Faculty of Medicine
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Item type:Publication, DETECTION OF LYNCH SYNDROME IN ENDOMETRIAL CANCER PATIENTS(Faculty of Medicine, University Ss. Cyril and Methodius in Skopje, 2023-12-27); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dopler ultasound scoring system for identification of endometrial cancer in postmenopausal patients(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2023-10-09); ; ; ; Spasoski, SIntroduction: Endometrial cancer (EC) is the most common malignancy of the female genital tract in the developed world. Nowadays, preoperative evaluations using advanced imaging techniques have become more common, but little has been done on the best imaging technique for routine use and preoperative evaluations of endometrial carcinoma. The aim of this study was to evaluate the predictive value of Doppler ultrasound scoring system in detection of endometrial malignancy in postmenopausal patients with vaginal bleeding. Material and Methods: This cross-sectional study, was conducted at the University Clinic of Obstetrics and Gynecology, Skopje and included 164 postmenopausal patients admitted to the Gynecology Department of the clinic. They were divided into two main groups based on their clinical presentation and further subdivided according to histopathological results. All patients underwent a standard transvaginal ultrasound examination followed by power Doppler endometrial vascularity assessment, as well as histopathological analyses of endometrial sampling for each of them was performed. Univariate and multivariate logistic regression were utilized to determine the predictive values of Doppler parameters and the scoring system. Results: Significant associations were found between endometrial malignancy and various factors, including number of blood vessels, presence of densely packed bundles, the values of pulsatility index, resistance index, time averaged maximum velocity and peak systolic velocity. Among these, pulsatility index had the greatest influence (Wald=11.32/ p<0.01 (p=0.001)) and time averaged maximum velocity had the weakest influence (Wald=0.10/ p>0.05 (p=0.73)). Clinical scoring system exhibited a sensitivity of 79.60%, the specificity is 97.30%, and overall model accuracy is 91.50%. Conclusion: The results of our study have proved that all Doppler parameters are significant predictive factors in determining endometrial cancer in postmenopausal patients with vaginal bleeding. Their combination could obtain a non-invasive scoring system that could reduce invasive procedure in diagnosis of the endometrial malignancy in patients with ultrasound characteristic of thickened endometrium more than 5mm. For this scoring system, there is a need of modern ultrasound device and clinician with greater experience. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, THE IMPACT OF OBESITY AND FAT DISTRIBUTION ON ENDOMETRIAL CANCER RISK IN POSTMENOPAUSAL PATIENTS(Macedonian Association of Anatomists, 2023); ; ; ; Endometrial cancer (EC) is the fourth most common cancer in women worldwide, with rising incidence partly due to changing reproductive trends and ever increasing obesity. Obesity, especially central adiposity, is linked with endometrial adenocarcinoma, possibly due to elevated estrogen and decreased sex hormone-binding globulin levels. The study aims to evaluate the impact of obesity on endometrial malignancy and to determine whether central adiposity (measured by the waist-to-hip circumference ratio) serves as a better indicator of endometrial cancer risk than BMI. In this cross-sectional study, we studied 164 postmenopausal patients from the University Clinic of Obstetrics and Gynaecology in Skopje. Patients were admitted to the hospital for histopathological examination of endometrial layer because of vaginal bleeding with endometrial thickness >4mm, or other sonographic endometrial abnormalities. Histopathological findings subdivided them into two categories: with malignancy (group I) or benign abnormality (group II). Standard examinations and measurements, including BMI and waist-to-hip ratio, were performed. A significant association was observed between endometrial malignancy and obesity as measured by waist-to-hip ratio. In the distribution of data related to BMI and histopathological findings from the endometrial biopsy for Pearson Chi-square=8.35 and p<0.01(p=0.004) there is a significant difference. For Odds Ratio=2.71 (95.%CI:1.36-5.38), patients who had a BMI ≥ 30 kg/m2 were 2.71 times more likely to have endometrial malignancy than patients who had a BMI <30 kg/m2, (p<0.01). There is a significant difference in the shown distribution of data related to waist circumference/hip circumference and histopathological findings of endometrial sampling Pearson Chi-square=79.22 and p<0.001(p=0.000). For Odds Ratio=40.89 (95.