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Baekelandt J, Jespers A, Huber D, Badiglian-Filho L, Stuart A, Chuang L, Ali O, Burnett A. vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series. Acta Obstet Gynecol Scand 2024. [PMID: 38623778 DOI: 10.1111/aogs.14843] [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: 11/25/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The current standard treatment for endometrial cancer is a laparoscopic hysterectomy with adnexectomies and bilateral sentinel node resection. A retroperitoneal vNOTES sentinel node resection has several theoretical potential advantages. These include being less invasive, leaving no visible scars, operating without Trendelenburg, and therefore offering the anesthetic advantage of easier ventilation in obese patients and following the natural lymph node trajectory from caudally to cranially and therefore a lower risk of missing the sentinel node. The aim of this study is to determine the feasibility of a retroperitoneal vNOTES approach to sentinel lymph node dissection for staging of endometrial cancer. MATERIAL AND METHODS A prospective multicenter case series was performed in four hospitals. A total of 64 women with early-stage endometrial carcinoma suitable for surgical staging with sentinel lymph node removal were operated via a transvaginal retroperitoneal vNOTES approach. The paravesical space was entered through a vaginal incision after injecting the cervix with indocyanine green. A vNOTES port was placed into this space and insufflation of the retroperitoneum was performed. Sentinel lymph nodes were identified bilaterally using near-infrared light followed by endoscopic removal of these nodes. RESULTS A total of 64 women with early-stage endometrial cancer underwent sentinel lymph node removal by retroperitoneal vNOTES technique. All patients also underwent subsequent vNOTES hysterectomy and bilateral salpingo-oophorectomy. The median age was 69.5 years, median total operative time was 126 min and the median estimated blood loss was 80 mL. In 97% of the cases bilateral sentinel nodes could be identified. A total of 60 patients had negative sentinel nodes, three had isolated tumor cells and one had macroscopically positive sentinel nodes. No complications with sequel occurred. CONCLUSIONS This prospective multicenter case series demonstrates the feasibility of the vNOTES approach for identifying and removing sentinel lymph nodes in women with endometrial carcinoma successfully and safely. vNOTES allows sole transvaginal access with exposure of the entire retroperitoneal space, following the natural lymph trajectory caudally to cranially, and without the need for a Trendelenburg position.
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Affiliation(s)
- Jan Baekelandt
- Department of Gynecology, Imelda Hospital, Bonheiden, Belgium
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Astrid Jespers
- Department of Gynecology, Imelda Hospital, Bonheiden, Belgium
| | - Daniela Huber
- Department of Obstetrics and Gynecology, Sion Hospital, Sion, Switzerland
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | | | - Andrea Stuart
- Department of Obstetrics and Gynecology, Institute for Clinical Sciences, Lund University, Lund, Sweden
| | - Linus Chuang
- Department of Gynecologic Oncology, Nuvance Health, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Oudai Ali
- Department of Gynecology, Epsom and St Helier University, London, UK
| | - Alexander Burnett
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- The Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Pandya D, Tomita S, Rhenals MP, Swierczek S, Reid K, Camacho-Vanegas O, Camacho C, Engelman K, Polukort S, RoseFigura J, Chuang L, Andikyan V, Cohen S, Fiedler P, Sieber S, Shih IM, Billaud JN, Sebra R, Reva B, Dottino P, Martignetti JA. Mutations in cancer-relevant genes are ubiquitous in histologically normal endometrial tissue. Gynecol Oncol 2024; 185:194-201. [PMID: 38452634 DOI: 10.1016/j.ygyno.2024.02.027] [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: 01/03/2024] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Endometrial cancer (EndoCA) is the most common gynecologic cancer and incidence and mortality rate continue to increase. Despite well-characterized knowledge of EndoCA-defining mutations, no effective diagnostic or screening tests exist. To lay the foundation for testing development, our study focused on defining the prevalence of somatic mutations present in non-cancerous uterine tissue. METHODS We obtained ≥8 uterine samplings, including separate endometrial and myometrial layers, from each of 22 women undergoing hysterectomy for non-cancer conditions. We ultra-deep sequenced (>2000× coverage) samples using a 125 cancer-relevant gene panel. RESULTS All women harbored complex mutation patterns. In total, 308 somatic mutations were identified with mutant allele frequencies ranging up to 96.0%. These encompassed 56 unique mutations from 24 genes. The majority of samples possessed predicted functional cancer mutations but curiously no growth advantage over non-functional mutations was detected. Functional mutations were enriched with increasing patient age (p = 0.045) and BMI (p = 0.0007) and in endometrial versus myometrial layers (68% vs 39%, p = 0.0002). Finally, while the somatic mutation landscape shared similar mutation prevalence in key TCGA-defined EndoCA genes, notably PIK3CA, significant differences were identified, including NOTCH1 (77% vs 10%), PTEN (9% vs 61%), TP53 (0% vs 37%) and CTNNB1 (0% vs 26%). CONCLUSIONS An important caveat for future liquid biopsy/DNA-based cancer diagnostics is the repertoire of shared and distinct mutation profiles between histologically unremarkable and EndoCA tissues. The lack of selection pressure between functional and non-functional mutations in histologically unremarkable uterine tissue may offer a glimpse into an unrecognized EndoCA protective mechanism.
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Affiliation(s)
- Deep Pandya
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America
| | - Shannon Tomita
- Departments of Obstetrics/Gynecology & Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Maria Padron Rhenals
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Sabina Swierczek
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America; Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, United States of America
| | - Katherine Reid
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Olga Camacho-Vanegas
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Catalina Camacho
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Kelsey Engelman
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Stephanie Polukort
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America
| | | | - Linus Chuang
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America
| | - Vaagn Andikyan
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America
| | - Samantha Cohen
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Paul Fiedler
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America
| | - Steven Sieber
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America
| | - Ie-Ming Shih
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States of America
| | - Jean-Noël Billaud
- QIAGEN Bioinformatics, 1001 Marshall Street, Redwood City, CA 94063, United States of America
| | - Robert Sebra
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Boris Reva
- Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Peter Dottino
- Departments of Obstetrics/Gynecology & Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; MDDx Inc., Tarrytown, NY 10591., United States of America
| | - John A Martignetti
- The Rudy L. Ruggles Biomedical Research Institute, Nuvance Health, Danbury, CT 06902, United States of America; Departments of Obstetrics/Gynecology & Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; Genetics and Genomic Science, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America; MDDx Inc., Tarrytown, NY 10591., United States of America.
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Ghose A, Agarwal A, Sirohi B, Nag S, Chuang L, Mitra S. Translating the COVID-19 experience in widening the HPV vaccination campaign for cervical cancer in India. Gynecol Oncol Rep 2023; 48:101247. [PMID: 37492441 PMCID: PMC10363615 DOI: 10.1016/j.gore.2023.101247] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
India has proven by the success of COVID vaccination that it has a huge production and distribution capacity, availability of professionally trained medical staff, world renowned digital infrastructure to enrol people, conduct camps and maintain records, and a positive mindset among the people towards vaccination. There is an unmet need to enforce that cervical cancer is a "preventable tragedy," and vaccination is an invaluable way ahead. With this article, we hope to attract attention to translating India's successful COVID-19 vaccination campaign experience to developing the HPV vaccination campaign.
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Affiliation(s)
- Aruni Ghose
- United Kingdom Global Cancer Network, Manchester, UK
- Department of Medical Oncology, Barts Cancer Centre, St. Bartholomew's Hospital, Barts, Health NHS Trust, London, UK
- Department of Medical Oncology, Medway NHS Foundation Trust, Kent, UK
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North, Hertfordshire NHS Trust, London, UK
| | | | - Bhawna Sirohi
- United Kingdom Global Cancer Network, Manchester, UK
- Department of Medical Oncology, BALCO Medical Centre, Vedanta Medical Research, Foundation, Chhattisgarh, India
| | - Shona Nag
- Department of Oncology, Sahyadri Group of Hospitals, Maharashtra, India
| | - Linus Chuang
- Division of Gynaecologic Oncology, Nuvance Health, Danbury, CT, USA
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Marinone M, Serino J, Stroever S, Brzozowski N, Kliss A, Doo D, Chuang L. Assessment of Pre-operative Vaginal Preparation for Laparoscopic Hysterectomy. JSLS 2023; 27:e2023.00013. [PMID: 37663434 PMCID: PMC10473181 DOI: 10.4293/jsls.2023.00013] [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] [Indexed: 09/05/2023] Open
Abstract
Objective Determine the difference in microbial growth from the vagina and uterine manipulator among patients undergoing laparoscopic hysterectomy after randomization to one of three vaginal preparation solutions (10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine). Method This was a prospective randomized controlled trial in an academic community hospital. Patients were ≥ 18 years old and scheduled for laparoscopic hysterectomy for benign and malignant indications. Results Fifty patients were identified and randomized into each arm. Prior to surgery, the surgical team prepared the vaginal field using 10% Povidone-iodine, 2% Chlorhexidine, or 4% Chlorhexidine, according to group assignment. Cultures were collected from the vagina after initial preparation, prior to the colpotomy, and on surfaces of the uterine manipulator. Bacterial count from the baseline vaginal fornix/cervical canal cultures did not differ significantly among the three groups. There was a difference in bacterial count among the second cervical canal/vaginal fornix cultures (p < 0.01), with the Povidone-iodine arm demonstrating the highest level of growth of cultures (93.8%), followed by 2% Chlorhexidine (47.4%), and 4% Chlorhexidine (20%). There was no difference in growth on the uterine manipulator handle and no difference in vaginal itching or burning was found across the three arms postoperatively. Conclusion Bacterial growth prior to colpotomy was the lowest with 4% Chlorhexidine followed by 2% Chlorhexidine, the Povidone-iodine group exhibited the highest bacterial growth. There was no difference in moderate to severe vaginal itching or burning. This showed that 4% Chlorhexidine is superior in reducing bacterial growth when used in laparoscopic hysterectomy.
