Surgical Pathology & Cancer Diagnosis

Biography

Biography: Elliot Levine

Abstract

Introduction:

As the continuum of Endometrial Neoplasia (EN) is recognized to extend from Atypical Endometrial Hyperplasia (AEH) through Endometrial Carcinoma (EC), ¹ we may need to non-invasively predict its natural biological behavior.  To that end, the authors have investigated the use of three-Dimensional transvaginal sonography (3D TVS) techniques to identify the features of this neoplastic entity pre-operatively, to possibly predict the extent of its required surgical treatment.

Methods:

All patients in this continuous ongoing investigation who were histologically diagnosed with AEH or EC were examined sonographically, using 3D TVS with Power Doppler Angiography (PDA), and Virtual Organ Computer-Aided Analysis (VOCAL) system from April 1, 2015 to the present.  All of these patients underwent a subsequent surgical procedure with the resulting histology surgically obtained to be compared with those pre-operative ultrasound findings.  

Results:

The identified sonographic features of the cases enrolled in this study were compared with the intraoperative and post-operative pathologic findings.  With the results of 20 patients thus far, the ultrasound findings predicted the minimum EC staging 100 % of the time.  Deep myometrial invasion (≥50%) and cervical stromal invasion were specifically identified and which is naturally associated with the surgical staging of EC. 

Conclusions:

This ongoing investigation seeks to validate the findings of Alcazar² and those of Karlsson³, to sonographically identify the features of this oncologic condition, to properly predict its optimal surgical treatment.  The clinical importance of this should be recognized, for the impact it can have on patient care, in that there is often difficulty in properly obtaining the diagnosis of this entity (EC) when it presents as Postmenopausal Bleeding (PMB).  An example of this is when cervical stenosis is encountered, which can prevent pipelle sampling of the endometrium.  It is believed that we are introducing what should become the standard care for patients who are at risk of Endometrial Carcinoma.  Though a variety of procedures have been used to determine the definitive staging of this disease entity at the time of surgery (e.g. Sentinel Node Biopsy and Frozen section) ⁴, the ideal time to determine the staging is preoperatively.  In this way, the optimal surgical treatment can be planned, as to whether pelvic lymphadenectomy should also be performed at the time of hysterectomy, if Stage IB or Stage II EC is present.