European journal of obstetrics, gynecology, and reproductive biology最新文献

{"title":"Therapeutic outcomes and patient-reported experiences for endometriosis in the canal of Nuck","authors":"Lotus van Duin , Sabrine Kol , Astrid Cantineau , Robert de Leeuw , Velja Mijatovic , Laura van Loendersloot","doi":"10.1016/j.ejogrb.2026.114944","DOIUrl":"10.1016/j.ejogrb.2026.114944","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114944"},"PeriodicalIF":1.9,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022743","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":"Impact of previous caesarean section on outcomes of first and second trimester surgical abortion: A systematic review and meta-analysis","authors":"Natalie Drever ,&nbsp;Vinay Gangathimmaiah ,&nbsp;Zinat Mohammadpour ,&nbsp;Cecelia O’Brien ,&nbsp;Catriona Melville ,&nbsp;Kirsten Black ,&nbsp;Caroline de Costa","doi":"10.1016/j.ejogrb.2026.114948","DOIUrl":"10.1016/j.ejogrb.2026.114948","url":null,"abstract":"<div><h3>Background</h3><div>It is unclear whether previous caesarean section (CS) increases the risk of complications during surgical abortion.</div></div><div><h3>Aims</h3><div>To compare surgical abortion complication rates in women with a history of previous CS to those without previous CS.</div></div><div><h3>Materials and methods</h3><div>Four databases were systematically searched in July 2024. Primary studies in English reporting on surgical abortion complications in women with and without a history of previous CS were included. Overall complications and major complications were compared between women with and without previous CS using a random effects meta-analysis. Sub-analyses were performed in women with &gt; 1 previous CS, and incidence of emergency hysterectomy. Certainty of evidence was assessed using GRADE.</div></div><div><h3>Results</h3><div>Ten retrospective cohort studies with 3123 women with and 14,514 without a previous CS were included in the meta-analysis. The overall incidence of major complications from surgical abortion was 0.9 %. Previous CS was associated with an increase in overall complications (OR = 2.00, CI 1.32–3.04, p = 0.001) and major complications (OR = 2.82, CI 1.83–4.36, p &lt; 0.00001). Major complications included haemorrhage requiring transfusion, uterine perforation and unplanned laparoscopy/laparotomy, while minor complications included cervical laceration and the need for repeat evacuation. There were no cases of uterine rupture during pre-procedural cervical ripening. Hysterectomy was an exceptionally rare occurrence (0.05 %); low-quality evidence from seven studies showed an association between history of CS and need for emergency hysterectomy (OR = 8.73, CI = 1.83–41.61, p = 0.007). The quality of the evidence was judged to be very low to medium mainly due to risk of bias of the included studies.</div></div><div><h3>Conclusion</h3><div>While major surgical complications of surgical abortion are rare, women with a prior history of CS were more than twice as likely to experience a complication.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114948"},"PeriodicalIF":1.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973291","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":"Anatomical distribution of ovarian and deep endometriosis using a multimodal diagnostic approach applying the updated international definition: A prospective observational study","authors":"Shay M. Freger ,&nbsp;Melissa Marien ,&nbsp;Ido Mick ,&nbsp;Mathew Leonardi","doi":"10.1016/j.ejogrb.2026.114947","DOIUrl":"10.1016/j.ejogrb.2026.114947","url":null,"abstract":"<div><h3>Objective</h3><div>To (1) determine how application of the updated international definition of deep endometriosis (DE) alters apparent disease prevalence across pelvic sites, and (2) characterize the distribution of endometriosis phenotypes, including ovarian (OE), DE, and superficial (SE) disease, using a standardized multimodal approach integrating transvaginal ultrasound (TVS), surgical, and histopathologic findings.</div></div><div><h3>Study design</h3><div>Prospective observational study conducted at a tertiary endometriosis center between November 2021 and January 2023.