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Introduction: Abnormal Uterine Bleeding (AUB), occurring atleast one year after menopause, is one of the most concerning complaints among gynaecological patients. Endometrial atrophy is the most common endometrial finding in women with Postmenopausal Bleeding (PMB), approximately 10-15% of whom have endometrial carcinoma. Earlier studies suggested that obesity, Type 2 diabetes mellitus, and hypertension are risk factors for endometrial hyperplasia. Diabetes mellitus, obesity, and hypertension form the triad of endometrial cancer. Aim: To assess endometrial thickness by Transvaginal Sonography (TVS) and compare it with histopathological findings in women with PMB, evaluating whether an endometrial thickness of <4 mm on TVS is more suggestive of malignancy. Materials and Methods: The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at King George Hospital, Vishakapatnam, Andhra Pradesh, India, from January 2022 to December 2022, comprising n=100 subjects. After routine necessary investigations for PMB, a transvaginal ultrasound examination was carried out to calculate endometrial thickness and compare it with the results of histopathological diagnosis of the endometrium. The parameters assessed were endometrial thickness and appearance, Type 2 Diabetes Mellitus (T2DM), hypertension, and Body Mass Index (BMI). The data was compiled and compared using the Chi-square test, with a p-value of ≤0.05 considered highly significant. Results: The results showed normal atrophic and thickened endometrium in 36% of subjects each, and abnormal endometrium such as hyperplasia, carcinoma, and polyps were recorded in 14%, 8%, and 6% (n=6) of cases, respectively. The histopathological results showed normal endometrium such as atrophic, secretory, and proliferative endometrium in 49%, 6%, and 19% of subjects, respectively. Abnormal endometrial findings such as endometrial hyperplasia, carcinoma, and polyps were observed in 14%, 7%, and 5% of cases, respectively. The majority of cases (58%) had endometrial thickness ≤4 mm, followed by 36% of cases with 5-10 mm and 6% of cases >11 mm, with mean and Standard Deviation (SD) values of 5.8±3. mm Statistical analysis data on the association between TVS findings and Histopathological Examination (HPE) findings was observed to be statistically significant (p<0.001). A statistically significant association was observed between T2DM, and BMI >25 kg/m2 together, DM+hypertension+BMI (Triad) and endometrial thickness, respectively. Conclusion: The TVS is easy, simple, non invasive, and involves no complications. Therefore, it can be used as the first diagnostic step in the investigations of women with PMB, combined with histopathological assessment. [ABSTRACT FROM AUTHOR]

Background: Bleeding per vagina following established menopause is called Post-Menopausal bleeding; even without amenorrhea or irregularity menstruation continuing after age of 55 years should be investigated. The objective of this study was to study the correlation of findings in TVS and Pipelle sampling biopsy in diagnosis of endometrial pathology. Methods: The present Prospective Observational study was conducted in the Department of Obstetrics and Gynaecology, Department of Pathology, and Department of Radiology, Calcutta National Medical College and Hospital, Kolkata, West Bengal, India between March 2022 to February 2023. Outdoor patients in postmenopausal age group presenting with Post-menopausal bleeding per vagina during same period after fulfilling the inclusion criteria were included in the study. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: We found that, out of 50 patients, 26(52%) patients were <50 years of age, 22(44.0%) patients were 51-60 years of age, 2(4.0%) patients were >61 years of age. The mean age of patients was 51.7600 years. We observed 32(64.0%) patients had 1-3 months duration of post-menopausal bleeding and 18(36.0%) patients had 4-6 months duration of PMB. We found that, 46(92.0%) patients had Successful entry of Pipelle's into endometrial cavity which was statistically significant. Our study showed that, 09(100.0%) patients were with detected endometrial carcinoma and atypical endometrial hyperplasia in TVS and was statistically significant. About 07(87.78%) patients were detected with endometrial carcinoma and atypical complex endometrial hyperplasia in Pipelle's biopsy which was statistically significant. Conclusion: The clinical approach to post-menopausal bleeding requires prompt and efficient evaluation to exclude or diagnose endometrial carcinoma and endometrial hyperplasia. [ABSTRACT FROM AUTHOR]

