation. To date, it has been commonly believed that once a disease stage has been assigned, it should not be changed, even when new clinical data arrive. In the new FIGO staging system, it seems justified to supplement the assigned stage following surgical verification or more advanced diagnostic tests, with an added note: “according to FIGO 2019.”

Keywords: cervical cancer, cancer stage, FIGO staging system, gynecologic cancers
Efficacy and safety of laparoscopic radical hysterectomy in cervical cancer based on the latest literature
Curr Gynecol Oncol 2019, 17 (1), p. 19–26
DOI: 10.15557/CGO.2019.0003

The surgical management standards in gynecologic oncology that have been applied in the past decade assume increased usage of endoscopic methods in operative treatment of cervical malignancies with no adverse effects on long-term outcomes. However, the LACC study, in which it was primarily assumed that these theses would be confirmed, yielded conflicting results. These outcomes were presented in the spring of 2018 during the 49th Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer in New Orleans and published in the same year. It occurred that the percentage of patients free from relapse at 2.5 years was significantly higher in the group treated with an open method compared with patients managed by endoscopic techniques. Moreover, the same year also brought other publications, which reported studies that included over 2,200 patients subjected to open and endoscopic procedures and which corroborated the conclusions drawn from the aforementioned LACC study. This article presents these investigations and draws attention to their potential weaknesses. Moreover, it also discusses comments and reviews that have appeared since the said results were published. This is a form of a specific debate on current guidelines concerning treatment of early invasive cervical cancer, taking into account oncological safety of these procedures and long-term patient outcomes.

Keywords: cervical cancer, radical abdominal hysterectomy, laparoscopy for cervical cancer, robotic surgery in cervical cancer treatment
Liquid biopsy in endometrial cancer
Curr Gynecol Oncol 2019, 17 (1), p. 27–42
DOI: 10.15557/CGO.2019.0004

Liquid biopsy involves molecular analysis of liquid biological material obtained by non-invasive or minimally invasive methods. This innovative method has been used in various fields of medicine, especially in oncology, including the diagnosis of endometrial cancer which is one of the most commonly diagnosed gynecologic cancers across the world. Since endometrial cancer is a serious medical and social problem, researchers are on the lookout for new diagnostic methods as well as novel targets for molecularly targeted therapy. Materials with potential applications in analyses include circulating tumor cells, circulating tumor DNA, exosomes, cell-free RNA, cell-free microRNAs and tumor-educated platelets. Materials obtained by liquid biopsy may have a variety of clinical uses in cancer diagnosis, selection of therapy, prediction of treatment prognosis, monitoring of therapeutic response, tracing the pattern of tumor evolution, detection of minimal residual disease, and determination of resistance to treatment. Liquid biopsy in endometrial cancer can be performed using different biological materials including blood (plasma, serum), uterine lavage fluid, urine, and peritoneal lavage fluid. Liquid biopsy may prove to be a truly revolutionary method in the diagnostic work-up for endometrial cancer, and it is considered to be a step forward on the path towards personalized medicine.

Keywords: liquid biopsy, endometrial cancer, cell-free nucleic acids, exosomes, microRNA
Fertility-sparing treatment of endometrial cancer
Curr Gynecol Oncol 2019, 17 (1), p. 43–48
DOI: 10.15557/CGO.2019.0005

Endometrial carcinoma is the most common gynecologic cancer. Surgical treatment primarily involves hysterectomy with bilateral salpingo-oophorectomy and, in selected cases, pelvic and periaortic lymphadenectomy. In premenopausal patients (in Poland 5% of cases are women below 40 years of age) it is possible to consider fertility-sparing treatment. The aim of this article is to summarize the methods and outcomes of fertility-sparing treatment and ways of assessing patients for such management taking into account the stage and grade of the disease. A patient is assessed for conservative treatment based on preliminary grading and staging of cancer. Cancer grade should be determined based on cervical and uterine dilation and curettage sample examination, which is more accurate than endometrial biopsy. However, if no surgery has been performed, staging can only be predictive, with magnetic resonance imaging providing the most accurate information. In clinical practice there is no cheap and repeatable non-surgical prognostic model for endometrial cancer staging. In patients treated conservatively, provided that contraindications have been excluded, oral gestagens or levonorgestrel-releasing intrauterine systems may be used or a hysteroscopic excision of the focal abnormal tissue may be performed. Patients require regular follow-up due to the risk of lack of response to treatment or recurrence. In young patients who have had their planned number of children it is also possible to consider hysterectomy with salpingectomy with the ovaries left in place. There is a possibility of conservative endometrial cancer treatment, but only in carefully selected cases. Staging and grading of cancer and treatment response monitoring remain the most significant challenges.

Keywords: endometrial cancer, conservative treatment, staging, grading, fertility