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Affiliation(s)
- Michelle Marinone
- Green Valley OB/GYN, Greensboro, North Carolina, USA. (Dr. Marinone)
| | - Jonathan Serino
- USF Health Morsani College of Medicine, Tampa, Fl, USA. (Mr. Serino)
| | - Stephanie Stroever
- Department of Medical Education and Clinical Research Institute, Texas Tech University Health Sciences Center, Lubbock, TX, USA. (Dr. Stroever)
| | - Nicole Brzozowski
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital of Nuvance Health, Danbury, CT, USA. (Drs. Brzozowski, Doo, and Chuang)
| | - Andrea Kliss
- Performance Improvement- Quality, Danbury Hospital of Nuvance Health, Danbury, CT, USA. (Ms. Kliss)
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Peretz A, Stark-Inbar A, Harris D, Tamir S, Shmuely S, Ironi A, Halpern A, Chuang L, Riggins N. Safety of remote electrical neuromodulation for acute migraine treatment in pregnant women: A retrospective controlled survey-study. Headache 2023. [PMID: 37335242 DOI: 10.1111/head.14586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Addie Peretz
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Shira Tamir
- Theranica Bio-Electronics LTD, Netanya, Israel
| | | | - Alon Ironi
- Theranica Bio-Electronics LTD, Netanya, Israel
| | - Audrey Halpern
- The Manhattan Center for Headache & Neurology, New York City, New York, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Nuvance Health, Danbury, Connecticut, USA
- University of Vermont Larner's College of Medicine, Burlington, Vermont, USA
| | - Nina Riggins
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
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Lapides A, Ma W, McKinney C, Chuang L. Laparoscopically-treated ovarian torsion in a 32-week pregnancy: A case report. Case Rep Womens Health 2023; 37:e00496. [PMID: 37020693 PMCID: PMC10068008 DOI: 10.1016/j.crwh.2023.e00496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Ovarian torsion is a gynecologic emergency which, while rare during pregnancy, is associated with increased risk during pregnancy. Most torsions during pregnancy occur during the first and second trimester, with only 10.5% of cases reported during the third trimester. A 35-year-old woman at 32 weeks and 2 days of gestation presented with right lower quadrant abdominal pain. Transvaginal ultrasound demonstrated a large right ovarian cyst and decreased flow on color Doppler consistent with ovarian torsion. The diagnosis was confirmed via diagnostic laparoscopy with direct visualization of the necrotic, edematous ovarian cyst and pedicle, which had been torsed twice. The pedicle was detorsed and the necrotic cyst was resected while sparing as much of the normal ovary as possible. The patient provided written consent for publication of this case report. Data supports that laparoscopy is a safe and reasonable treatment for ovarian torsion during pregnancy. It is associated with shorter hospital stays and fewer postoperative complications without increasing the risk of obstetric or neonatal complications. Much of this data, however, is obtained from case reports of torsions during the first and second trimester. The incidence of third trimester ovarian torsion is estimated to be 5-10% of torsion cases that occur in pregnancy. This case demonstrates a successful laparoscopic treatment of a third-trimester torsion in a woman who went on to deliver a healthy baby girl by spontaneous vaginal delivery.
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Ferraro A, Laibangyang A, Yazdani A, Hurwitz J, Chuang L. Recurrent cervical cancer after trachelectomy diagnosed by hysteroscopy: A case report. Gynecol Oncol Rep 2023; 45:101134. [PMID: 36683776 PMCID: PMC9853302 DOI: 10.1016/j.gore.2023.101134] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Surveillance for cervical cancer recurrence after radical trachelectomy is challenging and warrants additional research to establish evidence-based screening guidelines. Papanicolaou (Pap smear) with HPV testing, physical exam, and symptom reporting remain the standard of care despite high false positive rates. In this patient with a history of early-stage cervical adenocarcinoma status post radical trachelectomy, a diagnosis of recurrence was made hysteroscopically, prompting evaluation of the utility of this technique for screening and management of patients with suspected recurrent cervical cancer after trachelectomy.
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Affiliation(s)
- Amanda Ferraro
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States,Corresponding author at: 24 Hospital Ave, Department of OBGYN, Danbury, CT 06810, United States.
| | - Anya Laibangyang
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States
| | - Ariella Yazdani
- Larner College of Medicine at the University of Vermont, 89 Beaumont Ave, Burlington, VT 0540, United States
| | - Joshua Hurwitz
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States,Illume Fertility, Reproductive Endocrinology and Infertility, 103 Newtown Rd #1A, Danbury, CT 06810, United States
| | - Linus Chuang
- Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States,Larner College of Medicine at the University of Vermont, 89 Beaumont Ave, Burlington, VT 0540, United States
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Ogamba I, Napolitano S, Chuang L, August D, LaVorgna K. Primary umbilical endometriosis presenting with umbilical bleeding: A case report. Case Rep Womens Health 2022; 36:e00441. [PMID: 36043222 PMCID: PMC9420471 DOI: 10.1016/j.crwh.2022.e00441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Endometriosis is a condition in which endometrial tissue implants outside the uterine cavity, which can cause cyclic pain, dysmenorrhea, dyspareunia, and infertility. Endometriosis implants are typically seen on pelvic peritoneal surfaces and extra-pelvic disease is uncommon. We present an interesting case of primary umbilical endometriosis in a patient who presented with umbilical bleeding with a history of pelvic inflammatory disease complicated by bilateral tubo-ovarian abscesses. She was found to have an umbilical mass, which was resected, and the pathology was consistent with endometriosis. The objective of this case report is to detail the case and discuss diagnosis and management of umbilical endometriosis. It is important to recognize that umbilical endometriosis can occur in patients with no surgical history. Primary umbilical endometriosis occurs spontaneously. Diagnosis of umbilical endometriosis is clinical, but pathology confirms it. Signs of umbilical endometriosis include cyclic umbilical bleeding/pain and swelling. Surgical management is the primary treatment of choice.
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Baekelandt J, Chuang L, Zepeda Ortega JH, Burnett A. A new approach to radical hysterectomy: First report of treatment of cervical cancer via vNOTES. Asian J Surg 2022; 46:1852-1853. [PMID: 36319544 DOI: 10.1016/j.asjsur.2022.10.067] [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] [Received: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/02/2022] Open
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Pandya DS, Swierczek S, Billaud JN, Farisello S, Swierczek M, Sieber S, Andikyan V, Chuang L, Martignetti JA. Abstract 1629: Integrated genomic and functional characterization of type I and II endometrial cancers reveals unexpected differences in novel candidate treatments. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Endometrial cancer (EndoCA), is the most common cancer of the female genital tract and is one of the few cancers in which incidence and death rates continue to rise. EndoCA is divided into Type I and II cancers: with type II cancers having poorer prognoses and accounting for a disproportionate number of EndoCA deaths. We sought to identify unique and potential therapeutic targets in type II EndoCA and then functionally validate these candidate targets using EndoCA patient-derived cell lines (PDCL).
Methods: Ten EndoCA tumors, five each type I/II, were collected at surgery and PDLC (n=10) generated. Whole transcriptomic was performed on all samples including normal endometrium (n=7) as a control. Data analysis was performed using QIAGEN informatics tools (CLC Genomics, QCI-T and IPA). Cell viability assays (MTT) were performed using all 10 PDCL following drug dosing and all experiments were performed three times and in triplicate.
Results: We analyzed differential gene expression profiles to explore molecular specificities between type I and II EndoCA using tumor samples and their paired PDCLs (passage 1 and 5). Our analysis revealed high degree of overlap between PDCL and their paired tumors and strong transcriptomic resemblance between type I and II tumors. Given the unexpected degree of similarities, we were intrigued to functionally interrogate representative shared canonical signaling pathways (Z>2.5) (activation of Sirtuin, RhoGDI and PTEN) and (inhibition of IL-8 and NF-kB) and potential drivers (Z>2.5) (including DNMT3B, NPAT, PDLIM2, FLCN, SIRT3, KRAS) between tumors and PDCL as potential therapeutic targets and interrogate their effectiveness between type I and II tumors. Based on drug availability, only three drug targets were identified: KDM1A, SIRT3, and PDLIM2 and, respectively, Seclidemstat, Resveratrol and Birabresib as potential inhibitors. To investigate the effect of these drugs, cell viability was determined. All predicted candidates resulted in tumor cell death; however, and while neither predicted nor suggested by our in-silico model, we observed a consistently higher in vitro anti-tumor activity of two of the drugs in type II versus type I derived PDCL. Specifically, Seclidemstat, had an ~6x increase while Birabresib an ~10x increase in achieving cell death.
