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Psomiadou V, Lekka S, Panoskaltsis T, Tsouma H, Novkovic N, Trihia HJ, Tzaida O, Korfias D, Giannakas P, Iavazzo C, Papadimitriou C, Vlahos N, Vorgias G. Fallopian tube cytology as a diagnostic tool for adnexal malignancy: the CytoSaLPs score. J Am Soc Cytopathol 2023; 12:368-377. [PMID: 37422370 DOI: 10.1016/j.jasc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/30/2023] [Accepted: 05/16/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION During the past decade, the theory that high-grade extrauterine pelvic tumors originate from the fallopian tube has been strongly suggested. Our study aims to illuminate the possible role of tubal cytology as an accessory identification tool for gynecologic extrauterine malignancies, allowing in the long term the implementation of population-level cytologic tube evaluation during all benign gynecologic surgeries that do not result in salpingectomy. MATERIALS AND METHODS We ex vivo collect salpingeal epithelial cells from the fibria directly from fresh fallopian tube specimens from women undergoing salpingectomy for any indication. The cytomorphologic characteristics of the salpingeal cells are subsequently evaluated and categorized into malignant and non-malignant. Finally, the ipsilateral adnexa are examined with the SEE-FIM (Sectioning and Extensively Examining the FIMbriated End) protocol and the pathology reports are corelated with the cytologic findings. Our research protocol is ongoing and is designed to include a total of 300 patients in order to confirm the sensitivity and specificity of salpingeal cytology as a method in the early diagnosis of extrauterine gynecologic malignancies. RESULTS So far, we have obtained 343 salpingeal brushings from a total of 214 patients. The sensitivity of cytology regarding distinguishing malignant from non-malignant tumors is 69.64% (95% CI: 55.90%-81.22%), and its specificity 75.96% (95% CI: 70.59%-80.79%). Cytology's positive predictive value (PPV) is 16.33% (95% CI: 12.57%-20.67%), while the negative predictive value (NPP) reached 92.77% (95% CI: 89.56%-95.04%). In general, the diagnostic accuracy of the cytologic evaluation reaches 74.93% (95% CI: 66.99%-79.43%). CONCLUSIONS Salpingeal cytomorphologic evaluation appears to be a promising method for early detection of adnexal cancer.
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Affiliation(s)
- Victoria Psomiadou
- Gynecoligical Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece.
| | - Sofia Lekka
- Gynecoligical Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics and Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece
| | - Helen Tsouma
- Cytopathology Laboratory, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Natasa Novkovic
- Cytopathology Laboratory, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Helen J Trihia
- Pathology Department of Metaxa Cancer Hospital of Piraeus
| | - Olympia Tzaida
- Pathology Department of Metaxa Cancer Hospital of Piraeus
| | - Dimitrios Korfias
- Gynecoligical Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Panagiotis Giannakas
- Gynecoligical Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Christos Iavazzo
- Gynecoligical Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Christos Papadimitriou
- Oncology Unit, Second Department of Surgery Aretaieion Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece
| | - George Vorgias
- Gynecoligical Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
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Psomiadou V, Lekka S, Panoskaltsis T, Tsouma H, Novkovic N, Trihia HJ, Tzaida O, Korfias D, Giannakas P, Iavazzo C, Papadimitriou C, Vlahos N, Vorgias G. The Utility of Fallopian Tube Cytology in the Early Detection of Extrauterine Serous Gynecological Malignancies: A Narrative Literature Review. Acta Cytol 2023; 67:519-527. [PMID: 37044076 DOI: 10.1159/000530600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION The aim of the study was to analyze the published evidence for the use of fallopian tube brush cytology for the early detection of extrauterine serous gynecological cancer. METHODS We systematically searched the literature and, additionally, cross-checked on the bibliographies of selected articles. The inclusion criteria involved studies assessing the utility of fallopian tube brush cytology and its applications in the diagnosis, screening, or follow-up of extrauterine serous gynecological cancer. RESULTS The search strategy resulted in 21 abstracts or full-text articles, 5 of which met the inclusion criteria. The year of publication ranged from 2016 to 2022, and a total of 193 fallopian tube samples were investigated. Cytobrush, Tubebrush©, and Cytuity™ were used to obtain salpingeal samples for liquid-based cytology evaluation. CONCLUSIONS Our findings indicate that, at present, there is a lack of satisfying evidence-based data in the literature which would support the implementation of fallopian tube brush cytology as an adjunctive tool for early detection of extrauterine serous gynecological cancer. Thus, we believe that there is need for well-designed clinical studies to assess the effectiveness and diagnostic accuracy of the method as well as to validate the cytological criteria for the diagnosis and prediction of gynecological malignancies.
