Archives of Gynecology and Obstetrics最新文献

Objective

The purpose of this study was to compare oral estradiol valerate and estradiol transdermal gel for clinical pregnancy outcomes in patients undergoing frozen–thaw embryo transfer (FET).

Methods

This was a prospective study performed between March 1, 2017 and October 30, 2019. Totally 244 HR FET cycles were included, with 123 cycles using oral estrogen tablets (oral group) and 121 applying estradiol transdermal gel (gel group). The primary aim of this study was to compare implantation (IR), clinical pregnancy (CPR), miscarriage (MR) and live birth (LBR) rates between the two groups. The secondary aim was to assess liver function, specifically measuring alanine transaminase (ALT) and aspartate transaminase (AST) levels at 12 weeks of gestation.

Results

There were no significant differences in EPR, IR, and CPR between the two groups. Meanwhile, the gel group had a higher live birth rate (55.37% versus 51.20%, p = 0.302) and a lower miscarriage rate (5.79% versus 10.57%, p = 0.173) compared with the oral group, but statistical significance was not reached. The oral group had higher ALT (16.58 ± 6.13 versus 23.78 ± 7.17, p < 0.001) and AST (19.70 ± 3.58 versus 23.78 ± 7.17, p = 0.001) levels at 12 weeks of gestation.

Conclusion

Estradiol transdermal gel is a safe and feasible alternative for endometrial preparation in frozen embryo transfer cycles, yielding comparable ongoing pregnancy rates to the standard oral regimen.

Objectives

This meta-analysis seeks to clarify the relationship between hysterectomy, oophorectomy, and the subsequent risk of developing breast cancer.

Methods

A comprehensive literature search was conducted across PubMed, the Cochrane Library, and Embase to identify relevant studies. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS). Statistical analyses were performed using Stata software (version 14.0), with hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) calculated. Publication bias was assessed using funnel plots and Egger’s test.

Results

A total of 12 studies were included, comprising 9 cohort studies and 3 case–control studies, with publication years ranging from 1988 to 2023, involving 5,868,660 participants, predominantly from the United States. The analysis revealed that both hysterectomy and oophorectomy are associated with a reduced risk of breast cancer, lowering the risk by 16% (HR 0.84; 95% CI: 0.76–0.92; I² = 76.5%; P < 0.001). Standalone hysterectomy was associated with a 13% reduction in breast cancer risk (HR 0.87; 95% CI: 0.77–0.99; I² = 82.3%; P = 0.033), while bilateral oophorectomy reduced the risk by approximately 19% (HR 0.81; 95% CI: 0.68–0.96; I² = 61.7%; P = 0.016). In contrast, unilateral oophorectomy did not significantly affect the risk of breast cancer (HR 0.89; 95% CI: 0.71–1.11; I² = 45.5%; P = 0.288). Patients who underwent bilateral oophorectomy and received hormone therapy experienced a 20% reduction in breast cancer risk (HR 0.80; 95% CI: 0.68–0.93; I² = 38.5%; P = 0.005), whereas those who did not receive hormone therapy showed no significant risk reduction (HR 0.87; 95% CI: 0.69–1.10; I² = 48.5%; P = 0.254). Premenopausal bilateral oophorectomy was associated with a 13% decrease in breast cancer incidence risk (HR 0.87; 95% CI: 0.79–0.96; I² = 0%; P = 0.004), while postmenopausal bilateral oophorectomy had no significant impact (HR 0.95; 95% CI: 0.88–1.03; I² = 1.2%; P = 0.196).

Conclusions

This meta-analysis suggests that both hysterectomy and oophorectomy are significantly associated with a reduction in breast cancer risk. The effectiveness of bilateral oophorectomy appears to be modulated by hormone therapy and menopausal status. Further research is needed to clarify these associations and to explore the underlying biological mechanisms.

Background

Up to 60% of breast cancer patients achieve pathological complete response (pCR) and factors associated with breast pCR have been extensively investigated. In patients with initially node-positive disease predicting axillary response to treatment remains challenging. Our study examines a biomarker panel assessed on core-biopsy lymph-node metastatic tissue with the goal to establish predictive markers for nodal positive breast cancer.

Materials and methods

Forty women with core biopsy-proven node-positive breast cancer scheduled to receive neoadjuvant treatment at the certified Breast Cancer Center of the University Hospital Schleswig–Holstein Campus Lübeck were included. The expressions of CAIX, PD-L1, TROP2, MSH2, MSH6, MLH1, and PMS2 as well as p53 mutation were assessed. Biomarkers were chosen based on their association with tumorigenesis and tumor progression. Statistical analysis was performed using SPSS 29. This investigator-initiated study was supported by a research grant from Gilead (Gilead Förderprogramm).