Conclusions: We identified three novel targets/drug inhibitors using combined transcriptomic profiling and functional characterization of type I and II EndoCA. Intriguingly, while selected based on shared profiles, two of these targets/drugs had markedly, and unexpectedly, greater effect in type II versus type I tumors. Interestingly, both of these drugs - Seclidemstat and Birabresib - are currently being tested in phase I clinical trials as novel epigenetic agents in solid tumors. Studies continue to explore the effectiveness of these agents in EndoCA.
Citation Format: Deep S. Pandya, Sabina Swierczek, Jean-Noel Billaud, Sara Farisello, Magdalena Swierczek, Steven Sieber, Vaagn Andikyan, Linus Chuang, John A. Martignetti. Integrated genomic and functional characterization of type I and II endometrial cancers reveals unexpected differences in novel candidate treatments [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1629.
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Nierenburg H, Rabany L, Lin T, Sharon R, Harris D, Ironi A, Wright P, Chuang L. Remote Electrical Neuromodulation (REN) for the Acute Treatment of Menstrual Migraine: a Retrospective Survey Study of Effectiveness and Tolerability. Pain Ther 2021; 10:1245-1253. [PMID: 34138449 PMCID: PMC8586055 DOI: 10.1007/s40122-021-00276-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/26/2021] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Migraine is one of the most prevalent neurological disorders worldwide, and estimations are that 60% of women who suffer from migraines experience attacks that are associated with menstruation. Menstrual migraines are typically more debilitating and less responsive to pharmacological treatment. Remote electrical neuromodulation (REN) is a non-pharmacological abortive treatment of migraine headache. The current study evaluated the self-reported effectiveness and tolerability of REN for the acute treatment of menstrual migraine, via a retrospective structured survey that was sent to adult female REN users. METHODS Women aged 18-55 years who experience menstrually related or pure menstrual migraine and have completed at least four REN treatments, participated in this retrospective, observational survey study. Participants completed a short online survey assessing effectiveness, satisfaction, and safety outcomes. RESULTS Ninety-one participants qualified for the analysis, out of which 74.7% (68/91) reported that the treatment was at least moderately effective (moderately effective 37.4%, very effective 26.4%, extremely effective 11.0%). Additionally, 45.1% (41/91) reported satisfaction from REN (slightly satisfied 33%, extremely satisfied 12.1%), while 34.1% were neutral and 20.9% (19/91) were not satisfied. Lastly, 100% of the participants reported that the treatment is at least moderately tolerable (moderately tolerable 8.8%, very tolerable 20.9%, extremely tolerable 70.3%), and 13.2% (12/91) of respondents reported mild short-term side effects. CONCLUSIONS Nearly 75% reported that the treatment was at least moderately effective, 45% reported satisfaction, and 100% of the participants reported that the treatment is at least moderately tolerable. Thirteen percent reported mild short-term side effects. REN was thus reported as effective for menstrual migraine by most participants and was very well tolerated. Therefore, REN may provide a safe, non-pharmacological alternative for the acute treatment of menstrual migraine. CLINICALTRIAL. GOV REGISTRATION NUMBER NCT04600388.
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Affiliation(s)
- Hida Nierenburg
- Division of Neurology, Nuvance Health, Poughkeepsie, NY, USA.
| | | | - Tamar Lin
- Theranica Bio-Electronics, Netanya, Israel
| | - Roni Sharon
- Headache and Facial Pain, Sheba Medical Center, Ramat Gan, Israel
| | | | - Alon Ironi
- Theranica Bio-Electronics, Netanya, Israel
| | - Paul Wright
- Division of Neurology, Nuvance Health, Poughkeepsie, NY, USA
| | - Linus Chuang
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Nuvance Health, 24 Hospital Avenue, Danbury, CT, 06810, USA
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Chuang L, Rainville N, Byrne M, Randall T, Schmeler K. Cervical cancer screening and treatment capacity: A survey of members of the African Organisation for Research and Training in Cancer (AORTIC). Gynecol Oncol Rep 2021; 38:100874. [PMID: 34692968 PMCID: PMC8511835 DOI: 10.1016/j.gore.2021.100874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/21/2022] Open
Abstract
This is a survey report of AORTIC members on cervical cancer screening and treatment capacity. Radiation therapy capacity is the most limited treatment modality available in Africa. Gynecologic oncologists who can provide surgical care for women with cervical cancer is needed.
Background Cervical cancer is the second most common cancer among women in Africa, and in half of the sub-Saharan African countries, it is the most common cancer. Currently, there are scarce resources and limited infrastructure to support cervical cancer screening and treatment in many African countries. Objectives The aim of this study is to investigate the capacity of cervical cancer screening and treatment among members of the African Organization for Research and Training in Cancer (AORTIC). Methods Data were collected from 183 participants through online surveys over a 3-month study period in 2016. Results The respondents reported large variations among different African countries. This study highlights the differences between African countries in the availability of screening programs as a result of the resources allocated to healthcare development. Radiation therapy capacity remained the most limited treatment modality available, followed by the lack of gynecologists or gynecologic oncologists who can perform radical hysterectomy. Conclusions This information is critical for physicians, public health educators, and policymakers aiming to improve the outcomes among women with cervical cancer in Africa.
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Affiliation(s)
- Linus Chuang
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, New York, NY, United States
| | - Nicole Rainville
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, CT, United States
- Corresponding author at: Department of Obstetrics & Gynecology, Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, United States.
| | - Maureen Byrne
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Thomas Randall
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Kathleen Schmeler
- Department of Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX, United States
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13
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Randall TC, Somashekhar SP, Chuang L, Ng JSY, Schmeler KM, Quinn M. Reaching the women with the greatest needs: Two models for initiation and scale-up of gynecologic oncology fellowship trainings in low-resource settings. Int J Gynaecol Obstet 2021; 155 Suppl 1:115-122. [PMID: 34669202 PMCID: PMC9298416 DOI: 10.1002/ijgo.13869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Women in low- and middle-income countries (LMICs) are significantly more likely to develop and die from invasive cervical cancer, while rates of other gynecologic malignancies are comparable to those faced by women in high-income countries. Despite this increased need, there are few specialist physicians in LMICs available to treat women with gynecologic cancers. Training specialists in low-resource settings faces multiple challenges, including ensuring protected time from other clinical demands, access to best practice guidelines, training that is tailored to the specific challenges faced in the trainee's environment, and isolation from other fully trained professionals and securing support services. In addition, training specialists from LMICs in high-resource settings is costly and return of trainees to their own country is not guaranteed. Here we describe two approaches to gynecologic oncology training in LMICs. The International Gynecologic Cancer Society (IGCS) developed the Global Curriculum Mentorship and Training Program (Global Curriculum) to support gynecologic oncology fellowships in regions of the world that do not currently have formal training in gynecologic oncology. In India, on the other hand, leaders in world-class gynecologic oncology centers must find a way to meet the training needs of a vast and disparate country.
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Affiliation(s)
- Thomas C Randall
- Division of Gynecologic Oncology, The Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S P Somashekhar
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Nuvance Health, Westchester, New York, USA
| | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Laibangyang A, Law C, Gupta G, Da Dong X, Chuang L. Parasitic leiomyoma causing small bowel perforation: A case report. Case Rep Womens Health 2021; 32:e00349. [PMID: 34430223 PMCID: PMC8365333 DOI: 10.1016/j.crwh.2021.e00349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background Parasitic leiomyomas are rare extra-uterine tumors that can be seen in patients after myomectomy or morcellation of leiomyomas. Case A 63-year-old woman with a history of abdominal myomectomy 20 years prior presented with worsening abdominal distension and pain for the past eight months. The patient delayed care due to fear of the COVID-19 pandemic and was found to have a 42 cm parasitic leiomyoma attached to the small bowel causing obstruction and perforation. Conclusion Parasitic leiomyomas can cause small bowel obstruction and perforation. Parasitic leiomyomas can range in presentation from asymptomatic to sepsis. Parasitic leiomyomas can cause small bowel obstruction and perforation. Care should not be delayed in the setting of the COVID-19 pandemic.