Objectives: Endometrial cancer is the most prevalent form of cancer affecting female reproductive organs. The most common histologic type, endometrioid carcinoma, accounts for 75--80% of all endometrial cancer cases. Studies on DKK1 expression profiles and their inhibitory role in the Wnt signalling pathway in the genesis and development of endometrial carcinoma are scarce. This study aimed to investigate DKK1 expression in endometrial carcinoma and its correlation with the Wnt/β-catenin pathway. Methods: A total of 160 formalin-fixed paraffinembedded samples were included in this study (50 cases of endometrial atypical hyperplasia, 50 cases of endometrioid endometrial carcinoma, 30 cases of proliferative endometrium and 30 cases of secretory endometrium). The expression patterns of DKK1, E-cadherin, β-catenin and c-Myc in endometrial atypical hyperplasia and carcinoma were investigated and compared with that of proliferative and secretory endometrium. Immunohistochemistry and analysis were performed from July 2018 to June 2020. Results: A decreasing pattern of immunopositivity for DKK1, E-cadherin and β-catenin from proliferative/secretory endometrium to endometrial atypical hyperplasia and endometrioid carcinoma was found. Increasing c-Myc immunopositivity was noted from proliferative/ secretory endometrium to endometrial atypical hyperplasia and endometrioid carcinoma. Moreover, decreasing DKK1 immunopositivity was well correlated with E-cadherin, β-catenin and c-Myc immunopositivity. Conclusion: Decreasing DKK1 positivity from benign endometrium to endometrioid carcinoma suggests a negative regulatory function of DKK1 in endometrioid carcinoma. DKK1 is downregulated in the Wnt signalling pathway in endometrioid endometrial carcinoma. Therefore, DKK1 is promising as a biomarker for screening endometrioid carcinoma. Future studies should examine the reactivation of the DKK1 gene, which may be a valuable strategy for antagonising the Wnt signalling pathway. [ABSTRACT FROM AUTHOR]

Background: Endometrial carcinoma is the 4th most commonly diagnosed gynecologic malignancy in the world and 11th most common in India [1]. Traditionally, endometrial carcinomas have been divided into two types. Type I-low grade, estrogen related, often clinically indolent, endometrioid carcinomas. Type II-non-endometrioid, clinically aggressive carcinomas that are unrelated to estrogen stimulation and include serous and clear cell carcinomas. This classification is not useful for tumor stratification because of significant overlap in various features with respect to high grade tumors of either types. Recent advances on genomic studies have classified endometrial carcinoma into 4 subtypes: 1. With Pole (DNA polymerase epsilon) mutations. 2. Microsatellite instability (MSI). 3. Showing low copy number alterations. 4. Tumors with high copy number alterations and TP53 mutations. Integration of molecular characteristics with morphologic features helps to stratify patients to predict prognosis. MSI can be identified by IHC which is efficient, relatively simple and cost effective. The present study is proposed to evaluate the morphological features of endometrial cancers and to analyze their profile based on loss of immunostaining for MMR proteins. Methods: A prospective study for a period of 2 years and 3 months from August 2020 to November 2022 was conducted in the Department of Pathology from Government General Hospital, Kakinada. A total of 50 endometrial samples were collected. Results: On histopathological examination 80% of cases were diagnosed as Type 1 endometrial carcinoma and 20% were type 2 endometrial carcinomas. On IHC for MMR protein expression, 22% cases showed loss of one or more MMR proteins. All of these deficient MMR cases were endometrioid type. Loss of MLH1 and PMS2 was the most common abnormality detected in deficient MMR tumors. Conclusion: Detecting MMR protein loss in endometrial carcinomas by IHC is an efficient, relatively simple and economical method. It needs to be routinely performed in all cases of endometrial carcinomas. [ABSTRACT FROM AUTHOR]

