Race and ethnicity reporting in endometriosis literature: a systematic review - Facts, Views and Vision in ObGyn

Background/Objectives: Breast cancer is the most common malignancy in young women, many of whom face fertility impairment due to gonadotoxic treatments and prolonged endocrine therapy. Ovarian tissue cryopreservation (OTC) has emerged as an alternative fertility preservation (FP) strategy, particularly when controlled ovarian stimulation is not feasible. This study aimed to evaluate the role of OTC in breast cancer patients, with the aim of clarifying its current clinical role and future perspectives within fertility preservation counselling for this population. Methods: A structured SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis was conducted based on the current literature, addressing clinical efficacy, safety, and applicability of OTC in breast cancer patients. Results: Key strengths of OTC include the absence of delay in cancer treatment and the potential to restore both endocrine and reproductive function. However, limitations include the need for surgery, the theoretical risk of reintroducing malignant cells, and variable, less predictable reproductive outcomes compared with gamete-based strategies. Opportunities lie in advances in cryopreservation, transplantation techniques, and integration with in vitro maturation. Major threats include limited data in breast cancer-specific populations, challenges in BRCA mutation carriers, and low utilization rates affecting cost-effectiveness and healthcare sustainability. Conclusions: OTC represents a valuable complementary FP option for selected breast cancer patients, particularly in urgent settings. Despite promising outcomes, its use should remain individualized within multidisciplinary counseling, considering patient-specific oncological and reproductive factors, while further research is needed to clarify long-term safety and efficacy.

In women with atypical endometrial hyperplasia or early endometrial carcinoma, a maximum duration of conservative treatment of 15 months is recommended. However, some studies have reported promising results for treatment lasting far in excess of 12 months. Evidence remains poor. To provide pooled estimates of oncological outcomes of prolonged conservative treatment (lasting > 12 months) in women with atypical endometrial hyperplasia or early endometrial carcinoma. A systematic review and meta-analysis was performed by searching six electronic databases from their inception to November 2024. Studies that reported data on oncological outcomes of prolonged conservative treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma. Pooled rates for complete response, poor response, progressive disease and recurrence following prolonged conservative treatment were calculated for each included study and as pooled estimates, with 95% confidence intervals (CI). Ten studies with 846 women (361 atypical endometrial hyperplasia and 485 early endometrial carcinoma) were included. The pooled rates were 58% (95% CI 38.0-78%) for complete response, 26% (95% CI 17-36%) for poor response, 1% (95% CI 0-5%) for progressive disease, and 33% (95% CI 18-49%) for recurrence. In women with atypical endometrial hyperplasia or early endometrial carcinoma, conservative treatment for > 12 months may represent a feasible option in carefully selected patients under strict surveillance, with a complete response in more than half of patients and a relatively low risk of progressive disease and recurrence. CRD42024609258.

Vascularization assessment is crucial for the diagnosis of ovarian masses. However, its subjectivity often results in suboptimal interobserver agreement. This study evaluated the impact of the OvAi denoising algorithm on IOTA color score assignment and perceived image quality in adnexal mass ultrasound. In this multicenter prospective study (May 2018–August 2022), color/power Doppler videos of 100 adnexal masses from 100 women were acquired in 2 outpatient clinics. Six experts, 5 moderately experienced, and 8 beginner examiners assessed IOTA color score and image quality before and after applying the denoising algorithm. Interobserver agreement regarding color score assignments was measured using Fleiss’ Kappa, and perceived image quality changes were tested via Chi-square. Interobserver agreement regarding color score assignment was fair across all observer groups (κ: 0.296–0.396) and remained unchanged post-denoising. In benign lesions, CS1 increased (+14.9%), while CS2–CS4 decreased. In malignant cases, CS1 and CS2 increased (+76.2% and +30.8%), with a smaller reduction in CS3 (–3.7%) and CS4 (–21.4%). The CS4 decrease was less marked in malignant than in benign lesions (–21.4% vs. –38.3%). A significant improvement in perceived image quality was observed in all observer groups (p < 0.05). The OvAi algorithm improved perceived image quality without significantly impacting interobserver agreement. Continued development may enable more objective and automated color score assignments, potentially reducing interobserver variability and supporting diagnostic reliability.

To describe the ultrasound characteristics of uterine perivascular epithelioid cell tumors (PEComas). This retrospective multicenter case series included patients from two Italian academic centers specializing in oncological care. All women with histologically confirmed uterine PEComas between January 2013 and December 2024 and available clinical and ultrasound data were included. Ultrasound images were reviewed by three expert sonographers using Morphological Uterus Sonographic Assessment (MUSA) terminology. Thirteen patients were identified, including 8 malignant and 5 benign PEComas. The median age was 54 years (IQR 46–65). Six patients (46%) were asymptomatic, five (38%) presented with abnormal uterine bleeding, one (8%) with pelvic pain, and one (8%) with abdominal bloating. Tumors originated from the cervix (38%), uterine corpus (46%), and isthmus (15%). On transvaginal ultrasound, most PEComas appeared as solitary, round, solid masses with regular margins (62%) and inhomogeneous echogenicity (69%), with a median diameter of 42 mm (IQR 23–66). Irregular cystic areas were observed in six cases (46%), while shadowing and hyperechoic islands were absent. Power Doppler assessment revealed moderate to rich vascularization (color score 3–4) in 9 cases (69%). Malignancy was suspected on initial ultrasound in only 4 cases (31%). Uterine PEComas commonly present as solitary, solid, round masses with regular margins, inhomogeneous echogenicity, and marked vascularization. Typical features such as shadowing or hyperechoic islands are absent. Despite these characteristics, malignancy is often underrecognized on initial ultrasound.