Smith AJ, Shermoen C, Hinkle SN
… +6 more, Koelper NC, Mills L, Doherty M, Bekelman JE, Simpkins F, Ko EM
Int J Gynecol Cancer
· 2026 May · PMID 41905008
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OBJECTIVE: To assess the feasibility of implementing an automated social determinants of health screening survey for gynecologic oncology into the electronic health record. METHODS: From May 2022 to July 2023, patients a...OBJECTIVE: To assess the feasibility of implementing an automated social determinants of health screening survey for gynecologic oncology into the electronic health record. METHODS: From May 2022 to July 2023, patients at 5 academic gynecologic oncology practices received a social determinants of health screening survey as an electronic message through the patient portal before an in-person or telemedicine visit. Each patient was eligible to complete the survey once; new patients received the survey prior to their initial visit, whereas returning patients received it around a single encounter during the study period. We assessed descriptive statistics of respondents compared with non-respondents using χ2 tests. We used multi-variable regression analyses to examine the association between survey completion and social needs with patient characteristics. RESULTS: Of 4369 patients seen, 1592 patients completed the social determinants of health survey (36% response rate). The mean age of survey completers was 56 years; 63% identified as White, 26% as Black, 4% as Asian, and 7% as Other. Patients who were younger and had private insurance were more likely to complete the screening. Black patients were more likely to complete the screening than White patients (p =.01). Of the 1592 patients who completed the survey, 380 (24%) identified 1 or more social needs: 189 (12%) financial worry, 150 (9%) food insecurity, 136 (9%) housing needs, and 78 (5%) transportation needs. Patients identifying as Asian, Black, or a race other than White and patients with Medicaid or Medicare Advantage insurance were more likely to report social needs compared with White patients and those with private insurance. CONCLUSION: In gynecologic oncology practices, social needs were prevalent and easily collected from an automated survey embedded in the electronic health record, with 1 in 4 patients reporting social needs. Integration of an automated social determinants of health screening in gynecologic oncology can identify patients at risk for referral to supportive care services.
Conte C, Aterno D, Congedo L
… +8 more, Parise G, Rosati A, Boccia S, Marchetti C, Mascilini F, Giannarelli D, Rauh-Hain JA, Fagotti A
Int J Gynecol Cancer
· 2026 May · PMID 41903273
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OBJECTIVE: This study aimed to assess the accuracy of pre-operative computed tomography in identifying candidates for minimally invasive interval cytoreductive surgery after neoadjuvant chemotherapy in patients with adva...OBJECTIVE: This study aimed to assess the accuracy of pre-operative computed tomography in identifying candidates for minimally invasive interval cytoreductive surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer. METHODS: This retrospective, single-center study included patients with advanced ovarian cancer who received 3 to 4 cycles of platinum-based neoadjuvant chemotherapy, followed by interval cytoreductive surgery, between July 2021 and May 2024. Pre-operative computed tomography scans were reviewed by expert radiologists to assess the extent and distribution of residual disease. Patients were deemed eligible or ineligible for minimally invasive interval cytoreductive surgery based on radiologic criteria. Computed tomography findings were compared with intra-operative findings to evaluate sensitivity, specificity, predictive values, and diagnostic accuracy. Site-specific concordance was assessed using Cohen's κ. RESULTS: A total of 87 patients were included. Computed tomography scan demonstrated an overall accuracy of 71.3% (95% confidence interval 61.76 to 80.77) in predicting feasibility of minimally invasive interval cytoreductive surgery, with a sensitivity of 71.4% (95% confidence interval 52.11 to 90.75) and a specificity of 71.2% (95% confidence interval 60.29 to 82.14). False-negative and false-positive rates were 28.6% and 28.8%, respectively. Concordance between computed tomography and surgical findings was moderate (Cohen's k = 0.35). The highest agreement was found for small bowel and mesenteric involvement, whereas diaphragmatic and perihepatic sites showed the lowest concordance. CONCLUSIONS: This study shows that the radiologic selection process for minimally invasive interval cytoreductive surgery is complex. The not negligible false-negative and false-positive rates suggest that a combined approach, including diagnostic laparoscopy or advanced imaging tools, may improve surgical planning and patient selection for minimally invasive surgery at interval cytoreductive surgery.