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing laparoscopy for chronic pelvic pain or infertility underwent systematic TVS and intraoperative assessment performed by a single fellowship-trained operator. Lesions were classified as DE if confirmed by at least two of three modalities. Prevalence estimates under the updated definition were compared descriptively with those using the previous &gt; 5 mm criterion.</div></div><div><h3>Results</h3><div>Among 131 participants, OE were present in 45.4 % (59/130; excluding one participant with prior bilateral oophorectomy) and DE in 64.1 % (84/131). Among individuals with DE, the uterosacral ligaments were the most frequently involved site (52.7 %), followed by bowel (18.3 %), pararectal spaces (16.8 %), posterior vaginal fornix (12.2 %), and parametrium (6.1 %). Under the updated definition, DE prevalence increased from 22.9 % to 52.7 % at the uterosacral ligaments and from 10.7 % to 16.8 % at the pararectal spaces compared with the prior &gt; 5 mm threshold. Isolated SE was found in 32.8 % (43/131) of participants, while OE and DE coexisted in over 90 % of cases with endometrioma.</div></div><div><h3>Conclusions</h3><div>The application of the updated DE definition substantially increases the reported prevalence across key posterior pelvic sites by reclassifying lesions previously categorized as superficial. Comprehensive multimodal assessment further delineates the distribution and overlaps of endometriosis phenotypes, providing a reproducible framework for future multicenter and outcome-based validation.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114947"},"PeriodicalIF":1.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973398","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":"Application and validation of AI-driven methods to explore patient experiences of pre-cervical cancer","authors":"Michael Y. Luo ,&nbsp;Christopher Y.K. Williams","doi":"10.1016/j.ejogrb.2026.114953","DOIUrl":"10.1016/j.ejogrb.2026.114953","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to apply novel natural language processing (NLP) tools to explore patient experiences of pre-cervical cancer on social media and validate the performance of these tools.</div></div><div><h3>Methods</h3><div>All posts and comments were extracted from the forum r/PreCervicalCancer on social media platform <em>Reddit</em>. Using BERTopic, posts were clustered into topics according to their semantic similarity, which were manually reviewed. Topic headings were derived using a large language model (LLM) and compared to manually curated headings. Clustering outliers were reassigned by BERTopic, an LLM and by manual methods in parallel and compared. Post and comment sentiment were quantitatively analysed using VADER. Post upvote scores and comments counts were analysed to measure community engagement.</div></div><div><h3>Results</h3><div>4592 posts were extracted from r/PreCervicalCancer. Posts clustered into 10 different topics using BERTopic with 88.0% accuracy. 80.0% of topic headings generated by GPT-4o mini were deemed appropriate. Reassignment of clustering outliers by BERTopic and GPT-4o mini was limited, 52.8% and 41.1% accuracy, respectively. Key clinical findings reflect several common concerns among patients, particularly regarding specific lasting physical and psychological impact of procedures like LEEP, result anxiety, and challenges in healthcare navigation. Comments had less negative sentiment than posts (Cohen’s d = 0.46), suggesting support.</div></div><div><h3>Conclusions</h3><div>In this cross-sectional study, we validated NLP tools to analyse content, sentiment and reactions to 4592 posts on pre-cervical cancer. Our findings suggest that, with minimal human oversight, automated methods can accurately conduct large-scale analyses of similar clinical content, unlocking new insights of patient experiences using non-traditional data sources.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114953"},"PeriodicalIF":1.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973386","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":"Emergency contraception pills among female students: Use, knowledge, perceptions, and expectations","authors":"Alison Catilaz ,&nbsp;Anne-Laure Clairet ,&nbsp;Marilia Girault ,&nbsp;Stéphanie Paris ,&nbsp;Virginie Nerich","doi":"10.1016/j.ejogrb.2026.114946","DOIUrl":"10.1016/j.ejogrb.2026.114946","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the rate of emergency contraception pills (ECP) use among female students, and to examine their characteristics, knowledge, perceptions and expectations regarding ECPs, with particular attention to the experiences and feedback of those who had previously used it.