Clinical application and evaluation of advanced diagnostic tools in women with endometrial cancer

Abstract

Endometrial cancer (EC) is the most common gynaecological cancer in the developed world, with a demand for developments in diagnostic and treatment strategies. This thesis evaluates the current diagnostic pathway and investigates the potential for novel technologies to improve the speed of diagnosis and minimise cost.

Firstly, a psychological, prognostic and economic evaluation of the current pathway was performed. A retrospective audit of all EC cases in the west London cancer network demonstrated that delays to surgical treatment negatively impact survival. Furthermore, a psychological survey of 250 women attending the rapid access clinic with suspected EC revealed, unsurprisingly, a desire for a rapid point of care (POC) diagnosis and high levels of anxiety and stress. The economic evaluation found POC testing minimised cost too. These findings provided justification for further research in novel technologies in POC testing.

In the second part of this thesis, these novel technologies were evaluated against current gold standards. Rapid evaporative ionisation mass spectrometry (REIMS) analyses aerosols generated by surgical diathermy, to provide a real time tissue diagnosis. In a pilot study, 150 endometrial biopsy samples were analysed, yielding 453 spectra. REIMS distinguished benign from malignant EC samples with an accuracy of almost 90% on cross validation.

Ultrasound guided biopsy was also found to be an effective alternative to hysteroscopy guided biopsy in a study of 10 consecutive patients. It was successful with sufficient tissue in 90% of cases. Though painful, it had high acceptability.

Three-dimensional ultrasound was found to have moderate diagnostic performance compared to MRI, in detecting deep myometrial infiltration in women with EC; in both the current study and in a meta-analysis of 627 women. Finally, radiomics using MR images helped predict survival.

In conclusion, POC testing has psychological, survival and financial benefits. REIMS, ultrasound guided biopsy, and 3D ultrasound can provide POC testing with promising results, but further work is necessary to evaluate effectiveness on a wider scale.