Results

Higher CAIX levels were associated with triple-negative and Her2-positive receptor status (p = 0.003), Ki67 ≥ 50% in breast core biopsy (p = 0.005), as well as postmenopausal status (p = 0.007). P53 mutation was more frequent in G3 tumors (p = 0.025). All lymph-node metastases were microsatellite stable (MSS). None of the markers could significantly predict pathological response (complete, breast, or nodal).

Conclusion

Our study shows upregulated CAIX in lymph-node metastasis frequently occurs in aggressive and highly proliferative tumors. However, none of the examined biomarkers could predict nodal response to therapy. Further research is necessary to better identify patients most likely to achieve nodal response through neoadjuvant chemotherapy.

Purpose

Idiopathic granulomatous mastitis (IGM) is a chronic, relapsing inflammatory breast disease of unknown etiology. Its unpredictable course and unclear pathogenesis have made treatment a persistent clinical challenge. This study aimed to evaluate treatment outcomes in patients with IGM, focusing on extending remission periods and reducing relapse rates after discontinuation of therapy.

Methods

This retrospective cohort study included 200 patients with histopathological confirmed idiopathic granulomatous mastitis who were referred to the Teaching and Therapeutic Center at the Central Hospital of Mazandaran University of Medical Sciences. Patient demographics, pathological characteristics, treatment regimens, remission duration, and recurrence rates were analyzed.

Results

From January 2018 to December 2024, a total of 200 patients were enrolled in the study, with a mean age of 33 years (range: 18–54 years) and a mean follow-up duration of 34 months (range: 8–51 months). Patients were divided into two treatment groups: Group A received high-dose prednisolone combined with abscess drainage (n = 99), while Group B received low-dose prednisolone, abscess drainage, and methotrexate (n = 101). Group B demonstrated a significantly shorter treatment duration (11.56 ± 2.15 months) compared to Group A (14.86 ± 3.42 months; P < 0.001). The mean time to follow-up was significantly longer in Group B (35.97 ± 6.96 months) than in Group A (20.00 ± 7.02 months; P < 0.001). The recurrence rate was lower in Group B (4.9%) than in Group A (23.2%), with the difference approaching statistical significance (P = 0.057). In addition, the mean time to relapse in Group B (34.46 ± 6.50 months) was significantly longer than that of Group A (16.96 ± 5.34 months), indicating that patients receiving the combined regimen of low-dose prednisolone, drainage, and methotrexate experienced a more sustained remission period.

Conclusions

According to the results, the treatment of idiopathic granulomatous mastitis, especially the moderate to severe form of the disease, using combination therapy with low-dose prednisolone and methotrexate can be associated with a reduction in treatment duration, and increase in remission duration, and a reduction in relapse, and drug side effects.

Purpose

Current data regarding prognostic factors for malignant tumors arising from mature cystic teratomas (MT-MCTs) and effective treatments are insufficient. This study aimed to identify risk factors for MT-MCTs of the ovary.

Methods

Tumor samples diagnosed as MT-MCTs were collected from 13 institutions that participated in the Kansai Clinical Oncology Group. Based on the clinicopathological features and prognoses of the tumors, risk factors for progression and death were statistically assessed using univariable and multivariable analyses.

Results

Among the 60 tumor samples collected, 56 were diagnosed as MT-MCTs. Four samples were excluded based on the results of a central pathological review. Nine histological types, including squamous cell carcinoma, were diagnosed. Thirty of the 56 included samples were classified as International Federation of Gynecology and Obstetrics (FIGO) stage I, seven were classified as FIGO stage II, 18 were classified as FIGO stage III, and one was classified as FIGO stage IV. The 5-year progression-free survival and overall survival probabilities for stage I disease were significantly higher than those for stages II–IV disease (p < 0.001). In the multivariable analysis, surgery with residual tumor margins was a prognostic factor for progression, and FIGO stages I–IV and the absence of adjuvant therapy were prognostic factors for death.

Conclusion

Surgery without residual tumor margins and adjuvant therapy may be promising treatments for advanced-stage MT-MCTs.

Background

In 2020, Germany implemented a revised cervical cancer screening program, incorporating co-testing with cytology and human papillomavirus (HPV) testing for women aged 35 and older. This study describes patient characteristics, referral patterns, and follow-up outcomes of histologically confirmed cervical intraepithelial neoplasia (CIN) 1 and CIN 2 lesions before and after the introduction of the organized cervical cancer screening program in Germany.

Methods

In a hybrid prospective-retrospective study, we analyzed two consecutive cohorts of patients with histologically confirmed CIN 1 or CIN 2 at the Department of Women’s Health, University Hospital Tuebingen, between 2013 and 2022. Patient characteristics, referral indications, and follow-up outcomes were described and compared.