Sia TY, Kraiem S, Rosalik K
… +16 more, Haney K, Schlappe B, Schiavone MB, Dagher C, Ducie J, Eriksson AGZ, Makker V, Allison DHR, Ellenson LH, Mueller JJ, Smith E, Feinberg J, Praiss A, Alektiar K, Abu-Rustum NR, Leitao MM
Int J Gynecol Cancer
· 2026 May · PMID 41886857
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OBJECTIVE: Pre-operative endometrial assessment may be discordant with final pathology. We sought to determine the outcome of discordant cases. METHODS: We identified patients who had primary surgical treatment of stage...OBJECTIVE: Pre-operative endometrial assessment may be discordant with final pathology. We sought to determine the outcome of discordant cases. METHODS: We identified patients who had primary surgical treatment of stage I endometrioid endometrial carcinoma found on final hysterectomy specimen from January 1, 2000, to December 31, 2020. We collected relevant patient, clinical, and pathologic characteristics and defined low grade as cases with pre-operative grade 1 or 2 tumors and concordant final pathology, and high grade as cases with pre-operative grade 3 tumors and concordant final pathology. We defined discordant as cases with a high-grade histology on pre-operative biopsy, inclusive of non-endometrioid histology, and grade 1 or 2 on final pathology. We compared clinicopathologic characteristics and used Kaplan-Meier survival estimates to compare outcomes between groups. RESULTS: Overall, 2936 patients were included: 2606 (89%) low grade, 247 (8%) high grade, and 83 (3%) discordant. Five-year progression-free survival was 95.1% for low-grade, 86.9% for discordant, and 86.0% for high-grade tumors (p <.001). Five-year overall survival was 95.0% for low-grade, 93.4% for discordant, and 85.7% for high-grade tumors (p <.001). After adjusting for age, myometrial invasion, lymphovascular space invasion, washings (progression-free survival), performance of nodal dissection (overall survival), and adjuvant therapy, discordant cases were not independently associated with progression-free survival (hazard ratio 1.82, 95% confidence interval 0.71 to 4.65), and only high-grade tumors were independently associated with worse overall survival. CONCLUSIONS: The clinical behavior of stage I endometrioid endometrial carcinoma diagnosed as high grade on pre-operative biopsy and low grade on subsequent hysterectomy seems to differ from cases diagnosed as low grade on both pre-operative and final pathology. Further analyses and larger series will be needed to better clarify this question. Both pre-operative and final hysterectomy results should be considered along with age, myometrial invasion, and lymphovascular space invasion when counseling patients regarding prognosis and need for adjuvant therapy.
Taliento C, Van Nieuwenhuysen E, Labie P
… +3 more, Van Rompuy AS, Timmerman D, Froyman W
Int J Gynecol Cancer
· 2026 May · PMID 41865621
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This narrative review integrates recent literature and representative, non-consecutive, cases from the International Ovarian Tumor Analysis (IOTA) database (University Hospitals Leuven) to illustrate macroscopic-sonograp...This narrative review integrates recent literature and representative, non-consecutive, cases from the International Ovarian Tumor Analysis (IOTA) database (University Hospitals Leuven) to illustrate macroscopic-sonographic correlations in epithelial and non-epithelial ovarian malignancies. The main objective was to explore the correlation between ultrasound and gross pathologic features of malignant ovarian tumors, highlighting histotype-specific patterns using IOTA terminology. All patients provided informed consent. Key tumor features (solid components, necrosis, septations, exophytic growth, and papillary projections) were evaluated using standardized IOTA terms. Ultrasound images were compared with matched gross pathology photographs. The integration of matched ultrasound and pathology images may represent an effective educational tool, improving diagnostic accuracy among sonographers. Knowledge of the ultrasound features more frequently reported for specific histotypes in the existing literature, interpreted using IOTA terminology and supported by gross-ultrasound image correlation, may aid the differential diagnosis of borderline and primary invasive ovarian tumors and support subsequent clinical management. This approach may inform surgical decision-making and guide pre-operative planning. A non-validated diagnostic flowchart is proposed to assist in the differential diagnosis of malignant ovarian tumors.
