Limei Chen

This study aims to explore the clinical efficacy and safety of hysteroscopic decidua polypectomy during pregnancy. This retrospective study analyzed 38 pat

Background/Objectives : Currently, no non-invasive detection method for endometrial cancer (EC) is recommended in clinical practice worldwide. This study aimed to evaluate the clinical value of detecting DNA methylation of CDO1 and CELF4 (CDO1m/CELF4m) in exfoliated cervical cells for the detection of EC in women with suspected endometrial lesions. Methods: A total of 2164 patients scheduled for hysteroscopic surgery due to suspected endometrial lesions at the Obstetrics and Gynecology Hospital of Fudan University between July 2023 and May 2024 were prospectively enrolled. Preoperative exfoliated cervical cells were collected for dual-gene methylation testing. Clinical data and endometrial thickness measured by transvaginal sonography (TVS) were recorded. Hysteroscopic histopathological diagnosis served as the gold standard to evaluate the performance of methylation testing alone and in combination with TVS. Results: This study included 2164 patients, comprising 33 EC cases, 31 cases of endometrial intraepithelial neoplasia (EIN), and 2100 cases of non-endometrial lesions, with mean ages of 51.7 ± 6.4, 49.5 ± 8.9, and 44.7 ± 9.8 years, respectively (p < 0.001). For EC detection, CDO1m/CELF4m positivity showed a sensitivity of 93.94% (95% CI: 79.77–99.26%), specificity of 96.7% (95% CI: 95.92–97.47%), positive predictive value (PPV) of 31.0% (95% CI: 25.96–36.53%), and negative predictive value (NPV) of 99.90% (95% CI: 99.63–99.98%). For EIN detection, the sensitivity was 83.87%, specificity 97.95%, PPV 37.68%, and NPV 99.76%. Combining TVS with DNA methylation detection further improved the sensitivity and NPV for both EC and EIN detection. Conclusions: DNA methylation detection in exfoliated cervical cells demonstrates high sensitivity and specificity for EC detection. The combination with TVS further enhances sensitivity and NPV, offering a simple and non-invasive triage strategy for patients with suspected endometrial lesions. This study was registered in China Clinical Trial Registry (ChiCTR2200055991) on 30 January 2023.

Objective: This study aims to evaluate the role of MRI-guided hysteroscopic one-step precise resection in diagnosing suspected myometrial invasion (MI) of endometrial cancer (EC) in patients desiring fertility preservation and to analyze the impact of suspected MI on the outcomes of fertility-preserving treatments.Methods: A total of 169 patients with early-stage endometrial cancer who required fertility preservation were enrolled. Among them, 103 cases were ruled out for myometrial invasion by MRI (control group), while 66 cases exhibited suspected myometrial invasion. MRI-guided hysteroscopic one-step resection, which involved the removal of the endometrial lesion, the underlying basal layer, and 3–5 mm of myometrium, was performed for pathological examination. Patients with pathological exclusion of myometrial invasion received fertility-preserving treatment, and their clinical characteristics and treatment outcomes were compared with those of the control group.Results: Based on the precise diagnosis of MRI-guided hysteroscopic one-step resection, 14 of the 66 patients with suspected myometrial invasion were confirmed by pathology and were included in the MI group for surgical treatment. The remaining 52 patients with no evidence of myometrial invasion were included in the non-MI group and received fertility-preserving treatment. The cumulative complete remission rate in the non-MI group was lower than that in the control group at 6 months (24.9% vs. 59.0%, P = 0.021) and 18 months (86.5% vs. 95.1%, P = 0.036). The cumulative recurrence rate in the non-MI group was higher than that in the control group after 12 months of follow-up (P = 0.037). There was no significant difference in the pregnancy rate between the non-MI group and the control group. There were three cases (25%) of successful pregnancy and full-term delivery in the non-MI group.Conclusion: MRI-guided hysteroscopic one-step resection can accurately diagnose the presence of myometrial invasion in early endometrial cancer, which helps about 79% of patients preserve their fertility compared with MRI evaluation alone. Hysteroscopic resection of endometrial lesions, high-dose progesterone treatment, and follow-up are important for the successful fertility-preserving treatment of patients with early endometrial cancer.

Background: Human papilloma virus (HPV) infection is an important risk factor for vaginal intraepithelial neoplasia (VAIN). Recent studies have suggested that the microbiome may play a potential role in cervicovaginal diseases. This study aimed to explore the characteristics of the types and viral load of HPV in VAIN, as well as the association between vaginal microbiota and VAIN. Methods: A total of 176 women, either with VAIN, or without VAIN but with HPV infection were enrolled in the study. Among them, 109 HPV positive cases were qualified for viral load assay. The vaginal microbiota of 122 HPV positive women, who were matched by severity of cervical lesions and menopause status, was determined by 16S ribosomal RNA (16S rRNA) sequencing. Results: The top 5 types of HPV-associated vaginal lesions were HPV16 (24.2%), HPV52 (24.2%), HPV53 (16.1%), HPV58 (14.5%) and HPV66 (14.5%). The viral load of HPV types 16, 52, and 58 appeared higher in separate vaginal lesions than in histopathologically normal cases (P=0.026, 0.002, and 0.013, respectively). The vaginal microbiota of HPV-positive patients with VAIN did not exhibit a large change in diversity. Vaginal microbiota of VAIN was characterized by an increased abundance of Atopobium, Gardnerella, Allobaculum and Clostridium, as well as decreased abundance of Finegoldia, Actinobaculum and Blautia. A higher level of Enterococcus and some specific Clostridium spp. might be associated with an elevated risk of VAIN2/3. Conclusions: A higher level of viral load of HPV16, 52, and 58 may indicate VAIN. The composition of vaginal microbiota changes during the progression of VAIN and specific bacteria such as Atopobium, Gardnerella, Allobaculum, Enterococcus and Clostridium, may help to promote its development.