• Klíčová slova
• submukózní myom,
• MeSH
• diagnostické zobrazování metody   MeSH
• hysteroskopie metody   MeSH
• leiomyom diagnóza   etiologie   patologie   terapie   MeSH
• lidé MeSH
• myom * chirurgie   diagnóza   etiologie   klasifikace   terapie   MeSH
• myometrium diagnostické zobrazování   patologie   MeSH
• nádory dělohy diagnóza   etiologie   klasifikace   patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• přehledy MeSH

OBJECTIVES: To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer. METHODS/MATERIALS: We included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases. RESULTS: The MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion (≥ 50%) (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011). CONCLUSIONS: Tumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.

• MeSH
• histiocyty patologie   MeSH
• hysterektomie MeSH
• invazivní růst nádoru MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie MeSH
• lymfatické uzliny diagnostické zobrazování   patologie   chirurgie   MeSH
• myometrium diagnostické zobrazování   patologie   chirurgie   MeSH
• nádory endometria diagnostické zobrazování   patologie   chirurgie   MeSH
• následné studie MeSH
• prognóza MeSH
• prospektivní studie MeSH
• senioři MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

Uterine leiomyosarcomas (uLMS) are rare, aggressive malignancies for which limited treatment options are available. To gain novel molecular insights into uLMS and identify potential novel therapeutic targets, we characterized 84 uLMS samples for genome-wide somatic copy number alterations, mutations, gene fusions and gene expression and performed a data integration analysis. We found that alterations affecting TP53, RB1, PTEN, MED12, YWHAE and VIPR2 were present in the majority of uLMS. Pathway analyses additionally revealed that the PI3K/AKT/mTOR, estrogen-mediated S-phase entry and DNA damage response signaling pathways, for which inhibitors have already been developed and approved, frequently harbored genetic changes. Furthermore, a significant proportion of uLMS was characterized by amplifications and overexpression of known oncogenes (CCNE1, TDO2), as well as deletions and reduced expression of tumor suppressor genes (PTEN, PRDM16). Overall, it emerged that the most frequently affected gene in our uLMS samples was VIPR2 (96%). Interestingly, VIPR2 deletion also correlated with unfavorable survival in uLMS patients (multivariate analysis; HR = 4.5, CI = 1.4-14.3, p = 1.2E-02), while VIPR2 protein expression was reduced in uLMS vs. normal myometrium. Moreover, stimulation of VIPR2 with its natural agonist VIP decreased SK-UT-1 uLMS cell proliferation in a dose-dependent manner. These data suggest that VIPR2, which is a negative regulator of smooth muscle cell proliferation, might be a novel tumor suppressor gene in uLMS. Our work further highlights the importance of integrative molecular analyses, through which we were able to uncover the genes and pathways most frequently affected by somatic alterations in uLMS.

• MeSH
• dospělí MeSH
• genomika metody   MeSH
• Kaplanův-Meierův odhad MeSH
• karcinogeneze genetika   MeSH
• leiomyosarkom genetika   mortalita   patologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium patologie   MeSH
• nádory dělohy genetika   mortalita   patologie   terapie   MeSH
• onkogeny genetika   MeSH
• proliferace buněk genetika   MeSH
• receptory vazoaktivního intestinálního peptidu typu II genetika   MeSH
• regulace genové exprese u nádorů genetika   MeSH
• sekvenční analýza RNA metody   MeSH
• sekvenování celého genomu metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• signální transdukce genetika   MeSH
• tumor supresorové geny MeSH
• vysoce účinné nukleotidové sekvenování metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy. METHODS: Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-TVU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (≥50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (ρ). RESULTS: Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually. CONCLUSIONS: Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-TVU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres.

