The effectiveness of a levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of endometrial hyperplasia--a long-term follow-up study

OBJECTIVES: Medical treatment of non-atypical endometrial hyperplasia with oral progestogens has limited efficacy and poor compliance. A levonorgestrel-releasing intrauterine system (LNG-IUS) has been shown to successfully treat hyperplasia in small-sized studies. Our aim was to examine the effectiveness of LNG-IUS in a larger study with long-term follow up. STUDY DESIGN: Prospective observational study of 105 women diagnosed with endometrial hyperplasia and treated with LNG-IUS between 1999 and 2004 at a University Teaching hospital. Baseline characteristics and outpatient endometrial Pipelle sampling were undertaken at 3 and 6 months post LNG-IUS insertion and 6-monthly intervals thereafter in all cases. Outcome included histological data derived from both Pipelle and uterine histologies at 1 and 2 years LNG-IUS therapy. RESULTS: LNG-IUS achieved endometrial regression in 90% (94/105) of cases by 2 years, with a significant proportion (96%, 90/94) achieving this within 1 year. Regression occurred in 88/96 (92%) of non-atypical and 6/9 (67%) of atypical hyperplasias, and in all 22 cases of endometrial hyperplasia associated with HRT. Regression rates did not differ between histological types of hyperplasia. Twenty-three women (22%) underwent hysterectomy of which 13 were indicated and 10 were performed at patient request despite regressed endometrium. Two cases of cancer (one uterine and one ovarian) were identified. CONCLUSION: LNG-IUS is highly effective in treating endometrial hyperplasia. Beneficial effects are observed by the majority within 1 year. Treatment can be reliably monitored through regular 6-montly outpatient endometrial Pipelle surveillance. LNG-IUS treatment of non-atypical hyperplasias is likely to reduce the number of hysterectomies performed in this subgroup.     

The management of endometrial hyperplasia: an evaluation of current practice

OBJECTIVE: To identify current management practices and evaluate subsequent outcomes of treatment for women diagnosed with endometrial hyperplasia. STUDY DESIGN: All women with a histological diagnosis of endometrial hyperplasia at the Birmingham Women's Hospital were identified between October 1998 and September 2000. A retrospective case note review was performed for each woman using a standardised data abstraction sheet. Baseline characteristics including clinical presentation and treatment strategy were obtained. Results of subsequent endometrial tissue examinations were used to assess histological response to treatment and the need and indication for hysterectomy was used to assess clinical response. RESULTS: There were 351 women diagnosed with endometrial hyperplasia during the study period of which 84% presented with symptoms of abnormal uterine bleeding and 54% were postmenopausal. Complex endometrial hyperplasia was the most common diagnosis accounting for 60% of all cases. Eighty percent of women with atypical endometrial hyperplasia were treated by hysterectomy compared with 30% without evidence of cytological atypia (relative hysterectomy rate of 2.6, 95% CI 2.0-3.3). Hysterectomy was avoided in 138/172 (80%, 95% CI 74-86%) women managed conservatively during the study period. Overall 35/108 (36%, 95% CI 27-46%) of women managed conservatively had persistent or progressive disease identified (mean follow up 36 months). 20/143 (14%) women initially diagnosed with endometrial hyperplasia who subsequently underwent hysterectomy were found to have endometrial cancer, the majority of whom had been diagnosed with atypical disease (14/20, 70%). CONCLUSION(S): The majority of women with atypical endometrial hyperplasia were managed by hysterectomy and the substantial risk of diagnostic under-call supports this approach to treatment. In contrast, there is no consensus regarding the initial management of women with endometrial hyperplasia without cytological atypia.     