Background: Abnormal uterine bleeding (AUB) is one of the most common complaints seen in gynecological practice, and transvaginal sonography (TVS) remains the first-line, non-invasive diagnostic tool in these women. Aims and Objectives: The aim was to study the endometrial thickness (ET) using TVS and correlate it with histopathological findings obtained through endometrial biopsy in patients with AUB. Materials and Methods: This was a prospective observational study conducted in a tertiary care center in Northern India, from January 2018 to June 2019. One hundred and sixty women in the reproductive age group presenting AUB were recruited. TVS was done to note (ET) and its echotexture with additional findings such as uterine, adnexal, or other pelvic pathology. The patient underwent endometrial aspiration using Karman Cannula, and its findings were correlated with TVS. Results: In our study, a majority of patients (40%, n=64) presenting with AUB belonged to the age group of 41-45 years, with fibroid being the most common cause (39.3%, n=63). Thickened ET (>12 mm) was noted in 44 (27.5%) patients and 4 had an endometrial polyp. The mean ET was 11.48±5.11 mm (range: 4-35 mm). The most common normal histopathology noted was secretory endometrium (29.37%, n=47), followed by proliferative endometrium (20.6%, n=33). The abnormal changes included disordered proliferative endometrium (23.1% n=37) and simple endometrial hyperplasia (6.8%, n=11). Four cases were found to have endometrial adenocarcinoma. On correlating TVS with histopathology, it was noted that out of 8 patients with ET of >20 mm, 3 patients had endometrial carcinoma, 2 had disordered proliferative endometrium, and 1 each had pill endometrium, normal secretory, and atypical hyperplasia. Conclusion: TVS provides crucial information on echo-morphological features of the uterine cavity, and increasing ET mandates histopathological confirmation for ruling malignancy. [ABSTRACT FROM AUTHOR]

Background: Postmenopausal bleeding is a frequently encountered symptom in women seen in gynaecological office visits. A significant number of women have gynaecological malignancies like endometrial cancer and in low-and middle-income countries like India, carcinoma cervix still remains a leading cause of postmenopausal bleeding. Objectives: The purpose of our study was to analyse the age distribution and various causes of postmenopausal bleeding. Materials and methods: Fifty patients with the complaint of postmenopausal bleeding were included in this prospective study (August 2020 - July 2022). A detailed history, systemic and gynaecological examination was carried out on these patients during their first visit. Each patient underwent a Pap smear test, transvaginal ultrasound followed by endometrial biopsy and cervical biopsy where indicated. Results: Eighty percent of women in the study had benign lesions and 20% women showed malignant lesions. Endometrial histopathological examination revealed the benign conditions like endometrial atrophy (24%), atrophic vaginitis (16%), cystic glandular hyperplasia (10%), proliferative endometrium (8%), chronic endometritis (8%), endometrial hyperplasia (6%), endometrial polyps (6%) and fibroids in one (2%) patient. Among malignant lesions, cervical cancer was seen in 16% and endometrial cancers in 4% women. In majority of cases the cancers were of well differentiated variety. Conclusion: The common causes of postmenopausal bleeding are usually benign lesions. Detailed evaluation is often needed, to rule out other lethal causes like endometrial and cervical cancer (especially in our country), both of which classically present with postmenopausal bleeding. [ABSTRACT FROM AUTHOR]

