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Background: Endometrial hyperplasia is a precursor to endometrioid adenocarcinoma (EMC), the most common uterine cancer. The likelihood of progression to carcinoma may be evaluated by histologic subclassification of endometrial hyperplasia, although these subclasses are subjective and only modestly reproducible among pathologists. Patient care would be improved by a more objective test to predict the risk of cancer progression., Methods: Next-generation sequencing was performed on archived endometrial biopsy specimens from a retrospective cohort of women with endometrial hyperplasia. Cases were considered to be either progressing if the patient subsequently developed EMC or resolving if the patient had a subsequent negative tissue sampling or no cancer during medium-term follow-up (32 patients: 15 progressing and 17 resolving). Somatic mutations in endometrial hyperplasia were assessed for enrichment in progressing cases versus resolving cases, with an emphasis on genes commonly mutated in EMC., Results: Several mutations were more common in progressing hyperplasia than resolving hyperplasia, although significant overlap was observed between progressing and resolving cases. Mutations included those in PTEN, PIK3CA, and FGFR2, genes commonly mutated in EMC. Mutations in ARID1A and MYC were seen only in progressing hyperplasia, although these were uncommon; this limited diagnostic sensitivity. Progressing hyperplasia demonstrated an accumulation of mutations in oncogenic signaling pathways similarly to endometrial carcinoma., Conclusions: Because of mutational differences between progressing and nonprogressing hyperplasia, mutational analysis may predict the risk of progression from endometrial hyperplasia to EMC., (© 2020 American Cancer Society.)

Endometrial intraepithelial neoplasia (EIN) and atypical endometrial hyperplasia (AH) are histomorphologically defined precursors to endometrioid adenocarcinoma, which are unified as EIN/AH by the World Health Organization. EIN/AH harbors a constellation of molecular alterations similar to those found in endometrioid adenocarcinoma. However, the process of clonal evolution from EIN/AH to carcinoma is poorly characterized. To investigate, we performed next-generation sequencing, copy number alteration (CNA) analysis, and immunohistochemistry for mismatch repair protein expression on EIN/AH and endometrioid adenocarcinoma samples from 6 hysterectomy cases with spatially distinct EIN/AH and carcinoma. In evaluating all samples, EIN/AH and carcinoma did not differ in mutational burden, CNA burden, or specific genes mutated (all P>.1). All paired EIN/AH and carcinoma samples shared at least one identical somatic mutation, frequently in PI(3)K pathway members. Large CNAs (>10 genes in length) were identified in 83% of cases; paired EIN/AH and carcinoma samples shared at least one identical CNA in these cases. Mismatch repair protein expression matched in all paired EIN/AH and carcinoma samples. All paired EIN/AH and carcinoma samples had identical The Cancer Genome Atlas subtype, with 3 classified as "copy number low endometrioid" and 3 classified as "microsatellite instability hypermutated." Although paired EIN/AH and carcinoma samples were clonal, private mutations (ie, present in only one sample) were identified in EIN/AH and carcinoma in all cases, frequently in established cancer-driving genes. These findings indicate that EIN/AH gives rise to endometrioid adenocarcinoma by a complex process of subclone evolution, not a linear accumulation of molecular events., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This pilot study examined whether an interactive, computer based decision aid can help patients with amyotrophic lateral sclerosis (ALS) engage in effective advance care planning. Individuals being treated for ALS (>18 years old, English speaking, and without dementia) were recruited to use a decision aid and complete pre-/post-intervention measures. Seventeen individuals completed the pre-intervention questionnaires and decision aid; 16/17 (94%) completed the post-intervention measures, and none reported any burden from the intervention. 'Overall satisfaction' with the decision aid was very high (mean = 8.5 ± 0.27: 1 = not at all satisfied, 10 = extremely satisfied), as was 'perceived accuracy' of the computer generated advance directive in reflecting patients' wishes (mean = 8.6 ± 0.27: 1 = not at all accurate, 10 = extremely accurate). Participants judged the 'amount of information' provided by the intervention appropriate (mean = 6.8 ± 0.38: 1 = too little, 5 = about right, 10 = too much), and on a detailed, 12-item assessment judged the decision aid very positively (mean = 4.16 ± 0.16: 1 = very dissatisfied, 5 = very satisfied). The intervention prompted many participants to discuss advance care planning with loved ones and to share their computer generated advance directive with their physician. This study demonstrates that individuals with ALS can successfully complete a computer based decision aid for advance care planning, and suggests that this intervention can help promote effective advance care planning.

Objective: To estimate the conversion rate of attempted laparoscopic staging for primary endometrial adenocarcinoma., Methods: Two hundred thirty-five consecutive patients with primary endometrial adenocarcinoma underwent attempted laparoscopic staging regardless of age, body mass index (BMI, calculated as weight (kg)/[height (m)]²), uterine size, and prior surgery. No patients were excluded., Results: Mean BMI was 39 (range, 22-77), and 85 patients (36%) had a BMI higher than 40 kg/m². Mean blood loss was 162 mL (range, 25-1850 mL), mean operating room time was 2 hours (range, 1-4 hours 20 minutes), and mean hospital stay was 1 day (range, 1-4 days). There were six conversions (3%) to laparotomy or vaginal hysterectomy, all occurring in patients with a BMI higher than 40; mean BMI of conversions was 66 (range, 55-77)., Conclusion: Of 235 consecutive cases of attempted laparoscopic staging for primary endometrial adenocarcinoma, conversion to laparotomy or vaginal hysterectomy occurred in 3% of the total patients and 7% in patients with a BMI of 40 or higher.

The purpose of this paper is to report results of the People with Diabetes survey conducted as part of the REACH 2010: Charleston and Georgetown Diabetes Coalition. The pilot data revealed that African Americans (AAs) (N=80) reported fewer A1c, lipid, and kidney testing, feet and eye exams, and less nutrition and diabetes self-management counseling during 1999-2000 than did Caucasians (Cs) (N=23). The survey was repeated in 2002 when data were collected from a convenience sample of 160 AAs and 150 Cs using the revised self-reported survey instrument. African Americans (AAs) were significantly likely to report that their understanding of results for the kidney function test were good as compared to Cs (P<.001) and were more likely to report receiving nutrition education (P=.003). Otherwise, there were no significant differences between AAs and Cs on the remaining items in the survey. Since REACH 2010 was actively involved in the AA community for 2 years between the pilot survey and the repeated survey, these results were anticipated and are also reflected in results of chart audits conducted within healthcare systems used by the same AA population.