Ledermann JA, Lortholary A, Penson RT
… +19 more, Asher R, Gebski V, Provencher D, Bruchim I, Huzarski T, Barretina-Ginesta MP, Pipitone S, Mileshkin L, Colombo N, Park-Simon TW, Matsumoto K, Boere I, Mikheeva O, Kim JW, Girotto G, Vergote I, Carter D, Lowe ES, Pujade-Lauraine E
Int J Gynecol Cancer
· 2026 May · PMID 41861615
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OBJECTIVE: To characterize the occurrence, duration, and outcomes of the most common non-hematological (nausea, vomiting, fatigue/asthenia) and hematological (anemia, neutropenia) adverse events experienced by patients r...OBJECTIVE: To characterize the occurrence, duration, and outcomes of the most common non-hematological (nausea, vomiting, fatigue/asthenia) and hematological (anemia, neutropenia) adverse events experienced by patients receiving olaparib in the phase III SOLO2 trial. METHODS: SOLO2 (NCT01874353) is a randomized, double-blind, placebo-controlled trial. Eligible patients had histologically confirmed relapsed high-grade serous ovarian cancer or high-grade endometrioid cancer with a BRCA mutation and were in response after platinum-based chemotherapy. Patients were randomized 2:1 to olaparib tablets 300 mg twice daily (N = 196) or placebo (N = 99). Safety outcomes were analyzed in all randomized patients who received ≥1 dose of study drug (olaparib, n = 195; placebo, n = 99). RESULTS: The most common adverse events of interest (nausea, vomiting, fatigue/asthenia, anemia, and neutropenia) were generally reported early, within the first 1 to 3 months of olaparib treatment, and were mostly grade 1/2. For all adverse events of interest, the risk of experiencing an event was statistically significantly higher with olaparib than with placebo (nausea hazard ratio [HR] 3.38, p <.001; vomiting HR 1.86, p =.016; fatigue/asthenia HR 2.11, p <.001; anemia HR 5.80, p <.001; and neutropenia HR 2.66, p =.027). Of these adverse events, only nausea had a statistically significantly higher risk of experiencing a second event with olaparib than with placebo (HR 3.62, p <.001). The prevalence of nausea, fatigue/asthenia, and anemia was higher with olaparib than with placebo across all time points. The median time to resolution of the first adverse event for olaparib versus placebo was 1.7 versus 0.4 months (nausea), 2 versus 2 days (vomiting), 6.4 versus 2.3 months (fatigue/asthenia), 3.2 versus 2.9 months (anemia), and 29 versus 14 days (neutropenia). Fatigue/asthenia was the slowest adverse event to resolve. CONCLUSION: These data confirm that the use of olaparib as long-term maintenance therapy for patients with platinum-sensitive relapsed ovarian cancer is tolerable. Adverse events occurred early, were manageable, and few occurred with late onset.
Giudici A, Tarantino V, De Vitis LA
… +10 more, Genovesi L, Mezzapesa F, Palmieri E, Shelden M, McGree ME, Fought AJ, Ghezzi F, Casarin J, Mariani A, Reynolds EA
Int J Gynecol Cancer
· 2026 May · PMID 41861614
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OBJECTIVE: This study aimed to assess oncologic outcomes associated with p53 abnormal expression in non-myoinvasive endometrial cancer and contextualize these outcomes by comparison with tumors showing limited (< 50%) my...OBJECTIVE: This study aimed to assess oncologic outcomes associated with p53 abnormal expression in non-myoinvasive endometrial cancer and contextualize these outcomes by comparison with tumors showing limited (< 50%) myometrial invasion and/or p53 wild-type expression. METHODS: We retrospectively evaluated patients with uterine-confined endometrial cancer and < 50% myometrial invasion, no cervical invasion, and known p53 status, who underwent complete surgical staging at Mayo Clinic Rochester (1999-2022). All histologic sub-types were included; molecular characterization beyond p53 (including mismatch repair and POLE status) was not systematically available. Adjuvant treatment was administered according to clinicopathological characteristics and institutional practice. Patients' tumors were classified into 4 groups according to p53 status and the presence of myoinvasion: p53 abnormal (p53abn) tumors non-myoinvasive, p53abn tumors with < 50% myoinvasion, p53 wild-type (p53wt) tumors non-myoinvasive, and p53wt with < 50% myoinvasion. Kaplan-Meier curves and log-rank tests were reported for 5-year recurrence-free and overall survival. Univariate and multi-variable Cox proportional hazards models were fitted to identify factors associated with death and recurrence in the overall