Study Question: Is the DNA damage response (DDR) dysregulated in the eutopic endometrium of women with endometriosis?Summary Answer: Endometrial expression of genes involved in DDR is modulated in women with endometriosis, compared to those without the disease.What Is Known Already: Ectopic endometriotic lesions are reported to harbour somatic mutations, thereby hinting at dysregulation of DDR and DNA repair pathways. However, it remains inconclusive whether the eutopic endometrium also manifests dysregulated DDR in endometriosis.Study Design, Size, Duration: For this case-control study conducted between 2015 and 2019, eutopic endometrial (E) samples (EE- from women with endometriosis, CE- from women without endometriosis) were collected in either mid-proliferative (EE-MP, n = 23; CE-MP, n = 17) or mid-secretory (EE-MS, n = 17; CE-MS, n = 9) phases of the menstrual cycle. This study compares: (i) DNA damage marker localization, (ii) expression of DDR genes and (iii) expression of DNA repair genes in eutopic endometrial samples from women with and without endometriosis.Participants/materials, Setting, Methods: The study included (i) 40 women (aged 31.9 ± 0.81 years) with endometriosis and (ii) 26 control women (aged 31.4 ± 1.02 years) without endometriosis. Eutopic endometrial samples from the two groups were divided into different parts for histological analysis, immunohistochemistry, RNA extraction, protein extraction and comet assays. Eighty-four genes of relevance in the DNA damage signalling pathway were evaluated for their expression in eutopic endometrial samples, using RT2 Profiler PCR arrays. Validations of the expression of two GADD (Growth Arrest DNA Damage Inducible) proteins - GADD45A and GADD45G were carried out by immunoblotting. DNA damage was assessed by immunohistochemical localization of γ-H2AFX (a phosphorylated variant of histone H2AX) and 8-OHdG (8-hydroxy-2'-deoxyguanosine). RNA sequencing data from mid-proliferative (EE-MP, n = 4; CE-MP, n = 3) and mid-secretory phase (EE-MS and CE-MS, n = 4 each) endometrial samples were scanned to compare the expression status of all the genes implicated in human DNA repair. PCNA (Proliferating Cell Nuclear Antigen) expression was determined to assess endometrial proliferation. Residual DNA damage in primary endometrial cells was checked by comet assays. Public datasets were also scanned for the expression of DDR and DNA repair genes as our RNASeq data were limited by small sample size. All the comparisons were made between phase-matched endometrial samples from women with and without endometriosis.Main Results and the Role Of Chance: Endometrial expression of DDR genes and intensity of immunolocalized γ-H2AFX were significantly (P < 0.05) higher in EE, compared to CE samples. DDR proteins, especially those belonging to the GADD family, were found to be differentially abundant in EE, as compared to CE. These patterns were evident in both mid-proliferative and mid-secretory phases. Intriguingly, higher DDR was associated with increased cell proliferation in EE-MP, compared to CE-MP. Furthermore, among the differentially expressed transcripts (DETs) encoded by DNA repair genes, the majority showed up-regulation in EE-MP, compared to CE-MP. Interestingly, CE-MP and EE-MP had a comparable percentage (P > 0.05) of cells with residual DNA damage. However, unlike the mid-proliferative phase data, many DETs encoded by DNA repair genes were down-regulated in EE-MS, compared to CE-MS. An analysis of the phase-matched control and endometriosis samples included in the GSE51981 dataset available in the Gene Expression Omnibus database also revealed significant (P < 0.05) alterations in the expression of DDR and DNA repair genes in EE, compared to CE.Large-scale Data: N/A.Limitations, Reasons For Caution: The study was conducted on a limited number of endometrial samples. Also, the study does not reveal the causes underlying dysregulated DDR in the eutopic endometrium of women with endometriosis.Wider Implications Of the Findings: Alterations in the expression of DDR and DNA repair genes indirectly suggest that eutopic endometrium, as compared to its healthy counterpart, encounters DNA damage-inducing stimuli, either of higher strength or for longer duration in endometriosis. It will be worthwhile to identify the nature of such stimuli and also explore the role of higher genomic insults and dysregulated DDR/DNA repair in the origin and/or progression of endometriosis.Study Funding/competing Interest(s): The study was supported by the Department of Biotechnology and Indian Council of Medical Research, Government of India. No conflict of interest is declared. [ABSTRACT FROM AUTHOR]

