Gynecologic and Obstetric Investigation最新文献

{"title":"Reproductive outcomes in infertile women with endometriosis undergoing ART.","authors":"Can Benlioglu, Savci Bekir Telek, Baris Ata","doi":"10.1159/000543213","DOIUrl":"https://doi.org/10.1159/000543213","url":null,"abstract":"<p><p>Background Endometriosis-related infertility and its treatment with assisted reproductive technologies (ART) have been broadly researched. Yet, underlying mechanisms of infertility, particularly in the absence of tubal dysfunction, remain unclear. While the impact of inflammatory milieu on the ovary and/or endometrium has been indicated as a contributing factor, recent evidence from euploid transfers and donor cycles questions the extent of these effects. Moreover, the frequent coexistence of other confounders, such as adenomyosis, further complicates the clinical picture, making it difficult to isolate the specific impact of endometriosis on ART outcomes. Objectives To evaluate the influence of endometriosis on various aspects of ART, including oocyte competence, ART success and whether surgical or medical treatments improve these. Methods We primarily focused on recent high-quality sources, including systematic reviews, large-scale observational studies, and meta-analyses, to ensure a robust and reliable synthesis of the available evidence. Outcome While oocyte yield can decrease in the presence of an endometrioma or history of endometrioma excision, oocyte quality, early embryo development indicators, aneuploidy rates, and clinical outcomes of endometriosis patients do not differ from other infertility diagnoses in ART settings. Surgical treatments and hormonal suppression before ART do not seem to improve outcomes. Ovarian stimulation for ART does not seem to exacerbate endometriosis. Conclusions and Outlook Endometriosis, despite its high prevalence among infertile patients, does not inherently impair ART success, except in cases where ovarian reserve is compromised due to ovarian disease or its surgical treatment. The causal link between endometriosis and infertility remains an enigma, and future studies should continue to explore this association with other confounding factors.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for and treatment of bacterial vaginosis reduced preterm delivery in high-risk pregnant women: a systematic review and meta-analysis.","authors":"Enav Yefet, Dalit Mirin, Manal Massalha, Adi Alter, Zohar Nachum","doi":"10.1159/000543502","DOIUrl":"https://doi.org/10.1159/000543502","url":null,"abstract":"<p><p>Introduction Bacterial vaginosis (BV) is a risk factor for preterm delivery. Yet, previous studies have found BV treatment ineffective in preventing preterm delivery in unselected population. This study aims to evaluate the effectiveness of BV screening and treatment in reducing the rate of preterm deliveries before 37 weeks in high-risk women. Material and methods Embase, PubMed, Ovid-Medline, and Web of Science were searched. Randomized controlled trials that evaluated antibiotic treatment for BV versus no treatment/placebo were included. The primary outcome was the rate of preterm delivery and/or late miscarriages in pregnant women with a history of preterm delivery. The pooled relative risks (with 95% CI) were estimated. The Cochrane's Q test of heterogeneity and I² were used to assess heterogeneity. In total, 4701 papers were retrieved of which seven met inclusion criteria and were analyzed. Results Among the participating women, 738 were at high risk for preterm delivery and included in the analysis. Among them, 397 and 341 women received active or placebo treatment, respectively. The included studies had a low risk of bias. In six out of seven studies, the risk factor for preterm delivery was a previous preterm delivery. One study (N=16) was excluded from the analysis since no group had preterm deliveries. Treatment for BV in high-risk women reduced the rate of preterm deliveries (pooled RR with 95% CI 0.65 [0.44-0.98[. The protective effect of BV treatment was statistically significant in women treated with clindamycin, and when treatment was started after 20 gestational weeks. Conclusion Screening for and treatment of BV may be effective in preventing preterm delivery in high risk pregnant women. Randomized clinical trials are needed to confirm the findings of this study. Trial registration: This study was registered on PROSPERO (CRD42020162621).</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-19"},"PeriodicalIF":2.