</div></div><div><h3>Study design</h3><div>A cross-sectional, voluntary online survey was conducted among female women students at the Marie and Louis Pasteur University during the 2022–2023 academic year. The questionnaire mainly assessed demographics, contraceptive use, knowledge and perceptions of ECP, and experiences with ECP use. Descriptive and comparative analyses were performed.</div></div><div><h3>Results</h3><div>Among 2,157 female students who completed the survey, i.e., response rate of 15.1 %, 39.1 % reported having previously used ECP at least once, with use increasing significantly with age groups (&lt; 20, 20–29, &gt;29 years). Female students who had used ECP showed higher knowledge and more positive perceptions about ECP, were more likely to use condoms, and primarily consulted pharmacists and the Internet for information. Most ECPs were obtained from community pharmacies, with nearly three-quarters of pharmacists providing information, but only 4 % of dispensations occurred in a confidential space. The main reasons for ECP use were condom breakage, forgetting regular contraception, or not using any regular contraceptive method. Practical and theoretical knowledge about ECP was higher among users.</div></div><div><h3>Conclusion</h3><div>Most female students were aware of emergency contraception and its indications, with a moderate rate of use. These results highlight the need to improve access to reliable information and to explore the role of healthcare professionals and educational strategies in promoting appropriate ECP use.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114946"},"PeriodicalIF":1.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973397","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":"Fetal 15q duplication syndrome detected by noninvasive prenatal testing: three case reports","authors":"Yong-Shan Chen ,&nbsp;De-Gang Wang ,&nbsp;Jun-Hui Wan ,&nbsp;Jie-Fu He ,&nbsp;Tao Quan ,&nbsp;Shu-Bin Li ,&nbsp;Shun-Ting Huang ,&nbsp;Dong-Zhi Li","doi":"10.1016/j.ejogrb.2026.114956","DOIUrl":"10.1016/j.ejogrb.2026.114956","url":null,"abstract":"","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114956"},"PeriodicalIF":1.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973294","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":"Development of predictive models for endometrial outcomes in patients with intrauterine adhesions post-hysteroscopic adhesiolysis: evaluating endometrial vascularization through narrow-band imaging hysteroscopy and Doppler ultrasound","authors":"Jiezhuang Huang ,&nbsp;Yanlan Huang ,&nbsp;Shengcai Chen ,&nbsp;Qing Ye ,&nbsp;Shuang Liang ,&nbsp;Caini Wei ,&nbsp;Zhifu Zhi","doi":"10.1016/j.ejogrb.2026.114951","DOIUrl":"10.1016/j.ejogrb.2026.114951","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the potential of narrow-band imaging (NBI) hysteroscopy and 2-Dimensional (2-D) ultrasound in predicting re-adhesion for patients with intrauterine adhesions (IUAs) following transcervical resection of adhesions (TCRA).</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Patients</h3><div>We included 56 patients diagnosed with IUAs who underwent TCRA with NBI hysteroscopy at the First Affiliated Hospital of Guangxi medical university from June 2020 to February 2023.</div></div><div><h3>Interventions</h3><div>Participants were divided into two groups based on their endometrial recovery during a three-month follow-up after TCRA: a recovery group (n = 42) and a poor recovery group (n = 14). Both univariable and multivariable logistic regression analyses were conducted to identify independent factors impacting postoperative outcomes. Subsequently, nomogram prediction models were constructed and internally validated using the identified independent factors in conjunction with the classifications established by the European Society of Gynecological Endoscopy (ESGE) and the American Fertility Society (AFS).</div></div><div><h3>Main outcome measures</h3><div>Endometrial restoration within the 3-month follow-up after TCRA.