Purpose: Uterine cancer is the second most prevalent cancer of the female genital tract, with 90% of it being of endometrial origin. The aim of this research was to create and validate a risk-scoring model using patients' clinical variables in predicting premalignant and malignant lesions of the uterine endometrium among premenopausal women with abnormal uterine bleeding (AUB). Methods: This is a retrospective cohort study conducted at a tertiary hospital of Southern India for a period of 5 years from July 2014 to August 2019, including women aged ≤ 55 years who had AUB and underwent endometrial biopsy. The incidence of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) was determined, and clinical and demographic variables were compared among cases (AEH/EC) and controls (no AEH/EC) using simple logistic regression. A risk-scoring model was derived and validated with a split-sample internal validation method. Results: A total of 472 premenopausal women presenting with AUB were included in the study. There were 20 women (4.2%) with AEH and eight (1.7%) with EC. We found a statistically significant positive correlation of an anovulatory pattern of bleeding (odds ratio [OR]=3.4; p=0.009), age ≥ 45 years (OR=1.12; p=0.01), body mass index (BMI) ≥ 30 kg/m2 (OR=2.46; p=0.04) and diabetes mellitus (OR=3.00; p=0.02) with a higher risk of AEH/EC diagnosis upon histopathological examination of endometrial biopsy specimens of the study population. A risk-scoring model (PAD30) was created using these variables to predict premalignant and malignant endometrial lesions. The best cutoff score derived by the receiver operating characteristics (ROC) curve, of ≥ 5, had a sensitivity of 85.7% and specificity of 87.6% with an area under the curve (AUC) of 0.84 (95% CI 0.75– 0.93; p=0.04). With a positive likelihood ratio of 6.91, our prediction model increases the post-test probability of AEH/EC to 30.6% from 6% of the pre-test probability. Conclusion: The proposed model demonstrated a moderate diagnostic accuracy in predicting premalignant and malignant lesions of the uterine endometrium among symptomatic premenopausal women. [ABSTRACT FROM AUTHOR]

Aims: To study the association of clinical profile of patients with Abnormal Uterine Bleeding with the different endometrial histopathological patterns Methods: A retrospective cross-sectional study was done in the department of Obstetrics and Gynaecology at a hospital in Karnataka, India from January 2017 to January 2019. Medical records were reviewed for all the cases of abnormal uterine bleeding who underwent endometrial biopsy. Results: There were 148 records of endometrial biopsies; >55% were in 41-50 years age group; 28% had postmenopausal bleeding; and 28% presented with menorrhagia. Menorrhagia and menometrorrhagia were equally common under 50 years of age. The various physiological patterns of endometrium (proliferative, secretory & menstruating endometrium) were noted in more than half the cases (51%). Proliferative endometrium was in 37%, followed by hyperplasia without atypia in 22% and only 3% showed malignancy; all of whom were in the postmenopausal group. Even in women with post menopausal bleeding, proliferative pattern was the commonest (33%), followed by atrophic endometrium and malignancy. Atypical hyperplasia was found to be most commonly associated with post menopausal bleeding. Conclusions: Both physiological and non physiological endometrial patterns were seen almost equally among the AUB cases. The knowledge of endometrial pattern in a case of AUB helps to decide a plan of management. Endometrial sampling plays a very important role in management of AUB, especially in the age group of more than 40 yrs; i.e, the peri and post-menopausal age groups, where incidence of malignant or pre malignant conditions was noted to be the highest. Key words: abnormal uterine bleeding, endometrial cancer, endometrial sampling, hyperplasia. [ABSTRACT FROM AUTHOR]