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound in deep endometriosis: A narrative review.","authors":"Stefano Guerriero, Fernanda Harumi Oyarce, Francesca Filippi, Martino Rolla, Marcelo Pedrassani, Juan Luis Alcázar, M Angela Pascual, Mariachiara Pagliuca, Antonietta Borzacchelli, Fabio Deiala, Annalisa Pisu, Alessandra Medas, Barbara Piras, Camilla Desogus, Silvia Ajossa","doi":"10.1159/000543342","DOIUrl":"https://doi.org/10.1159/000543342","url":null,"abstract":"<p><p>Background Over the past decade, transvaginal ultrasound (TVUS) has revolutionized the diagnosis of deep endometriosis. We can now accurately describe and evaluate lesions in multiple compartments of the pelvis, increasing diagnostic capacity without the need for initial laparoscopy. Recent consensus and publications support the new and growing evidence for this technique. Research into deep endometriosis has increased substantially and new diagnostic evidence is now available. Objectives The aim of this article is to review the state of the art in ultrasound diagnosis of deep endometriosis. Methods We performed a detailed search of the PubMed database to identify eligible primary studies. We included English-language publications with the following terms: \"endometriosis\" AND \"deep\" AND \"ultrasound\" AND \"transvaginal\". Studies focusing on ultrasound in deep endometriosis were included, we selected them based on title reading, then narrowed the selection by reading the abstract. -We excluded publications that didn't use TVUS as one of the main techniques to evaluate deep endometriosis. Results 243 studies were identified and selected as described above, resulting in a total of 73 studies included in this review. Conclusions and outlook Our understanding of deep endometriosis has evolved over the past decade. Efforts have been made to reduce the diagnostic delay in this common disease, particularly with the increased use of imaging, especially transvaginal ultrasound, as a first-line diagnostic modality because of its availability, good test performance, cost-effectiveness, and low environmental impact compared to other imaging modalities. This statement is supported by recent publications and guidelines from some medical societies. Advances in technology, equipment and research have allowed us to identify additional compartments involved, including the parametrium. The progress made in recent years offers hope for earlier detection and improved management of patients with suspected endometriosis who suffer not only from pelvic pain but also from infertility.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-29"},"PeriodicalIF":2.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Interventions in HBV Care: Nursing-Sensitive Approach.","authors":"Juan Zhang, Xinger Xie, Longju Qi","doi":"10.1159/000542999","DOIUrl":"https://doi.org/10.1159/000542999","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of a comprehensive intervention using nursing-sensitive quality indicators on pregnant women with hepatitis B and their newborns.</p><p><strong>Design: </strong>A randomized controlled monocentric trial conducted from January 2020 to May 2022. Participants/Materials: 80 pregnant women diagnosed with hepatitis B were randomly assigned to either a control group (n=40) or an experimental group (n=40). The experimental group received care-sensitive quality indicators during treatment.</p><p><strong>Setting: </strong>Department of Traditional Chinese Medicine, Nantong Third People's Hospital, affiliated with Nantong Hospital 3 of Nantong University, Jiangsu, China.</p><p><strong>Methods: </strong>Participants in the experimental group received daily Tenofovir from late pregnancy to early postpartum, and newborns received hepatitis B vaccine and immunoglobulin within 24 hours of birth. Healthcare personnel underwent six months of training on care-sensitive quality indicators. The effectiveness of the intervention was assessed using various indicators such as health education coverage, antiviral medication compliance, follow-up rates, and psychological health.</p><p><strong>Results: </strong>The results showed that after comprehensive intervention, the coverage rate of health education increased from 82.50% before intervention to 92.50% (P=0.033), and adherence to antiviral medication improved from 82.50% to 97.50% (P=0.000). The follow-up rate for hepatitis B mothers also significantly increased from 80.00% to 95.00% (P=0.001). In addition, the incidence of negative emotions such as anxiety and depression among pregnant women significantly decreased from 57.50% to 30.00% (P=0.000). These findings demonstrate the effectiveness of comprehensive interventions in improving health education coverage and participation, enhancing adherence to antiviral medication, and effectively reducing the psychological burden of pregnant women. Moreover, after the intervention, the awareness of mother-to-child transmission prevention for hepatitis B significantly increased from 82.36 points before intervention to 94.32 points after intervention (P=0.000). At the same time, adherence to neonatal immunization increased from 80.00% to 95.00%, and satisfaction with nursing services improved from 90.66 points to 98.64 points (P=0.000). These results indicate that comprehensive interventions significantly enhance knowledge related to mother-to-child transmission prevention, increase immunization adherence, and improve satisfaction with nursing services.