• MeSH
• dospělí MeSH
• invazivní růst nádoru MeSH
• kontrastní látky MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium diagnostické zobrazování   patologie   MeSH
• nádory endometria diagnostické zobrazování   patologie   chirurgie   MeSH
• odchylka pozorovatele MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů metody   MeSH
• ultrasonografie metody   MeSH
• zobrazování trojrozměrné * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

OBJECTIVE: To investigate differences and similarities in the clinical approach of young clinicians managing women with endometrial cancer (EC) conservatively. METHODS: A web-based survey was carried out. A platform of the European Network of Young Gynaecological Oncologists (ENYGO) database was used. A 38-item multiple-choice questionnaire was used to evaluate current practice in fertility-sparing management of EC. The survey covered investigations, treatment options, follow-up and management of recurrence and future family planning. Descriptive statistics were used. RESULTS: Overall, 116 out of 650 (17.84%) ENYGO members responded to the survey. In 92 (79.3%) centres, the caseload of early stage EC treated conservatively was less than 10 per year. One hundred and seven responders (93.8%) believe that treatment with progestins could be offered in grade 1 EC without myometrial invasion, but a minority would recommend it even for grade 2 tumours with no myometrial invasion or grade 1 with superficial invasion. The diagnostic tool for establishing grade of tumour was hysteroscopy with dilatation and curettage in 64 (55%) centres. Medroxyprogesterone acetate represents the most commonly prescribed progestogen (55, 47.4%). In 78 (67.2%) centres, a repeat endometrial biopsy was offered after 3 months of treatment commencement. Recurrences are treated mostly with hysterectomy (81, 69.9%) with only a small number of responders recommending to repeat progestin treatment. Lynch syndrome is a contraindication for conservative management in half of the responders (57, 49.1%). Most clinicians agree that patients should be referred promptly for assisted reproductive techniques once complete response has been achieved (68, 58.6%). CONCLUSIONS: Our study shows that conservative management is increasingly offered to women affected by early stage EC wishing to preserve their fertility. Further studies and joint registries are required to evaluate safety and effectiveness of this approach in this probably growing number of patients.

• MeSH
• asistovaná reprodukce MeSH
• dilatace a kyretáž MeSH
• dospělí MeSH
• endometrium patologie   MeSH
• hormonální protinádorové látky terapeutické užití   MeSH
• hysteroskopie MeSH
• konzervativní terapie metody   MeSH
• lidé MeSH
• lokální recidiva nádoru patologie   terapie   MeSH
• medroxyprogesteronacetát terapeutické užití   MeSH
• myometrium patologie   MeSH
• nádory endometria farmakoterapie   patologie   MeSH
• progestiny terapeutické užití   MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• zachování plodnosti MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

The aim of this study was to assess the diagnostic accuracy of subjective ultrasound evaluation of myometrial invasion of endometrial cancer and to compare its accuracy to objective methods. All consecutive patients with histologically proven endometrial cancer, who underwent ultrasound evaluation followed by surgical staging between January 2009 and December 2011, were prospectively enrolled. Myometrial invasion was evaluated by subjective assessment using ultrasound (<50% or ≥50%) and calculated as deepest invasion/normal myometrium ratio (Gordon's ratio) and as tumor/uterine anteroposterior diameter ratio (Karlsson's ratio). Histological assessment from hysterectomy was considered the gold standard. Altogether 210 patients were prospectively included. Subjective assessment and two objective ratios were found to be statistically significant predictors of the myometrial invasion (AUC = 0.65, p value < 0.001). Subjective assessment was confirmed as the most reliable method to assess myometrial invasion (79.3% sensitivity, 73.2% specificity, and 75.7% overall accuracy). Deepest invasion/normal myometrium (Gordon's) ratio (cut-off 0.5) reached 69.6% sensitivity, 65.9% specificity, and 67.3% overall accuracy. Tumor/uterine anteroposterior diameter (Karlsson's) ratio with the same cut-off reached 56.3% sensitivity, 76.4% specificity, and 68.1% overall accuracy. The subjective ultrasound evaluation of myometrial invasion performed better than objective methods in nearly all measures but showed statistically significantly better outcomes only in case of sensitivity.