Endometrial cancer is the 4th most common cancer in females in India as per 2020 report from National Cancer Registry Programme (NCRP). Incidence of endometrial cancer in India is 105.5 per 100,000 women with highest being observed in Bangalore and Delhi. Management of endometrial cancer remains a challenge due to an older age population with considerable comorbidity. Surgery with or without adjuvant therapy is the standard of care in endometrial cancer, whereas upfront combination of external beam radiotherapy (EBRT) and HDR (High Dose Rate) brachytherapy (BT) or BT alone is indicated for inoperable or unresectable cases. Twenty two patients with inoperable or unresectable endometrial cancer were treated with upfront radiotherapy from 2015 to 2021. Eighteen patients received EBRT followed by HDR BT as Intracavitary radiotherapy (ICR) with Central Vaginal Cylinder (CVC), while four patients received HDR BT as monotherapy. Definitive radiotherapy was given in the form of EBRT 50 Gy in 25 fractions, 5 fractions/week followed by HDR BT as CT based ICR plus CVC, 7.5Gy per fraction, 2 fractions, 1 week apart. Outcomes were analysed retrospectively in terms of Cancer Specific Survival (CSS), Overall survival(OS) and Local control (LC). Kaplan Meire estimates of OS and PFS were determined using SPSS IBM Software version 26.0. Median age of presentation was 56.5 years (IQR: 45-74 years) and median Body mass index (BMI) was 28.48 (range 20.56-49.12). For the entire cohort, median follow up was 15.5 months (range 6-74). The mean CSS was 45.11 months (range- 28-62.19). The overall mean survival time of the study population was 46.34 months (range 27.71-64.98), with a survival rate of 75% at 2 years. The mean progression free survival was 49.22 months (range-32.26-66.19) and 2 years local control rate was 100%. No acute grade 3 and late grade 3 genitourinary or gastrointestinal toxicities were noted. Upfront radiotherapy is tolerated well among inoperable endometrial cancer patients, also including high risk patients with favorable local control and improved overall survival. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal Uterine Bleeding (AUB) is a major clinical problem among women in peri and postmenopausal age groups which needs complete scrutiny. Various methods are in vogue for the assessment of endometrium. Histopathological interpretation of endometrial tissue is the gold standard investigation. Studies have raised concern about diagnostic accuracy and adequacy of pipelle endometrial sample. Aim: To compare the efficacy of pipelle endometrial sampling method with conventional Dilatation (D) and Curettage (C) in diagnosis of AUB. Materials and Methods: This comparative cross-sectional study was carried out at DM Wayanad Institute of Medical Science, Kerala, India (January 2016 to June 2017). Endometrial samples collected from 210 patients with AUB initially by pipelle method followed by D and C formed the material for this study. Slides were prepared after routine histopathological processing and sectioning. Staining was done using Haematoxylin and Eosin (H&E) stains and the slides were subjected to thorough and independent microscopic examination for comparative analysis. Data analysis was performed using IBM SPSS Software version 21.0. Results: Histopathological examination of endometrial samplings by pipelle method revealed endometrial carcinoma in seven cases, atypical endometrial hyperplasia in seven cases, endometrial hyperplasia in 85 cases and disordered proliferative endometrium in 30 cases. These were correlated with histopathological findings of conventional D and C sampling method which showed pipelle sampling method had sensitivity and specificity in endometrial carcinoma (80% and 100% respectively), atypical endometrial hyperplasia (100% and 99.5% respectively), endometrial hyperplasia (100% and 93.98% respectively) and disordered proliferative endometrium (81.1% and 100% respectively). There was significant positive correlation (p<0.01) between the two techniques. Endometrial sampling by pipelle method had a high sensitivity and negative predictive value in diagnosing abnormal endometrium. Conclusion: Endometrial sampling by pipelle method is a safer and simpler alternative for diagnosis of endometrial lesions in patients with AUB. It has a fair degree of diagnostic accuracy almost comparable to that of curettage material. The diagnostic accuracy is high if interpreted by an experienced pathologist. [ABSTRACT FROM AUTHOR]

