Endometrial biopsy of limited value

A retrospective study of Pipelle endometrial biopsy for ovarian, fallopian tube, and peritoneal cancers

https://tinyurl.com/3jc3my57

Although well established in the diagnosis of endometrial cancer, the value of endometrial biopsy for ovarian and fallopian tube cancer is not well understood. Much ovarian cancer starts in the fallopian tube, it has been suggested that endometrial biopsy could be a low-invasive means to obtain a tissue diagnosis.

This retrospective study reviewed biopsies obtained from 99 women who had endometrial biopsy as part of their workup for ovarian cancer. Findings from the review showed that the biopsy had a low specificity, with high false negative results for early-stage ovarian cancer but the sensitivity for a positive test was acceptable at 44% for late-stage disease.

The tissue type found at biopsy was confirmed in the resected ovarian cancer specimen in 74% of cases.

A negative result therefore does not exclude ovarian cancer especially early-stage disease. However, as a minimally invasive test endometrial biopsy has the potential to speed access to personalised therapy.It is unlikely due to cost and resource issues that endometrial biopsy will become part of standard care for ovarian cancer.

PID and cancer

Pelvic inflammatory disease and risk of epithelial ovarian cancer: a national population-based case-control study in Sweden

https://tinyurl.com/2mk66bpe

Once again, the large data base of clinical information in Sweden gives further insight into the epidemiology of ovarian cancer. This study compares the risk of developing ovarian cancer after previous pelvic inflammatory disease. (PID) It is becoming increasingly obvious that infection is an important cause for much cancer.

The retrospective review compared the incidence of PID in 1000 women who developed ovarian cancer with 10000 women who did not have cancer. PID may occur as salpingitis possibly sexually transmitted, be associated with endometriosis, urinary tract infection or inflammatory bowel disease.

Results from the study showed that women with a past history of PID were 39% more likely to develop epithelial ovarian cancer and 46% more likely to develop serous ovarian cancer. The greater the number of PID events the more likely subsequent ovarian cancer occurred.

The authors suggest the increased cancer risk may be due to inflammatory change or persisting bacterial effect and that women with a history of PID should be more actively screened for subsequent ovarian cancer.

Brain Fog possibly infective

Prevalence of active cytomegalovirus infection at diagnosis of ovarian cancer and during chemotherapy and subsequent changes in cognitive functioning

https://tinyurl.com/yc5mfuf9

Cytomegalovirus (CMV) is a herpes type virus found in 50% of the population. It lies dormant after initial infection and can recur causing various symptoms which include fatigue and decreased cognitive function.

This prospective study looked at the CMV status of 89 women with ovarian cancer and reviewed their cognitive function before and following chemotherapy.

At the time of initial presentation 30% of the women had blood levels of antibodies suggested active CMV infection. This increased to 60% following chemo. The infection rate reverted to 30% once chemo was ceased. 

Those women with active CMV disease at the onset had significantly worse cognitive function than the uninfected. The authors suggest that “brain fog”, which is a complication of chemo for ovarian cancer may be in part be due to the presence of active CMV infection, and that women should be screened for CMV as part of the diagnostic workup.

BRCA maybe not relevant

Causality and functional relevance of BRCA1 and BRCA2 pathogenic variants in non-high-grade serous ovarian carcinomas

https://tinyurl.com/e5859f7b

With increased availability more and more patients with ovarian cancer have genetic screening with the BRCA variants being the primary target. Is this a suitable use of resources?

This paper; a prospective review of almost 1000 ovarian cancer cases looked at the incidence of BRCA variants for patients who had the commonest type being high-grade serous ovarian cancer versus the less common non-high-grade types.

BRCA variants were found in 13% of the high-grade cancers and 3% of the non-high-grade cancers. Further review showed that some of the less common cancers had incorrect pathology, the others had faulty BRCA genotyping or that the variation was only partial with incomplete penetration.

The authors suggest that BRCA genotyping for non-high-grade serousovarian cancer has no value