population. RESULTS: Of the 473 patients, the focus is on 81 patients with p53abn non-myoinvasive endometrial cancer. This group showed an 88.1% (95% confidence interval [CI] 80.5 to 96.3) 5-year recurrence-free survival, with most recurrences being distant (75%). Among patients with p53abn tumors, overall survival did not differ between those with and without myometrial invasion (p53abn non-myoinvasive and p53abn with < 50% myoinvasion pairwise log-rank p =.63), although recurrence-free survival was significantly worse in the p53abn with < 50% myoinvasion group (p53abn non-myoinvasive and p53abn with < 50% myoinvasion pairwise log-rank p =.02). When p53abn non-myoinvasive tumors were compared with p53wt tumors, no differences in overall or recurrence-free survival were observed in pairwise analyses; however, overall survival was significantly shorter for p53abn non-myoinvasive tumors when all p53wt cases were combined (log-rank p =.04), whereas recurrence-free survival remained similar (log-rank p =.59). Abnormal p53 expression was associated with recurrence (hazard ratio [HR] 1.93, 95% CI 1.12 to 3.32) and shorter survival (HR 1.80, 95% CI 1.004 to 3.24), whereas the presence of myometrial invasion was not predictive of either overall or recurrence-free survival. CONCLUSION: This retrospective study confirms the aggressive nature of p53abn tumors, even in the absence of myometrial invasion, underscoring the importance of molecular assessment in endometrium-confined tumors. These results warrant validation in larger, prospective cohorts.
Warsame S, Levin G, Tummala V
… +6 more, Khatib A, Zeng X, Ribeiro R, Bernard L, Gilbert L, Leung SOA
Int J Gynecol Cancer
· 2026 May · PMID 41855712
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OBJECTIVE: Pre-treatment thrombocytosis and elevated C-reactive protein have been linked to poor prognosis in endometrial cancer, although findings are inconsistent. We aimed to study the prognostic significance of C-rea...OBJECTIVE: Pre-treatment thrombocytosis and elevated C-reactive protein have been linked to poor prognosis in endometrial cancer, although findings are inconsistent. We aimed to study the prognostic significance of C-reactive protein and platelet count in a contemporary single-center endometrial cancer cohort. METHODS: A retrospective study was conducted at a single tertiary referral center. We included consecutive patients with endometrial cancer who underwent staging surgery between January 2010 and December 2022. Pre-operative C-reactive protein and platelet counts were recorded. Receiver operating characteristic curve analysis and Kolmogorov-Smirnov statistics were applied. Kaplan-Meier curves and Cox regression were calculated for progression-free survival and overall survival. RESULTS: Overall, 797 patients were included. The median age was 64 years (interquartile range [IQR]; 57-70), and the mean body mass index was 32.4 kg/m (IQR 26.0-37.1). The median follow-up time was 53 months (IQR 31-75). Endometrioid carcinoma was the most common histologic sub-type, comprising 75.4% of cases (n = 601), including grade 1 (46.3%, n = 369), grade 2 (22.1%, n = 176), and grade 3 (7.0%, n = 56)]. The median age was 64 years, and 71% of patients had stage I disease. Thrombocytosis (platelet ≥400,000) was observed in 5.6% of patients, and the median C-reactive protein was 3.2 mg/L. Thrombocytopenia (platelet <150,000) occurred in 24 (3.0%) patients. Receiver operating characteristic analysis showed limited predictive performance for recurrence (area under the curve: 0.434 for platelet, 0.506 for C-reactive protein) and modest performance for death (area under the curve: 0.513 and 0.613, respectively). Using a C-reactive protein cutoff of 2.45 mg/L, patients with elevated C-reactive protein had significantly worse overall survival (p <.001). In multi-variable Cox analysis, C-reactive protein remained independently associated with overall survival (adjusted hazard ratio [HR] 2.37, 95% confidence interval [CI ] 1.23 to 4.55), along with age (HR 1.05, 95% CI 1.02 to 1.08), stage IV disease (HR 5.82, 95% CI 3.06 to 11.08), and P53 mutated (HR 2.69, 95% CI 1.06 to 6.79). Platelet was not prognostic. CONCLUSIONS: Pre-treatment C-reactive protein is an independent predictor of survival in endometrial cancer, whereas platelet count shows limited prognostic relevance. C-reactive protein may serve as an accessible biomarker to refine risk stratification, particularly in low-resource settings where molecular profiling is not routinely available.