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Affiliation(s)
- Victoria Psomiadou
- Gynecological Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Sofia Lekka
- Gynecological Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics and Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece
| | - Helen Tsouma
- Cytopathology Laboratory, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Natasa Novkovic
- Cytopathology Laboratory, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Helen J Trihia
- Pathology Department of Metaxa Cancer Hospital of Piraeus, Athens, Greece
| | - Olympia Tzaida
- Pathology Department of Metaxa Cancer Hospital of Piraeus, Athens, Greece
| | - Dimitrios Korfias
- Gynecological Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Panagiotis Giannakas
- Gynecological Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Christos Iavazzo
- Gynecological Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
| | - Christos Papadimitriou
- Oncology Unit, 2nd Department of Surgery Aretaieion Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Vlahos
- Second Department of Obstetrics and Gynecology, Medical School, University of Athens "Aretaieio" Hospital, Athens, Greece
| | - George Vorgias
- Gynecological Oncology Department, Metaxa Memorial Cancer Hospital of Piraeus, Athens, Greece
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Psomiadou V, Lekka S, Panoskaltsis T, Tsouma E, Novkovic N, Trihia H, Tzaida O, Korfias D, Giannakas P, Iavazzo C, Papadimitriou C, Vlahos N, Vorgias G. 2022-RA-442-ESGO Fallopian tube cytological findings in women undergoing salpingectomy and correlation with the adnexal pathology. Pathology 2022. [DOI: 10.1136/ijgc-2022-esgo.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Charatsi D, Vanakara P, Evaggelopoulou E, Simopoulou F, Korfias D, Daponte A, Kyrgias G, Tolia M. Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors. Medicine (Baltimore) 2022; 101:e28705. [PMID: 35089231 PMCID: PMC8797530 DOI: 10.1097/md.0000000000028705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 01/05/2023] Open
Abstract
This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life.Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at P < .05.The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12 months of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12 months. Starting VD therapy ≤3 months after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12 months of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12 months of dilation.Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3 months after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12 months. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.
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Affiliation(s)
- Dimitra Charatsi
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Polyxeni Vanakara
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Greece
| | | | - Foteini Simopoulou
- Department of Radiation Oncology, Iaso Thessaly Hospital, Larissa, Greece
| | - Dimitrios Korfias
- Department of Gynecology, Metaxa Cancer Hospital, Mpotasi 51, Piraeus, Greece
| | - Alexandros Daponte
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Obstetrics and Gynecology, University Hospital of Larissa, Larissa, Greece
| | - George Kyrgias
- School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Radiation Oncology, University Hospital of Larissa, Larissa, Greece
| | - Maria Tolia
- Radiotherapy Department, Faculty of Medicine, School of Health Sciences, University of Crete, University Hospital of Heraklion, Heraklion, Crete, Greece
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Iavazzo C, Psomiadou V, Fotiou A, Prodromidou Α, Douligeris A, Lekka S, Korfias D, Karavioti E, Vorgias G. Concurrent gynecologic surgery and panniculectomy in morbidly obese women with gynecologic cancer, a single-center experience. Arch Gynecol Obstet 2021; 304:1271-1278. [PMID: 33740102 DOI: 10.1007/s00404-021-06033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE As the prevalence of obesity has been rising during the past decades worldwide and especially in Greece, surgeons have faced significant challenges concerning the treatment of morbidly obese women with gynecologic cancer. Panniculectomy is a safe procedure that offers better visualization of pelvic anatomy and prevention of major complications in these women. METHODS Aim of this study is to describe a single-center experience of surgical treatment of morbidly obese women with gynecologic cancer and concurrent panniculectomy. We, also, review the literature for articles that report concurrent gynecologic surgery and panniculectomy, to summarize the complications that were encountered. RESULTS From 2015 to 2018, 38 obese women were treated with concurrent panniculectomy at the time of gynecologic surgery for cancer in a single institution. Median age was 55.62 years old, median BMI 43.79 kg/m2, median blood loss 243.75 ml and median operative time approximately 200 min. Twenty-nine patients had endometrial cancer, one patient had concurrent endometrial cancer and fallopian tube cancer, six patients had borderline ovarian cancer, and two had adult granulosa ovarian tumour. Intraoperative and postoperative complications were documented. Five patients suffered from wound infection and were treated with antibiotics and one patient died after wound infection, wound dehiscence, and renal failure. CONCLUSION For selected obese patients, concurrent panniculectomy with surgical treatment of gynecological cancer is a safe and efficient procedure.
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Affiliation(s)
- C Iavazzo
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - V Psomiadou
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - Alexandros Fotiou
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece.
| | - Α Prodromidou
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - A Douligeris
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - S Lekka
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - D Korfias
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - E Karavioti
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
| | - G Vorgias
- Gynecologic Oncology Department, Metaxa Memorial Cancer Hospital, 51, Botassi Str., 18537, Piraeus, Greece
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