DOI: 10.3897/jbcr.e145118

Authors: Nadezhda Hinkova, Kamelia Tsvetanova, Tihomir Totev, Margarita Nikolova, Teodora Semova, Dimitar Dimitrov, Elitsa Petkova

Abstract: Endometrial carcinoma remains one of the leading places in terms of frequency among oncogynecological diseases, both in countries with developed primary and secondary prevention and in countries with poorly functioning prevention. The implementation of screening programs would lead to the detection of oncological diseases in outpatient settings at an early stage, which would lead to positive socio-economical effects for society. This study aims to determine the test’s validity through the following criteria: sensitivity, specificity, and negative and positive predictive value of endometrial cytology compared with the histological result of examined tissue samples. We studied 300 women with abnormal uterine bleeding examined at the Clinic of Obstetrics and Gynecology at Saint Marina University Hospital– Pleven. Specimens for endometrial cytology were taken from all patients before invasive intervention. We compared the cytological results to evaluate the test validity, including sensitivity, specificity, and negative and positive predictive value in the cases with endometrial carcinoma. Statistical data processing was performed using the software programs MS Office Excel 2019 and IBM SPSS Statistics 28.0. The significance of results, findings and conclusions was determined at p < 0.05. A comparative analysis was performed on the cytological and histological results we obtained before and after the invasive manipulation. The study found statistical significance between the Pipelle biopsy results and cytological results (χ2 = 50.05, df = 24, p = 0.01, Cramer’s v = 0.439). Data analysis showed that endometrial cytology had a high specificity in proving endometrial carcinoma and a low positive predictive value (Se = 80%; Sp = 98%; PV = 66.7%; NV = 96.9%). Endometrial cytology could be an effective diagnostic method and can be applied to diagnose endometrial pathology. The combination of the two methods - cytological examination and transvaginal ultrasound would undoubtedly improve the detection rate of endometrial carcinoma. Additionally, cytology is an appropriate outpatient procedure that can be recommended for endometrial screening, especially in patients at high risk of developing endometrial cancer.

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DOI: 10.3897/jbcr.e138140

Authors: Dimitar Dimitrov, Nadezhda Hinkova, Teodora Semova, Zornitsa Gorcheva, Mirela Vasileva, Elitsa Petkova

Abstract: The main methods of histological diagnosis of endometrial carcinoma are dilatation and curettage, fractional curettage, and diagnostic hysteroscopy with endometrial biopsy. This retrospective study aims to compare the preoperative histological results obtained by different diagnostic methods with the postoperative ones in patients with endometrial carcinoma and determine the most accurate and safest method for diagnosing the disease. From 06.2020 to 09.2023, a retrospective study was conducted on 80 patients with histologically proven carcinoma of the endometrium, treated at University Hospital Saint Marina-Pleven. The mean age of the patients was 58.04 ± 10.46, ranging from 28 to 78. The comparative analysis of the discrepancies of the histological verification methods in the evaluation of the preoperative and postoperative histological result showed that a statistically significantly higher percentage of discrepancies (19.5%) had the dilatation and curettage compared to the zero discrepancy of the hysteroscopy (0.0%). The relative proportion of discrepancies of the fractional curettage is 14.3%. The cytological result was negative for tumor cells in 97.5% and positive in 2.5%. In all patients with a positive cytological result for tumor cells, the method of histological verification was dilatation and curettage. Performing diagnostic hysteroscopy and observing safety principles such as creating low intrauterine pressure and short operative time is a safe and reliable method for diagnosing endometrial carcinoma.

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DOI: 10.3897/jbcr.e138141

Authors: Teodora Semova, Slavcho Tomov, Tihomir Totev, Dimitar Dimitrov, Zornitsa Gorcheva, Valeria Racheva

Abstract: Standard treatment for ovarian cancer includes optimal cytoreduction, followed by chemotherapy in most cases. This study aimed to evaluate the role of minimally invasive approaches in diagnosing and treating ovarian carcinoma. We conducted a retrospective analysis of patients diagnosed with ovarian carcinoma who underwent surgery at the Department of Obstetrics and Gynecology at St. Marina University Hospital–Pleven from January 2020 to April 2023. The study included 213 patients; the average age was 58.90 years. Out of all patients in the study, 64 initially received only diagnostic intervention. Of these patients, 53 (24.9%) underwent minimally invasive diagnostic intervention, while 11 (5.2%) had diagnostic intervention through conventional laparotomy. Among the patients who had surgery, the most common procedure (53.1%) was total abdominal hysterectomy with bilateral salpingo-oophorectomy, followed by diagnostic laparoscopy with subsequent laparotomy (14.6%). Thirty-one (14.6%) of the patients had interval surgery. Twenty-seven (87.1%) patients underwent minimally invasive diagnostic intervention. Moreover, 21 (67.7%) patients who had interval surgery also underwent surgery using a minimally invasive approach. The obtained results show that minimally invasive approaches are widely used in the diagnosis and treatment of ovarian carcinoma. The increasing adoption of interval surgery will expand another application of minimally invasive surgery - robot-assisted interval surgery after neoadjuvant chemotherapy.

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DOI: 10.3897/jbcr.e126709

Authors: Hristo S. Milev, Vasil Nanev, Desislava Dimitrova, Strahil Strashilov, Angel Yordanov, Miroslava Mihailova-Strashilova, Silvia Naneva, Simoneta Ivanova, Milena Karcheva, Ivan Ivanov

Abstract: There are no specific recommendations for evaluating the Ki-67 index in heterogeneous breast carcinomas. This study aimed to evaluate the applicability of currently accepted recommendations for Ki-67 evaluation in breast cancer in the context of intratumor heterogeneity. Twelve cases of heterogeneous breast carcinomas obtained from 110 patients were retrospectively studied. Ki-67 staining was performed according to protocols provided by the reagent manufacturer. Results for Ki-67 of the separate components in each tumor were obtained, described, and analyzed statistically using a paired t-test. Values of p < 0.05 were considered as statistically significant. SPSS software was used for statistical analysis. Results from the comparison of the Ki-67 index evaluation in each heterogeneous component of the studied tumors demonstrated no statistically significant difference of mean values t = 0.4802, p = 0.6405. The anticipation of an average Ki-67 score in the evaluated cases would have changed the molecular subtype from Luminal B to Luminal A (due to the Ki-67 index below 14%) in two of the cases. Heterogeneous tumors had a different Ki-67 index in their separate components. Our observations suggest that Ki-67 in heterogeneous breast carcinoma is evaluated and reported separately for the distinguishable tumor components.

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