Int J Gynecol Cancer
· 2026 Feb · PMID 41850927
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OBJECTIVE: This study aimed to evaluate the associations of parity, breastfeeding duration, oral contraceptive use, menopausal hormone replacement therapy, age at menarche, age at menopause, and reproductive lifespan wit...OBJECTIVE: This study aimed to evaluate the associations of parity, breastfeeding duration, oral contraceptive use, menopausal hormone replacement therapy, age at menarche, age at menopause, and reproductive lifespan with ovarian cancer risk in post-menopausal women using large-scale real-world data from the Korean National Health Insurance Service. METHODS: This nationwide, population-based retrospective cohort study used National Health Insurance Service health screening and claims data. The study included 3,754,906 post-menopausal women aged 40 to 79 years who underwent national health examinations between 2009 and 2012. Reproductive factors were assessed at baseline using standardized self-administered questionnaires, whereas menopausal hormone replacement therapy exposure was identified from prescription records. Incident ovarian cancer was defined as ≥3 claims with an International Classification of Diseases, 10th Revision (ICD-10) C56 diagnosis. Univariable and multi-variable Cox proportional hazards regression analyses were performed to estimate the hazard ratios and 95% confidence intervals. RESULTS: During follow-up, 7702 women (0.2%) developed ovarian cancer. Compared with nulliparity, having ≥2 births was associated with lower risk. Breastfeeding for ≥12 months and oral contraceptive use for ≥1 year were also associated with reduced risk. By contrast, menopause at ≥55 years and a reproductive lifespan of ≥40 years were associated with increased risk. Menopausal hormone replacement therapy use for ≥5 years was also associated with higher risk, whereas age at menarche showed no association with ovarian cancer. CONCLUSIONS: In this cohort, reproductive factors that reduce lifetime ovulatory exposure were associated with lower ovarian cancer risk, whereas factors that prolong ovulatory lifespan and long-term menopausal hormone replacement therapy were associated with higher risk. These observational findings may help refine ovarian cancer risk assessment and counseling in post-menopausal women, but do not establish causality.
Int J Gynecol Cancer
· 2026 Apr · PMID 41844494
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Endometrial cancer is the most common gynecologic malignancy in women, and has undergone many changes in treatment and management. We conducted a scoping review of the literature examining changing patterns of care over...Endometrial cancer is the most common gynecologic malignancy in women, and has undergone many changes in treatment and management. We conducted a scoping review of the literature examining changing patterns of care over the last 20 years. We aimed to document key trends in endometrial cancer management and identify areas where the literature is lacking to provide guidance for future directions of research, institutional needs, and policy development.