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Affiliation(s)
- Anya Laibangyang
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
| | - Cassandra Law
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
| | - Gunjan Gupta
- Pathology & Laboratory Medicine, Danbury Hospital, Danbury, CT, United States of America
| | - Xiang Da Dong
- Department of Surgery, Nuvance Health, Danbury, CT, United States of America
| | - Linus Chuang
- Departments of Obstetrics, Gynecology, and Reproductive Biology, Danbury Hospital, Danbury, CT, United States of America
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15
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Jeng CJ, Ou KY, Long CY, Chuang L, Ker CR. 500 Cases of High-intensity Focused Ultrasound (HIFU) Ablated Uterine Fibroids and Adenomyosis. Taiwan J Obstet Gynecol 2021; 59:865-871. [PMID: 33218403 DOI: 10.1016/j.tjog.2020.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Clinical outcomes of 500 high-intensity focused ultrasound (HIFU)-treated uterine fibroids and adenomyosis are analyzed and presented. MATERIALS AND METHODS This is a retrospective cross-sectional analysis from a single tertiary medical center. From April 2015 to October 2018, 546 cases were enrolled for the study. After excluding 46 patients with less than 3 months of follow-up period, there were 404 fibroids, 149 adenomyosis and 53 mixed conditions entered for analysis. The patients' uterine fibroids and adenomyosis were treated by HIFU according to Chongqing Haifu protocol, with 12 cm diameter transducer of focal length 10-16 cm at 0.8 or 1.6 MHz T2-weight MRI imaging was rendered prior to and 3 month post treatment to assess lesion volume change using non-perfusion volume, which was the primary outcome. Secondary outcomes including quality of life, subjective satisfaction, adverse events and pregnancy rate were determined using self-reported questionnaires. The mean follow up period ranged from 3 to 38 months with an average of 21 months. RESULTS Three months after HIFU-treated uterine fibroids and adenomyosis, the lesion size reduced 40.2% and 46.3%, respectively. Symptoms all improved with better quality of life for the fibroid group, while those with adenomyosis or combined diseases benefit the most from pain control. Serum CA125 decreased significantly for all studied groups, and LDH only showed improvement for fibroids group. Number of adverse events is comparable to Chongqing data (approximately 10.2%), with mostly mild and self-resolving conditions. No permanent sequelae or death was documented. Twelve pregnancies are reported in this cohort. CONCLUSION HIFU is safe and effective in treating uterine fibroids and adenomyosis. The results are reproducible if standardized treatment schedules are followed. It is a promising treatment alternative with the advantages of precision, non-invasiveness, rapid recovery and readiness for pregnancy.
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Affiliation(s)
- Cherng-Jye Jeng
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, Graduate School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kae-Ying Ou
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, Graduate School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Western Connecticut Health Network, Larner College of Medicine at University of Vermont, Danbury, CT, USA
| | - Chin-Ru Ker
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, Graduate School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Ogamba I, Chuang L, Panarelli E, Zilberman D. A case report of COVID-19 infection and management during pregnancy. SAGE Open Med Case Rep 2021; 9:2050313X211015899. [PMID: 34035922 PMCID: PMC8132078 DOI: 10.1177/2050313x211015899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which started in Wuhan, Hubei Province, China, and progressed to a pandemic affecting over 210 countries and territories including the United States. The severity of symptoms range from mild to critical disease involving multi-organ failure; however, many pregnant COVID-19 patients have mild symptoms. The understanding of COVID-19 is evolving and there is limited data about its effects in pregnancy. This case series features two pregnant patients with COVID-19 with a range of symptoms, including fever, non-productive cough, headache, and worsening dyspnea. Both patients had chest x-ray findings notable for lung opacities, and lymphopenia was a consistent abnormal laboratory finding. Both of the patients had hypoxia which was treated with hydroxychloroquine and lopinavir-ritonavir with significant improvement in clinical symptoms and prolongation of pregnancy.
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Affiliation(s)
- Ifeoma Ogamba
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, CT, USA.,Department of Obstetrics and Gynecology, Norwalk Hospital, Norwalk, CT, USA
| | - Erin Panarelli
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Dimitry Zilberman
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, CT, USA.,Department of Obstetrics and Gynecology, Norwalk Hospital, Norwalk, CT, USA.,Division of Maternal Fetal Medicine, Danbury Hospital, Danbury, CT, USA
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Tran DT, Vo VK, Le MT, Chuang L, Nguyen VQH. Copenhagen Index versus ROMA in preoperative ovarian malignancy risk stratification: Result from the first Vietnamese prospective cohort study. Gynecol Oncol 2021; 162:113-119. [PMID: 33994145 DOI: 10.1016/j.ygyno.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/26/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate the diagnostic performances of the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA) in the preoperative prediction of ovarian cancer. METHODS In a prospective cohort study, data were collected from 475 patients with ovarian masses diagnosed by gynecologic examination / ultrasound who were hospitalized at the Departments of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital, Vietnam, between January 2018 and June 2020. ROMA and CPH-I were calculated based on measurements of serum carbohydrate antigen (CA-125) and human epididymis protein (HE4). The final diagnosis was based on clinical features, radiologic and histologic findings, and the International Federation of Gynecology and Obstetrics (FIGO) 2014 stages of ovarian cancer were recorded. Matching the values of ROMA and CPH-I to postoperative histopathology reports resulted in the preoperative prediction values. RESULTS Among the 475 women, 408 had benign tumors, 5 had borderline tumors and 62 had malignant tumors. The two indices showed similar discriminatory performances with no significant differences (p > 0.05). At an optimal cut-off, the sensitivities/specificities of ROMA and CPH-I for ovarian cancer diagnosis were 74.2% and 91.8%, 87.1% and 78.5%, respectively. The optimal cut-off for CPH-I was 1.89%. The areas under the ROC curves (AUCs) of ROMA and CPH-I were 0.882 (95% CI: 0.849-0.909) and 0.898 (95% CI: 0.867-0.924), respectively. CONCLUSIONS The introduction of the Copenhagen Index to help stratify the malignancy risk of ovarian tumors, irrespective of menopausal status, might be applied as a simple alternative with a similar efficacy to ROMA in clinical practice.
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Affiliation(s)
- Doan Tu Tran
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, Hue 491200, Viet Nam
| | - Van Khoa Vo
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, Hue 491200, Viet Nam
| | - Minh Tam Le
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, Hue 491200, Viet Nam
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Nuvance Health, University of Vermont Larner College of Medicine, Burlington, VT 05405, United States
| | - Vu Quoc Huy Nguyen
- Department of Obstetrics and Gynecology, Hue University of Medicine and Pharmacy, Hue University, 06 Ngo Quyen Street, Hue 491200, Viet Nam.
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18
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Ogamba I, Kliss A, Rainville N, Chuang L, Panarelli E, Petrini J, Zilberman D. Initial review of pregnancy and neonatal outcomes of pregnant women with COVID-19 infection. J Perinat Med 2021; 49:263-268. [PMID: 33141109 DOI: 10.1515/jpm-2020-0446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/10/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Data regarding the pathogenesis and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to emerge, however, there's limited data in regard to maternal and neonatal outcomes. Therefore, we conducted a retrospective analysis of all pregnant women who tested positive for SARS-CoV-2 within Nuvance Health system. METHODS Data were abstracted from the medical records of each patient and descriptive analysis was performed. Variables included demographics, COVID testing results, symptoms, management, labor course, neonatal information, and complications. RESULTS Total of 40 patients were identified. Average age was 29.6 years old, 35% were Hispanic, and approximately one in three patients had comorbidities. Of the patients who had repeated testing, the average number of days between first positive test and negative test was 36.8 days (± 19.9 days). Three out of four women reported symptoms. Of the 40 pregnant women who were positive for SARS-CoV-2, 25 of them delivered. About 84% of the women delivered after 37 weeks. Twelve percent of the women delivered under 33 and 6/7 weeks. Most patients had vaginal deliveries (68%) and the remaining had cesarean deliveries. Neonatal outcomes included: mean 1 and 5 min Apgar scores of 8 and 8.8, respectively and the mean birth weight was 3212 g. Twenty neonates were tested for SARS-CoV-2 and were all found to be negative. CONCLUSIONS Overall, with routine prenatal care and preventive measures, pregnant patients and neonates in our study had good outcomes. At this time, there appears to be no evidence of vertical transmission.
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Affiliation(s)
- Ifeoma Ogamba
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Andrea Kliss
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Nicole Rainville
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury and Norwalk Hospital, Danbury/Norwalk, CT, USA
| | - Erin Panarelli
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Joann Petrini
- Department of Obstetrics & Gynecology, Danbury Hospital, Danbury, CT, USA
| | - Dimitry Zilberman
- Department of Obstetrics and Gynecology, Danbury and Norwalk Hospital, Danbury/Norwalk, CT, USA
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Randall T, Chuang L, Ng SYJ, Schmeler KM, Quinn MA. The IGCS global curriculum mentorship and training program: building human capacity for gynecologic cancer treatment and research where the need is greatest. Int J Gynecol Cancer 2021; 31:1380-1381. [PMID: 33727221 DOI: 10.1136/ijgc-2021-002480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Thomas Randall
- Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Linus Chuang
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Danbury, Connecticut, USA
| | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology, M.D. Anderson Cancer Center, Houston, Texas, USA
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Chuang L, Long CY, Jeng CJ. Which is a superior non-surgical uterine myoma treatment option? Taiwan J Obstet Gynecol 2021; 60:384. [PMID: 33678353 DOI: 10.1016/j.tjog.2021.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Linus Chuang
- Nuvance Health, University of Vermont, 24 Hospital Ave., Danbury, CT, 06810 USA.
| | - Cheng-Yu Long
- Nuvance Health, University of Vermont, 24 Hospital Ave., Danbury, CT, 06810 USA
| | - Cherng-Jye Jeng
- Nuvance Health, University of Vermont, 24 Hospital Ave., Danbury, CT, 06810 USA
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21
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Sen D, Brunton J, Melchior L, Klein D, Levy GH, Wainscoat B, Chuang L. Peritoneal tuberculosis: A case report on a rare cause of tumor marker elevation. Case Rep Womens Health 2020; 28:e00264. [PMID: 33145180 PMCID: PMC7591737 DOI: 10.1016/j.crwh.2020.e00264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022] Open
Abstract
Peritoneal tuberculosis (TB) is a rare extrapulmonary manifestation of TB with non-specific clinical characteristics which can produce test results mimicking malignancy and granulomatous peritonitis. This case describes a Filipino 59-year-old, nulliparous woman who was admitted with abdominal pain, ascites, and an elevated CA-125 level. Radiographically, peritoneal nodules were visualized and initial suspicion was high for malignancy. Following a bilateral salpingo-oophorectomy and peritoneal biopsy, histology was negative for malignancy but revealed non-caseating granulomas. She was discharged then readmitted with progressive abdominal pain, and a repeat laparoscopic biopsy yielded specimens with growth of acid-fast bacilli (AFB). A delay in diagnosis and treatment of tuberculous peritonitis increases mortality rates, making early diagnosis with laparoscopic biopsy of paramount importance in prompt diagnosis and initiation of therapy. This patient was initiated on standard anti-TB therapy and experienced no complications.