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-26"},"PeriodicalIF":2.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in Ultrasound Diagnosis of Superficial Endometriosis: Current Challenges and Emerging Techniques.","authors":"Shay Freger, Mathew Leonardi","doi":"10.1159/000543075","DOIUrl":"https://doi.org/10.1159/000543075","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Endometriosis is a chronic disease characterized by endometrial-like tissue outside the uterus. Superficial endometriosis (SE) is the most prevalent form, yet it remains underdiagnosed due to subtle clinical and imaging presentations. Traditionally, diagnosis relies on laparoscopy, which is relatively invasive and often contributes to diagnostic delay. With advancements in imaging techniques, especially transvaginal ultrasound (TVS), a reassessment of the diagnostic approach for SE is needed. This review updates the understanding of SE diagnostics and integrates both historical perspectives and contemporary clinical insights.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The review aims to explore advancements in the diagnosis of SE, focusing on the growing role of TVS as a non-invasive diagnostic tool. Additionally, it seeks to highlight emerging diagnostic challenges and present new approaches to managing SE to offer updated recommendations for clinicians.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive literature search was conducted using PubMed, MEDLINE, and Google Scholar. The following keywords were used: \"superficial endometriosis,\" \"diagnostic pathways,\" \"endometriosis diagnosis,\" \"superficial lesions,\" \"transvaginal ultrasound,\" \"laparoscopy,\" \"non-invasive imaging,\" and \"diagnostic accuracy.\" Only English-language articles were included, focusing on original research, metanalyses, and clinical guidelines, offering historical and current perspectives. In addition to the literature review, contemporary insights were gathered from our clinical practice at a tertiary endometriosis clinic to offer real-world context to the literature findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcome: &lt;/strong&gt;The review highlights TVS as a promising non-invasive method for diagnosing SE. While SE has historically been diagnosed through laparoscopy, TVS is gaining recognition as a valuable tool for detecting SE lesions, particularly through the identification of key sonographic features such as hyperechoic foci and cystic spaces. These advancements help overcome the challenges posed by the variability of SE presentation on imaging. Emerging techniques, such as SPG (sonoPODography), further enhance SE diagnosis and offer the potential for broader clinical application. Despite challenges such as the need for operator expertise and variability in lesion presentation, the literature and clinical insights support the growing utility of TVS in diagnosing SE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and outlook: &lt;/strong&gt;TVS has significant potential as a non-invasive diagnostic tool for SE. While limitations such as variability in sensitivity and the need for operator expertise remain, TVS can significantly reduce reliance on invasive methods like laparoscopy. Additionally, the review provides insights into managing cases where TVS results are negative for SE. In such cases, clinicians must adopt a patient-centred approach that emphasizes symptom management, patient autonomy,","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-18"},"PeriodicalIF":2.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"UPDATE ON MEDICAL TREATMENT OF ENDOMETRIOSIS: NEW DRUGS OR NEW THERAPEUTIC APPROACHES?","authors":"Paolo Vercellini, Camilla Buffo, Paola Viganò, Edgardo Somigliana","doi":"10.1159/000542947","DOIUrl":"https://doi.org/10.1159/000542947","url":null,"abstract":"<p><strong>Background: </strong>No conceptually new drugs for the safe and successful cure of endometriosis are likely to become available soon. Hormonal modulation of ovarian function and suppression of menstruation remain the pillars of disease control. However, existing drugs may be used following novel modalities to limit the consequences of endometriosis progression.