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Quintana-Bertó R, Padilla-Iserte P, Lago V, Tauste C, Díaz-Feijoo B, Cabrera S, Oliver-Pérez R, Coronado PJ, Martín-Salamanca MB, Pantoja-Garrido M, Marcos-Sanmartin J, Cazorla E, Lorenzo C, Rodríguez-Hernández JR, Roldán-Rivas F, Gilabert-Estellés J, Muruzábal JC, Cañada A, Domingo S. Endometrial cancer: predictors and oncological safety of tumor tissue manipulation. Clin Transl Oncol 2024; 26:1098-1105. [PMID: 37668932 DOI: 10.1007/s12094-023-03310-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE The main goal of this study is to assess the impact of tumor manipulation on the presence of lympho-vascular space invasion and its influence on oncological results. METHODS We performed a retrospective multi-centric study amongst patients who had received primary surgical treatment for apparently early-stage endometrial cancer. A multivariate statistical analysis model was designed to assess the impact that tumor manipulation (with the use of uterine manipulator or preoperative hysteroscopy) has on lympho-vascular development (LVSI) in the final surgical specimen. RESULTS A total of 2852 women from 15 centers were included and divided into two groups based on the lympho-vascular status in the final surgical specimen: 2265 (79.4%) had no LVSI and 587 (20.6%) presented LVSI. The use of uterine manipulator was associated with higher chances of lympho-vascular involvement regardless of the type used: Balloon manipulator (HR: 95% CI 4.64 (2.99-7.33); p < 0.001) and No-Balloon manipulator ([HR]: 95% CI 2.54 (1.66-3.96); p < 0.001). There is no evidence of an association between the use of preoperative hysteroscopy and higher chances of lympho-vascular involvement (HR: 95% CI 0.90 (0.68-1.19); p = 0.479). CONCLUSION Whilst performing common gynecological procedures, iatrogenic distention and manipulation of the uterine cavity are produced. Our study suggests that the use of uterine manipulator increases the rate of LVSI and, therefore, leads to poorer oncological results. Conversely, preoperative hysteroscopy does not show higher rates of LVSI involvement in the final surgical specimen and can be safely used.
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Affiliation(s)
- Raquel Quintana-Bertó
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain.
| | - Pablo Padilla-Iserte
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Víctor Lago
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
| | - Carmen Tauste
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Berta Díaz-Feijoo
- Institute Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Silvia Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Reyes Oliver-Pérez
- Gynecologic Oncology-Unit, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Pluvio J Coronado
- Women's Health Institute of the Hospital Clínico San Carlos, IdISSC, University Complutense, Madrid, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena, Sevilla, Spain
| | - Josefa Marcos-Sanmartin
- Department of Obstetrics and Gynecology, Dr. Balmis General University Hospital, Alicante, Spain
- Department of Public Health, Miguel Hernández University, Sant Joan d'Alacant, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Eduardo Cazorla
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrevieja, Alicante, Spain
| | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Nuestra Señora de La Calendaria, Santa Cruz de Tenerife, Spain
| | | | - Fernando Roldán-Rivas
- Department of Obstetrics and Gynaecology, Clinico Lozano Blesa Hospital, Zaragoza, Spain
| | - Juan Gilabert-Estellés
- Department of Obstetrics and Gynecology, University General Hospital of València, València, Spain
| | - Juan Carlos Muruzábal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Antonio Cañada
- Department of Biostatistics, Health Research Institute La Fe, València, Spain
| | - Santiago Domingo
- Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, València, Spain
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Zouridis A, Kehoe ST, Soleymani Majd H. Should laparoscopy be revisited in the management of stage II endometrial cancer in the post-LACC era? Minerva Obstet Gynecol 2023; 75:553-558. [PMID: 36847526 DOI: 10.23736/s2724-606x.23.05258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND A recent randomized trial showed that laparoscopy had poorer outcomes compared with open surgery for early-stage cervical cancer. Whether this is of concern in endometrial cancer, when the cervix is involved has received little attention. This study aimed to investigate whether there is any difference on overall and cancer specific survival between patients treated with laparoscopy and laparotomy for stage II endometrial cancer. METHODS Data from patients with histologically proven stage II endometrial cancer who were treated between 2010 and 2019 in a single cancer center were reviewed. Demographic, histopathological characteristics and treatment modalities were recorded. Recurrence rate, cancer specific and overall survival were compared between patients that were treated with laparoscopic and open surgery. RESULTS From 47 patients with stage II disease, 33 (70%) were treated with laparoscopy and 14 (30%) with open surgery. There was no difference on age (P=0.86), BMI (P=0.76), Comorbidity Index Score (P=0.96), upstaging/upgrading after surgery (P=0.41), performance of lymphadenectomy (P=0.74), histological type (P=0.32), LVSI (P=0.15), depth of myometrial invasion (P=0.07), postoperative hospital stay (P=0.18) and administration of adjuvant treatment (P=0.11) between the two groups. Recurrence rate (P=0.756), overall (P=0.606) and cancer specific survival (P=0.564) were also comparable between laparoscopy and laparotomy groups. CONCLUSIONS Laparoscopic and open surgery seem to have comparable outcomes for stage II endometrial cancer. The oncological safety of laparoscopy for stage II endometrial cancer should be further investigated with a randomized controlled trial.