• MeSH
• invazivní růst nádoru diagnóza   diagnostické zobrazování   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium diagnostické zobrazování   patologie   chirurgie   MeSH
• nádory endometria diagnóza   diagnostické zobrazování   patologie   chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ultrasonografie * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIM: An optimal surgical staging in the group of patients with the high-risk type of endometrial cancer is often limited by age and serious internal comorbidities. Therefore, in this study we focused on human epididymis protein 4 and its contribution to the preoperative differentiation of prognostically distinct groups of patients and to individualized surgical treatment as compared with cancer antigen (CA) 125 and imaging methods. MATERIAL AND METHODS: The study included 115 patients with endometrioid adenocarcinoma diagnosed through endometrial biopsy. Before the final operation, blood sampling was performed for the determination of human epididymis protein 4 (HE4) and CA125 levels. Serum levels of both biomarkers were analyzed in relation to individual prognostic factors (stage of disease, depth of myometrial invasion, tumor grade, risk type of disease). RESULTS: In the case of HE4, we demonstrated a statistically significant difference (P < 0.001) between patients with low and high risk of the disease. In our model, achieving the maximum sum of sensitivity and specificity, HE4 shows a sensitivity of 72.4% and a specificity of 75.4% for the cut-off 76.5 pmol/L and is a better predictor in distinguishing the high-risk patients than CA125 (area under the curve 0.77 for HE vs 0.71 for CA125). CONCLUSION: HE4 is a marker that could complement the findings of imaging techniques and that may be useful in decision-making on how to individualize surgical staging. The possibility of its introduction as an independent marker in routine practice remains, at the moment however, limited. The optimal cut-off for HE4 has not been established yet and further studies are needed.

• MeSH
• antigen CA-125 krev   MeSH
• endometroidní karcinom krev   patologie   MeSH
• lidé MeSH
• membránové proteiny krev   MeSH
• myometrium patologie   MeSH
• nádorové biomarkery krev   MeSH
• nádory endometria krev   patologie   MeSH
• proteiny metabolismus   MeSH
• staging nádorů MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: To develop and validate strategies, using new ultrasound-based mathematical models, for the prediction of high-risk endometrial cancer and compare them with strategies using previously developed models or the use of preoperative grading only. METHODS: Women with endometrial cancer were prospectively examined using two-dimensional (2D) and three-dimensional (3D) gray-scale and color Doppler ultrasound imaging. More than 25 ultrasound, demographic and histological variables were analyzed. Two logistic regression models were developed: one 'objective' model using mainly objective variables; and one 'subjective' model including subjective variables (i.e. subjective impression of myometrial and cervical invasion, preoperative grade and demographic variables). The following strategies were validated: a one-step strategy using only preoperative grading and two-step strategies using preoperative grading as the first step and one of the new models, subjective assessment or previously developed models as a second step. RESULTS: One-hundred and twenty-five patients were included in the development set and 211 were included in the validation set. The 'objective' model retained preoperative grade and minimal tumor-free myometrium as variables. The 'subjective' model retained preoperative grade and subjective assessment of myometrial invasion. On external validation, the performance of the new models was similar to that on the development set. Sensitivity for the two-step strategy with the 'objective' model was 78% (95% CI, 69-84%) at a cut-off of 0.50, 82% (95% CI, 74-88%) for the strategy with the 'subjective' model and 83% (95% CI, 75-88%) for that with subjective assessment. Specificity was 68% (95% CI, 58-77%), 72% (95% CI, 62-80%) and 71% (95% CI, 61-79%) respectively. The two-step strategies detected up to twice as many high-risk cases as preoperative grading only. The new models had a significantly higher sensitivity than did previously developed models, at the same specificity. CONCLUSION: Two-step strategies with 'new' ultrasound-based models predict high-risk endometrial cancers with good accuracy and do this better than do previously developed models.Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

• MeSH
• časná detekce nádoru MeSH
• cervix uteri * diagnostické zobrazování   patologie   MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• invazivní růst nádoru MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium * diagnostické zobrazování   patologie   MeSH
• nádory endometria * diagnostické zobrazování   patologie   MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• staging nádorů MeSH
• teoretické modely MeSH
• ultrasonografie dopplerovská barevná * MeSH
• ultrazvuk * trendy   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