</p><p><strong>Objectives: </strong>To propose a pharmacological approach aimed at limiting the potential detrimental effects of the recent dramatic increase in postmenarcheal repetitive ovulatory menses and to define the type of hormones and the routes of administration that can be used to maximize safety and tolerability in the medical treatment of endometriosis.</p><p><strong>Methods: </strong>For this narrative review, we selected the best quality evidence, prioritizing RCTs, systematic reviews, meta-analyses, network meta-analyses, and international guidelines, preferably published in the last decade.</p><p><strong>Outcome: </strong>Medical treatment of endometriosis should be included into all aspects of prevention. Very-low-dose combined oral contraceptives can be used for years to counteract the increased risk of ovarian cancer observed in patients with endometriosis. This primary prevention measure saves lives and can effectively integrate targeted risk-reducing surgery. Secondary pharmacological prevention, based on a working diagnosis of early-onset adenomyosis-endometriosis selectively in adolescents with severe dysmenorrhea and heavy menstrual bleeding, can potentially impede the development of advanced disease forms, and reduce the need for management of complications due to a delay in diagnosis and treatment. Tertiary prevention, i.e., medical therapy of established disease, is based initially on the safest available estrogen-progestogen combinations and progestogen monotherapies. Whenever possible, ethinyl estradiol and cyproterone acetate should be avoided because of thromboembolic and meningioma risks, respectively. Estradiol can be administered transdermally. Switching to GnRH agonists and antagonists should not be delayed when first-line agents fail.</p><p><strong>Conclusions and outlook: </strong>Two-thirds of symptomatic endometriosis patients can be managed satisfactorily for many years using, with the right modality, the existing safe, effective, and well-tolerated medications. Despite the constant plea for new drugs, this already appears to be an excellent clinical outcome, unsurpassed in managing other human chronic inflammatory diseases. Cohort studies are needed to verify whether turning off the recurrent inflammation caused by repeated ovulation and menstruation could also affect the risk of systemic conditions associated with endometriosis.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-37"},"PeriodicalIF":2.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Surgical Staging with Sentinel Node Biopsy for Apparently Early-Stage Endometrial Cancer Using the Modular Multi-Arm Surgical Robot System Versius® (Cambridge Medical Robots): A Case Series.","authors":"Stefano Uccella, Liliana Galli, Chiara Casprini, Anna Festi, Mariachiara Bosco, Pier Carlo Zorzato, Andrea Caraffini, Biancamaria Del Prete, Simone Giacopuzzi, Alessandro Favilli, Massimo Franchi, Callisto Marco Bravi, Simone Garzon","doi":"10.1159/000543122","DOIUrl":"10.1159/000543122","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to report the first cases of surgical staging for apparently early-stage endometrial cancer performed using the Versius® next-generation robotic surgical system (Cambridge Medical Robots [CMR] Surgical, Cambridge, UK).</p><p><strong>Design: </strong>The study used a prospective case series. Participants/Materials: Women who underwent surgical staging, including total hysterectomy, bilateral adnexectomy, and sentinel lymph node (SLN) biopsy, for apparently early-stage endometrial cancer using the Versius® next-generation robotic surgical system (CMR Surgical, Cambridge, UK) were included.</p><p><strong>Setting: </strong>The study was conducted at a Gynecologic Oncology Referral Center.</p><p><strong>Methods: </strong>We prospectively recorded data of all consecutive women who underwent the investigated surgical procedure.</p><p><strong>Results: </strong>Fourteen endometrial cancer patients were treated between March and August 2024 at the Azienda Ospedaliera Universitaria Integrata of Verona. The mean age was 69.4 ± 8.7 years, and the average body mass index was 27.2 ± 4.8. SLN biopsy was performed on all patients: 5 patients had unilateral and 9 bilateral successful SLN detection; 6 women underwent systematic pelvic lymphadenectomy in the unmapped areas. The median operative time was 122 (min-max, 77-185) minutes, and the median hysterectomy time was 34 (min-max, 18-68) minutes. None of the surgical procedures required conversion to conventional laparoscopic or open surgery for technical reasons, and no intraoperative complications were recorded. No readmissions, reoperations, or deaths were observed during the follow-up (median 102 days, min-max 39-249).