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Risk Prediction for Gynecological Cancer
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Risk Prediction for Gynecological Cancer

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 September 2025 | Viewed by 3172

Special Issue Editor

Dr. Federico Ferrari

E-Mail Website
Guest Editor
Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy
Interests: gynecological cancers; primary peritoneal cancer; tubo-ovarian cancer; uterine and cervical cancer; vaginal and vulvar cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Risk prediction for gynaecological cancer is crucial for the early prevention, timely diagnosis, and effective treatment of cervical, endometrial and tubo-ovarian cancers. These cancers pose significant health threats to women worldwide, and understanding risk factors and tools to achieve early diagnosis can help researchers to reduce their incidence and mortality rates. Cervical cancer risk prediction relies heavily on screening and vaccination. Human papillomavirus (HPV) is the primary cause, so regular pap smears and HPV testing are essential, and screening programs and new assessments should be incorporated in clinical practice worldwide. Endometrial cancer, primarily affecting postmenopausal women, is often linked to obesity, diabetes, hypertension, and hormonal imbalances. Predictive models focus on these factors,  as well as genetic predispositions and lifestyle choices. Early detection through symptom awareness and ultrasound assessment, both combined with timely endometrial biopsies, is crucial, and in this context, a hysteroscopic approach is of utmost importance. Ovarian cancer presents the greatest challenge due to its often-late diagnosis and subtle early symptoms. Risk factors include age, a family history of ovarian or breast cancer, and genetic mutations like BRCA1 and BRCA2. Risk prediction involves genetic testing, particularly for those with a family history, and regular pelvic exams. Prophylactic surgeries (such as salpingo-oophorectomy) are considered for high-risk individuals. Research into biomarkers and advanced imaging techniques continues to evolve, aiming to improve early detection rates. Integrating these risk prediction strategies into routine healthcare can significantly enhance the prevention and early diagnosis of gynaecological cancers. This Special Issue will highlight recent advances in the context of diagnosis, treatment, and the prediction of prognosis for these malignancies.

Dr. Federico Ferrari
Guest Editor

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Keywords

  • cervical cancer
  • endometrial cancer
  • tubo-ovarian cancer
  • diagnosis
  • treatment
  • prognosis

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Published Papers (4 papers)

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Review

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13 pages, 1231 KiB  
Review
Cervical Dysplasia and Cervical Cancer During Pregnancy: From Pathogenesis to Clinical Management
by Aleksandra Piórecka, Weronika Marcinkowska, Filip Gągorowski, Magdalena Gąsior, Katarzyna Kazimierczuk, Agnieszka Żalińska, Przemysław Oszukowski and Agnieszka Pięta-Dolińska
J. Clin. Med. 2025, 14(11), 3784; https://doi.org/10.3390/jcm14113784 - 28 May 2025
Abstract
The incidence of malignancies diagnosed during pregnancy is estimated at 1 in 1000 pregnancies, with cervical cancer being the most common gynecological malignancy in this population. The increasing maternal age and widespread use of prenatal screening contribute to the rising detection rates. Early [...] Read more.
The incidence of malignancies diagnosed during pregnancy is estimated at 1 in 1000 pregnancies, with cervical cancer being the most common gynecological malignancy in this population. The increasing maternal age and widespread use of prenatal screening contribute to the rising detection rates. Early symptoms of cervical cancer, such as vaginal bleeding or discharge, often mimic normal pregnancy changes, leading to potential delays in diagnosis. Cervical dysplasia, a known precursor of cervical cancer, is closely associated with high-risk HPV infection, which affects approximately 25% of women of reproductive age. Screening using cytology and HPV testing is considered safe and effective during pregnancy in early detection. Colposcopy remains the gold standard in further diagnostics, with targeted biopsy indicated in selected cases. In cases of high-grade lesions (CIN II/III), conservative management is often preferred, as more than 60% of lesions regress postpartum. Invasive cervical cancer diagnosed during pregnancy is rare, with an estimated incidence of 1.4–4.6 per 100,000 pregnancies. Management decisions depend on gestational age, cancer stage, and the patient’s reproductive preference. Chemotherapy can be administered after the first trimester with acceptable maternal and fetal safety profiles. This review presents current evidence on screening, diagnostic pathways, and treatment strategies. It emphasizes the importance of individualized care, multidisciplinary collaboration, and shared decision-making to optimize outcomes for both mother and fetus. Full article
(This article belongs to the Special Issue Risk Prediction for Gynecological Cancer)
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14 pages, 613 KiB  
Review
Advancements in Minimally Invasive Techniques and Biomarkers for the Early Detection of Endometrial Cancer: A Comprehensive Review of Novel Diagnostic Approaches and Clinical Implications
by Aleksandra Asaturova, Andrew Zaretsky, Aleksandra Rogozhina, Anna Tregubova and Alina Badlaeva
J. Clin. Med. 2024, 13(24), 7538; https://doi.org/10.3390/jcm13247538 - 11 Dec 2024
Cited by 2 | Viewed by 1769
Abstract
This review evaluates the advances in the early detection and diagnosis of endometrial cancer (EC), emphasizing the growing importance of minimally invasive techniques and novel biomarkers. Current diagnostic protocols for EC rely heavily on invasive procedures such as transvaginal ultrasound (TVU), hysteroscopy, and [...] Read more.
This review evaluates the advances in the early detection and diagnosis of endometrial cancer (EC), emphasizing the growing importance of minimally invasive techniques and novel biomarkers. Current diagnostic protocols for EC rely heavily on invasive procedures such as transvaginal ultrasound (TVU), hysteroscopy, and endometrial biopsy, which, although effective, can be overly burdensome for patients and inefficient for asymptomatic or low-risk populations. As there is no consensus on EC screening in high-risk or general populations, recent studies have explored alternative methods using biofluids and genomic biomarkers to improve sensitivity and specificity and facilitate access for patients. This review summarizes findings on DNA methylation markers, circulating tumor-derived nucleic acids, and the potential of liquid biopsy approaches for the early detection of EC. These innovations may not only streamline screening but also reduce the need for invasive procedures. This review highlights the potential of these biomarkers to be integrated seamlessly into the existing cervical cancer screening programs, which could transform screening methods for endometrial cancer and support the development of personalized, less invasive diagnostic procedures. Full article
(This article belongs to the Special Issue Risk Prediction for Gynecological Cancer)
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Other