</div></div><div><h3>Results</h3><div>A higher endometrial microvascular index assessed by NBI hysteroscopy and enhanced endometrial blood flow in zone 3, as measured by 2-D Doppler ultrasound, were identified as independent protective factors for postoperative endometrial recovery. The identified factors, when combined with ESGE or AFS classifications, were utilized to build nomogram prediction models, referred to as the NUE and NUA models, respectively. The NUE model (AUC = 0.935, 95% CI: 0.865–1.000) and the NUA model (AUC = 0.939, 95% CI: 0.876–1.000) demonstrated superior discrimination compared to the ESGE (AUC = 0.651, 95% CI: 0.490–0.813) and AFS classifications (AUC = 0.736, 95% CI: 0.578–0.893) alone. The calibration curve indicated that the NUA model exhibited greater consistency between predicted and actual outcomes than the NUE model.</div></div><div><h3>Conclusion</h3><div>Endometrial vascularity is a critical factor for postoperative endometrial recovery in IUAs patients following TCRA. NBI hysteroscopy and Doppler ultrasound provide significant advantages in evaluating endometrial blood vessels, thereby facilitating accurate predictions of endometrial outcomes.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114951"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973399","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":"Multidimensional factors increase menstrual distress in patients with endometriosis","authors":"Silvia Vannuccini ,&nbsp;Francesco La Torre ,&nbsp;Ernesto Gallucci ,&nbsp;Anna Rosa Speciale ,&nbsp;Eleonora Rossi ,&nbsp;Emanuele Cassioli ,&nbsp;Valdo Ricca ,&nbsp;Giovanni Castellini ,&nbsp;Felice Petraglia","doi":"10.1016/j.ejogrb.2026.114950","DOIUrl":"10.1016/j.ejogrb.2026.114950","url":null,"abstract":"<div><h3>Background</h3><div>Endometriosis is a chronic endocrine and inflammatory disease commonly presenting with dysmenorrhea, pelvic pain, and/or infertility. Despite the importance of menstrual symptoms, the impact of menstruation on stress is still poorly assessed. This study aims to objectively measure menstrual distress and identify its determinants in patients with endometriosis.</div></div><div><h3>Materials and methods</h3><div>A cross-sectional study was conducted over one year, including 75 patients newly diagnosed with endometriosis and an age-matched control group (n = 75) of healthy women. All participants completed the Menstrual Distress Questionnaire (MEDI-Q), which explores 25 items and provides a total score along with subscales: Menstrual Symptoms (MS), Menstrual Symptoms Distress (MSD), and Menstrual Specificity Index (MESI). Scores were compared between cases and controls. A sub-analysis among endometriosis patients identified the key contributors to distress.</div></div><div><h3>Results</h3><div>Women with endometriosis showed significantly higher score for MEDI-Q Total (median = 14.00, interquartile range: [5.00–––30.50] vs 12.00 [2.00–––20.00], p &lt; 0.05) as well for the subscale MSD (2.24 [1.67–––2.81] vs 1.71 [1.00–––2.30], p &lt; 0.01) compared to controls. Menstrual distress was primarily associated with dyspareunia, dyschezia, dysuria, gastrointestinal symptoms (nausea, diarrhea, constipation, decreased appetite), reduced sexual drive, impaired concentration, and insomnia. A heightened perception of discomfort with bleeding, particularly in the presence of adenomyosis, further increased distress.</div></div><div><h3>Conclusion</h3><div>Menstrual distress is significantly higher in women with endometriosis and involves multidimensional factors beyond pain. These findings support the need for a personalized and comprehensive approach in the clinical management of endometriosis.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114950"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997850","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":"Stem cell therapy in thin endometrium and Asherman’s syndrome: a systematic review and meta-analysis","authors":"Leila Adamyan ,&nbsp;Laura Pivazyan ,&nbsp;Maria Yurkanova ,&nbsp;Veronika Tarlakyan ,&nbsp;Elizaveta Platonova ,&nbsp;Agnessa Osipova ,&nbsp;Karina Mailova ,&nbsp;Assia Stepanian","doi":"10.1016/j.ejogrb.2026.114949","DOIUrl":"10.1016/j.ejogrb.2026.114949","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy and safety of mesenchymal stem cell (MSC)-based therapies in improving endometrial thickness and reproductive outcomes in women with refractory thin endometrium or Asherman’s syndrome.