Publications Update # 52

Publications Update # 52
Photo by Shubham Dhage / Unsplash

Non-Medical Article of the Week

Can You Create More Value?
by Loren Gary

Be a goat, and then you will be a GOAT one day!

Thanks to their unique adaptations, goats climb and munch on thorny plants. They navigate challenging terrains and consume prickly bushes without harm. Their agility and climbing prowess are supported by their muscular build and specialized hoof design, allowing them to grip and balance on narrow ledges.

But the critical lesson here is that the goats adapted to go after food no other animal could! Thus adding value to the entire ecosystem by their adaptations.

At your work, can you adapt? There are not enough ovarian debulkings to go around. Can you be the go-to person for placenta accreta cases? There is not enough mentorship in your early career. Can you be the person who builds a program for that as you figure out the challenges of an early career and thus add value to your department?

There is always room for adaptation. In doing so, one day, you might find that by adopting the mentality of the goat, you became the Greatest Of All Time (G.O.A.T).

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Endometrial Cancer

Molecular and pathologic data to guide selection of patients with endometrioid endometrial cancer for ovarian preservation - PubMed
The integration of molecular and pathologic data may improve risk stratification of pre-menopausal patients with endometrial cancer and enhance candidate selection for ovarian preservation.

This is one of the best papers on ovarian preservation and the risk of ovarian metastasis. The paper has a lot of helpful information to counsel patients regarding ovarian preservation while undergoing treatment for endometrial cancer. Table 2 is very important, and I highly encourage you to download and read the paper. Here is a summary of the risk of ovarian metastasis:

Risk Factor Association with Ovarian Metastasis
Molecular Sub-type
POLEmut (DNA polymerase epsilon mutated) 0/14 (0%)
Copy number-low/NSMP (No specific molecular profile) 2/48 (4%)
Microsatellite instability-high/MMRd (Mismatch repair deficient) 10/22 (45%)
Copy number-high/TP53abnormal 3/6 (50%)
CTNNB1 Mutational Status
Hotspot CTNNB1-mutated 1/30 (3%)
Wildtype/CTNNB1 non-hotspot mutated 10/60 (16%)
Lynch Syndrome Status
Lynch syndrome patients 7/28 (25%)
Non-Lynch syndrome patients 7/74 (9%)
Endometrial Cancer Grade
Grade 1 5%
Grade 2 19%
Grade 3 22%
Lymphovascular Space Invasion (LVSI)
Present 20%
Absent 6%
Peritoneal Cytology
Positive 28%
Negative 7%
≥50% 24%
<50% 7%

I have also summarized the risk stratification a bit differently to make the interpretation of this paper easier:

  1. For a patient with Grade 1 disease, no LVSI, negative cytology, and no myoinvasion (and no high-risk molecular profile):
    • Risk Category: Low Risk
    • Estimated Risk of Ovarian Metastasis: <5%
  2. For a patient with Grade 2 disease, presence of LVSI, negative cytology, and less than 50% myoinvasion (and no high-risk molecular profile):
    • Risk Category: Moderate Risk
    • Estimated Risk of Ovarian Metastasis: 5% to 20%
  3. For a patient with Grade 3 disease, presence of LVSI, positive cytology, and 50% or more myoinvasion (and a high-risk molecular profile of CN-H/TP53abnormal):
    • Risk Category: High Risk
    • Estimated Risk of Ovarian Metastasis: >20%

Here is a quick calculator that can help you estimate the risk of ovarian mets (it will only work on the website, not in the email)

Ovarian Metastasis Risk Calculator

Ovarian Metastasis Risk Calculator

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