Results

Patients post-2020 were older (median 41 vs. 31 years), more often hrHPV-positive (93.4% vs. 63.3%), and more frequently presented with CIN 1 (62% vs. 51%). Immediate intervention was less common post-2020 (CIN 1: 7% vs. 25%; CIN 2: 37% vs. 67%). Among those followed, remission was higher in the post-2020 cohort (CIN 1: 63.5% vs. 42.2%; CIN 2: 61.6% vs. 41.0%). Progression to CIN 3 remained rare in both cohorts. Multivariable regression indicated that CIN 2 diagnosis and smoking reduced remission, while the post-2020 period was associated with increased remission odds.

Conclusion

The differences in remission and persistence between cohorts likely reflect changes in referral pathways, patient age rather than causal program effects. These data provide a descriptive benchmark for clinicians, supporting conservative management of CIN 1 and selected CIN 2 under the new screening program.

Objective

This study aimed to evaluate the impact of repeated cesarean deliveries on isthmocele formation and to investigate the diagnostic value and clinical presentation of morphometric parameters, including niche depth, width, length, residual myometrial thickness (RMT), adjacent myometrial thickness (AMT), and the depth/AMT ratio.

Methods

A cross-sectional study was conducted with 116 symptomatic and asymptomatic women aged 18–45 years who had undergone one or more cesarean sections. The presence and dimensions of the isthmocele were assessed via transvaginal ultrasonography using Delphi consensus criteria. Morphometric and obstetric data were analyzed using descriptive statistics, correlation analysis, and binary logistic regression.

Results

Isthmocele was identified in 71.6% of participants, with prevalence rising from 42.9% after the first cesarean to 100% after the fourth. The isthmocele group had significantly higher gravidity, parity, and cesarean numbers (p < 0.001). Niche depth, length, and the depth/AMT ratio were significantly elevated, while RMT was reduced (p < 0.001). The number of cesareans showed a strong negative correlation with RMT (r = –0.499, p < 0.001) and a strong positive correlation with the depth/RMT ratio (r = 0.615, p < 0.001). Multivariate analysis identified having three or more cesareans as an independent predictor of isthmocele (OR = 15.6; 95% CI 3.27–74.4; p < 0.001). Niche length had the highest diagnostic accuracy for symptomatic isthmocele (AUC 0.700; 95% CI 0.589–0.796; cutoff 5 mm).

Conclusion

Repeated cesarean deliveries significantly increase both the risk and severity of isthmocele. In women with four cesareans, isthmocele was detected in 100% of cases. A niche length of ≥ 5 mm proved to be the most reliable morphometric marker in identifying symptomatic cases.

Implications for clinical practice

These findings emphasize the importance of routine transvaginal ultrasound screening post-cesarean—especially in women with multiple cesarean sections—and the incorporation of morphometric assessment (including RMT and depth/RMT ratio) into clinical decision-making.

Purpose

To compare the efficacy of ultrasound-guided alcohol sclerotherapy versus laparoscopic cystectomy for the management of ovarian endometriomas, focusing on complications, recurrence, pain relief, and healthcare costs.

Methods

We conducted a multicentre, randomized clinical trial across 20 centers in Spain. A total of 167 women aged 18–40 years with ovarian endometriomas (35–100 mm) were recruited between June 2018 and June 2022. Participants were randomized to receive either ultrasound-guided aspiration with ethanol sclerotherapy or standard laparoscopic cystectomy. Complications were graded using the Clavien–Dindo classification. Pain was assessed using a visual analogue scale (VAS) before and six months after treatment. Recurrence was defined as the reappearance of a cystic lesion at the treated site and analyzed using Kaplan–Meier curves and log-rank tests. The primary analysis followed an intention-to-treat approach and included 158 patients (sclerotherapy: n = 84; cystectomy: n = 74). The per-protocol analysis included 92 patients (sclerotherapy: n = 57; cystectomy: n = 37). Direct hospital costs, complication rates, recurrence, and pain relief were compared between groups.

Results

Intention-to-treat analyses show that complications were low in both groups (12%), most of which were Grade I–II, although 4.1% were Grade III in the surgery group. The cost of sclerotherapy was significantly lower (€472 vs. €2128, p < 0.001). In per-protocol analyses, the cyst recurrence or reappearance was similar between the two groups, with rates of 25.7% (9 of 35) in the surgery group and 22.8% (13 of 57) in the sclerotherapy group (p = 0.16). Pain was improved or completely resolved in 49 of 55 cases (89.1%) in the sclerotherapy group and in 21 of 32 cases (65.7%) in the laparoscopic surgery group (p = 0.05).

Conclusions

Ultrasound-guided alcohol sclerotherapy is a safe, cost-effective alternative to laparoscopic cystectomy for the treatment of endometriomas, with comparable recurrence rates and pain relief. Clinical Trial Registration: https://clinicaltrials.gov/search?term=NCT03571776. Registered May 5, 2018.