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Affiliation(s)
- Dilek Sen
- Ross University School of Medicine, Miramar, Florida, USA
| | - Joshua Brunton
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, Connecticut, USA
| | - Landon Melchior
- Department of Radiology, Norwalk Hospital, Norwalk, Connecticut, USA
| | - David Klein
- Department of Radiology, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Gillian H Levy
- Department of Pathology, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Booth Wainscoat
- Department of Infectious Disease, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, Connecticut, USA
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Koirala P, Moon AS, Chuang L. Clinical Utility of Preoperative Assessment in Ovarian Cancer Cytoreduction. Diagnostics (Basel) 2020; 10:E568. [PMID: 32784719 PMCID: PMC7459574 DOI: 10.3390/diagnostics10080568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/01/2020] [Accepted: 08/02/2020] [Indexed: 01/04/2023] Open
Abstract
Ovarian cancer is the deadliest gynecologic cancer, in part due to late presentation. Many women have vague early symptoms and present with disseminated disease. Cytoreductive surgery can be extensive, involving multiple organ systems. Novel therapies and recent clinical trials have provided evidence that, compared to primary cytoreduction, neoadjuvant chemotherapy has equivalent survival outcomes with less morbidity. There is increasing need for validated tools and mechanisms for clinicians to determine the optimal management of ovarian cancer patients.
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Affiliation(s)
- Pratistha Koirala
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Danbury Hospital, Danbury, CT 06810, USA; (A.S.M.); (L.C.)
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23
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Ker CR, Ou KY, Long CY, Chuang L, Jeng CJ. Acute renal insufficiency and thrombocytopenia after high-intensity focused ultrasound (HIFU) ablation for uterine myomas. Taiwan J Obstet Gynecol 2020; 59:594-597. [PMID: 32653136 DOI: 10.1016/j.tjog.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Ultrasound-guided high-intensity focused ultrasound (USg-HIFU) has emerged in recent years as the new treatment modality for uterine myomas and adenomyosis with the advantages of being non-invasive, safe and effective. As its utility increases, adverse reactions emerge and deserve clinicians' attention for experience accrual. We herein report a case who suffered from acute renal insufficiency and thrombocytopenia immediately after receiving HIFU for uterine myomas. CASE REPORT A 38-year-old nulliparous healthy female received HIFU for huge uterine myoma that caused heavy vaginal bleeding and chronic anemia. The procedure went smoothly but the patient immediately suffered from oliguria and dark-colored urine. With conservative management and aggressive hydration, her condition had improved spontaneously after 1 week without leaving any long-term sequelae. Myoma size reduced by 70% 3 months post-treatment and her bleeding problems significantly improved. CONCLUSION This is the first report of post-HIFU acute renal failure and thrombocytopenia. Thermal injuries, drug toxicity and mechanical obstruction of ureters are some plausible explanations for speculations.
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Affiliation(s)
- Chin-Ru Ker
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kae-Ying Ou
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Western Connecticut Health Network, Larner College of Medicine at University of Vermont, Danbury, CT, USA
| | - Cherng-Jye Jeng
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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Carbajal-Mamani SL, Dideban B, Schweer D, Balavage KT, Chuang L, Wang Y, Wang S, Lee JH, Amaro B, Cardenas-Goicoechea J. Incidence of venous thromboembolism after robotic-assisted hysterectomy in obese patients with endometrial cancer: do we need extended prophylaxis? J Robot Surg 2020; 15:343-348. [DOI: 10.1007/s11701-020-01110-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/22/2020] [Indexed: 01/29/2023]
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25
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Moon AS, DeAngelis AM, Fairbairn M, Kulikowski K, Goldenberg D, Chuang L, Andikyan V. Removal of 132-pound ovarian mucinous cystadenoma: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20906738. [PMID: 32477549 PMCID: PMC7233899 DOI: 10.1177/2050313x20906738] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Ovarian masses larger than 100 pounds are rarely encountered in developed countries given advancements in early diagnosis and treatment. Their successful resections pose unique surgical and anesthetic challenges. An otherwise healthy 38-year-old para 1 woman developed a 50 × 60 cm pelvic mass. An exploratory laparotomy, left salpingo-oophorectomy and anterior abdominal wall reconstruction were performed. A total of 60 L of cystic fluid were drained. Close monitoring of hemodynamics and massive volume resuscitation required intensive care. Inpatient physical rehabilitation reinstated independent mobility. Final pathology revealed benign ovarian mucinous cystadenoma. A multidisciplinary approach in the preoperative, intraoperative and postoperative stages of management optimizes patient outcomes.
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Affiliation(s)
| | - Anthony M DeAngelis
- Reproductive Biology and Medicine Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Linus Chuang
- Danbury Hospital, Nuvance Health, Danbury, CT, USA
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Abstract
The robotic-assisted laparoscopic surgical approach has improved complex gynecologic surgeries. It has the advantages of excellent visualization through the high-resolution 3-dimensional view, a wrist-like motion of the robotic arms and improved ergonomics. Similar to conventional laparoscopic surgeries, it is associated with a decrease in long-term surgical morbidity, early recovery and return to work, and improved esthetics. We discuss preoperative planning, surgical techniques, and some of the latest clinical results of robotic-assisted laparoscopic gynecologic surgery.
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Affiliation(s)
- Ashley S Moon
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, USA.
| | - John Garofalo
- Department of Obstetrics, Gynecology and Reproductive Biology, Norwalk Hospital, Nuvance Health, 30 Stevens Street, Norwalk, CT 06850, USA
| | - Pratistha Koirala
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, USA
| | - Mai-Linh T Vu
- Complete Women Care, 3711 Long Beach Boulevard, Suite 110, Long Beach, CA 90807, USA
| | - Linus Chuang
- Department of Obstetrics, Gynecology and Reproductive Biology, Danbury Hospital, Nuvance Health, 24 Hospital Avenue, Danbury, CT 06810, USA
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Affiliation(s)
- Linus Chuang
- Department of Gynecologic Oncology, Danbury Hospital, Western Connecticut Health Network Danbury, CT
| | - Pratistha Koirala
- Department of Obstetrics and Gynecology, Danbury Hospital, Western Connecticut Health Network Danbury, CT
| | - Farr Nezhat
- Department of Obstetrics and Gynecology, Weill Cornell Medical College of Cornell University, NY, NY
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Aramin H, Koirala P, Shah A, Adams K, Buza N, Desai S, Fairbairn M, Goldenberg D, Gao W, Chuang L, Vidhun R, Andikyan V. Metachronous vulvar ectopic breast cancer, a case report and literature review. Gynecol Oncol Rep 2019; 30:100515. [PMID: 31867432 PMCID: PMC6890968 DOI: 10.1016/j.gore.2019.100515] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 11/11/2022] Open
Abstract
When two or more primary tumors arise at the same time, they are considered synchronous. A metachronous tumor in a new primary that develops after an initial cancer diagnosis. The diagnosis of vulvar breast cancer is primarily histopathologic, based on morphology and immunostaining. Identifying a cancer as a metastasis versus as synchronous/metachronous significantly impacts staging and treatment.