Caruso G, Delfrati S, Casaccia Giordano F
… +16 more, Panizzolo E, De Luca Carignani B, Laudani ME, Stefani E, Donatiello G, Fumagalli D, Ribero L, Rosanu M, Ainio C, Betella I, Schivardi G, Bogani G, Multinu F, Aletti G, Cliby W, Colombo N
Int J Gynecol Cancer
· 2026 Apr · PMID 41844493
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The role of systematic pelvic and para-aortic lymphadenectomy in presumed early-stage ovarian cancer remains controversial due to the lack of high-quality prospective evidence. No therapeutic benefit has been confirmed f...The role of systematic pelvic and para-aortic lymphadenectomy in presumed early-stage ovarian cancer remains controversial due to the lack of high-quality prospective evidence. No therapeutic benefit has been confirmed for systematic lymphadenectomy during surgical staging for apparent early-stage ovarian cancer. Lymphadenectomy may improve progression-free survival but has demonstrated no impact on overall survival, except for clear cell ovarian cancer, where a potential survival benefit has been suggested in retrospective studies. Systematic lymphadenectomy retains a diagnostic role in identifying occult nodal metastases (9% to 30% across series) undetected on pre-operative imaging or intra-operative assessment. The decision to perform lymphadenectomy should be individualized based on several factors, including histological sub-type, tumor grade, stage, and biomarker profile. Key considerations include the anticipated risk of lymph node metastasis, the opportunity to tailor adjuvant treatment by either omitting chemotherapy or offering maintenance targeted therapy, peri-operative morbidity, long-term sequelae impacting quality of life (eg, lower limb lymphedema), and cost-effectiveness. Systematic lymphadenectomy is guideline-recommended for high-grade tumors, including high-grade serous, high-grade endometrioid, and clear cell histologies, whereas it can be omitted in low-grade endometrioid and expansile mucinous sub-types. Its significance in low-grade serous and infiltrative mucinous ovarian cancers remains unclear, although guidelines frequently advocate for lymphadenectomy in these cases. To optimize patient selection, large-scale prospective studies with proper stratification by histotype and molecular profile are required. Emerging approaches to lymph node assessment, such as sentinel lymph node biopsy, artificial intelligence-assisted pre-operative imaging, and liquid biopsy, hold promise for improving staging accuracy.
Rosati A, Criscione M, Lilli L
… +4 more, Petrillo M, Capobianco G, Patarnello S, Fagotti A
Int J Gynecol Cancer
· 2026 Apr · PMID 41819636
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OBJECTIVE: Natural language processing is emerging as a key application of artificial intelligence in oncology. This systematic review aims to evaluate the performance and methodological frameworks of natural language pr...OBJECTIVE: Natural language processing is emerging as a key application of artificial intelligence in oncology. This systematic review aims to evaluate the performance and methodological frameworks of natural language processing systems in gynecologic oncology. METHODS: We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. MEDLINE, EMBASE, and Web of Science were searched for studies published between January 2015 and February 2025. Outcomes were synthesized across 3 research questions: the accuracy of natural language processing systems used as consultation service platforms; the accuracy of natural language processing systems used as clinical decision support systems; and the benchmarking methodologies applied, including their associated methodological outcomes. Consultation service platforms deliver general medical information, whereas clinical decision support systems provide recommendations that are integrated into the patient's clinical workflow. RESULTS: This review analyzed 12 retrospective studies. Consultation service platforms were less accurate than clinicians (60% vs 86.7%) and rated lower in response quality (2.96/5 vs 4.2/5) but outperformed guideline-based answers (1.54/2 vs 1.38/2). In cervical cancer, ChatGPT surpassed experts (7.0 vs 6.1). ChatGPT-4 showed a concordance of 70% with the National Comprehensive Cancer Network and 60% with the European Society of Gynaecological Oncology guidelines in clinical decision support tasks, with an overall recommendation accuracy of 75%. IBM Watson achieved a 72.8% concordance with guidelines. Prompting was applied from 100% to 37.5% across studies. Qualitative benchmarking varied across studies: 83.3% used clinical guidelines and 37.5% of consultation service platforms studies used expert answers. Four- or 5-point scales and binary scoring were used to assess consultation service platforms and clinical decision support systems, respectively. CONCLUSIONS: Clinicians remain superior in complex reasoning, but natural language processing systems demonstrate robust performance in guideline-driven tasks, with advantages in speed, readability, and reproducibility. However, performance declined in nuanced scenarios and among under-represented patient sub-groups. Large language models currently play a supportive rather than substitutive role in gynecologic oncology.