OBJECTIVES: To identify major factors in the under- and overestimation of cervical and myometrial invasion by endometrial cancer at preoperative staging by ultrasound. METHODS: This prospective study involved all patients with histologically confirmed endometrial cancer referred consecutively for surgical staging between January 2009 and December 2011. All patients underwent transvaginal ultrasound examination, obtaining metric and perfusion data, and the results were compared with final histology: myometrial invasion was defined at histology in the final pathology report as being either < or ≥ 50%, while cervical stromal invasion was reported as being either present or absent, and sonographic over-/underestimation was determined relative to these. RESULTS: Enrolled prospectively into the study were 210 patients. The proportion of cases with sonographic underestimation, relative to final histology, of myometrial invasion (i.e. false-negative estimation of no or superficial invasion < 50%) and of cervical invasion (i.e. false-negative finding of absence of stromal invasion) was comparable: 8.6% (n = 18) and 10.5% (n = 22), respectively. Myometrial invasion was overestimated by ultrasound (i.e. false-positive estimation of deep invasion ≥ 50%) in 15.7% (n = 33) of cases, and cervical invasion was overestimated (i.e. false-positive finding of presence of stromal invasion) in 4.8% (n = 10) of cases. These outcomes correspond to positive and negative predictive values of 67.6% (95% CI, 57.7-76.6) and 83.3% (95% CI, 74.9-89.8), respectively, for the subjective assessment of myometrial invasion, and 60.0% (95% CI, 38.2-79.2) and 88.1% (95% CI, 82.5-92.4), respectively, for that of cervical stromal invasion. The staging error in subjective assessment was not related to body mass index (BMI), to the position of the uterus in the pelvis or to image quality. Cervical and myometrial invasion were more often underestimated in well-differentiated endometrial cancers that were smaller in size, with thick minimum tumor-free myometrium and lower perfusion, and more often overestimated in moderately and poorly differentiated cancers that were larger in size, with thin minimum tumor-free myometrium and richer perfusion. CONCLUSION: The accuracy of subjective assessment of myometrial and cervical invasion by ultrasound was significantly influenced by tumor size, density of tumor vascularization, tumor vessel architecture and histological grading, while it was not significantly affected by BMI, uterine position and image quality.

• MeSH
• cervix uteri patologie   ultrasonografie   MeSH
• index tělesné hmotnosti MeSH
• invazivní růst nádoru MeSH
• lidé středního věku MeSH
• lidé MeSH
• myometrium patologie   ultrasonografie   MeSH
• nádory endometria patologie   ultrasonografie   MeSH
• pohyb buněk MeSH
• předoperační péče metody   MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

I přes vysoké rozlišovací schopnosti ultrazvuku nebo magnetické rezonance a využití bioptického vyšetření se diagnostická chyba předoperačního odlišení méně a vysoce rizikového endometriálního karcinomu pohybuje kolem 20 %. Nádory v nízkém riziku jsou endometroidní nebo mucinózní karcinomy s histologickým gradingem 1 a 2, superficiální nádorovou invazí do myometria (< 50 %) a absencí cervikální stromální invaze, zatímco do vysokého rizika patří všechny další případy. Biopsie má tendenci nádory podhodnocovat až ve 20 % případů, proto byly identifikovány sonomorfologické a dopplerovské charakteristiky, které nás mohou před-operačně upozornit na přítomnost nádorů s nízkým a vysokým rizikem metastázování. V případě nesouhlasu mezi předoperačními ultrazvukovými charakteristikami nádoru a výsledkem předoperační biopsie je doporučeno doplnit peroperační vyšetření preparátu zmraženým řezem. Ultrazvukové vyšetření provedené zkušeným sonografistou je přesné ve většině případů, má však tendenci nadhodnocovat myometriální invazi a podhodnocovat cervikální stromální invazi. Na základě identifikace faktorů, které ultrazvukovou přesnost významně ovlivňují, bylo doporučeno striktně hodnotit pouze sonomorfologické parametry nádoru v rámci předoperačního vyšetření. Důvodem je, že ultrazvukový expert při znalosti klinických dat pacientky, prognostických parametrů onemocnění a při detekci nepříznivých charakteristik nádoru během ultrazvukového vyšetření (nehomogenní, hypo- nebo izoechogenní nádor s bohatou perfuzí) má tendenci „intuitivně“ nadhodnocovat stadium onemocnění a naopak. Možnost nahradit subjektivní hodnocení nádorové invaze objektivním měřením jednoduše detekovatelných ultrazvukových proměnných se zatím neukázala jako efektivní. Slibným objektivním parametrem je měření minimální vzdálenosti nádoru od děložní serózy. Pokud zadáme tento parametr do nového objektivního modelu, dosáhneme shodné přesnosti v odlišení zhoubného nádoru endometria v nízkém a vysokém riziku metastázování, jako bychom dosáhli na základě subjektivního stanovení hloubky invaze nádoru expertem. Byl navržen a externě otestován efektivní postup předoperační selekce pacientek k adekvátnímu chirurgickému výkonu, který je založen na kombinaci výsledku předoperační biopsie a ultrazvuku. Tento jednodušší postup dosahuje srovnatelné přesnosti jako komplikovanější přístup s využitím magnetické rezonance a cílené hysteroskopické biopsie hrdla a těla děložního. Oba postupy správně předoperačně identifikují 8 z 10 endometriálních karcinomů ve vysokém riziku metastázování a na druhou stranu 8 z 10 pacientek s endometriálním karcinomem v nízkém riziku metastázování nezatíží zbytečně radikální stagingovou operací.