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Affiliation(s)
- Andreas Zouridis
- Department of Gynecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sean T Kehoe
- Department of Gynecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- St Peter's College, Oxford, UK
| | - Hooman Soleymani Majd
- Department of Gynecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK -
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VandenBussche CJ, Crothers B, Chandra A, Schmitt F, Kurtycz DFI. The international system for reporting serous fluid cytopathology: The initial project survey. Cytopathology 2023; 34:191-197. [PMID: 36752688 DOI: 10.1111/cyt.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE An international panel in the field of body fluid cytology, supported by the International Academy of Cytology and the American Society of Cytopathology, conducted a survey to identify opinions and explore existing practice patterns regarding body fluid cytopathology. METHODS The study group, formed during the 2018 European Congress of Cytology in Madrid, generated a survey of 54 questions related to the practice and taxonomy of body fluid cytology. The survey was available online from 28 August 2018 until 10 December 2018. Participants were invited through the websites and listserves of the professional societies. RESULTS The survey collected 593 international participant responses. Questions pertained to practice patterns and diagnostic language. Information was collected regarding credentials, work setting, work volume (4-10,000 samples) and years in practice (0-60 years). The responses revealed variations in diagnostic practice and sample management. Direct smears and ThinPrep® preparations are the most popular methods, followed by Cytospin® and SurePath®. Most (70%) respondents perform ancillary studies on their material, with over 50% preferring a cell block preparation. Approximately 32% indicated that they are capable of performing genetic studies on the samples. Nearly 78% of participants would accept a two-stage cytology report, with a preliminary assessment followed by a final diagnosis that accounts for ancillary studies to generate a more precise cytological interpretation. Approximately one-third (36%) never report adequacy on body fluid samples. Most (78%) report a general category result (negative, atypical, suspicious, or positive) and 22% provide a detailed surgical pathology type report. Most (73.6%) participants believe that both Papanicolaou stains and a modified Giemsa stain (eg Diff Quik) should be standard preparations for all serous fluid cytology. CONCLUSIONS The results of the survey demonstrated strong support for the development of a unified system for reporting body fluid cytopathology among respondents.
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Affiliation(s)
- Christopher J VandenBussche
- Departments of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Cianci S, Rosati A, Vargiu V, Capozzi VA, Sozzi G, Gioè A, Gueli Alletti S, Ercoli A, Cosentino F, Berretta R, Chiantera V, Scambia G, Fanfani F. Sentinel Lymph Node in Aged Endometrial Cancer Patients "The SAGE Study": A Multicenter Experience. Front Oncol 2021; 11:737096. [PMID: 34737952 PMCID: PMC8560967 DOI: 10.3389/fonc.2021.737096] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The incidence of endometrial cancer is increasing in elderly people. Considering that aging progressively affects lymphatic draining function, we aimed to define its impact on IGC uptake during SLN mapping. METHODS A multicenter retrospective cohort of endometrial cancer patients with apparently early-stage endometrial cancer undergoing complete surgical staging with SLN dissection was identified in four referral cancer centers from May 2015 to March 2021. Patients were classified in Group 1 (<65 years old) and Group 2 (≥65 years old). The primary endpoint was the assessment of the overall, bilateral, and unsuccessful SLN mapping in the two groups. Secondary outcomes were the evaluation of SLN anatomical distribution and the identification of predictors for mapping failure applying a logistic regression. RESULTS A total of 844 patients were enrolled in the study (499 in Group 1 and 395 in Group 2). The overall detection rate, the successful bilateral mapping, and the mapping failure rate of the SLN were 93.8% vs. 87.6% (p = 0.002), 77.1% vs. 66.8% (p = 0.001), and 22.9% vs. 33.2% (p = 0.001), respectively, in Group 1 vs. Group 2. The advanced age affects the anatomical distribution of the SLN leading to a stepwise reduction of "unexpected" mapping sites (left hemipelvis: p < 0.001; right hemipelvis: p = 0.058). At multivariate analysis age ≥ 65 (OR: 1.495, 95% CI: 1.095-2.042, p = 0.011), BMI (OR: 1.023, 95% CI: 1.000-1.046, p = 0.047), non-endometrioid histotype (OR: 1.619, 95% CI: 1.067-2.458, p = 0.024), and LVSI (OR: 1.407, 95% CI: 1.010-1.961, p = 0.044) represent independent predictors of unsuccessful mapping. Applying binomial logistic regression analysis, there was a 1.280-fold increase in the risk of failed mapping for every 10-year-old increase in age (OR: 1.280, 95% CI: 1.108-1.479, p = 0.001). A higher rate of surgical under-staging (0.9% vs. 3.3%, p = 0.012) and adjuvant undertreatment (p = 0.018) was reported in Group 2. CONCLUSIONS Old age represents a risk factor for SLN mapping failure both intrinsically and in relation to the greater incidence of other independent risk factors such as LVSI, non-endometrioid histotype, and BMI. Surgeons should target the usual uptake along UPP during the SLN dissection in this subgroup of patients to minimize mapping failure and the consequent risk of surgical under-staging and adjuvant undertreatment.
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Affiliation(s)
- Stefano Cianci
- Department of Gynecologic Oncology and Minimally-invasive Gynecologic Surgery, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Andrea Rosati
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Virginia Vargiu
- Department of Gynecologic Oncology, Gemelli Molise, Campobasso, Italy
| | | | - Giulio Sozzi
- Department of Gynecologic Oncology, Aziende di Rilievo Nazionale di Alta Specializzazione (ARNAS) Civico Di Cristina Benfratelli, Palermo, Italy
| | - Alessandro Gioè
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alfredo Ercoli
- Department of Gynecologic Oncology and Minimally-invasive Gynecologic Surgery, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Francesco Cosentino
- Department of Gynecologic Oncology, Gemelli Molise, Campobasso, Italy
- Department of Gynecologic Oncology, Università degli studi del Molise, Campobasso, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, Università di Parma, Parma, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, Aziende di Rilievo Nazionale di Alta Specializzazione (ARNAS) Civico Di Cristina Benfratelli, Palermo, Italy
- Department of Gynecologic Oncology, Università di Palermo, Palermo, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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