Background: Endometrial cancer is the second most frequent genital malignancy in women, which is showing a constant rise all over world. Endometrial hyperplasia is the precursor of endometrial cancer. Levonorgestrel intrauterine system is the first line management in patients with endometrial hyperplasia without atypia. Metformin has shown to reverse endometrial hyperplasia, but its effectiveness and safety in endometrial hyperplasia is uncertain., Objective: To compare the efficacy in terms of histopathological response, clinical response and safety at the end of 6 months in patients with endometrial hyperplasia without atypia managed with Levonorgestrel intrauterine system alone versus patients managed with Levonorgestrel intrauterine system plus metformin., Methods: The randomized control trial was conducted on 51 cases of endometrial hyperplasia without atypia. Twenty-five subjects were prescribed metformin 500mg twice daily with Levonorgestrel intrauterine system and 26 subjects, with Levonorgestrel intrauterine system only for 6 months. At the end of 6 months, endometrial sampling was performed for histopathological response., Results: Clinical response was observed in 23 of 25 subjects in metformin group and 22 of 24 in Levonorgestrel only group. The metformin group responded significantly with amenorrhea (p= 0.0053), while Levonorgestrel only group responded with regular cycles (p=0.027). At the end of study, of 46 subjects available for histopathological evaluation, 100% subjects in metformin group and 95.45% in Levonorgestrel only group (p=0.47826) showed complete response. The metformin group had a significant reduction in body mass index at end of study [P = 0∙023, 95% confidence interval (-1.7802, -0.1418)]., Conclusion: No significant difference in regression of endometrial hyperplasia was observed on adjunctive use of metformin but a significant reduction in BMI was observed. Use of metformin in obese patients may improve the treatment response.

Lymphovascular space invasion is one of the important prognostic factors for endometrial cancer. Therefore, determination of lymph node status becomes very important in deciding the management and adjuvant therapy for endometrial cancer. Majority of endometrial cancers are type I and present at an early stage. Hence these women may not require a complete lymphadenectomy for the purpose of staging. Complete lymphadenectomy is also associated with increased operating time and postoperative morbidities. Sentinel node biopsy is considered to be a bridge between no lymph node assessment and a complete lymph node dissection. Hence the focus of research is now on assessing the most reliable and efficacious method of assessing sentinel lymph nodes in endometrial cancer. However, there is a complete dearth of research from India in this area. The need of the hour is to standardize the technique and protocols for SLN mapping in endometrial cancer. Hence, we decided to do this study on the feasibility of sentinel lymph node biopsy in endometrial cancer using cervical injection of Technetium 99m nanocolloid. OBJECTIVES: To study the feasibility of sentinel node biopsy in early stage endometrial cancer and to analyse the detection rate of sentinel lymph node (SLN) using preoperative cervical injection of Tc99m nanocolloid. METHODS: 20 patients with preoperative histological diagnosis of endometrial cancer without any extra-uterine involvement on imaging were included in the study from January 2016 to June 2017. Sentinel node mapping was done by cervical injection of Tc 99m nanocolloid on the evening before surgery. Scintigraphic images were taken using gamma camera. Intraoperatively, nodes showing radioactivity were detected using hand-held gamma probe, dissected out separately and labelled as sentinel lymph nodes. Detection rate was calculated and analysed with respect to various parameters. RESULTS: Sentinel lymph node biopsy is feasible in endometrial cancer using cervical injection of Tc99m nanocolloid. SLN detection was possible in 18(90%) out of 20 patients. Bilateral detection was feasible in 11 patients (61.1%) with detection in left and right hemipelvis being 83% and 77.7% respectively. Detection rate of SLN was 88.88% in endometrioid adenocarcinoma. Sentinel node was detected in both the patients with non-endometrioid histology. CONCLUSION: SLNB using cervical injection of Tc99m nanocolloid is feasible in endometrial cancer. It is a safe and easily reproducible technique with good detection rates and high sensitivity. Stage of the tumour, grade and myometrial invasion do not seem to have an influence on sentinel node detection. Cervical involvement, enlarged lymph nodes and obstructed lymphatics can affect sentinel node mapping adversely. [ABSTRACT FROM AUTHOR]