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17 pages, 3628 KiB  
Systematic Review
Role of L1 HPV Protein Expression in the Cytological Diagnosis of Precancerous Cervical Lesions
by Darya Dobrovolskaya, Aleksandra Asaturova, Alina Badlaeva, Anna Tregubova, Olga Mogirevskaya, Zaira Dzharullaeva, Yulia Davydova, Andrea Palicelli, Guldana Bayramova and Gennady Sukhikh
J. Clin. Med. 2025, 14(10), 3376; https://doi.org/10.3390/jcm14103376 - 12 May 2025
Viewed by 344
Abstract
Human papillomavirus (HPV) infection is a major risk factor for cervical cancer, demanding improved diagnostic strategies to distinguish between transient infections and those requiring intervention. Background: This systematic review and meta-analysis evaluated the diagnostic accuracy of HPV L1 immunocytochemistry (ICC) in detecting [...] Read more.
Human papillomavirus (HPV) infection is a major risk factor for cervical cancer, demanding improved diagnostic strategies to distinguish between transient infections and those requiring intervention. Background: This systematic review and meta-analysis evaluated the diagnostic accuracy of HPV L1 immunocytochemistry (ICC) in detecting high-grade cervical intraepithelial neoplasia (CIN2+). Methods: We systematically analyzed data from 15 studies (PROSPERO 2022 CRD42022375916) comprising 3804 cervical smears with varying cytological findings (NILM to ≥ASC-US). Results: The pooled sensitivity for detecting CIN2+ was 80.7% (95% CI: 76.2–84.4%); however, substantial heterogeneity was present (I2 = 65.97%, p < 0.001). Similarly, the pooled specificity was 56.9% (95% CI: 49.6–64%), with even higher heterogeneity (I2 = 90.46%, p < 0.001). This considerable heterogeneity, which may be attributable to methodological variations or regional differences in HPV prevalence and genotyping, limits the generalizability of these findings. Furthermore, the moderate specificity suggests a high rate of false positives, limiting the clinical utility of HPV L1 ICC as a standalone diagnostic test. Conclusions: In conclusion, although HPV L1 ICC exhibits acceptable sensitivity for detecting CIN2+, its limitations, including low specificity and substantial heterogeneity, necessitate its use as an adjunct to other established diagnostic methods, alongside further research to enhance its diagnostic performance, and necessitate its use as a supplementary test alongside established diagnostic methods, pending further research to refine its clinical utility. Full article
(This article belongs to the Special Issue Risk Prediction for Gynecological Cancer)
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16 pages, 2448 KiB  
Systematic Review
Ki-67 as a Prognostic Marker in Squamous Cell Carcinomas of the Vulva: A Systematic Review
by Gilbert Georg Klamminger, Elke Eltze, Annick Bitterlich, Yaman Degirmenci, Annette Hasenburg, Mathias Wagner and Meletios P. Nigdelis
J. Clin. Med. 2025, 14(6), 2045; https://doi.org/10.3390/jcm14062045 - 17 Mar 2025
Viewed by 582
Abstract
Background/Objectives: To evaluate the prognostic impact of immunohistochemical ki-67 staining analysis regarding lymph node involvement and survival data (overall/progression-free survival) in squamous cell carcinoma of the vulva. Methods: A systematic literature search of English and German articles was conducted (PubMed, Embase, [...] Read more.
Background/Objectives: To evaluate the prognostic impact of immunohistochemical ki-67 staining analysis regarding lymph node involvement and survival data (overall/progression-free survival) in squamous cell carcinoma of the vulva. Methods: A systematic literature search of English and German articles was conducted (PubMed, Embase, Scopus, Web of Science) from 1980 to December 2023, including the search terms “vulvar Neoplasms”, “vulvar cancer”, “vulvar carcinoma”, “vulvar tumor”, ”vulvar tumour”, “vulvar malignancy”, “vulvar malignant”, “ki-67”, “MIB-1”, “MIB1”, “proliferative index”, “proliferative activity”, “mitotic index”, and “mitotic count”. Study quality was assessed using a two-step “mixed-criteria” approach; to synthesize study results, a narrative summary is provided. Results: In total, 13 studies were included in this systematic literature review. In general, two distinct methods of staining interpretation could be retrieved: A “pattern-based” method, as well as a cell count-based method. Ten of the included studies examined the relationship between ki-67 and lymph node involvement, nine studies included survival data as a parameter of interest; and only five studies defined both groin lymph node metastasis and survival data as outcome variables. While nine out of ten studies found no statistically significant association between ki-67 staining and lymph node metastasis, five out of nine studies determined an association between ki-67 status and overall survival, especially when employing a “pattern-based” method of staining interpretation. Conclusions: The prognostic value of ki-67 staining in terms of survival data has been reported ambivalently and should be subject to future studies. Furthermore, we did not find convincing evidence of an association between ki-67 and lymph node involvement. Full article
(This article belongs to the Special Issue Risk Prediction for Gynecological Cancer)
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