Harris FR, De Vitis LA, Grcevich L
… +33 more, Capasso I, Murphy SJ, Smadbeck JB, McCune AF, Ali MF, Karagouga G, Johnson SH, Sadeghian D, Schivardi G, Cucinella G, Reynolds EA, Choong GM, Yang L, Larish AM, Barrett MT, Emanuel AR, Schaefer-Klein JL, Kosari F, Penheiter AR, Grassi T, Sotiriou S, Cheville J, Feathers RW, Lin WH, Lemens M, Borad MJ, Mansfield AS, Fought AJ, McGree ME, Anastasiadis PZ, Weroha SJ, Mariani A, Vasmatzis G
Int J Gynecol Cancer
· 2026 May · PMID 41813530
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OBJECTIVE: We investigated the clinical validity and feasibility of a DNA junction-based quantitative polymerase chain reaction assay to detect and quantitate circulating tumor DNA (ctDNA) in the blood of high-risk patie...OBJECTIVE: We investigated the clinical validity and feasibility of a DNA junction-based quantitative polymerase chain reaction assay to detect and quantitate circulating tumor DNA (ctDNA) in the blood of high-risk patients with endometrial cancer. METHODS: Whole genome sequencing tumor data was analyzed from 36 patients to select prominent somatic tumor-specific DNA junctions. Personalized quantitative polymerase chain reaction assays were developed for each junction and applied to available blood specimens to measure levels of ctDNA. RESULTS: Pre-surgical blood ctDNA was detected in 71% of the cases tested (56% early-stage vs 88% advanced-stage). In patients with available pre-amplified pre-surgical ctDNA (n = 15), pre-surgical ctDNA levels were elevated in patients with vital status or "alive with disease" or "died of disease" compared to patients with "no evidence of disease" (p < .005). Among 17 patients followed serially, ctDNA detection preceded clinical detection of recurrence in 5 of 8 cases and was concurrent in 1, with the caveat that imaging was rarely concurrent with blood draw timing. CONCLUSIONS: Personalized junction-based measurement of ctDNA demonstrated promising clinical validity in pre-surgical prognosis and relapse prediction.
Poncova R, Frühauf F, Borcinova M
… +4 more, Fischerova D, Kocian R, Zikan M, Cibula D
Int J Gynecol Cancer
· 2026 Apr · PMID 41812303
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OBJECTIVE: Tissue biopsy is an important component of pre-surgical pathologic diagnosis of cancer for treatment planning and clinical research. Core needle biopsy, or Tru-Cut biopsy, was introduced in the 1960s and 1970s...OBJECTIVE: Tissue biopsy is an important component of pre-surgical pathologic diagnosis of cancer for treatment planning and clinical research. Core needle biopsy, or Tru-Cut biopsy, was introduced in the 1960s and 1970s but has not yet become routine in gynecologic oncology, and few studies have examined its adequacy or accuracy in this setting. We report our experience of ultrasound-guided core needle biopsy in patients with gynecologic malignancies. METHODS: We conducted a retrospective study of ultrasound-guided core needle biopsy at a single tertiary hospital in Prague, Czech Republic, using electronic medical records of cases between 2010 and 2022. We examined the adequacy of biopsy samples, accuracy relative to surgical pathology specimens, and safety. Ultrasound-guided core needle biopsy was performed using standardized procedures. RESULTS: A total of 690 core needle biopsy procedures were evaluated (456 in newly diagnosed cases and 234 in recurrent cases), including 16 repeat procedures, in 674 patients. The 3 most common biopsy sites were ovary (29.3%), carcinomatosis (17.4%), and indeterminate pelvic mass (10.2%). Most (85.9%) biopsies retrieved 3 tissue samples. Core needle biopsy was adequate to establish a diagnosis in 622 of 690 cases (90.1%), and repeat core needle biopsy yielded an additional 16 adequate samples (2.3%). The adequacy rate was highest for ovarian biopsies (96.6%) and lowest for uterine body biopsies (83.3%). Pathologic assessment of core needle biopsy agreed with surgical specimens in 263 of 273 patients who underwent surgery, with an accuracy rate of 96.3%. There was no clear correlation between inaccurate biopsy results and final histotypes. Complications occurred in 9 of 690 core needle biopsy procedures (1.3%), including 6 cases of intra-procedural bleeding (3 required hospitalization), 2 cases of infection, and 1 case of a psychogenic reaction (non-epileptic seizure). CONCLUSIONS: Ultrasound-guided core needle biopsy is an accurate, well-tolerated technique that provides reliable diagnostic tissue in gynecologic oncology and may be considered a preferred approach for initial evaluation and confirmation of disease.