</p><p><strong>Limitations: </strong>The limitations of the study are the first experience in a limited study population and the use of methylene blue for SLN mapping.</p><p><strong>Conclusions: </strong>Our preliminary results with the Versius® platform appear encouraging regarding surgical time, blood loss, rate of completion of the robotic procedures, and complications risk. Further studies will confirm the indications, feasibility, and safety of the Versius® surgical robot system for treating apparently early-stage endometrial cancer.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circ_0008927 Promotes the Progression of Endometriosis via miR-608-/PROM2-Mediated Ferroptosis.","authors":"Yanping Shen, Yun Chen, Lingli Li, Yingyan Yan, Yanan Xu","doi":"10.1159/000543000","DOIUrl":"10.1159/000543000","url":null,"abstract":"<p><strong>Objective: </strong>Abnormal expression of circular RNA (circRNA) leads to the occurrence and development of endometriosis (EM), but its underlying mechanisms are largely unknown.</p><p><strong>Methods: </strong>Abnormally expressed circRNAs were screened in EM and normal tissues. A series of gain-of-function or loss-of-function experiments were conducted to evaluate the biological behavior of circ_0008927 in EM cells. The role of circ_0008927 in the proliferation, migration, and invasion of EM cells was investigated. The downstream mechanisms of circ_0008927 were studied through bioinformatics analysis and RNA sequencing, and this was confirmed through RNA immunoprecipitation and dual-luciferase reporter assays.</p><p><strong>Results: </strong>Circ_0008927 is highly expressed in EM tissues. From a biological perspective, silencing circ_0008927 can inhibit the proliferation, migration, and invasion of EMS cells in vitro. Mechanistically, circ_0008927 can interact with miR-608 through a competitive endogenous RNA mechanism, upregulating prominin2 (PROM2) and inhibiting ferroptosis in EM, thereby exacerbating the progression of EM.</p><p><strong>Conclusions: </strong>Our research results not only reveal the key role of circ_0008927 in regulating the progression of EM but also advocate for attenuating the circ_0008927/miR-608/PROM2 regulatory axis to combat EM.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Statement.","authors":"","doi":"10.1159/000543019","DOIUrl":"https://doi.org/10.1159/000543019","url":null,"abstract":"","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence of Occult Malignancy in Women Undergoing Hysterectomy or Myomectomy for Benign Indications and the Impact of Morcellation on Survival Outcomes: A Meta-Analysis.","authors":"Dan Jiang, Hongxuan Liu, Kui Huang, Yan Chen, Qiao Liu, Chuqiang Shu, Qi Tian","doi":"10.1159/000542894","DOIUrl":"10.1159/000542894","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine fibroids (UFs), also known as leiomyomas, are the most common benign gynecological tumors. Currently, morcellation is discouraged due to the risk of disseminating undetected malignancies. This study aimed to update the prevalence data on occult malignancies in surgeries for suspected benign uterine lesions and analyze the impact of treatment strategies on the survival outcomes in patients with occult malignancy.</p><p><strong>Methods: </strong>Five English-language literature databases were systematically searched up to July 25, 2024, for studies reporting the incidence of occult malignancies in patients with suspected UFs and their survival outcomes. The study was preregistered on PROSPERO (CRD42024580233).</p><p><strong>Results: </strong>A total of 34 studies were included in the analysis. The pooled incidence of occult malignancies, calculated using a random-effects model, was 2.88 (2.10-3.94) per 1,000 individuals. Significant regional variations were observed in the subgroup comparisons (p < 0.01). Morcellation did not significantly affect progression-free survival (PFS) (hazard ratio [HR]: 1.26, 95% confidence interval [CI]: 0.86-1.84, p = 0.240) or overall survival (OS) (HR: 1.13, 95% CI: 0.70-1.82, p = 0.614). Pooled analysis of HR revealed that chemotherapy significantly improved PFS (HR: 0.49; 95% CI: 0.32-0.77; p = 0.002) and OS (HR: 0.49; 95% CI: 0.28-0.87; p = 0.015).</p><p><strong>Conclusions: </strong>The incidence of occult malignancies in women undergoing hysterectomy or myomectomy for benign conditions is approximately 2.88 per 1,000 individuals. Morcellation does not impact survival outcomes, whereas adjuvant chemotherapy provides a survival benefit. Further well-designed clinical trials are required to validate these findings.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}