</div></div><div><h3>Methods</h3><div>Following PRISMA 2020 guidelines, a systematic search of PubMed, Cochrane Library, Embase, Scopus, <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, and Google Scholar through June 2025 was performed. Eighteen clinical studies involving 323 patients were included. MSCs derived from umbilical cord, bone marrow, adipose tissue, endometrium, or menstrual blood were administered via intrauterine infusion, transmyometrial injection, or scaffold-assisted delivery. The primary outcome was change in endometrial thickness; secondary outcomes included clinical pregnancy rate, live birth rate, and miscarriage rate.</div></div><div><h3>Results</h3><div>Meta-analysis demonstrated a significant increase in endometrial thickness following MSC therapy compared to baseline or control (mean difference = 2.35 mm; 95 % CI, 1.97–2.74; p &lt; 0.00001). Subgroup analysis showed the largest gains in endometrial- and adipose-derived MSC groups. Randomized controlled trials confirmed higher clinical pregnancy (OR = 2.72; p = 0.002) and live birth rates (OR = 2.27; p = 0.01), with a reduced miscarriage rate (OR = 0.24; p = 0.004). No serious adverse events were reported.</div></div><div><h3>Conclusion</h3><div>While MSC therapy appears to be safe, its efficacy must be confirmed by large-scale randomized trials before it can be presented to the public or recommended as an effective approach for endometrial regeneration.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"319 ","pages":"Article 114949"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076484","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":"High-grade uterine cancer with ambiguous features – a clinicopathological study","authors":"Roy Kessous ,&nbsp;Ofer Wiesel ,&nbsp;Jacob Dreiher ,&nbsp;Mihai Meirovitz ,&nbsp;Sharon Davidesko ,&nbsp;Yarden Kezerle ,&nbsp;Benzion Samueli ,&nbsp;Ruthy Shaco-Levy","doi":"10.1016/j.ejogrb.2026.114952","DOIUrl":"10.1016/j.ejogrb.2026.114952","url":null,"abstract":"<div><h3>Objective</h3><div>Endometrial endometrioid carcinoma FIGO grade 3 (EC3) and endometrial serous carcinoma (SEC), sometimes present diagnostic challenges due to overlapping and ambiguous features. The prognostic significance of assigning histological subtype remains debatable due to conflicting clinical outcome data. This study examined definite and ambiguous EC3 and SEC cases to compare clinicopathologic characteristics and prognosis.</div></div><div><h3>Methods</h3><div>This is a retrospective study of 129 patients diagnosed with EC3 and SEC at a single tertiary center between 2006–2022. Pathological slides were revised and classified as definite or ambiguous for EC3 and SEC. Survival, progression-free survival, and associations between tumor histologic type and clinicopathologic characteristics were analyzed.</div></div><div><h3>Results</h3><div>Definite SEC displayed higher mortality compared to definite EC3 (68.2 % vs. 41.4 %, p = 0.023) as well as a non-significant trend towards lower 5-year survival (p = 0.096). Ambiguous SEC also showed higher mortality compared to ambiguous EC3 (68.8 % vs. 37.5 %, p = 0.020) and a non-significant trend towards lower 5-year survival (p = 0.098). Several parameters suggest that ambiguous cases are intermediate between the definite EC3 (lower) and definite SEC (higher) groups. Rates of lymph node metastases (EC3 6.9 %; ambiguous 16.4 % and SEC 29.5 %; p = 0.013), broad ligament involvement (EC3 0 %; ambiguous 1.8 % and SEC 11.4 %; p = 0.016), and omental involvement (EC3 3.4 %; ambiguous 10.9 % and SEC 29.5 %; p = 0.002). A similar trend was observed for ovarian involvement, but it did not reach statistical significance (EC3 6.9 %; ambiguous 12.7 % and SEC 22.7 %; p = 0.055).</div></div><div><h3>Conclusion</h3><div>Ambiguous cases may represent an intermediate group that displays clinicopathologic features which are more aggressive than in EC3, yet more favorable than in SEC. These results hold implications for managing patients with high-grade endometrial carcinomas, as identifying an intermediate group may inform treatment strategies and prognostic evaluations.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114952"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973387","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}