% CI:15.23-109.78), patients who had waist circumference/hip circumference ≥ 0.85 were 40.89 times more likely to have endometrial malignancy than patients who had waist circumference/hip circumference <0.85, (p<0.001). Upon analysing the contribution of central obesity determined by waist-to-hip ratio, it was found to have a more substantial impact (Wald = 37.76, p < 0.001) compared to BMI (Wald = 0.97, p= 0,32). Our study confirms that obesity is a risk factor for endometrial malignancy. Furthermore, fat distribution proves to be a more crucial and accurate indicator of endometrial cancer risk than overall obesity. The statistical significance of the waist circumference to hip circumference ratio exceeded that of BMI. Therefore, even if a patient has a normal BMI, but a waist-to-hip circumference ratio greater than 0,80, she should be considered at increased risk for endometrial malignancy and should be closely monitored in the future in order to detect any malignant changes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Adjuvant chemotherapy in patients with stage IIIA endometrial carcinoma with solitary adnexal involvement(Macedonian Association of Pathology, 2016-09); ; ; Objective: The optimal adjuvant therapy in endometrial cancer patients with solitary adnexal involvement is still controversial. The purpose of this study was to evaluate, retrospectively, the outcome and efficacy of adjuvant chemotherapy in these patients. Material and Methods: The medical records of the patients with stage IIIA endometrial cancer with solitary adnexal involvement who were treated with surgical resection and adjuvant chemotherapy between 2005 and 2010, were retrospectively analyzed. A total of 40 patients treated with platinum-based adjuvant chemotherapy were included. Following surgery, all patients received 4 cycles of Carboplatin 300 mg/m2 and Paclitaxel 175 mg/m2 by intravenous injection every 3 weeks. The survival and recurrence rates were evaluated. Results: The median follow-up period was 5 years (60 months). Recurrences occurred in 12.5 % (n=5) of the patients. One local recurrence (1/5, 20%) and 4 distant metastases (4/5, 80%) in liver (n=2, 40%), lung (n=1, 20%) and paraaortal lymph nodes (n=1, 20%) were observed. The 3-year disease-free survival (DFS) and overall survival (OS) rates were 87.5% and 92.3%, respectively. Conclusions: In conclusion, platinum-based adjuvant chemotherapy may improve prognosis and survival in stage IIIA endometrial cancer patients with solitary adnexal involvement and could be considered as a potential adjuvant treatment. Although adjuvant chemotherapy has demonstrated improved both disease-fee and overall survival compared to radiotherapy (DFS 87.5% vs 69%; OS 92.3% vs 78%), further studies are needed to define the optimal treatment strategy. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Adjuvant chemotherapy and radiotherapy for Stage III endometrial cancer: Impact on Survival(RAD Association, 2018-06); ; ; Introduction. Adjuvant treatment options for advanced-stage endometrial cancer include chemotherapy (CT) and radiation therapy (RT), but the optimal treatment strategy is currently under debate. The aim of this study is to investigate the utilization of adjuvant RT and CT in patients with stage III endometrial cancer and their impact on overall survival (OS) and disease-free survival (DFS). Materials and Methods. A retrospective review was performed of 40 patients with Stage III endometrial cancer who received adjuvant treatment at University Clinic of Radiotherapy and Oncology (UCRO) in Skopje between 2012 and 2015. Postoperative treatment was administered based on performance status and medical comorbidities. Chemotherapy regimens comprised of Carboplatin (AUC 5) and Paclitaxel (175 mg/m2), a 3-week interval for 6 cycles (chemotherapy alone) and 4 cycles (sequential arm). RT was delivered using 3-D CRT with a total dose of 50 Gy in 25 fractions prescribed in PTV for 5 weeks with/without an additional 7 Gy prescribed at a depth of 0.5 cm from the vaginal surface. The primary endpoints were overall survival (OS) and disease-free survival (DFS). Combined radiotherapy and chemotherapy were compared with radiotherapy alone and chemotherapy alone. Results. The distribution of surgical stages is as follows: IIIA accounted for 60% (n=24), stage IIIB accounted for 9.8% (n=4) and stage IIIC accounted for 30% (n=12). The median age was 65 years and median follow-up was 35.5 months. There were 40 patients who received adjuvant treatment, 10% (n=4) received CT alone, 27.5% (n=11) received RT alone, and 62.5% (n=25) received sequential combined CT followed by 3D CRT with/without vaginal vault brachytherapy. Relapse occurred in 55% (n=22) of the patients. High grade and lymphovascular space invasion (LVSI) are risk factors for recurrence and poor prognosis. Overall survival (OS) and Disease-free survival (DFS) at 3 years for patients receiving combined CT and RT, adjuvant RT alone and adjuvant CT alone were 68.8%, 41.26%, and 37.57% for OS and 58.03%, 33.08%, and 24.96% for DFS, respectively. DFS and OS were significantly longer in patients treated with combined RT and CT than in those treated with CT alone (DFS: p= 0.0005; hazard ratio [HR], 5.677; OS: p= 0.0143; HR, 4.289) or RT alone (DFS: p = 0.0137; HR, 2.482; OS: p = 0.0151; HR, 3.036). Conclusion. Combined modality treatment with chemotherapy and radiotherapy can improve both overall and disease-free survival in patients with Stage III endometrial cancer compared with single modality alone. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ENDOMETRIAL THICKNESS ASSESSED BY TRANSVAGINAL ULTRASOUND AS A PREDICTOR OF THE RISK OF ENDOMETRIAL CANCER AND ATYPICAL ENDOMETRIAL HYPERPLASIA IN ASYMPTOMATIC POSTMENOPAUSAL PATIENTS(Macedonian association of anatomists and morphologists, 2020-06); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of systematic pelvic lymphadenectomy on short term postoperative quality of life in patients with early stage endometrial cancer(SHMSHM / AAMD, 2020-08); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Brachytherapy alone in the postoperative treatment of stage I endometrial carcinoma(Institut za onkologiju Vojvodine, 2018-11-17); ; ; Dimoski IIntroduction: This study evaluate the local control efficacy and toxicity of postoperative intravaginal brachytherapy (IVBT) alone among patients with endometrial cancer stage I. Material and methods: Between January-2004 and December-2011, 60 stage I endometrial adenocarcinoma patients were treated with IVBT alone, 47 in stage IA, 13 patients in stage IB. The surgical approaches were total abdominal hysterectomy (HTA) and bilateral salpingoopforectomy (BSO) in 45 patients, plus bilateral pelvic, paraaortic lymph node dissection in 15 patients. The mean interval between the surgery and the brachytherapy was 30-37 days. <½ miometrial invasion was found in 48 patients, and >½ in 12 patients. The brachytherapy was applied in 3 weekly fractions of 7Gy per fraction, prescribed at depth of 0,5cm from the applicator surface with HDR, Iridium-192. The mean diameter of the vaginal applicator was 3 (2-3,5) cm. Results: With a mean follow up time of 38 months (12-84), all 60 patients are alive. Reccurence was observed in 5 patients (8,3%): 3 patients experienced local recidiv and 2 patients developed a pelvic mass. The mean rectal dose was estimated 14,1Gy and the mean bladder dose was 13Gy. Acute genitourinary toxicity was observed in 31 patients during the therapy. Vaginal stenosis as late complication occurred in 3 patients. Conclusion: Intravaginal brachytherapy alone in the postoperative treatment of stage I endometrial carcinoma achieves local control associated with acceptable toxicity and minimal morbidity. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, INTRAVAGINAL BRACHYTHERAPY SUPPORTED BY LOCAL ANAESTHESIA IN THE TREATMENT OF ENDOMETRIAL CANCER – SINGLE INSTITUTIONAL EXPERIENCE(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University Skopje, R.N.Macedonia, 2020-10); ; ; ; Bojoski PIntravaginal brachytherapy in endometrial cancer is an inevitable part of the treatment. In the early stages of the disease, it signifcantly reduces the risk of local recurrence in the vaginal cuff with low rates of late toxicity. In the advanced stages, it provides palliative control usually with a hemostyptic effect. Brachytherapy may be the only postoperative treatment – monotherapy, or as a boost following the external beam radiotherapy, depending on many prognostic factors. Placing the vaginal applicator deep into the vagina is certainly an uncomfortable feeling, combined with pain, anxiety and discomfort. Local anaesthesia helps in reducing the painful sensations, gives adequate relaxation, but more importantly provides a quality insight into the condition of the vagina, and thus a successful application. Through our experience with the local vaginal anaesthesia with lidocaine 2% gel, we want to emphasize that intravaginal brachytherapy, supported by local anaesthesia, regardless of the degree of pain relief is directly related to successful treatment. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ULTRASONOGRAPHIC ENDOMETRIAL THICKNESS AS A PREDICTOR OF THE RISK OF ENDOMETRIAL CANCER IN PATIENTS WITH POSTMENOPAUSAL BLEEDING(Department of Anesthesia and Reanimation, Faculty of Medicine, "Ss. Cyril and Methodius" University, Skopje, R.N.Macedonia, 2020-06); ; ; ; Objective: to determine the diagnostic performance of endometrial thickness measured by transvaginal sonography in diagnosing endometrial cancer in patients presenting with post-menopausal bleeding. Patients and Methods: The databases of the Department of Gynecological Oncology at the University Clinic of Gynecology and Obstetrics in Skopje, in the period January – December 2015 were searched in order to identify patients that underwent endometrial sampling due to newly-diagnosed postmenopausal bleeding. Results: A total of 158 patient records that met the criteria were identified. The prevalence of endometrial cancer was 15.2%. Endometrial thickness was a statistically significant independent predictor of the presence of endometrial cancer and atypical endometrial hyperplasia (OR 1.19 95% CI 1.09-1.29 for each 1mm increase in thickness, p<0.001). The ROC curve analysis in our study had an AUC of 0.83 (p<0.001) and identified a cut-off level for endometrial thickness of 8mm which was associated to a sensitivity of 88.9%, specificity of 65.6%, PPV of 34.8% and NPV of 96.6% for the detection of endometrial cancer. Using a cut-off for endometrial thickness of ≤3mm achieved 100% sensitivity. Conclusion: None of the analyzed cut-off points for endometrial thickness achieved optimal diagnostic accuracy, as all cut-off values associated to sensitivity rates above 95% had false positive rates of over 60%. Nevertheless, an endometrial thickness cut-off of 3mm, due to the associated high sensitivity, can safely be used to identify women with postmenopausal bleeding who are highly unlikely to harbor endometrial cancer and that can forego initial endometrial sampling.