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Affiliation(s)
- Hermineh Aramin
- Department of Pathology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Pratistha Koirala
- Department of Obstetrics and Gynecology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Abhishek Shah
- Department of Pathology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Kendall Adams
- Department of Obstetrics and Gynecology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Natalia Buza
- Department of Pathology Yale School of Medicine New Haven, CT, USA
| | - Sapna Desai
- Department of Pathology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Melissa Fairbairn
- Department of Gynecologic Oncology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - David Goldenberg
- Department of Plastic Reconstructive Surgery, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Wenli Gao
- Department of Oncology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA.,Department of Gynecologic Oncology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Ramapriya Vidhun
- Department of Pathology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
| | - Vaagn Andikyan
- Department of Obstetrics and Gynecology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA.,Department of Gynecologic Oncology, Danbury Hospital, Western Connecticut Health Network Danbury, CT, USA
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Moon AS, Bourdeth A, Jerez R, Alger J, Chuang L. Evaluation of Ovarian Neoplasms in Honduras: Characteristics and Diagnostic Concordance Between Ultrasound, Tumor Markers and Histopathology. Gynecol Oncol Rep 2019; 30:100501. [PMID: 31692578 PMCID: PMC6806398 DOI: 10.1016/j.gore.2019.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 08/18/2019] [Accepted: 09/13/2019] [Indexed: 12/24/2022] Open
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Pandya DS, Tomita S, Camacho O, Swierczek S, Camacho C, Engelman K, Polukort S, Padron MM, RoseFigura J, Irish J, Chuang L, Andikyan V, Cohen S, Fiedler P, Sieber S, Shih IM, Billaud JN, Reva B, Sebra R, Dottino P, Martignetti JA. Abstract 2729: Development of a targeted liquid biopsy for early gynecologic cancer detection leads to discovery of a highly prevalent genomic landscape of cancer driver gene mutations in uterine tissue from women without cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Ovarian and endometrial cancers are, respectively, the most lethal and most frequent female reproductive tract malignancies. Currently, there are no effective screening methodologies or protocols for these cancers. We hypothesized that the use of ultra-deep, targeted gene sequencing on a highly specific and gynecologic cancer-focused analyte source, namely, uterine lavage fluid, could detect somatic mutations associated with these cancers. Using these highly sensitive NGS-based assays, we demonstrated both (1) the ability to detect tumor-specific mutations in uterine lavage from women even with microscopic stage IA ovarian and endometrial cancers and (2) the existence of highly prevalent populations of cancer driver gene mutated cells in uterine tissue from women without cancer.
Methods: In total, and following written informed consent, samples were prospectively collected and analyzed from two institutions from more than 250 women at the time of their surgery. Sequencing was performed using both Ion Torrent and Illumina-based sequencing and additional orthogonal mutation validation was performed using dPCR and Sanger sequencing.
Results: Targeted sequencing of cellular and cell free DNA isolated from uterine lavage samples was performed on all samples in a blinded fashion. Histopathologic diagnosis and sample decoding, revealed that lavage mutations were present in nearly all women with ovarian and endometrial cancer, even those with microscopic stage IA disease. These mutations were demonstrated to be tumor-specific by sequencing their respective tumors. Notably, we also identified mutations in approximately half of all women without any evidence of cancer. To define the possible origin of these mutations in normal tissue, we analyzed uterine tissue from women without cancer. Two hundred biopsy samples were obtained from 24 uterine samples following hysterectomy for non-cancerous conditions. Remarkably, sequencing revealed relatively high allele fraction cancer-associated mutations in more than half of these samples. The overwhelming majority of samples harbored low frequency mutations.
Conclusions: Our studies demonstrate the ability to detect with very high sensitivity, tumor-specific somatic mutations in women with ovarian and endometrial cancers; suggesting the future possibility of earlier diagnosis and better outcomes. At the same time, our studies again highlight caveats regarding NGS-based results for cancer screening. Finally, the identification of a previously unknown, highly prevalent, cancer-driver mutation landscape in apparently normal uterine tissue opens the door onto new areas of biologic exploration for understanding tumorigenesis and the protective mechanisms which inhibit cancer development.
Citation Format: Deep S. Pandya, Shannon Tomita, Olga Camacho, Sabina Swierczek, Catalina Camacho, Kelsey Engelman, Stephanie Polukort, Maria Mercedes Padron, Jordan RoseFigura, Jon Irish, Linus Chuang, Vaagn Andikyan, Samantha Cohen, Paul Fiedler, Steven Sieber, Ie-Ming Shih, Jean-Noel Billaud, Boris Reva, Robert Sebra, Peter Dottino, John A. Martignetti. Development of a targeted liquid biopsy for early gynecologic cancer detection leads to discovery of a highly prevalent genomic landscape of cancer driver gene mutations in uterine tissue from women without cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2729.
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Affiliation(s)
| | | | - Olga Camacho
- 2Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ie-Ming Shih
- 4Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Boris Reva
- 2Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert Sebra
- 2Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter Dottino
- 2Icahn School of Medicine at Mount Sinai, New York, NY
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Abstract
Objective To determine perioperative outcome differences in patients undergoing vaginal hysterectomy based on uterine weight, vaginal delivery, and menopausal state. Material and Methods Retrospective chart review of 452 patients who underwent vaginal hysterectomy performed by a single surgeon. Patients’ age, vaginal delivery, uterine weight, previous pelvic surgery, previous cesarean delivery, removal of ovaries were compared, as well as estimated blood loss (EBL), operating room time (ORT), length of stay, intraoperative complications and postoperative complications. Multivariable logistic regression was used, and all data were analyzed at the level of p<0.05 statistical significance using SAS system software (SAS Institute Inc., Cary, NC), version 9.3. Results The mean age was 57.13±11.52 years and the median vaginal delivery was 2. The uterine weight range was 16.6-1174.5 g (mean 169.79±183.94 g). The incidences of blood transfusion and bladder injury were 3.03% and 0.66%, respectively. Factors shown to be associated with longer ORT included greater uterine weight, removal of ovaries, posterior repair, tension-free vaginal tape sling, prolapse, and EBL >500 mL (p<0.001). The factors associated with EBL >500 mL were greater uterine weight (p=0.001), uterine myomas (p=0.016) and premenopausal state (p=0.014). The factors associated with conversion to laparotomy were greater uterine weight (p<0.001) and premenopausal state (p<0.001). Conclusion Vaginal hysterectomy is a safe and feasible approach for patients desiring hysterectomy regardless of uterine weight and vaginal delivery.
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Affiliation(s)
- Ido Sirota
- Department of Obstetrics and Gynecology, New York-Presbyterian Queens Weill Cornell Medicine, New York, USA
| | - Shannon A Tomita
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, USA,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Lisa Dabney
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alan Weinberg
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Danbury Hospital – Western Connecticut Health Network, Connecticut, USA
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Murphy K, Pereira E, Gupta V, Chuang L. Management of Locally Advanced Cervical Cancer Presenting with Spontaneous Uterine Rupture. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kelsey Murphy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elena Pereira
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vishal Gupta
- Department of Radiation Oncology, Mount Sinai Health System, New York, NY
| | - Linus Chuang
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
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Schwartz M, Gavane SC, Bou-Ayache J, Kolev V, Zakashansky K, Prasad-Hayes M, Taouli B, Chuang L, Kostakoglu L. Feasibility and diagnostic performance of hybrid PET/MRI compared with PET/CT for gynecological malignancies: a prospective pilot study. Abdom Radiol (NY) 2018; 43:3462-3467. [PMID: 29948057 DOI: 10.1007/s00261-018-1665-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the study was to assess the feasibility and diagnostic performance of FDG-PET/MR imaging compared to PET/CT for staging of patients with a gynecological malignancy. METHODS 25 patients with a gynecological malignancy were prospectively enrolled into this pilot study. Patients underwent sequential full-body PET/CT and PET/MR of the abdomen and pelvis after administration of a single dose of F-18 FDG. PET/MRI and PET/CT images were independently reviewed by two expert radiologists. Readers were blinded to the results of the other imaging procedures. Clinical and pathologic information was abstracted from medical charts. RESULTS 18 patients were included in the final analysis with a median age of 62 years (range 31-88). 61% of patients (11/18) had cervical cancer, while the remaining patients had endometrial cancer. PET/MRI as compared to PET/CT detected all primary tumors, 7/7 patients with regional lymph nodes, and 1/1 patient with an abdominal metastasis. Two patients had additional lymph nodes outside of the abdominopelvic cavity detected on PET/CT that were not seen on PET/MRI, whereas 6 patients had parametrial invasion and one patient had invasion of the bladder seen on PET/MRI not detected on PET/CT. Five cervical cancer patients had discordant clinical vs. radiographic staging based on PET/MRI detection of soft tissue involvement. Management changed for two patients who had clinical stage IB1 and radiographic stage IIB cervical cancer. CONCLUSIONS PET/MRI is feasible and has at least comparable diagnostic ability to PET/CT for identification of primary cervical and endometrial tumors and regional metastases. PET/MRI may be superior to PET/CT for initial radiographic assessment of cervical cancers.
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Affiliation(s)
- Melissa Schwartz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1170, New York, NY, 10029, USA.
| | - Somali C Gavane
- Division of Nuclear Medicine, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jad Bou-Ayache
- Division of Nuclear Medicine, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valentin Kolev
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1170, New York, NY, 10029, USA
| | - Konstantin Zakashansky
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1170, New York, NY, 10029, USA
| | - Monica Prasad-Hayes
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1170, New York, NY, 10029, USA
| | - Bachir Taouli
- Division of Nuclear Medicine, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Linus Chuang
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1170, New York, NY, 10029, USA
| | - Lale Kostakoglu
- Division of Nuclear Medicine, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Nair N, Schwartz M, Guzzardi L, Durlester N, Pan S, Overbey J, Chuang L. Hysterectomy at the time of risk-reducing surgery in BRCA carriers. Gynecol Oncol Rep 2018; 26:71-74. [PMID: 30364812 PMCID: PMC6198097 DOI: 10.1016/j.gore.2018.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/02/2022] Open
Abstract
In this study, women at risk for BRCA were surveyed to understand their choice of prophylactic surgery and associated risk of uterine cancers. The study was conducted as an anonymous online web-based survey that assessed personal and family histories and choice of prophylactic surgery. Respondents were targeted through social media groups that bring awareness to hereditary breast and ovarian cancer. The study cohort included an international group of 601 respondents. The majority were female (99.3%), in their 40s (34.2%), and had completed college or graduate school (68.8%). 87% of respondents carry BRCA gene mutation. Of 339 respondents who underwent risk-reducing salpingo-oophorectomy (RRSO), 55.8% had a hysterectomy at time of RRSO. Most common reasons for hysterectomy at time of RRSO included: 39% provider recommendation, 27.6% personal desire, 9.7% benign indications, 1.6% cancer in uterus, 1.1% precancerous uterine lesion, and 21.1% other (N = 185). In this cohort, nine were diagnosed with uterine cancer. Three were diagnosed after risk-reducing surgery. Both patients with uterine serous carcinoma were BRCA1 carriers. Two thirds of BRCA carriers surveyed had undergone RRSO. Of these, more than half had hysterectomy at time of RRSO. One third chose to have hysterectomy based on surgeon recommendation. <1% (2 out of 258) of BRCA1 gene mutation carriers reported being diagnosed with uterine serous carcinomas. While this incidence is low, it may be an underestimate based on the limitations of this study. Additional studies are needed to select which patients will benefit from concurrent hysterectomy and RRSO.
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Affiliation(s)
- Navya Nair
- Department of Obstetrics, Gynecology, and Reproductive Services, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa Schwartz
- Department of Obstetrics, Gynecology, and Reproductive Services, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa Guzzardi
- BRCA Advanced 101 & 102 Journal Club, New York, NY, USA
| | | | - Stephanie Pan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica Overbey
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Sirota I, Tomita SA, Dabney L, Weinberg A, Chuang L. Overcoming barriers to vaginal hysterectomy: an analysis of perioperative outcomes. J Turk Ger Gynecol Assoc 2018. [DOI: 10.4274/jtgga.2018.0021] [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: 12/01/2022] Open
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Jacobson G, Chuang L, Pankow M. Improving quality of care and timely access to radiation therapy for patients with invasive cervical cancer at the National Cancer Institute Paraguay. Gynecol Oncol Rep 2018; 25:82-86. [PMID: 29928685 PMCID: PMC6008498 DOI: 10.1016/j.gore.2018.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/22/2018] [Accepted: 06/08/2018] [Indexed: 11/23/2022] Open
Abstract
The purpose of this report is to describe the interventions implemented between 2012 and 2017 at the National Cancer Institute Paraguay (NCI Paraguay) to improve treatment quality and efficiency for patients with cervical cancer, with an emphasis on radiation quality and access. The NCI Paraguay requested collaboration with Health Volunteers Overseas (HVO), an international volunteer organization, to improve the care of patients with cervical cancer. This report is based on site visits to NCI Paraguay by HVO volunteers in 2012, 2013, and 2016, with a follow-up report from the site in 2017. During the study period, increased access to external beam radiation and brachytherapy led to a decrease in wait time to start radiation from 2 to 3 months to 4-6 weeks. The center transitioned from 2-dimensional (2D) to 3-D planning and was able to offer concurrent chemotherapy and radiation, including brachytherapy, to patients with locally advanced cervical cancer. Based on the American Society of Clinical Oncology's resource-stratified clinical guidelines, from 2012 to 2017, the practice transitioned from a "basic setting" to an "enhanced setting".
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Affiliation(s)
- Geraldine Jacobson
- Department of Radiation Oncology, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506, United States
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Western Connecticut Health Network, 24 Hospital Avenue, Danbury, CT 06810, United States
| | - Maximilian Pankow
- Department of Radiation Oncology, National Cancer Institute Paraguay, Teniente Jara Mendez 477 e/Pitiantuta, Asunción, Paraguay
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Chuang L, Berek J, Randall T, McCormack M, Schmeler K, Manchanda R, Rebbeck T, Jeng C, Pyle D, Quinn M, Trimble E, Naik R, Lai C, Ochiai K, Denny L, Bhatla N. Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities. Gynecol Oncol Rep 2018; 25:65-69. [PMID: 29928684 PMCID: PMC6008286 DOI: 10.1016/j.gore.2018.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022] Open
Abstract
Eighty-five percent of the incidents and deaths from cervical cancer occur in low and middle income countries. In many of these countries, this is the most common cancer in women. The survivals of the women with gynecologic cancers are hampered by the paucity of prevention, screening, treatment facilities and gynecologic oncology providers. Increasing efforts dedicated to improving education and research in these countries have been provided by international organizations. We describe here the existing educational and research programs that are offered by major international organizations, the barriers and opportunities provided by these collaborations and hope to improve the outcomes of cervical cancer through these efforts.
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Affiliation(s)
- L. Chuang
- Western Connecticut Health Network, Larner College of Medicine at the University of Vermont, Danbury, CT, USA
| | - J. Berek
- Stanford University School of Medicine, Stanford, CA, USA
| | - T. Randall
- The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - K. Schmeler
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R. Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - T. Rebbeck
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - C.J. Jeng
- Kaohsiung Medical University Hospital, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - D. Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - M. Quinn
- University of Melbourne, Melbourne, VIC, Australia
| | - E. Trimble
- Center for Global Health, National Cancer Institute, Bethesda, MS, USA
| | - R. Naik
- Northern Gynecological Oncology Centre, Gateshead, UK
| | - C.H. Lai
- Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - K. Ochiai
- Jikei University School of Medicine, Tokyo, Japan
| | - L. Denny
- University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa
| | - N. Bhatla
- All India Institute of Medical Sciences, New Delhi, India
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40
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Affiliation(s)
- Linus Chuang
- Western Conneticut Health Network, Larner College of Medicine at University of Vermont, Danbury, VT
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Ager BJ, Gallardo-Rincón D, de León DC, Chávez-Blanco A, Chuang L, Dueñas-González A, Gómez-García E, Jerez R, Jhingran A, McCormack M, Mileshkin L, Pérez-Plasencia C, Plante M, Poveda A, Gaffney DK. Advancing clinical research globally: Cervical cancer research network from Mexico. Gynecol Oncol Rep 2018; 25:90-93. [PMID: 30014021 PMCID: PMC6019404 DOI: 10.1016/j.gore.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/29/2018] [Accepted: 06/08/2018] [Indexed: 12/02/2022] Open
Abstract
Cervical cancer is the fourth most common cancer in women with 85% of the mortality burden occurring in less-developed regions of the world. The Cervix Cancer Research Network (CCRN) was founded by the Gynecologic Cancer InterGroup (GCIG) with a mission to improve outcomes in cervix cancer by increasing access to high-quality clinical trials worldwide, with particular attention to less-developed, underrepresented sites. The CCRN held its second international educational symposium in Mexico City with ninety participants from fifteen Latin America countries in January 2017. The purpose of this symposium was to advance knowledge in cervix cancer therapy, promote recruitment to CCRN clinical trials, and to identify relevant future CCRN clinical trial concepts that could improve global care standards for women with cervical cancer. Cervix cancer is the fourth most common cancer in women worldwide with up to an 18-fold disparity in mortality rates. The Cervix Cancer Research Network (CCRN) aims to increase access to clinical trials in order to improve outcomes for women. The 2nd CCRN international symposium was held in Mexico City including 90 participants from 15 Latin American countries. CCRN clinical trials were discussed, including new trials proposed of hypofractionation and HPV targeted therapy.
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Affiliation(s)
- Bryan J. Ager
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Corresponding author at: Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 1950 Circle of Hope, Room 1570, Salt Lake City, UT, 84112, USA.
| | | | - David Cantú de León
- Sub-Direction of Clinical Research, Instituto Nacional de Cancerología, México City, Mexico
| | - Adriana Chávez-Blanco
- Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México (GICOM), México City, Mexico
| | - Linus Chuang
- Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai, New York City, NY, USA
| | - Alfonso Dueñas-González
- Biomedical Research Unit in Cancer, Instituto de Investigaciones Biomédicas UNAM/Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary McCormack
- University College London Hospitals, London, United Kingdom
| | - Linda Mileshkin
- Division of Hematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Marie Plante
- Department of Gynecologic Oncology, Hotel-Dieu de Quebec, Quebec, Canada
| | - Andrés Poveda
- Department of Gynecologic Oncology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - David K. Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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42
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Bourdeth A, Moon A, Jerez R, Andikyan V, Chuang L, Alger J. Ovarian neoplasia: Characteristics and diagnostic concordance between ultrasound, tumor markers and histopathology in Honduras 2015-2016. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.546] [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: 11/16/2022]
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43
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Huy NVQ, Tam LM, Tram NVQ, Thuan DC, Vinh TQ, Thanh CN, Chuang L. The value of visual inspection with acetic acid and Pap smear in cervical cancer screening program in low resource settings - A population-based study. Gynecol Oncol Rep 2018. [PMID: 29527550 PMCID: PMC5842293 DOI: 10.1016/j.gore.2018.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study aims to determine the diagnostic values of visual inspection with acetic acid (VIA) and Pap smear in a cervical cancer screening program at a community level in Vietnam. A cross-sectional analysis was obtained, including 1034 women of reproductive age from Thua Thien Hue Province, Vietnam from 09/2012 to 09/2013. Samples were taken from cervixes for Pap smear testing, followed by visual inspection with acetic acid. Subjects with abnormal VIA and/or positive cytology results were invited for colposcopy and biopsy. Histologic confirmed cervical intraepithelial neoplasia (CIN2+) served as gold standards for diagnostic values analysis. Abnormal VIA results were recorded in 87 cases (7.7%). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of VIA for CIN2+ were 88.8%, 43.8%, 63.4%, 51.2% and 83.3%, respectively. Diagnostic values of Pap smear were 58.0%, 85.2%, 69.9%, 83.3% and 61.3% for its sensitivity, specificity, accuracy, PPV and NPV, respectively. VIA yielded high sensitivity but its accuracy is still limited in pre-cancerous lesions during cervical cancer screening. The Pap smear has acceptable sensitivity and specificity, but its false-negative rate is still high. We recommend a combination of different tests to increase the efficiency of screening in our community.
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Affiliation(s)
- Nguyen Vu Quoc Huy
- Department of Obstetrics & Gynecology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
- Corresponding author at: Department of Obstetrics & Gynecology, Hue University of Medicine and Pharmacy, Hue University, 6 Ngo Quyen St., Hue 530000, Viet Nam.
| | - Le Minh Tam
- Department of Obstetrics & Gynecology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Ngo Viet Quynh Tram
- Department of Microbiology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Dang Cong Thuan
- Department of Pathology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Truong Quang Vinh
- Department of Obstetrics & Gynecology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Cao Ngoc Thanh
- Department of Obstetrics & Gynecology, Hue University of Medicine and Pharmacy, Hue University, Viet Nam
| | - Linus Chuang
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, USA
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44
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Ou KY, Jeng CJ, Long CY, Chuang L. Re: Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound: Is the noninvasive nature of HIFU ablation for uterine fibroids and adenomyosis setting patients up for future operative delivery? BJOG 2018; 125:762-763. [PMID: 29405613 DOI: 10.1111/1471-0528.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Kae-Yng Ou
- Department of Obstetrics and Gynaecology/HIFU Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cherng-Jye Jeng
- Department of Obstetrics and Gynaecology/HIFU Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Obstetrics and Gynaecology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynaecology/HIFU Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Obstetrics and Gynaecology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Linus Chuang
- Department of Obstetrics and Gynaecology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Mount Sinai Medical School, New York, NY, USA
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45
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Ou KY, Jeng CJ, Long CY, Chuang L. Re: A comparison of the cost-utility of ultrasound-guided high-intensity focused ultrasound and hysterectomy for adenomyosis: a retrospective study: Is the cost-effectiveness of HIFU for adenomyosis and fibroids feasible? BJOG 2018; 125:763-764. [PMID: 29405542 DOI: 10.1111/1471-0528.15115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Kae-Yng Ou
- Department of Obstetrics and Gynaecology/HIFU Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Cherng-Jye Jeng
- Department of Obstetrics and Gynaecology/HIFU Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Obstetrics and Gynaecology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynaecology/HIFU Centre, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Obstetrics and Gynaecology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Linus Chuang
- Department of Obstetrics and Gynaecology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Mount Sinai Medical School, New York, NY, USA
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46
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Tsai Y, Chuang L, Chiu C. PROFILES OF MORBIDITY, DISABILITY, AND RISK FACTORS FOR OLDER ADULTS IN TAIWAN: A GIS-BASED APPROACH. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y. Tsai
- Institute of Gerontology, National Cheng Kung University, Tainan, Taiwan,
- Sinhua Branch, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan,
| | - L. Chuang
- Department of Sports Medicine, Kauhsiung Medical University, Kauhsiung, Taiwan,
- Lee’s Clinic, Pingtung, Taiwan
| | - C. Chiu
- Institute of Gerontology, National Cheng Kung University, Tainan, Taiwan,
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Randall TC, Chuang L, Orang'o E, Rosen B, Uwinkindi F, Rebbeck T, Trimble EL. Strengthening care and research for women's cancers in Sub-Saharan Africa. Gynecol Oncol Rep 2017; 21:109-113. [PMID: 28819635 PMCID: PMC5548333 DOI: 10.1016/j.gore.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/26/2017] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
The burden of gynecologic cancers in low resource settings is overwhelming. Areas with the highest needs have few human resources and limited infrastructure. Cancer specialists can best help by leveraging ongoing work to assist local leaders.
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Affiliation(s)
- Thomas C. Randall
- Division of Gynecologic Oncology, The Massachusetts General Hospital, Boston, MA, United States
- The National Cancer Institute, Center for Global Health, Rockville, MD, United States
- Corresponding author at: Division of Gynecologic Oncology, The Massachusetts General Hospital, Boston, MA, United States.Division of Gynecologic OncologyThe Massachusetts General HospitalBostonMAUnited States
| | - Linus Chuang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mount Sinai Medical Center, New York, NY, United States
| | - ElkanahOmenge Orang'o
- Department of Reproductive Health, Moi University School of Medicine, Eldoret, Kenya
| | - Barry Rosen
- Gynecologic Oncology, Beaumont Hospital, Grosse Point, MI, United States
| | | | - Timothy Rebbeck
- Epidemiology, Harvard T.H. Chan School of Public Health, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Edward L. Trimble
- The National Cancer Institute, Center for Global Health, Rockville, MD, United States
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48
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Huang H, Lee C, Lin S, Chuang L, Chang C, Chen N. 1017 CLINICAL OUTCOMES OF CONTINUOUS POSITIVE AIRWAY PRESSURE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND NON-DIPPING BLOOD PRESSURE: A PROSPECTIVE COHORT STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1016] [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: 11/13/2022] Open
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Grover S, Xu M, Jhingran A, Mahantshetty U, Chuang L, Small W, Gaffney D. Clinical trials in low and middle-income countries - Successes and challenges. Gynecol Oncol Rep 2017; 19:5-9. [PMID: 28004030 PMCID: PMC5157789 DOI: 10.1016/j.gore.2016.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/12/2016] [Accepted: 11/21/2016] [Indexed: 12/23/2022] Open
Abstract
Gynecologic malignancies affect women in low and middle-income countries (LMICs) at equal or higher rates compared to high income countries (HICs), yet practice guidelines based on clinical trials performed in HICs do not routinely account for resource disparities between these regions. There is a need and growing interest for executing clinical trials in LMICs. This has led to the creation of multinational cooperative groups and the initiation of several ongoing clinical trials in Mexico, China, and Korea. In this article we describe the challenges involved in initiating clinical trials in LMICs, review current efforts within surgical, medical, and radiation oncology, and introduce high priority topics for future research.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Melody Xu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, United States
| | - Anuja Jhingran
- Division of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Linus Chuang
- Department of Gynecological Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - William Small
- Department of Radiation Oncology, Loyola University, Chicago, IL, United States
| | - David Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT, United States
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50
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Johnston C, Ng JS, Manchanda R, Tsunoda AT, Chuang L. Variations in gynecologic oncology training in low (LIC) and middle income (MIC) countries (LMICs): Common efforts and challenges. Gynecol Oncol Rep 2017; 20:9-14. [PMID: 28203627 PMCID: PMC5295505 DOI: 10.1016/j.gore.2017.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 12/29/2022] Open
Abstract
Gynecologic cancer, cervical cancer in particular, is disproportionately represented in the developing world where mortality is also high. Screening programs, increased availability of chemotherapy, and an awareness of HIV-related cancers have in part accelerated a need for physicians who can treat these cancers, yet the infrastructure for such training is often lacking. In this paper, we address the variations in gynecology oncology training in LMICs as well as the ubiquitous challenges, in an effort to guide future agendas.
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Affiliation(s)
- Carolyn Johnston
- Division of Gynecologic Oncology, Dept Ob/Gyn, 1500 E. Medical Center Dr SPC 5276 L4606 UH-South, Ann Arbor, MI 48109, USA
- Corresponding author.
| | - Joseph S. Ng
- Dept of Obstetrics & Gynecology, National University Hospital, 1E Kent Ridge Road, Level 12, 119228, Singapore
| | - Ranjit Manchanda
- Barts Cancer Institute, a Cancer Research UK Centre of Excellence, Queen Mary University of London, Room 4, Basement, Old Anatomy Building, Charterhouse Square, EC1M 6BQ, London
- Department of Gynaecological Oncology, Bartshealth NHS Trust, Royal London Hospital, 10th Floor, South Block, Whitechapel Road, E1 1BB, London
| | | | - Linus Chuang
- Divisional and Fellowship Director of Minimally Invasive Surgery Department of Obstetrics, Gynecology and Reproductive Science Icahn School of Medicine at Mount Sinai, New York, NY, USA
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