Non-contraceptive uses of levonorgestrel-releasing hormone system (LNG-IUS)--a systematic enquiry and overview

Levonorgestrel releasing-intrauterine systems (LNG-IUS) were originally developed as a method of contraception in the mid 1970s. The only LNG-IUS approved for general public use is the Mirena LNG-IUS, which releases 20 mcg of levonorgestrel per day directly in to the uterine cavity. However, new lower dose (10 and 14 mcg per day) and smaller sized LNG-IUS (MLS, FibroPlant-LNG) are currently under clinical development and investigation. Research into the non-contraceptive uses of LNG-IUS is rapidly expanding. In the UK, LNG-IUS is licensed for use in menorrhagia and to provide endometrial protection to perimenopausal and postmenopausal women on estrogen replacement therapy. There is limited evidence to suggest that LNG-IUS may also be beneficial in women with endometriosis, adenomyosis, fibroids, endometrial hyperplasia and early stage endometrial cancer (where the patient is deemed unfit for primary surgical therapy). This systematic enquiry and overview evaluates the quality of evidence relating to the non-contraceptive therapeutic uses of LNG-IUS in gynaecology.     

左炔诺孕酮宫内缓释系统治疗子宫内膜单纯性增生过长的研究

目的：探讨左炔诺孕酮宫内缓释系统（曼月乐）治疗子宫内膜单纯性增生过长的疗效及可能作用机制。方法：选取 2011年11月—2012年2月门诊应用曼月乐治疗子宫内膜单纯性增生过长的患者60例,观察放置曼月乐6个月后的子宫内膜活检病理变化及经阴道超声测量子宫内膜厚度、子宫动脉血流[阻力指数（RI）、搏动指数（PI）]及月经模式的改变。结果：2例由于阴道持续性点滴出血提前取出,58例子宫内膜转归正常。放置曼月乐前后子宫内膜厚度、RI分别为（1.52±0.33） cm、（0.62±0.14）cm和0.64±0.07、0.79±0.08,差异均有统计学意义（P＜0.05或P＜0.01）,PI分别为1.98±0.51、1.96±0.04,差异无统计学意义（P＞0.05)。放置曼月乐后经量明显减少,24例表现为月经稀发,32例表现为闭经。结论：曼月乐是治疗子宫内膜单纯性增生过长的简单有效方法,对子宫动脉血流的影响是其可能的作用机制。     

The utility of sentinel lymph node mapping in the management of endometrial atypical hyperplasia

Objectives

To determine the risk of endometrial cancer (EC) and lymph node involvement in patients with a preoperative diagnosis of “AH-only” versus “AH - cannot rule out carcinoma” and to study the value of SLN mapping.

Bcl-2, BAX, and apoptosis in endometrial hyperplasia after high dose gestagen therapy: a comparison of responses in patients treated with intrauterine levonorgestrel and systemic medroxyprogesterone

OBJECTIVES: The aim of the study was to investigate apoptosis as a growth regulatory mechanism of gestagen in endometrial precancers and to compare differences in the apoptotic cascade after high and low dose gestagen regimens. METHOD: Pre- and post-treatment paraffin-embedded endometrial hyperplasia specimens from women treated with levonorgestrel intrauterine device (n = 26) and women treated with 10 mg medroxyprogesterone for 10 days per cycle (n = 31) were examined for changes in the expression of Bcl-2 and BAX and the extent of apoptosis after 3 months of treatment. Immunohistochemical expression in tissue specimens for Bcl-2 and BAX was evaluated by H-score. Average number of apoptotic cells per hundred cells within ten different high power field (40 x) was evaluated for each section after in situ apoptosis detection (TUNEL method). A second group of patients with endometrial hyperplasia was examined after 1 week treatment with levonorgestrel IUD (n = 6) or medroxyprogesterone (n = 5) to determine early effects on expression of Bcl-2 and BAX and the extent of apoptosis. RESULTS: All the patients in the IUD group (n = 31) but only about half of the patients in per oral group (16 of 26) responded to treatment. The glandular reduction in Bcl-2 expression was markedly greater for the IUD patients than for the patients who received oral gestagen. The decrease in BAX expression after IUD treatment was less than the reduction of Bcl-2. Decrease in glandular Bcl-2 after 3 months of treatment was coincident with a significant increase in the measurable amount of apoptosis. In stromal cells, the increase in expression of Bcl-2 and BAX was found after gestagen treatment, the response being much more marked for the IUD group. The non- responders to per oral gestagen had no Bcl-2 expression in stroma after 3 months of therapy whereas an increase was observed for the responders. After 1 week, glandular Bcl-2 expression was significantly reduced after treatment in the IUD group. As for the rest, no changes were detected in either of the groups. CONCLUSION: Our results indicate that proteins in the apoptotic cascade are regulated by gestagen therapy in human endometrial precancers. Expression of these proteins is shown to be dependent on administration form and/or type of gestagen. Stromal Bcl-2 expression appears to be a potential biomarker which can separate responders of gestagen treatment from non-responders after oral administration.     

子宫内膜非典型增生79例临床病理特征分析

目的 分析子宫内膜非典型增生患者的临床病理特征.方法 选择2007年3月至2010年7月北京大学人民医院收治的诊断为子宫内膜非典型增生患者79例,其中49例(62%)为单纯子宫内膜非典型增生(增生组),30例(38%)为子宫内膜非典型增生合并癌变(癌变组).回顾性分析子宫内膜非典型增生患者的临床病理特征[包括年龄、孕产次、体质指数(BMI)、绝经及阴道流血情况、合并症、B超检查等],并对两组患者进行比较.分析了分段诊刮及宫腔镜检查在子宫内膜非典型增生诊断中的价值.结果 (1)年龄:患者平均年龄为(50±11)岁,其中癌变组为(51±11)岁,增生组为(50±10)岁,两组比较,差异无统计学意义(P=0.994).(2)孕产次:两组患者孕产次分别比较,差异均无统计学意义(P＞0.05).(3)合并症:增生组和癌变组有合并症的患者分别为23例(47%)和13例(43%),两组比较,差异无统计学意义(P=0.755).(4)BMI:癌变组明显高于增生组[分别为(27.9±5.4)和(25.2±2.9)kg/m2,P=0.024].(5)绝经及阴道流血情况:绝经后患者癌变组为50%(15/30),增生组为31%(15/49),两组比较,差异无统计学意义(P=0.085);绝经后阴道流血患者癌变组为13/15,增生组为8/15,两组比较,差异无统计学意义(P=0.109);未绝经有月经改变患者癌变组为12/15,增生组为68%(23/34),两组比较,差异无统计学意义(P=0.590).(6)B超检查:癌变组阳性(指官腔有回声团)率明显高于增生组[分别为73%(22/30)和51%(25/49),P=0.050].(7)分段诊刮和官腔镜检查的诊断价值:行分段诊刮活检患者23例(29%)、宫腔镜活检44例(56%),两者对非典型增生的初次诊断率分别为87%(21/23)和93%(41/44),对非典型增生伴癌变的初次诊断率分别为6/12和12/16,诊断为非典型增生的患者中癌变的漏诊率分别为6/13和19%(4/21),分别比较,差异均无统计学意义(P＞0.05).结论 对于围绝经期异常阴道流血患者,应积极进行分段诊刮及官腔镜检查,分段诊刮或官腔镜活检诊断为子宫内膜非典型增生患者中,若其BMI较高或B超提示官腔有回声团,应警惕合并子宫内膜癌的可能.

Abstract：

Objective To explore the clinicopathological characteristics in atypical endometrial hyperplasia patients. Methods A retrospective study was carry out on 79 cases with atypical endometrial hyperplasia patients admitted to Department of Gynecology, Peking University People's Hospital from Mar.2007 to Jul. 2010. All patients were divided into two groups, hyperplasia group (merely atypical endometrial hyperplasia, 49 cases, 62%) and cancerization group (atypical endometrial hyperplasia accompanying endometrial carcinoma, 30 cases, 38%). Results The mean age of 79 cases were (50 ± 11) years old ,while they were (50 ± 10) and (51 ± 11) years old for hyperplasia group and cancerization group, there were not difference (P = 0.994). The gravidity and delivery frequencies were also not differently between two groups. The rates of complicated other diseases were 47% (23/49) and 43% (13/30), which was not significantly different (P = 0.755). The body mass index (BMI) of cancerization group was higher than that of hyperplasia group [(27.9 ± 5.4) vs. (25.2 ± 2.9) kg/m2, P = 0.024]. There were 50% (15/30) and 31% (15/49) menopause cases in two groups, respectively. Among them there were 13/15 and 8/15 cases showed vaginal bleeding. Among premenopausal patients, there were 12/15 and 68% (23/34) showed abnormal vaginal bleeding, but there were not significantly different between two groups (all P ＞ 0.05). The uterine cavity mass found by ultrasonography in the cancerization group patients was more than that in hyperplasia group [73% (22/30) vs. 51% (25/49), P = 0.050]. There were 23 cases (29%), 44 cases (56%) and 12 cases (15%) were diagnosed by dilatation and curettage (D&G), hysteroscopy and hysterectomy, respectively. The rates of diagnosing atypical endometrial hyperplasia by D&G and hysteroscopy were 87 % (21/23) and 93 % (41/44), respectively. The rate of diagnosis of canceration were 6/12 and 12/16, respectively. While, the rate of missed diagnosis of canceration in the atypical endometrial hyperplasia patients by D&G and hysteroscopy were 6/13 and 19% (4/21) ,respectively. Which all did not shown significantly different (P ＞ 0.05). Conclusion Hysteroseopy or D&G should be chosen on those peri-menopausal patients with abnormal bleeding, while those atypical endometrial hyperplasia patients with high BMI and uterine cavity mass diagnosed with D&G and ultrasonography should consider the possibility of canceration.     

Impact of obesity on the results of fertility-sparing management for atypical hyperplasia and grade 1 endometrial cancer

Objectives

The aim of the present study was to evaluate the impact of obesity on reproductive and oncologic outcomes on the success of fertility-sparing management.

Methods

This retrospective multicenter cohort study included women treated conservatively for atypical hyperplasia (AH) and endometrial cancer (EC) to preserve fertility. Five inclusion criteria were defined: (i) the presence of AH or grade 1 EC confirmed by two pathologists; (ii) adequate radiological examination before conservative management; (iii) available body mass index (BMI) at the beginning of treatment; and (iv) a minimum follow-up time of six months.

Results

Forty patients fulfilled the inclusion criteria (17 had EC, and 23 had AH), mean age and BMI were 33 years and 29 kg/m² respectively. Among the 15 obese patients, after medical treatment, 10 patients responded (67%) and three relapsed, whereas in the 25 non-obese patients, 19 responded (76%) and three relapsed (p = 0.72). The overall pregnancy rate and follow-up time were 35% and 35 months respectively. Among the 15 obese patients, after medical treatment, two patients became pregnant, whereas in the 25 non-obese patients, 12 became pregnant (p = 0.04).

Conclusion

Despite similar response and recurrence rates, our results suggest that fertility-sparing management for AH and EC is associated with a lower probability of pregnancy in obese patients.     

子宫内膜不典型增生和早期子宫内膜癌保守治疗方案分析

随着癌症发病的年轻化,患有子宫内膜癌的育龄期女性越来越多。为了保留生育能力,大部分患者倾向于保守治疗。故而众多研究者提出了子宫内膜不典型增生和早期子宫内膜癌的保守治疗方案,并在临床上进行了小样本研究。传统治疗以口服大剂量孕激素为主,然而多数口服孕激素治疗的患者复发率高、并发症多。左炔诺孕酮宫内缓释节育系统通过局部作用于子宫内膜,可减少大量孕激素对机体造成的不良反应。宫腔镜能够精准切除病灶,保护正常子宫内膜,相对降低了发生不孕、流产风险。二甲双胍的抗肿瘤作用能增加孕激素的有效率。通过综述子宫内膜不典型增生和早期子宫内膜癌各种保守治疗后的缓解率、复发率和妊娠结局,为临床上在治疗前对每位患者的自身因素及疾病特点进行评估,以采取对患者最有益的治疗方案及管理模式提供依据。     

子宫内膜癌及癌前病变危险因素的调查研究

目的:研究子宫内膜癌(EC)及癌前病变的流行病学特征及其发病的高危因素,为明确EC筛查的适宜人群提供依据.方法:选取2009年3月到2010年7月在北京大学第一医院妇产科行宫腔镜检查+分段诊刮术且同时行子宫内膜细胞学检查的540例患者.比较组织病理学诊断与子宫内膜细胞学筛查的结果.采用SPSS1O.0软件二分类非条件Logistic回归分析对影响组织病理学与子宫内膜细胞学结果的高危因素进行分析.结果:组织病理学结果为EC/非典型增生的相关危险因素:BMI≥25kg/m2、年龄≥40岁、糖尿病、高血压、绝经、恶性肿瘤家族史和毒物放射线接触史;独立危险因素:BMI≥25kg/m2、年龄≥40岁、糖尿病和恶性肿瘤家族史.子宫内膜细胞学报告为非典型腺细胞以上的相关危险因素:BMI≥23 kg/m2、年龄≥40岁、糖尿病、高血压、绝经和恶性肿瘤家族史;独立危险因素:BMI≥23 kg/m2和年龄≥40岁.结论:建议对年龄≥40岁或恶性肿瘤家族史的患者中进行EC的筛查;对肥胖、糖尿病的患者加强子宫内膜状况的监测.子宫内膜细胞学报告与病理学诊断的高危因素谱基本相同.     

高分化子宫内膜样癌及子宫内膜重度不典型增生患者孕激素治疗的临床分析

目的探讨35岁以下高分化子宫内膜样癌及子宫内膜重度不典型增生患者采用孕激素治疗以保留患者子宫的疗效,并随访其治疗后的生育情况.方法采用回顾性分析的方法对1991年至2005年北京协和医院收治的35岁以下、接受孕激素治疗（以醋酸甲羟孕酮为主）的25例高分化子宫内膜样癌及子宫内膜重度不典型增生患者的临床病理资料进行研究.其中,子宫内膜样癌8例（内膜癌组）,子宫内膜重度不典型增生17例（不典型增生组）.孕激素治疗前对患者进行全面的分期评估,治疗后每1～6个月诊刮以评价疗效,对有生育要求者随访其生育情况.结果内膜癌组患者孕激素治疗前经全面的分期评估,证实为早期、高分化子宫内膜样癌.除1例子宫内膜样癌患者尚未评估疗效外,内膜癌组其他7例及不典型增生组17例患者治疗后有效者分别为6例（6/7）、17例（100%）;缓解者分别为5例（5/7）、14例（82%）;缓解后复发者分别为1例（1/5）、3例（21%）,复发时间为缓解后6～30个月;随访缓解后要求生育的14例患者中,内膜癌组4例患者尚未生育,不典型增生组10例患者中4例妊娠共7次.1例自然受孕后失访;3例经促排卵治疗后受孕并足月分娩,其中1例产后人工流产3次.结论对于要求保留子宫的高分化子宫内膜样癌及子宫内膜重度不典型增生的年轻患者,孕激素治疗是一种治疗选择.孕激素治疗前应对子宫内膜样癌患者进行详细全面的分期评估,辅助生殖措施的介入有望提高治疗后的妊娠率.     

Current practice for the treatment of benign intrauterine polyps: a national questionnaire survey of consultant gynaecologists in UK

OBJECTIVE: To determine current practice regarding removal of endometrial polyps. STUDY DESIGN: A self-administered questionnaire to all 1509 UK consultant gynaecologists to enquire about their current practice and potential willingness to participate in a randomised trial. RESULTS: Treatment methods varied considerably. Inpatient polypectomy was used by 91% and the favoured method was blind removal of polyp following hysteroscopic localisation (53%). Direct hysteroscopic polypectomy was more commonly performed by 46% members of endoscopic societies compared to 33% of non-members. Outpatient polypectomy was performed by 19% of users of outpatient diagnostic hysteroscopy compared to 2.5% of non-users. One-third of respondents were willing to enter patients into a randomised controlled trial to determine the optimal intrauterine polyp removal technique. CONCLUSION: Opinion regarding the relative roles of inpatient or outpatient, and blind or hysteroscopic methods, is divided and a randomised trial comparing the efficacy and safety of these methods is practicable.     

Endometrial hyperplasia involving endometrial polyps: report of a series and discussion of the significance in an endometrial biopsy specimen

Objectives  Endometrial polyps are a common cause of abnormal uterine bleeding. Rarely, a hyperplasia, either complex or atypical in type, is identified within a polyp in a biopsy or polypectomy specimen. Currently, it is not known whether the hyperplasia is likely to be confined to the polyp or also involve nonpolypoid endometrium. We aim to assess the likelihood of hyperplasia being confined to an endometrial polyp.
Design  In this study, we identified 32 women from pathology archives in whom endometrial hyperplasia was present within a polyp. The number of endometrial polyps during the study period was 1031 and therefore 3.1% of all endometrial polyps diagnosed during the study period contained a hyperplasia.
Setting  A major teaching hospital in the UK.
Methods  The biopsies were retrieved from the pathology archives of Royal Group of Hospitals, Belfast, between 2000 and 2006. We traced any follow-up biopsy or hysterectomy specimens to evaluate the status of the surrounding endometrium.
Results  The hyperplasias were complex ( n = 23) or atypical ( n = 9) in type. In 14 of 27 (52%) women in whom nonpolypoid endometrium was available for histological evaluation, either on the original biopsy or in a follow-up specimen, hyperplasia involved the nonpolypoid endometrium, and in three other women, hyperplasia was present in a polyp in follow-up specimens. Women with atypical hyperplasia in a polyp were slightly more likely to have hyperplasia in the surrounding endometrium than those with complex hyperplasia.
Conclusions  Our study illustrates that the risk of endometrial hyperplasia in a polyp concurrently involving nonpolypoid endometrium is significant. We suggest a strategy for the management of women with hyperplasia identified within an endometrial polyp in a biopsy or polypectomy specimen.     

子宫内膜增殖症诊治的研究进展

子宫内膜增殖症是子宫内膜腺体增生和（或）腺体间质比例增加的子宫内膜增生性病变，雌激素刺激子宫内膜而无孕激素抵抗被认为是主要的致病风险因素，其确切病因仍未完全明确。子宫内膜增殖症目前主要根据病理结果分类为子宫内膜增生不伴不典型和子宫内膜不典型增生，其中子宫内膜不典型增生被认为是Ⅰ型子宫内膜癌的癌前病变。诊断子宫内膜增殖症需结合病史、影像学、细胞学，以组织学结果为最终诊断依据。子宫内膜增殖症的治疗主要分为药物治疗和手术治疗，具体采用的治疗方法主要依据子宫内膜增生的类型和患者的生育要求。本文从子宫内膜增殖症的概念、分型、发病机制、诊断、治疗等几个方面进行综述。     

Endometrial hyperplasia - the dilemma of management remains: a retrospective observational study of 280 women

Objective

To quantify the rate of inconsistency in histopathological reporting between endometrial biopsy specimens (obtained by Pipelle^® endometrial sampler or curettage) and hysterectomy specimens using the World Health Organization classification criteria.

Study design

A retrospective review of the records of 280 women with a histopathological diagnosis of endometrial hyperplasia treated in Ipswich Hospital NHS Trust, UK from 1 January 1998 to 31 May 2009.

Results

Discrepancy was found between the histopathological results of endometrial samples and hysterectomy specimens. The discrepancy was doubled for specimens obtained using a Pipelle^® endometrial sampler, with false-positive (i.e. overdiagnosis when the hysterectomy specimen showed a better diagnosis) and false-negative (i.e. underdiagnosis when the hysterectomy specimen showed a worse diagnosis) rates of 5.3% and 22.6%, respectively. For curettage specimens, the false-positive and false-negative rates were 1.8% and 13.2%, respectively. All cases of curettage were performed under general or regional anaesthesia, and were preceded by hysteroscopy. Apart from age, no risk factors were associated with a worse diagnosis. The association of age differed between types of endometrial hyperplasia and cancer; the strongest association was seen for cancer and the weakest association was seen for simple hyperplasia.

Conclusion

Hysteroscopy and curettage may be considered when simple or complex hyperplasia is diagnosed from a specimen obtained with a Pipelle^® endometrial sampler. When a diagnosis of atypical hyperplasia is made, irrespective of the method of endometrial sampling, the gynaecologist must be concerned that endometrial carcinoma exists concomitantly within the uterus.     

Current practice for the laparoscopic diagnosis and treatment of endometriosis: a national questionnaire survey of consultant gynaecologists in UK

OBJECTIVE: To determine current practice regarding laparoscopic diagnosis and treatment of endometriosis. DESIGN: A prospective questionnaire survey. SETTING: The United Kingdom. POPULATION: All 1411 UK consultant gynaecologists identified from a Royal College of Obstetricians and Gynaecologists database. METHODS: A postal questionnaire was sent to all consultants with reply paid envelopes. A postal reminder was sent three months following the initial questionnaire. MAIN OUTCOME MEASURE: Current practice for the laparoscopic diagnosis and treatment of endometriosis and willingness to participate in a randomised trial. RESULTS: The response rate was 66% (893/1411). Diagnostic laparoscopy was performed by 87% (772/893) of respondents. Seventy-six percent of these (58/772) were confident to visually diagnose endometriosis and 6% (47/772) routinely verified the diagnosis histologically. Laparoscopic surgery was routinely undertaken by 41% (318/772) of respondents. Ablative therapy was the most frequently employed technique utilised [620/653 (95%)] and electrodiathermy was the most popular energy modality (80%). Among respondents expressing a preference, excision of disease was believed to be more effective, but less safe compared with ablation. One-third of respondents (273/893) were willing to enter patients into a randomised controlled trial to compare laparoscopic treatments for pelvic pain associated with endometriosis. CONCLUSION: Laparoscopic surgery for endometriosis associated with pelvic pain is routinely undertaken by a large number of UK consultant gynaecologists, but techniques used and beliefs about efficacy vary. In view of this division of opinion regarding the relative roles of laparoscopic treatment methods, a randomised trial comparing the efficacy and safety of these methods is urgently needed.     

子宫内膜微刺激与宫腔内人工授精患者妊娠结局的新研究

卵巢刺激与宫腔内人工授精(IUI)是世界范围内治疗不孕患者经常用到的基本助孕方案,但其临床妊娠率相对较低;相关文献表明内膜微刺激通过提高内膜容受性能改善不明原因反复移植失败患者体外受精-胚胎移植(IVF-ET)的妊娠结局,那么,其是否同样有益于改善IUI的妊娠结局呢?本文就有关内膜微刺激改善子宫内膜容受性的最新作用机制及IUI临床妊娠率能否得到改善的最新研究进行概述。     

Involution of PTEN-null endometrial glands with progestin therapy

OBJECTIVES: Loss of PTEN tumor suppressor gene function characterizes most (63%) endometrial precancerous lesions (endometrial intraepithelial neoplasia, EIN) and up to 83% of endometrioid endometrial cancers. Because systemic progestins are known to promote involution of precancerous endometrial lesions, we tested the hypothesis that this therapy preferentially leads to clearance of immunohistochemically detected PTEN-null endometrial glands in a variety of histopathologic settings. METHODS: PTEN immunohistochemistry of pre and postprogestin-treated endometria was successfully performed on 17 women presenting with an intake endometrial biopsy diagnosis of "hyperplasia". Intake biopsies were rediagnosed using EIN criteria as 5 normal (proliferative or secretory), 4 anovulatory, 3 polyps, and 5 EIN endometria. The persistence of PTEN-null glands in progestin-treated patients was compared to that seen previously in rebiopsied normal proliferative endometrium of endogenously cycling premenopausal women. RESULTS: Ten of 17 women prehormonal therapy had PTEN-null glands in the initial biopsy, and 90% (9/10) of these disappeared in the postprogestin sample. This contrasts with only 17% (2/12) involution in the endometria of normal cycling women (Fishers exact test P=0.002, Odds Ratio 45). CONCLUSIONS: We conclude that progestin therapy promotes involution, or disappearance, of PTEN-null endometrial glands relative to the persistence rate seen for normal cycling women. This effect occurs among PTEN-null glands having a variety of histopathologic presentations.