Despite the high resolution of ultrasound or magnetic resonance imaging and modern bioptic approaches, diagnostic error of preoperative staging is around 20%. The preoperative staging is focused to differentiate low risk (< 50% myometrial invasion, histological grade 1 and 2, endometrioid cancer, no cervical invasion) or high risk endometrial cancer (all others). Preoperative biopsy tends to underestimate the tumour histotype and grading in 20% of cases. Therefore, the sonomorphological and Doppler pattern have been identified that can preoperatively alert us to the presence of low or high risk endometrial cancer. With discrepancy between preoperative ultrasound tumour characteristics and results of endometrial biopsy a supplementary intraoperative frozen section of uterus is recommended. Ultrasound examination performed by an experienced sonographer is accurate in most cases but tends to overestimate myometrial invasion and underestimate cervical stromal invasion. Based on the identification of factors that significantly affected the accuracy of ultrasound, it was recommended to restrict evaluation to sonomorphological tumour parameters within the preoperative tumour staging. This is in response to the tendency of ultrasound experts with knowledge of the clinical data of patients, and prognostic parameters of the disease who have encountered adverse tumour characteristics through ultrasound (e.g. inhomogeneous, hypo- or isoechogenous tumor with high tumour perfusion) to ‚intuitively‘ overestimate the stage of the disease and conversely. The attempts to restrict the assessment of tumour invasion to those parameters that are easily and objectively evaluated has not so far proved effective. A promising objective parameter seems to be the minimum distance between the tumour and uterine serosa. When this parameter was included in the new objective model, the high-risk endometrial cancer was predicted with an accuracy similar to subjective assessment of tumour invasion by an expert. The preoperative work-up for high-risk endometrial cancer prediction was designed and externally validated in order to triage the patients for adequate staging surgery. This approach was based on the combination of the results of preoperative endometrial biopsy and transvaginal ultrasound and reached the similar accuracy as a more complicated approach using a combination of magnetic resonance imaging and hysteroscopic-directed biopsies. Both approaches can identify eight of 10 women with high-risk of lymph node metastases and spare eight of 10 low-risk women extended surgery.

• MeSH
• endometrium anatomie a histologie   patologie   ultrasonografie   MeSH
• hodnocení rizik MeSH
• lidé MeSH
• metastázy nádorů * diagnóza   ultrasonografie   MeSH
• multicentrické studie jako téma MeSH
• myometrium anatomie a histologie   patologie   ultrasonografie   MeSH
• nádory děložního čípku * diagnóza   klasifikace   patologie   ultrasonografie   MeSH
• nádory endometria diagnóza   ultrasonografie   MeSH
• předoperační péče MeSH
• prospektivní studie MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH