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Villiger AS, Zurbriggen S, Imboden S, Solass W, Christe L, Saner FAM, Gmür A, Rau TT, Mueller MD, Siegenthaler F. Reviving peritoneal cytology: Exploring its role in endometrial cancer molecular classification. Gynecol Oncol 2024; 182:148-155. [PMID: 38266401 DOI: 10.1016/j.ygyno.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/26/2023] [Accepted: 01/06/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The prognostic significance of positive peritoneal cytology in endometrial cancer has long been debated. In 2009, the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) removed cytology as a staging criterion from the endometrial cancer staging system. However, there is still evidence that positive peritoneal cytology may decrease survival among patients with endometrial cancer. The aim of this study was to determine the prognostic significance of positive peritoneal cytology among the different molecular subgroups. METHODS This study included patients with endometrial cancer who underwent primary surgical treatment between 2004 and 2015 at the Bern University Hospital, Switzerland, with molecular classification of the primary tumor and peritoneal cytology performed. RESULTS A total, 250 patients with endometrial cancer were enrolled. Peritoneal cytology was assessed in 206 patients, of whom 24% were positive: 25% of the POLEmut, 16% of the MMRd, 41% of the p53abn, and 24% of the NSMP cases. The mean follow-up was 128.7 months. Presence of positive peritoneal cytology was associated with significantly decreased mean recurrence-free and overall survival in patients with p53abn (p = .003 and p = .001) and NSMP (p = .020 and p = .049) endometrial cancer. In multivariable Cox regression analysis, positive peritoneal cytology remained an independent predictor of recurrence (p = .033) and death (p = .008) in p53abn endometrial cancer patients. CONCLUSION Positive peritoneal cytology is associated with worse oncologic outcomes in NSMP and p53abn endometrial cancer and remains an independent predictor of recurrence and death in patients with p53abn endometrial cancer.
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Affiliation(s)
- Anna-Sophie Villiger
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Wiebke Solass
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Lucine Christe
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Flurina A M Saner
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Gmür
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tilman T Rau
- Institute of Pathology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland.
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Joder C, Gmür A, Solass W, Christe L, Rabaglio M, Fluri M, Rau TT, Saner FAM, Knabben L, Imboden S, Mueller MD, Siegenthaler F. Real-World Data on Institutional Implementation of Screening for Mismatch Repair Deficiency and Lynch Syndrome in Endometrial Cancer Patients. Cancers (Basel) 2024; 16:671. [PMID: 38339422 PMCID: PMC10854690 DOI: 10.3390/cancers16030671] [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: 12/31/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
Lynch syndrome is an inherited tumor syndrome caused by a pathogenic germline variant in DNA mismatch repair genes. As the leading cause of hereditary endometrial cancer, international guidelines recommend universal screening in women with endometrial cancer. However, testing for Lynch syndrome is not yet well established in clinical practice. The aim of this study was to evaluate adherence to our Lynch syndrome screening algorithm. A retrospective, single-center cohort study was conducted of all endometrial cancer patients undergoing surgical treatment at the Bern University Hospital, Switzerland, between 2017 and 2022. Adherence to immunohistochemical analysis of mismatch repair status, and, if indicated, to MLH1 promoter hypermethylation and to genetic counseling and testing was assessed. Of all 331 endometrial cancer patients, 102 (30.8%) were mismatch repair-deficient and 3 (0.9%) patients were diagnosed with Lynch syndrome. Overall screening adherence was 78.2%, with a notable improvement over the six years from 61.4% to 90.6%. A major reason for non-adherence was lack of provider recommendation for testing, with advanced patient age as a potential patient risk factor. Simplification of the algorithm through standardized reflex screening was recommended to provide optimal medical care for those affected and to allow for cascading testing of at-risk relatives.
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Affiliation(s)
- Carmen Joder
- Faculty of Medicine, University of Bern, 3010 Bern, Switzerland;
| | - Andrea Gmür
- Department of Obstetrics and Gynecology, Bern University Hospital, 3010 Bern, Switzerland
| | - Wiebke Solass
- Institute of Tissue Medicine and Pathology, University of Bern, 3010 Bern, Switzerland
| | - Lucine Christe
- Institute of Tissue Medicine and Pathology, University of Bern, 3010 Bern, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology, Bern University Hospital, 3010 Bern, Switzerland
| | - Muriel Fluri
- Department of Medical Oncology, Bern University Hospital, 3010 Bern, Switzerland
| | - Tilman T. Rau
- Institute of Pathology, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany
| | - Flurina A. M. Saner
- Department of Obstetrics and Gynecology, Bern University Hospital, 3010 Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, Bern University Hospital, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital, 3010 Bern, Switzerland
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital, 3010 Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital, 3010 Bern, Switzerland
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Buechi CA, Siegenthaler F, Sahli L, Papadia A, Saner FAM, Mohr S, Rau TT, Solass W, Imboden S, Mueller MD. Real-World Data Assessing the Impact of Lymphovascular Space Invasion on the Diagnostic Performance of Sentinel Lymph Node Mapping in Endometrial Cancer. Cancers (Basel) 2023; 16:67. [PMID: 38201495 PMCID: PMC10778553 DOI: 10.3390/cancers16010067] [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: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND SLN mapping has emerged as a standard of care in endometrial cancer due to its high sensitivity and significant reduction in morbidity. Although lymphovascular space invasion (LVSI) is a known risk factor for lymph node metastasis and recurrence, evidence on the reliability of SLN mapping in LVSI-positive patients is scarce. The aim of this study was to determine the impact of LVSI on the diagnostic performance of SLN mapping. METHODS This retrospective cohort study included patients with endometrial cancer who underwent primary surgical treatment at the Bern University Hospital, Switzerland, between 2012 and 2022. RESULTS LVSI was present in 22% of patients and was significantly associated with lymph node metastasis (p < 0.001) and recurrence (p < 0.001). In node-negative patients with only SLN mapping performed, LVSI was an independent predictor of recurrence during multivariable Cox regression analysis (p = 0.036). The negative predictive value of SLN mapping was 91.5% and was significantly lower in tumors with LVSI (75.0%) compared to LVSI-negative tumors (95.6%, p = 0.004). CONCLUSION The presence of LVSI was significantly associated with worse oncological outcomes. LVSI was an independent predictor of recurrence in node-negative patients with only SLN mapping performed. Furthermore, the negative predictive value of SLN mapping was significantly lower in LVSI-positive tumors.
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Affiliation(s)
- Carol A. Buechi
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Laura Sahli
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale of Lugano, 6900 Lugano, Switzerland
- Facoltà di Scienze Biomediche, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Flurina A. M. Saner
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Stefan Mohr
- Department of Gynecology and Obstetrics, Bürgerspital Solothurn, 4500 Solothurn, Switzerland;
| | - Tilman T. Rau
- Institute of Pathology, Universitätsklinikum Düsseldorf, 40225 Düsseldorf, Germany
| | - Wiebke Solass
- Institute of Tissue Medicine and Pathology, University of Bern, 3008 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, 3010 Bern, Switzerland; (C.A.B.)
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Imboden S, Liu X, Payne MC, Hsieh CJ, Lin NY. Trustworthy in silico cell labeling via ensemble-based image translation. Biophys Rep (N Y) 2023; 3:100133. [PMID: 38026685 PMCID: PMC10663640 DOI: 10.1016/j.bpr.2023.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Artificial intelligence (AI) image translation has been a valuable tool for processing image data in biological and medical research. To apply such a tool in mission-critical applications, including drug screening, toxicity study, and clinical diagnostics, it is essential to ensure that the AI prediction is trustworthy. Here, we demonstrate that an ensemble learning method can quantify the uncertainty of AI image translation. We tested the uncertainty evaluation using experimentally acquired images of mesenchymal stromal cells. We find that the ensemble method reports a prediction standard deviation that correlates with the prediction error, estimating the prediction uncertainty. We show that this uncertainty is in agreement with the prediction error and Pearson correlation coefficient. We further show that the ensemble method can detect out-of-distribution input images by reporting increased uncertainty. Altogether, these results suggest that the ensemble-estimated uncertainty can be a useful indicator for identifying erroneous AI image translations.
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Affiliation(s)
- Sara Imboden
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, Los Angeles, California
| | - Xuanqing Liu
- Department of Computer Science, University of California, Los Angeles, Los Angeles, California
| | - Marie C. Payne
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, Los Angeles, California
| | - Cho-Jui Hsieh
- Department of Computer Science, University of California, Los Angeles, Los Angeles, California
| | - Neil Y.C. Lin
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, Los Angeles, California
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California
- Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, Los Angeles, California
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
- Broad Stem Cell Center, University of California, Los Angeles, Los Angeles, California
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Siegenthaler F, Epstein E, Büchi CA, Gmür A, Saner FACM, Rau TT, Carlson JW, Mueller MD, Imboden S. Prognostic value of lymphovascular space invasion according to the molecular subgroups in endometrial cancer. Int J Gynecol Cancer 2023; 33:1702-1707. [PMID: 37666529 PMCID: PMC10646877 DOI: 10.1136/ijgc-2023-004606] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE Lymphovascular space invasion (LVSI) is a known prognostic factor for oncological outcome in endometrial cancer patients. However, little is known about the prognostic value of LVSI among the different molecular subgroups. The aim of this study was to determine the prognostic dependence of LVSI from the molecular signature. METHODS This study included endometrial cancer patients who underwent primary surgical treatment between February 2004 and February 2016 at the Karolinska University Hospital, Sweden and the Bern University Hospital, Switzerland (KImBer cohort). All cases had complete molecular analysis performed on the primary tumor according to the WHO Classification of Tumors, 5th edition. LVSI was reviewed by reference pathologists for all pathology slides. RESULTS A total of 589 endometrial cancer patients were included in this study, consisting of 40 POLEmut (polymerase epsilon ultramutated), 198 MMRd (mismatch repair deficient), 83 p53abn (p53 abnormal), and 268 NSMP (non-specific molecular profile) cases. Altogether, 17% of tumors showed LVSI: 25% of the POLEmut, 19% of the MMRd, 30% of the p53abn, and 10% of the NSMP cases. There was a significant correlation of LVSI with lymph node metastasis in the entire study cohort (p<0.001), remaining significant in the MMRd (p=0.020), p53abn (p<0.001), and NSMP (p<0.001) subgroups. Mean follow-up was 89 months (95% CI 86 to 93). The presence of LVSI significantly decreased recurrence-free survival among patients with MMRd, p53abn, and NSMP endometrial cancer, and overall survival in patients with p53abn and NSMP tumors. In patients with NSMP endometrial cancer, evidence of substantial LVSI remained a significant independent predictor of recurrence in multivariable Cox regression analysis including tumor stage and grade (HR 7.5, 95% CI 2.2 to 25.5, p=o.001). CONCLUSION The presence of LVSI was associated with recurrence in each subgroup of patients with MMRd, p53abn, and NSMP endometrial cancer, and LVSI remained an independent predictor of recurrence in NSMP endometrial cancer patients.
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Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital Bern and Univeristy of Bern, Bern, Switzerland
| | - Elisabeth Epstein
- Department of Clinical Science and Education, Södersjukhuset (KI-SÖS), Stockholm, Sweden
| | - Carol A Büchi
- Department of Obstetrics and Gynecology, University Hospital Bern and Univeristy of Bern, Bern, Switzerland
| | - Andrea Gmür
- Department of Obstetrics and Gynecology, University Hospital Bern and Univeristy of Bern, Bern, Switzerland
| | - Flurina A C M Saner
- Department of Obstetrics and Gynecology, University Hospital Bern and Univeristy of Bern, Bern, Switzerland
| | - Tilman T Rau
- Institue for Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Joseph W Carlson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital Bern and Univeristy of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital Bern and Univeristy of Bern, Bern, Switzerland
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Saner FACM, Ruggeri G, Siegenthaler F, Wampfler J, Imboden S, Mueller MD. Change of Fagotti score is associated with outcome after neoadjuvant chemotherapy for ovarian cancer. Int J Gynecol Cancer 2023; 33:1595-1601. [PMID: 37567597 PMCID: PMC10579493 DOI: 10.1136/ijgc-2023-004540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/26/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To investigate whether a change in the Fagotti score (ΔFagotti) following neoadjuvant chemotherapy is predictive of resection to no residual disease (R0) and survival in women diagnosed with ovarian cancer. METHODS Women treated with neoadjuvant chemotherapy for newly diagnosed ovarian cancer between January 2012 and June 2021 at the Bern University Hospital were included in this retrospective cohort study. Fagotti scores before and after neoadjuvant chemotherapy treatment were assessed for a potential association with resection status at interval debulking surgery defined as no residual disease (R0), macroscopic residual disease with a diameter of 0.1-1 cm (R1) or >1 cm (R2), and survival. RESULTS During the study period, 130 patients received neoadjuvant chemotherapy, mainly in response to advanced ovarian cancer International Federation of Gynecology and Obstetrics (FIGO) stages IIIC (68.5%) or IV (20.8%). 91 patients (70%) experienced a relapse and 81 (62%) died due to their disease. Median overall survival was 40 months (95% CI 30.6 to 49.4). Fagotti scores dropped from a mean of 7.8 (95% CI 7.14 to 8.42) at diagnosis to 3.9 (95% CI 3.34 to 4.46, p<0.001) after neoadjuvant therapy. This decrease was associated with resection status during interval debulking surgery (mean ΔFagotti -4.9 in R0, -2.2 in R1, -0.6 in R2, p<0.001). Women whose Fagotti score declined more than 2 points after neoadjuvant chemotherapy (n=51/88, 58%) survived significantly longer (median overall survival of 42 vs 32 months, p=0.048). CONCLUSION Fagotti scores and ΔFagotti scores are associated with complete cytoreduction at interval debulking surgery and longer overall survival in women treated with neoadjuvant chemotherapy for ovarian cancer. These markers are valuable for individualized patient treatment planning and should always be performed after neoadjuvant therapy.
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Affiliation(s)
| | - Giovanni Ruggeri
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Julian Wampfler
- University of Bern, Bern, Switzerland
- Department of Medical Oncology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
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Mohr S, Imboden S, Siegenthaler F, Mueller MD. Complementary use of indocyanine green and technetium to enhance sentinel lymphadenectomy in vulvar cancer. Int J Gynecol Cancer 2023:ijgc-2023-004562. [PMID: 37648407 DOI: 10.1136/ijgc-2023-004562] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
| | - Michael David Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women's Hospital, University of Bern, Bern, Switzerland
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Mohr S, Imboden S, Mueller MD, Kuhn A. Laparoscopic sacrocolpopexy mesh excision step-by-step. Int Urogynecol J 2023; 34:1987-1989. [PMID: 36897370 PMCID: PMC10415470 DOI: 10.1007/s00192-023-05494-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to demonstrate the surgical procedure of laparoscopic mesh removal after sacrocolpopexy to aid clinicians facing mesh complications. METHODS Video footage shows the laparoscopic management of mesh failure and mesh erosion after sacrocolpopexy with narrated video sequences of two patients. RESULTS Laparoscopic sacrocolpopexy represents the gold standard in advanced prolapse repair. Mesh complications occur infrequently but infections, failure of prolapse repair and mesh erosions necessitate mesh removal and repeat sacrocolpopexy if applicable. The video deals with two women referred to our tertiary referral urogynecology unit in the University Women's Hospital of Bern, Switzerland, after laparoscopic sacrocolpopexies that were carried out in remote hospitals. Both patients were asymptomatic more than 1 year after surgery. CONCLUSIONS Complete mesh removal after sacrocolpopexy and repeat prolapse surgery can be challenging but is feasible and is aimed at improving patients' complaints and symptoms.
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Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
| | - Annette Kuhn
- Department of Obstetrics and Gynecology, Inselspital, Bern University Women’s Hospital, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland
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Krause E, Neumann S, Maier M, Imboden S, Knabben L, Mueller MD, Kuhn A. LASER treatment in gynaecology -A randomized controlled trial in women with symptomatic lichen sclerosus. Eur J Obstet Gynecol Reprod Biol 2023; 287:171-175. [PMID: 37352640 DOI: 10.1016/j.ejogrb.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/21/2023] [Revised: 04/20/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Aim of our study was to evaluate the therapeutic effect of laser treatment in vulvar lichen sclerosus, mainly the reduction of existing symptoms as itching, burning and pain. We asked about the different outcome by using different application doses. STUDY DESIGN We conducted a prospective randomized double-blind dose-controlled trial in our dysplasia unit specializing vulvar disorders. 67patients with active LS were included. LS was confirmed by biopsy or by the validated CSS (clinical scoring system of vulvar LS). Computer generated randomization resulted in two groups, each group received a different application dose.(LDG- low dose group, NDG- normal dose group) During the study period of 18 weeks all participants received three laser applications in three subsequent sessions of three weeks. Two follow-ups six and twelve weeks after the first application was performed. At every visit, the participants filled in the VAS (visual analogue scale) for recording the actual vulvar symptoms as itching burning or pain on a range from 0 to 10. RESULTS Before treatment the mean VAS-Score was 4.3 (STD ± 2.4) in the NDG and 5.1(±2.6) in the LDG. After 18 weeks, the mean reduction was -2.4 (±2.3) for NDG and -2.7 (±2.8) for LDG. Four patients (two of each group) reported more pain after than before treatment. Both groups show significant lower VAS-Scores 18 weeks after the treatment than before therapy (p < 0.0001). The reduction of symptoms after 18 weeks between NDG and LDG was not significant (p = 0.6244). CONCLUSION Laser treatment with the microablative CO2 laser leads to a significant improvement for symptoms of LS. A higher dosage of laser radiation shows no benefit concerning the symptoms. We have not observed any serious adverse events during this study.
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Affiliation(s)
- Elke Krause
- Frauenklinik, Inselspital Bern, University of Bern, Switzerland.
| | | | - Marina Maier
- Frauenklinik, Inselspital Bern, University of Bern, Switzerland.
| | - Sara Imboden
- Frauenklinik, Inselspital Bern, University of Bern, Switzerland.
| | - Laura Knabben
- Frauenklinik, Inselspital Bern, University of Bern, Switzerland.
| | | | - Annette Kuhn
- Frauenklinik, Inselspital Bern, University of Bern, Switzerland.
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Dedes I, Kolovos G, Arrigo F, Toub D, Vaineau C, Lanz S, Imboden S, Feki A, Mueller MD. Radiofrequency Ablation for Adenomyosis. J Clin Med 2023; 12:jcm12093069. [PMID: 37176514 PMCID: PMC10179480 DOI: 10.3390/jcm12093069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/05/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Adenomyosis is a common benign gynecologic condition characterized by ectopic endometrial glands and stroma in the myometrium causing pain (dysmenorrhea) and abnormal uterine bleeding. New interventional techniques have been introduced over recent years. This study evaluates the treatment success and side effects of radiofrequency ablation. An electronic literature search in the PubMed, Scopus, and ScienceDirect databases was carried out on the outcomes of pain reduction and, secondarily, on abnormal uterine bleeding, reintervention, reproductive outcome, imaging outcome, and complications. There was a mean decrease in dysmenorrhea pain scores by -63.4 ± 9.0% at 12 months. Data on other outcome parameters were sparse. No major complications were reported. Radiofrequency ablation represents a promising minimally invasive and organ-preserving treatment in patients with symptomatic adenomyosis. It is associated with clinically meaningful improvement of adenomyosis-related pain in the short term.
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Affiliation(s)
- Ioannis Dedes
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Georgios Kolovos
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Fruscalzo Arrigo
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - David Toub
- Gynesonics®, Redwood City, CA 94063, USA
| | - Cloé Vaineau
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Susanne Lanz
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Anis Feki
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
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Wüest A, Limacher JM, Dingeldein I, Siegenthaler F, Vaineau C, Wilhelm I, Mueller MD, Imboden S. Pain Levels of Women Diagnosed with Endometriosis: Is There a Difference in Younger Women? J Pediatr Adolesc Gynecol 2023; 36:140-147. [PMID: 36343859 DOI: 10.1016/j.jpag.2022.10.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE Early diagnosis and treatment of endometriosis affecting adolescent women are important in preventing chronic pain. Our aim was to analyze the clinical characteristics and severity of symptoms in adolescent patients with endometriosis compared with older patients. METHODS This single-center retrospective cohort study in a tertiary referral hospital analyzed women whose first consultation at the certified endometriosis center of Bern University Hospital between January 2017 and December 2020 resulted in the clinical diagnosis of endometriosis. Patients, divided into 2 groups by age, reported visual analog scale (VAS) scores for noncyclic pelvic pain, dysmenorrhea, dyschezia, dysuria, and dyspareunia. The symptom types and severity in the 2 groups were compared. The young patients with endometriosis were analyzed in greater detail, comparing VAS scores and types of endometriosis. RESULTS From a total of 826 patients, 144 (17.4%) patients 24 years old or younger and 682 (82.6%) patients over 24 years old were compared. The younger patients reported significantly higher pain scores for dysmenorrhea (VAS 7.3 vs 6.6; P = .015), dyspareunia (VAS 4.6 vs 3.4; P = .001), and noncyclic pelvic pain (VAS 4.3 vs 3.7; P = .032) compared with the older patient collective. Similar results were found when excluding patients with hormonal treatment. CONCLUSION Young patients with clinically diagnosed endometriosis have significantly higher dysmenorrhea and dyspareunia pain levels than older patients. By acknowledging and understanding this, early diagnosis and adequate treatment can be promoted. Dyspareunia in adolescents in particular merits clinical attention.
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Affiliation(s)
- A Wüest
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - J M Limacher
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - I Dingeldein
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - F Siegenthaler
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - C Vaineau
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - I Wilhelm
- Department of Anesthesiology and Pain Medicine, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - M D Mueller
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland
| | - S Imboden
- Department of Gynecology and Obstetrics, Bern University Hospital and the University of Bern, Bern, Switzerland.
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12
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Buda A, Paniga C, Taskin S, Mueller M, Zapardiel I, Fanfani F, Puppo A, Casarin J, Papadia A, De Ponti E, Grassi T, Mauro J, Turan H, Vatansever D, Gungor M, Ortag F, Imboden S, Garcia-Pineda V, Mohr S, Siegenthaler F, Perotto S, Landoni F, Ghezzi F, Scambia G, Taskiran C, Fruscio R. The Risk of Recurrence in Endometrial Cancer Patients with Low-Volume Metastasis in the Sentinel Lymph Nodes: A Retrospective Multi-Institutional Study. Cancers (Basel) 2023; 15:cancers15072052. [PMID: 37046712 PMCID: PMC10093146 DOI: 10.3390/cancers15072052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/19/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
The aim of this study was to assess the impact of low-volume metastasis (LVM) on disease-free survival (DFS) in women with apparent early-stage endometrial cancer (EC) who underwent sentinel lymph node (SLN) mapping. Patients with pre-operative early-stage EC were retrospectively collected from an international collaboration including 13 referring institutions. A total of 1428 patients were included in this analysis. One hundred and eighty-six patients (13%) had lymph node involvement. Fifty-nine percent of positive SLN exhibited micrometastases, 26.9% micrometastases, and 14% isolated tumor cells. Seventeen patients with positive lymph nodes did not receive any adjuvant therapy. At a median follow-up of 33.3 months, the disease had recurred in 114 women (8%). Patients with micrometastases in the lymph nodes had a worse prognosis of disease-free survival compared to patients with negative nodes or LVM. The rate of recurrence was significantly higher for women with micrometastases than those with low-volume metastases (HR = 2.61; p = 0.01). The administration of adjuvant treatment in patients with LVM, without uterine risk factors, remains a matter of debate and requires further evaluation.
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Affiliation(s)
- Alessandro Buda
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Cristiana Paniga
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Salih Taskin
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Michael Mueller
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Puppo
- Department of Obstetrics and Gynecology, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, University of the Italian Switzerland, 6900 Lugano, Switzerland
| | - Elena De Ponti
- Medical Physics Department, Foundation IRCCS San Gerardo Hospital, 20900 Monza, Italy
| | - Tommaso Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Jessica Mauro
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Hasan Turan
- Department of Obstetrics and Gynecology, İstanbul Training and Research Hospital, University of Health Sciences, 34766 İstanbul, Turkey
| | - Dogan Vatansever
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Mete Gungor
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, 34750 İstanbul, Turkey
| | - Firat Ortag
- Department of Obstetrics and Gynecology, School of Medicine, Ankara University, 06620 Ankara, Turkey
| | - Sara Imboden
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefan Mohr
- Inselspital, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | | | - Stefania Perotto
- Division of Gynecologic Oncology, Ospedale Michele e Pietro Ferrero, 12060 Verduno, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, 21100 Varese, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Women and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, School of Medicine, Koc University, 34450 İstanbul, Turkey
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Clinic of Obstetrics and Gynecology, IRCCS San Gerardo, 20900 Monza, Italy
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Payne MC, Ho S, Hashimoto T, Imboden S, Diaz JA, Lee BS, Rupert MJ, Cai NY, Goldstein AS, Lin NYC. Microwell-based flow culture increases viability and restores drug response in prostate cancer spheroids. Biotechnol J 2023:e2200434. [PMID: 36905340 DOI: 10.1002/biot.202200434] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 08/24/2022] [Revised: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
3D cancer spheroids represent a highly promising model for study of cancer progression and therapeutic development. Wide-scale adoption of cancer spheroids, however, remains a challenge due to the lack of control over hypoxic gradients that may cloud the assessment of cell morphology and drug response. Here, we present a Microwell Flow Device (MFD) that generates in-well laminar flow around 3D tissues via repetitive tissue sedimentation. Using a prostate cancer cell line, we demonstrate the spheroids in the MFD exhibit improved cell growth, reduced necrotic core formation, enhanced structural integrity, and downregulated expression of cell stress genes. The flow-cultured spheroids also exhibit an improved sensitivity to chemotherapy with greater transcriptional response. These results demonstrate how fluidic stimuli reveal the cellular phenotype previously masked by severe necrosis. Our platform advances 3D cellular models and enables study into hypoxia modulation, cancer metabolism, and drug screening within pathophysiological conditions.
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Affiliation(s)
- Marie C Payne
- Department of Mechanical & Aerospace Engineering, University of California, Los Angeles, California, USA
| | - SumYat Ho
- Department of Biochemistry, University of California, Los Angeles, California, USA
| | - Takao Hashimoto
- Departments of Molecular, Cell & Developmental Biology and Urology, University of California, Los Angeles, California, USA
| | - Sara Imboden
- Department of Mechanical & Aerospace Engineering, University of California, Los Angeles, California, USA
| | - Johnny A Diaz
- Departments of Molecular, Cell & Developmental Biology and Urology, University of California, Los Angeles, California, USA
| | - Brandon S Lee
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Melissa J Rupert
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Nathan Y Cai
- Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Andrew S Goldstein
- Departments of Molecular, Cell & Developmental Biology and Urology, University of California, Los Angeles, California, USA
| | - Neil Y C Lin
- Department of Mechanical & Aerospace Engineering, University of California, Los Angeles, California, USA
- Department of Bioengineering, University of California, Los Angeles, California, USA
- Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, California, USA
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14
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Weber L, Lee BS, Imboden S, Hsieh CJ, Lin NY. Phenotyping senescent mesenchymal stromal cells using AI image translation. Curr Res Biotechnol 2023; 5:100120. [PMID: 38045568 PMCID: PMC10691861 DOI: 10.1016/j.crbiot.2023.100120] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Mesenchymal stromal cells (MSCs) offer promising potential in biomedical research, clinical therapeutics, and immunomodulatory therapies due to their ease of isolation and multipotent, immunoprivileged, and immunosuppersive properties. Extensive efforts have focused on optimizing the cell isolation and culture methods to generate scalable, therapeutically-relevant MSCs for clinical applications. However, MSC-based therapies are often hindered by cell heterogeneity and inconsistency of therapeutic function caused, in part, by MSC senescence. As such, noninvasive and molecular-based MSC characterizations play an essential role in assuring the consistency of MSC functions. Here, we demonstrated that AI image translation algorithms can effectively predict immunofluorescence images of MSC senescence markers from phase contrast images. We showed that the expression level of senescence markers including senescence-associated beta-galactosidase (SABG), p16, p21, and p38 are accurately predicted by deep-learning models for Doxorubicin-induced MSC senescence, irradiation-induced MSC senescence, and replicative MSC senescence. Our AI model distinguished the non-senescent and senescent MSC populations and simultaneously captured the cell-to-cell variability within a population. Our microscopy-based phenotyping platform can be integrated with cell culture routines making it an easily accessible tool for MSC engineering and manufacturing.
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Affiliation(s)
- Leya Weber
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles 90095, CA, United States
| | - Brandon S. Lee
- Department of Bioengineering, University of California, Los Angeles 90095, CA, United States
| | - Sara Imboden
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles 90095, CA, United States
| | - Cho-Jui Hsieh
- Department of Computer Science, University of California, Los Angeles 90095, CA, United States
| | - Neil Y.C. Lin
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles 90095, CA, United States
- Department of Bioengineering, University of California, Los Angeles 90095, CA, United States
- California NanoSystems Institute, University of California, Los Angeles 90095, CA, United States
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles 90095, CA, United States
- Institute for Quantitative and Computational Biosciences, University of California, Los Angeles 90095, CA, United States
- Broad Stem Cell Center, University of California, Los Angeles 90095, CA, United States
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15
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Pagano F, Schwander A, Vaineau C, Laura K, Nirgianakis K, Imboden S, Mueller MD. True Prevalence of Diaphragmatic Endometriosis and Its Association with Severe Endometriosis: A Call for Awareness and Investigation. J Minim Invasive Gynecol 2023; 30:329-334. [PMID: 36669679 DOI: 10.1016/j.jmig.2023.01.006] [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: 11/20/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE To identify characteristics indicating preoperatively the presence of diaphragmatic endometriosis (DE). DESIGN Comparison of characteristics of patients with diaphragmatic endometriosis (DE) with characteristics of patients with abdominal endometriosis without diaphragmatic involvement, in a prospective cohort study. SETTING Tertiary referral center; endometriosis center. PATIENTS A total of 1372 patients with histologically proven endometriosis. INTERVENTIONS Surgery performed laparoscopically under general anesthesia. All patients with suspected endometriosis underwent a complete bilateral inspection of the diaphragm. MEASUREMENTS AND MAIN RESULTS Demographic and clinical pathologic characteristics were evaluated using basic descriptive statistics (comparison of the groups using the χ2 test and the Mann-Whitney t test). A logistic regression analysis was performed to evaluate the relationship (hazard ratio) between symptoms and the presence of DE. DE was diagnosed in 4.7% of the patients (65 of 1372). There was no significant difference between the 2 groups (patients with abdominal endometriosis with or without DE) with regard to typical endometriosis pain (dysmenorrhea, dyschezia, dysuria, and/or dyspareunia). However, in the DE group, diaphragmatic pain was present significantly more often preoperatively (27.7% vs 1.8%, p <.001). Four DE patients (6.1 %) were asymptomatic (with infertility the indication for surgery). In the DE group, 78.4 % had advanced stages of endometriosis (revised American Fertility Society III° or IV°); the left lower pelvis was affected in more patients (73.8%). In cases of ovarian endometriosis, patients with DE showed a significantly higher prevalence of left ovaries involvement (left 63% vs right 35.7%, p <.001). Patients with DE had a significantly higher rate of infertility (49.2% vs 28.7%, p <.05). CONCLUSION Patients with shoulder pain, infertility, and/or endometriosis in the left pelvis have a significant higher risk of DE and therefore need specific preoperative counseling and if indicated surgical treatment.
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Affiliation(s)
- Flavia Pagano
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Adriana Schwander
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Cloé Vaineau
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Knabben Laura
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Konstantinos Nirgianakis
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Sara Imboden
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors).
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16
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Jungen SH, Noti L, Christe L, Galvan JA, Zlobec I, Müller MD, Imboden S, Siegenthaler F, Carlson JW, Pellinen T, Heredia-Soto V, Ruz-Caracuel I, Hardisson D, Redondo A, Mendiola M, Rau TT. Spatial distribution of CD3- and CD8-positive lymphocytes as pretest for POLE wild-type in molecular subgroups of endometrial carcinoma. Front Med (Lausanne) 2023; 10:1110529. [PMID: 37035329 PMCID: PMC10076655 DOI: 10.3389/fmed.2023.1110529] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Over the years, the molecular classification of endometrial carcinoma has evolved significantly. Both POLEmut and MMRdef cases share tumor biological similarities like high tumor mutational burden and induce strong lymphatic reactions. While therefore use case scenarios for pretesting with tumor-infiltrating lymphocytes to replace molecular analysis did not show promising results, such testing may be warranted in cases where an inverse prediction, such as that of POLEwt, is being considered. For that reason we used a spatial digital pathology method to quantitatively examine CD3+ and CD8+ immune infiltrates in comparison to conventional histopathological parameters, prognostics and as potential pretest before molecular analysis. Methods We applied a four-color multiplex immunofluorescence assay for pan-cytokeratin, CD3, CD8, and DAPI on 252 endometrial carcinomas as testing and compared it to further 213 cases as validation cohort from a similar multiplexing assay. We quantitatively assessed immune infiltrates in microscopic distances within the carcinoma, in a close distance of 50 microns, and in more distant areas. Results Regarding prognostics, high CD3+ and CD8+ densities in intra-tumoral and close subregions pointed toward a favorable outcome. However, TCGA subtyping outperforms prognostication of CD3 and CD8 based parameters. Different CD3+ and CD8+ densities were significantly associated with the TCGA subgroups, but not consistently for histopathological parameter. In the testing cohort, intra-tumoral densities of less than 50 intra-tumoral CD8+ cells/mm2 were the most suitable parameter to assume a POLEwt, irrespective of an MMRdef, NSMP or p53abn background. An application to the validation cohort corroborates these findings with an overall sensitivity of 95.5%. Discussion Molecular confirmation of POLEmut cases remains the gold standard. Even if CD3+ and CD8+ cell densities appeared less prognostic than TCGA, low intra-tumoral CD8+ values predict a POLE wild-type at substantial percentage rates, but not vice versa. This inverse correlation might be useful to increase pretest probabilities in consecutive POLE testing. Molecular subtyping is currently not conducted in one-third of cases deemed low-risk based on conventional clinical and histopathological parameters. However, this percentage could potentially be increased to two-thirds by excluding sequencing of predicted POLE wild-type cases, which could be determined through precise quantification of intra-tumoral CD8+ cells.
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Affiliation(s)
| | - Luca Noti
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Lucine Christe
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Jose A. Galvan
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Michael D. Müller
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Joseph W. Carlson
- Karolinska Institutet, Klinisk Patologi KS, Solna, Sweden
- Keck School of Medicine of USC, Pathology, Health Sciences Campus, Los Angeles, CA, United States
| | - Teijo Pellinen
- Institute for Molecular Medicine Finland, Helsinki, Finland
| | - Victoria Heredia-Soto
- Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - David Hardisson
- Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Andres Redondo
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Mendiola
- Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Tilman T. Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
- *Correspondence: Tilman T. Rau,
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17
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Zografou Themeli M, Nirgianakis K, Neumann S, Imboden S, Mueller MD. Endometriosis is a risk factor for recurrent pelvic inflammatory disease after tubo-ovarian abscess surgery. Arch Gynecol Obstet 2023; 307:139-148. [PMID: 36036826 PMCID: PMC9422932 DOI: 10.1007/s00404-022-06743-6] [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: 05/14/2022] [Accepted: 08/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and prognosis of patients undergoing laparoscopic surgery for tubo-ovarian abscess (TOA) and identify risk factors for pelvic inflammatory disease (PID) recurrence. METHODS We conducted a retrospective cohort analysis including 98 women who underwent laparoscopic surgery for TOA at the Department of Obstetrics and Gynecology at the Bern University Hospital from January 2011 to May 2021. The primary outcome studied was the recurrence of PID after TOA surgery. Clinical, laboratory, imaging, and surgical outcomes were examined as possible risk factors for PID recurrence. RESULTS Out of the 98 patients included in the study, 21 (21.4%) presented at least one PID recurrence after surgery. In the univariate regression analysis, the presence of endometriosis, ovarian endometrioma, and the isolation of E. coli in the microbiology cultures correlated with PID recurrence. However, only endometriosis was identified as an independent risk factor in the multivariate analysis (OR (95% CI): 9.62 (1.931, 47.924), p < 0.01). With regard to the time of recurrence after surgery, two distinct recurrence clusters were observed. All patients with early recurrence (≤ 45 days after TOA surgery) were cured after 1 or 2 additional interventions, whereas 40% of the patients with late recurrence (> 45 days after TOA surgery) required 3 or more additional interventions until cured. CONCLUSION Endometriosis is a significant risk factor for PID recurrence after TOA surgery. Optimized therapeutic strategies such as closer postsurgical follow-up as well as longer antibiotic and hormonal therapy should be assessed in further studies in this specific patient population.
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Affiliation(s)
- Maria Zografou Themeli
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - Stephanie Neumann
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
| | - M. D. Mueller
- Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Friedbuehlstrasse 19, 3010 Bern, Switzerland
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18
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Siegenthaler F, Johann S, Imboden S, Samartzis N, Ledermann-Liu H, Sarlos D, Eberhard M, Mueller MD. ASO Visual Abstract: Prospective Multicenter Trial Assessing the Impact of Positive Peritoneal Cytology Conversion on Oncological Outcome in Patients with Endometrial Cancer Undergoing Minimally Invasive Surgery with the Use of an Intrauterine Manipulator : Positive Peritoneal Cytology Conversion and Its Association with Oncological Outcome in Endometrial Cancer. Ann Surg Oncol 2022; 29:8336-8337. [PMID: 36029383 DOI: 10.1245/s10434-022-12453-9] [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: 11/18/2022]
Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland.
| | - Silke Johann
- Department of Obstetrics and Gynecology Spitalzentrum Oberwallis, Standort Visp, Visp, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Nicolas Samartzis
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Haiyan Ledermann-Liu
- Department of Obstetrics and Gynecology, Canton Hospital Aarau, Aarau, Switzerland
| | - Dimitri Sarlos
- Department of Obstetrics and Gynecology, Canton Hospital Aarau, Aarau, Switzerland
| | - Markus Eberhard
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
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Siegenthaler F, Johann S, Imboden S, Samartzis N, Ledermann-Liu H, Sarlos D, Eberhard M, Mueller MD. Prospective Multicenter Trial Assessing the Impact of Positive Peritoneal Cytology Conversion on Oncological Outcome in Patients with Endometrial Cancer Undergoing Minimally Invasive Surgery with the use of an Intrauterine Manipulator : Positive Peritoneal Cytology Conversion and Its Association with Oncological Outcome in Endometrial Cancer. Ann Surg Oncol 2022; 29:8320-8333. [PMID: 36057902 PMCID: PMC9640429 DOI: 10.1245/s10434-022-12356-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/20/2022] [Indexed: 12/16/2023]
Abstract
BACKGROUND Minimally invasive surgery is the standard approach in early-stage endometrial cancer according to evidence showing no compromise in oncological outcomes, but lower morbidity compared with open surgery. However, there are limited data available on the oncological safety of the use of intrauterine manipulators in endometrial cancer. PATIENTS AND METHODS This prospective multicenter study included patients with endometrial cancer undergoing laparoscopic staging surgery with the use of an intrauterine manipulator. We obtained three different sets of peritoneal washings: at the beginning of the surgical procedure, after the insertion of the intrauterine manipulator, and after the closure of the vaginal vault. The rate of positive peritoneal cytology conversion and its association with oncological outcomes was assessed. RESULTS A total of 124 patients were included. Peritoneal cytology was negative in 98 (group 1) and positive in 26 (group 2) patients. In group 2, 16 patients presented with positive cytology at the beginning of the surgery (group 2a) and 10 patients had positive cytology conversion during the procedure (group 2b). Recurrence rate was significantly different among the study groups, amounting to 9.2%, 25.0%, and 60.0% for groups 1, 2a, and 2b, respectively (p < 0.001). Group 1 showed the best recurrence-free and overall survival, followed by group 2a, while patients in group 2b had the worst oncological outcomes (p = 0.002 and p = 0.053, respectively). Peritoneal cytology was an independent predictor of recurrence and death on multivariable analysis. CONCLUSION A total of 8.1% of patients with endometrial cancer undergoing minimally invasive surgery with intrauterine manipulation showed positive peritoneal cytology conversion associated with significantly worse oncological outcome.
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Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - Silke Johann
- Department of Obstetrics and Gynecology Spitalzentrum Oberwallis, Standort Visp, Visp, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nicolas Samartzis
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Haiyan Ledermann-Liu
- Department of Obstetrics and Gynecology, Canton Hospital Aarau, Aarau, Switzerland
| | - Dimitri Sarlos
- Department of Obstetrics and Gynecology, Canton Hospital Aarau, Aarau, Switzerland
| | - Markus Eberhard
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
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Rau TT, Deppeler MV, Christe L, Siegenthaler F, Imboden S, Papadia A, Mueller MD. Pathological processing of sentinel lymph nodes in endometrial carcinoma - routine aspects of grossing, ultra-staging, and surgico-pathological parameters in a series of 833 lymph nodes. Virchows Arch 2022; 481:421-432. [PMID: 35854139 PMCID: PMC9485184 DOI: 10.1007/s00428-022-03377-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 06/17/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Abstract
Sentinel lymph nodes are widely accepted in the treatment of endometrial carcinoma. Whereas surgical aspects are well studied, the pathological work-up in terms of grossing, frozen section, and the so-called ultra-staging is still a matter of debate. This results in conflicting national or center-based recommendations. In a series of consecutive 833 sentinel lymph nodes from 206 patients in endometrial carcinomas, we compared three different grossing techniques and the use of frozen section in terms of anatomy, detection rates, and survival. In total, 42 macro-metastases, 6 micro-metastases, and 25 nodes with isolated tumor cells were found. Lymph nodes affected at least with micro-metastasis were about 0.5cm enlarged. Detection rates in lamellation technique increased with a step of 5.9% to 8.3% in comparison to bi-valved or complete embedding. The lamellation technique presented with a slight beneficial prognosis in pN0 subgroup (OS, p=0.05), which besides size effects might be attributed to trimming loss. In frozen section, this effect was less pronounced than expected (OS, p=0.56). Ultra-staging only revealed additional micro-metastases and isolated tumor cells. Exclusively, macro-metastases showed poor survival (p<0.001). In multivariate analysis, T-stage, subtype, and lympho-vascular invasion status outperformed this staging parameter significantly. Grossing of sentinel lymph nodes is the most essential step with evidence to prefer lamellation in 2 mm steps. Step sectioning should consider widely spaced protocols to exclude macro-metastases. Frozen sections might add value to the intra-operative assessment of endometrial carcinoma in selected cases. The excellent biological behavior of cases with isolated tumor cells might question the routine application of pan-cytokeratin as ultra-staging method.
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Affiliation(s)
- Tilman T Rau
- Institute of Pathology, University Hospital Düsseldorf, Moorenstr. 5, 40235, Düsseldorf, Germany.
- Institute of Pathology, University Bern, Murtenstrasse 31, 3008, Bern, Switzerland.
| | - Mona V Deppeler
- Institute of Pathology, University Bern, Murtenstrasse 31, 3008, Bern, Switzerland
| | - Lucine Christe
- Institute of Pathology, University Bern, Murtenstrasse 31, 3008, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Gynecology and Obstetrics, Inselspital University Hospital and University, Bern, Switzerland
| | - Sara Imboden
- Department of Gynecology and Obstetrics, Inselspital University Hospital and University, Bern, Switzerland
| | - Andrea Papadia
- Department of Gynecology and Obstetrics, Inselspital University Hospital and University, Bern, Switzerland
- Department of Gynecology and Obstetrics, Regional Hospital Lugano, Lugano, Switzerland
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, Inselspital University Hospital and University, Bern, Switzerland
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Wüest A, Imboden S, Dingeldein I, Mueller M. 063 Awareness of endometriosis for adolescence thru education in schools. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.092] [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: 11/25/2022]
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Andrieu T, Chicca A, Pellegata D, Bersinger NA, Imboden S, Nirgianakis K, Gertsch J, Mueller MD. Association of endocannabinoids with pain in endometriosis. Pain 2022; 163:193-203. [PMID: 34001768 PMCID: PMC8675052 DOI: 10.1097/j.pain.0000000000002333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Endocannabinoid (eCB) levels fluctuate in inflammatory conditions and as such may take part in endometriosis-associated pain or even in endometriosis pathogenesis. In this case-control (23 cases and 19 controls) study, targeted lipids were measured in the serum and peritoneal fluid collected during laparoscopy. Endometriosis was confirmed histologically. Dysmenorrhea, abdominal pain, and dyspareunia were assessed using the Numeric Rating Scale for pain. Steroids, eCBs, and related lipids were quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Tumor necrosis factor alpha, IL-8, PAPP-A, PP14, RANTES, OPG, MIDKINE, MCP-1, VEGF, leptin, and defensins were quantified by ELISA. We found that eCB levels were significantly influenced by both noncyclic and cyclic abdominal pain. Specifically, women suffering from noncyclic abdominal pain were characterized by a higher 2-AG level in the peritoneal fluid throughout the menstrual cycle, whereas women suffering from dysmenorrhea had higher 2-AG levels and lower AEA levels during the proliferative phase alone. In addition, 2-AG positively correlated with prostaglandin E2 (PGE2), and the ratio AEA/2-AG positively correlated with defensins, suggesting a possible link between endocannabinoids system and inflammatory pain. The results of the current study indicate that the eCB system may play a role in endometriosis-associated pain, but additional studies are needed to investigate the causal relationship.
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Affiliation(s)
- Thomas Andrieu
- Department of BioMedical Research (DBMR), University of Bern, MEM, Bern, Switzerland
| | - Andrea Chicca
- Institute of Biochemistry and Molecular Medicine (IBMM), NCCR TransCure, University of Bern, Bern, Switzerland
| | - Daniele Pellegata
- Institute of Biochemistry and Molecular Medicine (IBMM), NCCR TransCure, University of Bern, Bern, Switzerland
| | - Nick A. Bersinger
- Department of BioMedical Research (DBMR), University of Bern, MEM, Bern, Switzerland
| | - Sara Imboden
- Department of BioMedical Research (DBMR), University of Bern, MEM, Bern, Switzerland
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of BioMedical Research (DBMR), University of Bern, MEM, Bern, Switzerland
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | - Juerg Gertsch
- Institute of Biochemistry and Molecular Medicine (IBMM), NCCR TransCure, University of Bern, Bern, Switzerland
| | - Michael D. Mueller
- Department of BioMedical Research (DBMR), University of Bern, MEM, Bern, Switzerland
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
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Eriksson LSE, Nastic D, Lindqvist PG, Imboden S, Järnbert‐Pettersson H, Carlson JW, Epstein E. Combination of Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) with sonographic and demographic characteristics in preoperative prediction of recurrence or progression of endometrial cancer. Ultrasound Obstet Gynecol 2021; 58:457-468. [PMID: 33314410 PMCID: PMC8457053 DOI: 10.1002/uog.23573] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/09/2020] [Accepted: 12/02/2020] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To evaluate the ability of demographic and sonographic variables and the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) classification to predict preoperatively tumor recurrence or progression in women with endometrial cancer. METHODS The study included 339 women with histologically confirmed endometrial cancer who underwent expert transvaginal ultrasound in a single center before surgery as part of the prospective International Endometrial Tumor Analysis 4 study or who were evaluated using the same protocol. The tumors were classified according to histotype, FIGO (International Federation of Gynecology and Obstetrics) grade and FIGO stage. In addition, molecular analysis was performed for classification into the four ProMisE subtypes: polymerase-ϵ exonuclease domain mutations (POLE EDM), mismatch repair proteins deficiency (MMR-D), protein 53 wild type (p53 wt) and protein 53 abnormal (p53 abn). Demographic and preoperative sonographic characteristics, tumor recurrence or progression and survival were compared between the ProMisE subgroups. Cox regression analysis was used to identify prognostic factors associated with recurrence or progression, using univariable models to study crude associations and multivariable models to study adjusted associations. Logistic regression and receiver-operating-characteristics (ROC)-curve analysis were used to assess the predictive ability of the preoperative prognostic factors regarding recurrence or progression of cancer within 3 years after surgery, and to compare their predictive ability to that of the European Society for Medical Oncology (ESMO) preoperative (based on depth of myometrial invasion, histotype and grade) and postoperative (based on histotype, grade, surgical stage and lymphovascular space invasion) risk classifications. In a separate subanalysis, cases were stratified according to ProMisE p53 abn status (present vs absent) and sonographic tumor size (anteroposterior (AP) diameter < 2 cm vs ≥ 2 cm). RESULTS Median follow-up time from surgery was 58 months (interquartile range, 48-71 months; range, 0-102 months). Recurrence or progression of cancer occurred in 51/339 (15%) women, comprising 14% of those with MMR-D, 8% of those with POLE EDM, 9% of those with p53 wt and 45% of those with p53 abn ProMisE subtype. On multivariable analysis, age, waist circumference, ProMisE subtype and tumor extension and AP diameter on ultrasound were associated with tumor recurrence or progression. A multivariable model comprising ProMisE subtype, age, waist circumference and sonographic tumor extension and size (area under the ROC curve (AUC), 0.89 (95% CI, 0.85-0.93)) had comparable ability to predict tumor recurrence/progression to that of a multivariable model comprising histotype, grade, age, waist circumference and sonographic tumor extension and size (AUC, 0.88 (95% CI, 0.83-0.92)), and better predictive ability than both the preoperative (AUC, 0.74 (95% CI, 0.67-0.82); P < 0.01) and postoperative (AUC, 0.79 (95% CI, 0.72-0.86); P < 0.01) ESMO risk classifications. Women with a combination of non-p53 abn subtype and tumor size < 2 cm (164/339 (48%)) had a very low risk (1.8%) of tumor recurrence or progression. CONCLUSIONS The combination of demographic characteristics, sonographic findings and ProMisE subtype had better preoperative predictive ability for tumor recurrence or progression than did the ESMO classification, supporting their use in the preoperative risk stratification of women with endometrial cancer. The combination of p53 status with ultrasound tumor size has the potential to identify preoperatively a large group of women with a very low risk of recurrence or progression. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. - Legal Statement: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Affiliation(s)
- L. S. E. Eriksson
- Department of Pelvic CancerKarolinska University HospitalStockholmSweden
- Department of Women's and Children's HealthKarolinska InstituteStockholmSweden
| | - D. Nastic
- Department of Pathology and CytologyKarolinska University HospitalStockholmSweden
- Department of Oncology–PathologyKarolinska InstituteStockholmSweden
| | - P. G. Lindqvist
- Department of Obstetrics and GynecologySödersjukhusetStockholmSweden
- Department of Clinical Science and EducationKarolinska Institute, SödersjukhusetStockholmSweden
| | - S. Imboden
- University of Bern, Department of Obstetrics and GynecologyUniversity Hospital of BernBernSwitzerland
| | - H. Järnbert‐Pettersson
- Department of Clinical Science and EducationKarolinska Institute, SödersjukhusetStockholmSweden
| | - J. W. Carlson
- Department of Pathology and CytologyKarolinska University HospitalStockholmSweden
- Department of Oncology–PathologyKarolinska InstituteStockholmSweden
| | - E. Epstein
- Department of Obstetrics and GynecologySödersjukhusetStockholmSweden
- Department of Clinical Science and EducationKarolinska Institute, SödersjukhusetStockholmSweden
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Cihoric N, Astrid Elisabeth H, Imboden S, Aebersold D, Blatti M, Tsikkinis A, Kristina L. PO-1296 Usage of PET/CT as a post-treatment surveillance strategy in locoregionally advanced cervical cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07747-1] [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: 11/29/2022]
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Imboden S, Nastic D, Ghaderi M, Rydberg F, Siegenthaler F, Mueller MD, Rau TT, Epstein E, Carlson JW. Implementation of the 2021 molecular ESGO/ESTRO/ESP risk groups in endometrial cancer. Gynecol Oncol 2021; 162:394-400. [PMID: 34127276 DOI: 10.1016/j.ygyno.2021.05.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 03/11/2021] [Accepted: 05/23/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION In 2021, a joint ESGO/ESTRO/ESP committee updated their evidence-based guidelines for endometrial cancer, recommending a new risk grouping incorporating both clinicopathologic and molecular parameters. We applied the new risk grouping and compared the results to those of the prior 2016 clinicopathologic system. MATERIALS AND METHODS We classified molecularly a cohort of 604 women diagnosed with endometrial cancer using immunohistochemistry for TP53 and MMR proteins on a tissue microarray, as well as Sanger sequencing for POLE mutations. These results, combined with clinicopathologic data, allowed the patients to be risk grouped using both the new 2021 molecular/clinicopathologic parameters and the prior 2016 clinicopathologic system. RESULTS The application of the 2021 molecular markers shows Kaplan-Meier curves with a significant difference between the groups for all survival. Molecular classification under the 2021 guidelines revealed a total of 39 patients (39/594, 7%) with a change in risk group in relation to the 2016 classification system: the shift was alone due to either P53abn or POLEmut molecular marker. In order to ensure correct 2021 molecular risk classification, not all patients with endometrial cancer need a molecular diagnostic: 433 (72.9%) cases would need to be analyzed by TP53 IHC, only 46 (7.7%) by MMR IHC and 286 (48.1%) POLE sequencing reactions. CONCLUSION Application of the 2021 molecular risk groups is feasible and shows significant differences in survival. IHC for TP53 and MMR and applying POLE sequencing is only needed in selected cases and leads to shifting risk groups both upward and downward for a sizeable number of patients. It is possible to significantly reduce the number of analyses required to implement the classification if resources are limited.
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Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Denis Nastic
- Department of Oncology-Pathology, Karolinska Institutet, Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Mehran Ghaderi
- Department of Oncology-Pathology, Karolinska Institutet, Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Filippa Rydberg
- Department of Oncology-Pathology, Karolinska Institutet, Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tilman T Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Elisabeth Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - Joseph W Carlson
- Department of Oncology-Pathology, Karolinska Institutet, Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
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Siegenthaler F, Imboden S, Knabben L, Mohr S, Papadia A, Mueller MD. Exploratory Study of the Clinical Value of Near-Infrared Sentinel Lymph Node Mapping With Indocyanine Green in Vulvar Cancer Patients. Front Oncol 2021; 11:652458. [PMID: 33968754 PMCID: PMC8100341 DOI: 10.3389/fonc.2021.652458] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study aimed to evaluate the clinical value of indocyanine green sentinel lymph node (SLN) mapping in patients with vulvar cancer. The conventional procedure of SLN mapping in vulvar cancer includes peritumoral injection of technetium-99m nanocolloid before surgery and intraoperative injection of a blue dye. However, these techniques harbor some limitations. Near-infrared fluorescence imaging with indocyanine green has gained popularity in SLN mapping in different types of cancer. Methods We analyzed retrospectively vulvar cancer patients at our institution between 2013 and 2020 undergoing indocyanine green SLN mapping by applying video telescope operating microscope system technology. Results 64 groins of 34 patients were analyzed. In 53 groins we used technetium-99m nanocolloid, in four patent blue, and in five both techniques, additionally to indocyanine green for SLN detection. In total, 120 SLNs were identified and removed. The SLN detection rate of indocyanine green was comparable to technetium-99m nanocolloid (p=.143) and higher than patent blue (p=.003). The best results were achieved using a combination of ICG and technetium-99m nanocolloid (detection rate of 96.9%). SLN detection rates of indocyanine green were significantly higher in patients with positive lymph nodes (p=.035) and lymphatic space invasion (p=.004) compared to technetium-99m nanocolloid. Conclusion Indocyanine green SLN mapping in vulvar cancer is feasible and safe, with reasonable detection rates. Due to its easy application and few side effects, it offers a sound alternative to the conventional SLN mapping techniques in vulvar cancer. In patients with lymph node metastasis, indocyanine green even outperformed technetium-99m nanocolloid in terms of detection rate.
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Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, Ente Ospedaliere Cantonale, University of the Italian Switzerland, Lugano, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
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Mohr S, Gygax LN, Imboden S, Mueller MD, Kuhn A. Screening for HPV and dysplasia in transgender patients: Do we need it? Eur J Obstet Gynecol Reprod Biol 2021; 260:177-182. [PMID: 33836363 DOI: 10.1016/j.ejogrb.2021.03.030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Aim of this study was the evaluation of prevalence of HPV infection and resulting genital dysplasia to assess the necessity and reasonability of pap smears and HPV testing in transgender patients. HPV is the most common sexually transmitted infection and responsible for the majority of genital dysplasias and malignancies. However, few data exist about the prevalence of HPV and dysplasia in transgender people. METHODS This retrospective data analysis of prospectively collected data includes all patients seen in our specialized outpatient clinic for transgender people. Gynecologic exam, colposcopy, cellular swabs and HPV typing were carried out. Primary endpoint was the prevalence of HPV and genital dysplasias in transgender patients. Secondary endpoints were the subtypes of HPV, demographic data, sexual orientation and co-morbidities in these patients. RESULTS We investigated overall 98 patients whereof 53 were transwomen and 45 transmen. Of those, 10.2 % had positive HPV tests and 10.2 % dysplastic changes in the PAP and one case of invasive anal carcinoma (1.02 %). Comorbidities included recurrent urinary tract infections, psychologic comorbidies and other, possibly hormone replacement related conditions. CONCLUSION The results underline the necessity of a routine gynecological examination including PAP and/or HPV screening and vaccinating, respectively, no matter of sexual orientation or comorbidities. Monitoring the existent anatomy may prevent invasive carcinoma requiring more invasive therapies. Moreover, concomitant pathologies are present and require long-term care of these patients almost all using hormone therapy and carrying several specific risk factors. Transgender-focused guidelines to take into account these peculiarities are needed.
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Affiliation(s)
- Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Linda N Gygax
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Annette Kuhn
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Imboden S, Liu X, Lee BS, Payne MC, Hsieh CJ, Lin NYC. Investigating heterogeneities of live mesenchymal stromal cells using AI-based label-free imaging. Sci Rep 2021; 11:6728. [PMID: 33762607 PMCID: PMC7991643 DOI: 10.1038/s41598-021-85905-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/08/2021] [Indexed: 12/27/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) are multipotent cells that have great potential for regenerative medicine, tissue repair, and immunotherapy. Unfortunately, the outcomes of MSC-based research and therapies can be highly inconsistent and difficult to reproduce, largely due to the inherently significant heterogeneity in MSCs, which has not been well investigated. To quantify cell heterogeneity, a standard approach is to measure marker expression on the protein level via immunochemistry assays. Performing such measurements non-invasively and at scale has remained challenging as conventional methods such as flow cytometry and immunofluorescence microscopy typically require cell fixation and laborious sample preparation. Here, we developed an artificial intelligence (AI)-based method that converts transmitted light microscopy images of MSCs into quantitative measurements of protein expression levels. By training a U-Net+ conditional generative adversarial network (cGAN) model that accurately (mean [Formula: see text] = 0.77) predicts expression of 8 MSC-specific markers, we showed that expression of surface markers provides a heterogeneity characterization that is complementary to conventional cell-level morphological analyses. Using this label-free imaging method, we also observed a multi-marker temporal-spatial fluctuation of protein distributions in live MSCs. These demonstrations suggest that our AI-based microscopy can be utilized to perform quantitative, non-invasive, single-cell, and multi-marker characterizations of heterogeneous live MSC culture. Our method provides a foundational step toward the instant integrative assessment of MSC properties, which is critical for high-throughput screening and quality control in cellular therapies.
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Affiliation(s)
- Sara Imboden
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, 90095, USA.
| | - Xuanqing Liu
- Department of Computer Science, University of California, Los Angeles, 90095, USA
| | - Brandon S Lee
- Department of Bioengineering, University of California, Los Angeles, 90095, USA
| | - Marie C Payne
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, 90095, USA
| | - Cho-Jui Hsieh
- Department of Computer Science, University of California, Los Angeles, 90095, USA
| | - Neil Y C Lin
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, 90095, USA.,Department of Bioengineering, University of California, Los Angeles, 90095, USA.,Institute for Quantitative and Computational Biosciences, University of California, Los Angeles, 90095, USA
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Kocbek V, Imboden S, Nirgianakis K, Mueller M, McKinnon B. Dual influence of TNFα on diverse in vitro models of ovarian cancer subtypes. Heliyon 2021; 7:e06099. [PMID: 33615005 PMCID: PMC7881225 DOI: 10.1016/j.heliyon.2021.e06099] [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: 08/16/2020] [Revised: 01/03/2021] [Accepted: 01/22/2021] [Indexed: 12/05/2022] Open
Abstract
Ovarian cancer is the most lethal gynecological cancer. Numerous subtypes exist, each with distinct risk factors and prognosis. What underlies these subtypes and their progression is not clear, although inflammation through NFκB may play a key role. We performed a study on a series of well-characterized in vitro ovarian cancer models including TOV21G, TOV112D and OV90 originally derived from clear cell, endometrioid and high grade serous carcinoma respectively. Cells were treated with 0–100 ng/ml TNFα over 6–72 h. The NFκB pathway was inhibited by a series of NFκB pathway inhibitors, 100μM PDTC, 1μM PS-1145 and 200nM TPCA and the influence on cellular viability and inflammation was measured via an MTS assay and qPCR respectively. TNFα stimulation of NFκB was confirmed via Western blot. We found TNFα facilitated continued growth of TOV21G and TOV112D cells in an NFκB independent method. In contrast, TNFα inhibited OV90 cell growth in an NFκB dependent manner. TNFα stimulated production of IL-6, IL-8, MCP-1 and RANTES on all three cells lines, but only IL-6 and IL-8 were via NFκB mediated mechanisms. These results indicate TNFα may have diverse effects mediated through both NFκB and non-NFκB pathways on ovarian cancer cells. Understanding the role for TNFα in each subtype may have significant implications for charting disease progression and designing personalized treatments.
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Affiliation(s)
- Vida Kocbek
- Department of Clinical Research, University of Berne, Murtenstrasse 35, Berne, CH-3010, Switzerland
- Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Effingerstrasse 102, Berne, CH-3010, Switzerland
| | - Sara Imboden
- Department of Clinical Research, University of Berne, Murtenstrasse 35, Berne, CH-3010, Switzerland
- Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Effingerstrasse 102, Berne, CH-3010, Switzerland
| | - Kostantinos Nirgianakis
- Department of Clinical Research, University of Berne, Murtenstrasse 35, Berne, CH-3010, Switzerland
- Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Effingerstrasse 102, Berne, CH-3010, Switzerland
| | - Michael Mueller
- Department of Clinical Research, University of Berne, Murtenstrasse 35, Berne, CH-3010, Switzerland
- Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Effingerstrasse 102, Berne, CH-3010, Switzerland
| | - Brett McKinnon
- Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Effingerstrasse 102, Berne, CH-3010, Switzerland
- Corresponding author.
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Imboden S, Bollinger Y, Härmä K, Knabben L, Fluri M, Nirgianakis K, Mohr S, Kuhn A, Mueller MD. Predictive Factors for Voiding Dysfunction after Surgery for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2021; 28:1544-1551. [PMID: 33476749 DOI: 10.1016/j.jmig.2021.01.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/03/2021] [Accepted: 01/10/2021] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the prognostic value of pre- and perioperative factors for voiding dysfunction after surgery for deep infiltrating endometriosis (DIE). DESIGN Single-center retrospective cohort study. SETTING University hospital. PATIENTS A total of 198 women with DIE in the posterior compartment who underwent surgery and a postoperative bladder scan. INTERVENTIONS Surgical resection of the DIE nodule from the dorsal compartment. MEASUREMENTS AND MAIN RESULTS After surgery, 41% of the patients initially experienced voiding dysfunction (defined as >100 mL postvoid residual urine volume at second bladder scan). The number decreased to 11% by the time of hospital discharge. Among those with a need for self-catheterization after discharge (n = 17), voiding dysfunction lasted for a median of 41 days before a return to normal bladder function, with a residual urine volume of <100 mL. The preoperative presence of DIE nodules in the ENZIAN compartment B was associated with postoperative voiding dysfunction (p = .001). The hazard ratio for elevated residual urine volume was highest when the disease stage was B3 (hazard ratio 6.43; CI, 2.3-18.2; p <.001), describing a nodule diameter of >3 cm in lateral distension. Receiver operating characteristic curve analyses showed that a first residual urine volume >220 mL has a good predictive value for the risk of intermittent self-catheterization (area under the receiver operating characteristic curve 0.893; p <.001). CONCLUSION Postoperative voiding dysfunction is frequent; of note, in most cases the problem is temporary. When DIE with an ENZIAN classification B is noted intraoperatively and, most of all, when the diameter of the lesion is >3 cm, a higher risk of postoperative voiding dysfunction is to be expected.
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Affiliation(s)
- Sara Imboden
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)..
| | - Yaelle Bollinger
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Kirsi Härmä
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Laura Knabben
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Mihaela Fluri
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Konstantinos Nirgianakis
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Stefan Mohr
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Annette Kuhn
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
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Knabben L, Siegenthaler F, Imboden S, Mueller MD. Fertility in BRCA mutation carriers: counseling BRCA-mutated patients on reproductive issues. Horm Mol Biol Clin Investig 2020; 43:171-177. [PMID: 33027047 DOI: 10.1515/hmbci-2020-0005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
Objectives Genetic testing rates for hereditary breast and ovarian cancer (HBOC) have steadily increased during the past decades resulting in a growing population of young and healthy mutation carriers. Available data on fertility issues in BRCA mutation carriers is rising but the results remain to some extent still conflicting. We have performed a systematic literature review in order to get an overview concerning the current evidence on fertility issues in BRCA mutation carriers. Data were analyzed critically with the aim to deliver physicians a solid basis for (onco) fertility counseling in women with BRCA mutations. Content We present the latest data on cancer risks in women with HBOC and analyze the influence of cancer treatment and preventive surgery on the reproductive potential. Epidemiological studies on fertility issues in BRCA mutation carriers showed heterogeneous results. However, several authors showed a decreased ovarian reserve with lower Anti-Müllerien hormone (AMH) levels and poorer response to ovarian stimulation in BRCA positive women. The diagnosis of BRCA mutations influences reproductive decision-making. Additionally, the shortened reproductive window and the need to complete family planning early has a significant psychological impact. Summary and Outlook This article highlights the importance of fertility counseling in BRCA mutation carriers. Individual fertility counseling is mandatory. Fertility preservation strategies should be discussed.
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Affiliation(s)
- Laura Knabben
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Franziska Siegenthaler
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Berne, Switzerland
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Aurore V, Röthlisberger R, Boemke N, Hlushchuk R, Bangerter H, Bergmann M, Imboden S, Mueller MD, Eppler E, Djonov V. Anatomy of the female pelvic nerves: a macroscopic study of the hypogastric plexus and their relations and variations. J Anat 2020; 237:487-494. [PMID: 32427364 DOI: 10.1111/joa.13206] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/11/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 01/16/2023] Open
Abstract
The autonomic nerves of the lesser pelvis are particularly prone to iatrogenic lesions due to their exposed position during manifold surgical interventions. Nevertheless, the cause of rectal and urinary incontinence or sexual dysfunctions, for example after rectal cancer resection or hysterectomy, remains largely understudied, particularly with regard to the female pelvic autonomic plexuses. This study focused on the macroscopic description of the superior hypogastric plexus, hypogastric nerves, inferior hypogastric plexus, the parasympathetic pelvic splanchnic nerves and the sympathetic fibres. Their arrangement is described in relation to commonly used surgical landmarks such as the sacral promontory, ureters, uterosacral ligaments, uterine and rectal blood vessels. Thirty-one embalmed female pelvises from 20 formalin-fixed and 11 Thiel-fixed cadavers were prepared. In all cases explored, the superior hypogastric plexus was situated anterior to the bifurcation of the abdominal aorta. In 60% of specimens, it reached the sacral promontory, whereas in 40% of specimens, it continued across the pelvic brim until S1. In about 25% of the subjects, we detected an accessory hypogastric nerve, which has not been systematically described so far. It originated medially from the inferior margin of the superior hypogastric plexus and continued medially into the presacral space. The existence of an accessory hypogastric nerve was confirmed during laparoscopy and by histological examination. The inferior hypogastric plexuses formed fan-shaped plexiform structures at the end of both hypogastric nerves, exactly at the junction of the ureter and the posterior wall of the uterine artery at the uterosacral ligament. In addition to the pelvic splanchnic nerves from S2-S4, which joined the inferior hypogastric plexus, 18% of the specimens in the present study revealed an additional pelvic splanchnic nerve originating from the S1 sacral root. In general, form, breadth and alignment of the autonomic nerves displayed large individual variations, which could also have a clinical impact on the postoperative function of the pelvic organs. The study serves as a basis for future investigations on the autonomic innervation of the female pelvic organs.
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Affiliation(s)
- Valerie Aurore
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Raphael Röthlisberger
- Institute of Anatomy, University of Bern, Bern, Switzerland.,Department of Urology, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Nane Boemke
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | | | | | | | - Sara Imboden
- Department of Obstetrics and Gynaecology, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynaecology, Inselspital Bern, University Hospital, Bern, Switzerland
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Nirgianakis K, McKinnon B, Ma L, Imboden S, Bersinger N, Mueller MD. Peritoneal fluid biomarkers in patients with endometriosis: a cross-sectional study. Horm Mol Biol Clin Investig 2020; 42:113-122. [PMID: 32926606 DOI: 10.1515/hmbci-2019-0064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Elevated concentrations of numerous molecules have been reported in the peritoneal cavity of women with endometriosis. Until now, no factor proved sufficiently specific to endometriosis. We aimed to investigate several biomarkers in endometriosis and report their association with the menstrual cycle in a large sample size study. METHODS Patients of reproductive age undergoing laparoscopic procedures for benign pathology in the Department of Obstetrics and Gynaecology, University of Bern between 2007 and 2018 were included. Exclusion criteria were the use of hormonal treatment in the three months prior to surgery, patients suffering from other inflammatory diseases, pregnancy, malignancy and surgery performed in an emergency. The concentrations of 13 different biomarkers in the peritoneal fluid (PF) were compared between patients with and without endometriosis both in the proliferative and the secretory cycle phase. RESULTS Out of 1,256 patients in the database, 521 met the inclusion and exclusion criteria. Glycodelin (PP14) and Midkine concentrations were significantly higher in patients with endometriosis compared to controls irrespective of the cycle phase in which the PF was collected. Interleukin-8 (IL-8), regulated on activation normal T cell expressed and secreted (RANTES) and osteoprotegerin (OPG) concentrations were higher in patients with endometriosis only in the proliferative cycle phase. Monocyte chemoattractant protein 1, CCL2 (MCP-1) and Defensin concentrations were higher in patients with endometriosis only in the secretory cycle phase. CONCLUSIONS Certain pathophysiological processes may take place only in the one cycle phase leading to a temporary increase of specific PF biomarkers. Correlation with clinical outcomes is mandatory to establish their potential as prognostic or therapeutic tools in endometriosis.
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Affiliation(s)
- Konstantinos Nirgianakis
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Brett McKinnon
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lijuan Ma
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nick Bersinger
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of BioMedical Research, University of Bern, Bern, Switzerland.,Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Siegenthaler F, Knabben L, Mohr S, Nirgianakis K, Imboden S, Mueller MD. What is the future of indocyanine green and near-infrared imaging in the surgical management of endometriosis? Acta Obstet Gynecol Scand 2020; 99:1419-1420. [PMID: 32356567 DOI: 10.1111/aogs.13884] [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] [Received: 04/18/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
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Siegenthaler F, Knabben L, Mohr S, Nirgianakis K, Imboden S, Mueller MD. Visualization of endometriosis with laparoscopy and near-infrared optics with indocyanine green. Acta Obstet Gynecol Scand 2020; 99:591-597. [PMID: 31943126 DOI: 10.1111/aogs.13803] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/23/2019] [Revised: 12/16/2019] [Accepted: 12/31/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. MATERIAL AND METHODS In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. CLINICAL TRIAL REGISTRATION clinicaltrials.gov NCT03850158. RESULTS In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. CONCLUSIONS The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal surgery and low rASRM stages have a significant positive effect on the ICG detection rate. NIR fluorescence imaging with ICG was helpful in the resection of deep infiltrating nodules in providing a better visualization of endometriosis.
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Affiliation(s)
- Franziska Siegenthaler
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland
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Imboden S, Tapia C, Scheiwiller N, Kocbek V, Altermatt HJ, Janzen J, Mueller MD, McKinnon B. Early-stage endometrial cancer, CTNNB1 mutations, and the relation between lymphovascular space invasion and recurrence. Acta Obstet Gynecol Scand 2019; 99:196-203. [PMID: 31562818 DOI: 10.1111/aogs.13740] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/26/2019] [Revised: 09/16/2019] [Accepted: 09/23/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Women diagnosed with early-stage (FIGO 1) endometrial cancer, grade 1 and 2 can have a good prognosis. Most of these women can be treated successfully with a hysterectomy and bilateral salpingo-oophorectomy and without the additional adjuvant treatment that is accompanied by more risks for complications. However, when recurrence does occur, the consequences can be dire. Accurate decisions must therefore be made by surgeons to avoid either under- or over-treatment. Risk and patient stratification for tailoring treatment still need further improvement. Both histopathology and genetic variants could be integrated into the decision process if relevant factors were identified. MATERIAL AND METHODS Morphological features and the presence of selected genetic mutations in isolated malignant endometrial epithelial cells from these tumors were analyzed in a strictly defined cohort of FIGO 1, grade 1 and 2 low-risk endometrial cancer. Their presence in this cohort, their relation to recurrence, and the association between histopathological features and mutations were determined. This analysis was performed using archival formalin-fixed paraffin-embedded tissue, complete re-evaluation of histopathological features, laser capture microdissection of epithelial cells, and a polymerase chain reaction-based mutational screening assay. RESULTS Twenty-one women with recurrence, after initial identification as low-risk endometrial cancer, were compared with 20 matched control women. The histological marker of lymphovascular invasion was significantly associated with recurrence. There was also a very high prevalence of mutations in CTNNB1 gene, occurring in 50% of this cohort. PTEN mutations were also observed in 27.8% of cases and PIK3CA mutations in 22.2%; none of these mutations were significantly related to recurrence. CONCLUSIONS This study supports the importance of lymphovascular space invasion to identify women with significant risk for recurrence in initially low-risk, early-stage endometrial cancer. It also identifies CTNNB1 as a significant mutation in early-stage disease, and although it may not represent a marker for recurrence its high prevalence in early stage disease could have relevance for both pathogenesis and early treatment.
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Affiliation(s)
- Sara Imboden
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Coya Tapia
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Nadja Scheiwiller
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Vida Kocbek
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Hans J Altermatt
- Division of Histopathology, Institute of Pathology Länggasse, Bern, Switzerland
| | - Jan Janzen
- Histopathology and VascPath, Bern, Switzerland
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Brett McKinnon
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland
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Knabben L, Imboden S, Mueller MD. Genetic testing in ovarian cancer - clinical impact and current practices. Horm Mol Biol Clin Investig 2019; 41:hmbci-2019-0025. [PMID: 31577534 DOI: 10.1515/hmbci-2019-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022]
Abstract
Background Clinical practices and testing strategies in patients with ovarian cancer differ worldwide. We therefor wanted to give an overview over the current data to advise best clinical practice. Materials and methods A systematic review of the literature was performed with the aim to define which ovarian cancer patients to refer for genetic counseling and how to perform genetic testing. We also discuss the timing of genetic testing and clinical relevance of the BRCA mutation status. Results The germline mutation rate in patients with ovarian cancer is high, independent of family history, age at diagnosis and histology. BRCA mutation carriers with ovarian cancer have improved survival rates. In recurrent ovarian cancer treatment by poly ADP ribose polymerase (PARP) inhibitors improves the disease-free survival in patients with BRCA mutations or homologous recombination deficiency with hazard ratios up to 0.23. But also patients with BRCA wild type show a benefit. The recently published SOLO-1 trial demonstrated a significant benefit for patients with germline BRCA mutations in the first line setting. By tumor testing about 7% additional BRCA mutations can be found but the somatic testing and interpretation of the results remains a challenge. Despite the clinical impact, analysis of our own data and also international publications show insufficient referral rates for genetic counseling. Conclusions Genetic testing in ovarian cancer has a prognostic and predictive value. Referral rates must be improved.
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Affiliation(s)
- Laura Knabben
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Effingerstrasse 102, 3010 Berne, Switzerland, Phone: +41 31 632 10 10, Fax: +41 31 632 12 05
| | - Sara Imboden
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
| | - Michel D Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
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Imboden S, Mereu L, Siegenthaler F, Pellegrini A, Papadia A, Tateo S, Mueller MD. Oncological safety and perioperative morbidity in low-risk endometrial cancer with sentinel lymph-node dissection. European Journal of Surgical Oncology 2019; 45:1638-1643. [DOI: 10.1016/j.ejso.2019.05.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/10/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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Bustamante Eduardo M, Popovici V, Imboden S, Aebi S, Ballabio N, Altermatt HJ, Günthert A, Jaggi R. Characterization of molecular scores and gene expression signatures in primary breast cancer, local recurrences and brain metastases. BMC Cancer 2019; 19:549. [PMID: 31174485 PMCID: PMC6556009 DOI: 10.1186/s12885-019-5752-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/30/2018] [Accepted: 05/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background Breast cancer is a leading cause of cancer-related death in women worldwide. Despite extensive studies in all areas of basic, clinical and applied research, accurate prognosis remains elusive, thus leading to overtreatment of many patients. Diagnosis could be improved by introducing multigene molecular scores in standard clinical practice. Several tests that work with formalin-fixed tissue have become routine. Molecular scores usually include several genes representing processes, response to oestrogens, progestogens and human epidermal growth factor receptor 2 (Her2), respectively, which are combined additively in single values. These multi-gene scores have the advantage of being more robust and reproducible than single-gene scores. Their utility may be further enhanced by combining them with classical diagnostic parameters. Here, we present an exploratory study comparing the RISK and research versions of Oncotype DX recurrence score (RS), Prosigna Risk of Recurrence (ROR) and EndoPredict (EP) with respect to their prognostic potential for ipsilateral recurrence and/or distant relapse in brain, and we compared the scores to the intrinsic subtypes based on PAM50. Methods RNA was extracted from formalin-fixed, paraffin-embedded (FFPE) tissue cores of primary tumours, local recurrences and brain metastases. Gene expression was measured on a NanoString nCounter Analysis System. Intrinsic subtypes and molecular scores were computed according to published literature and RISK, RS, ROR and EP were compared against each other and to the intrinsic subtypes Luminal A (lumA), Luminal B (lumB), Her2-enriched (Her2↑), Basal-like (basal), and Normal-like (normal) of PAM50. Local recurrences and brain metastases were compared to their corresponding primary tumours. Results All four molecular scores were highly correlated. Highest correlations were observed among genes related to proliferation while lower correlations were found among oestrogen-related genes. The scores were significantly higher in primary tumours progressing to brain metastases as compared to recurrence-free primary tumours and primary tumours that relapsed as local recurrences. Conclusions RISK and ROR-P are prognostic for primary tumours metastasizing to the brain. All four scores, RISK, RS, EP and ROR-P failed to discriminate between primary tumours that remained recurrence-free and primary tumours relapsing as local recurrences. Electronic supplementary material The online version of this article (10.1186/s12885-019-5752-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Vlad Popovici
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Sara Imboden
- Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Aebi
- Department of Medical Oncology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | | | | | | | - Rolf Jaggi
- Department for Biomedical Research, University of Bern, Murtenstrasse, 40, 3008, Bern, Switzerland.
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Imboden S, Nastic D, Ghaderi M, Rydberg F, Rau TT, Mueller MD, Epstein E, Carlson JW. Phenotype of POLE-mutated endometrial cancer. PLoS One 2019; 14:e0214318. [PMID: 30917185 PMCID: PMC6436745 DOI: 10.1371/journal.pone.0214318] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Background and purpose Individualized therapy in endometrial cancer, the most common gynaecologic cancer in the developed world, focuses on identifying specific molecular subtypes. Mutations in the exonuclease domain of the DNA polymerase epsilon (POLE) gene define one such subtype, which causes an ultra-mutated tumour phenotype. These tumours may have an improved progression-free survival and may be receptive to specific therapies. However, the clinical phenotype of these tumours is unknown. The objective of this study was to evaluate the clinical and genetic features of POLE-mutated tumours from a large cohort of women whose cases are characterized by: (1) the availability of detailed clinical and lifestyle data; (2) mutation analysis; and (3) long-term follow-up. Methods A total of 604 patients with endometrial cancer were included in the study. Data from a detailed questionnaire, including lifestyle and family history information, provided extensive pertinent information on the patients. Sequencing of exons 9–14 of the POLE gene was performed. Follow-up data were gathered and analysed. Results Hotspot pathogenic POLE mutations were identified in N = 38/599 patients (6.3%). Patients with a POLE-mutated tumour were significantly younger, were more often nulliparous, and had a history of smoking. POLE-mutated tumours were more frequently aneuploid. Prognosis for patients with hotspot POLE-mutated tumours was significantly better in comparison with patients with non-mutated tumours; however careful selection of pathogenic mutations is essential to the definition of this prognostically favourable group. Conclusions This study demonstrates that POLE-mutated endometrial cancer is significantly associated with previously unknown clinicopathologic characteristics. Outcome in POLE-mutated tumours was excellent in cases with hotspot mutations. Our results suggest that prediction of excellent outcome in cases of POLE-mutated EMCA should be restricted to cases of EMCA with hotspot mutations until further data are available on the rising number of mutations with unknown significance.
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Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynaecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Denis Nastic
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Mehran Ghaderi
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Filippa Rydberg
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Tilman T. Rau
- Institute of Pathology, University Bern, Bern, Switzerland
| | - Michael D. Mueller
- Department of Obstetrics and Gynaecology, University Hospital of Bern and University of Bern, Bern, Switzerland
| | - Elisabeth Epstein
- Department of Clinical Science and Education Karolinska Institutet, and Department of Obstetrics and Gynaecology Södersjukhuset, Stockholm, Sweden
| | - Joseph W. Carlson
- Department of Oncology-Pathology, Karolinska Institutet, and Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
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Imboden S, Knabben L, Mueller MD, Günthert AR, Lössl K. Bone in the breast? Long term toxicity 21 years after interstitial brachytherapy as a boost. Rep Pract Oncol Radiother 2018; 23:337-340. [PMID: 30127673 DOI: 10.1016/j.rpor.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/20/2017] [Revised: 03/02/2018] [Accepted: 06/23/2018] [Indexed: 11/17/2022] Open
Abstract
An 81-year-old patient developed an exulcerous tumor in her left breast 21 years after breast cancer treatment with lumpectomy and adjuvant radiotherapy. At the time of the initial treatment 21 years ago, whole breast irradiation was performed with a prescribed dose of 48 Gy and a maximal dose of 69 Gy. In addition, the patient received a 14.7 Gy boost with multicatheter brachytherapy as partial breast irradiation. In general, fat necrosis after radiotherapy, surgery or trauma is a minor problem for patients, but can lead to diagnostic difficulties. The incidence varies: the literature indicates that it occurs in up to 34% of cases. The direct pathogenesis is not clear; it can be due to high radiation dose to the breast, dosimetric inhomogeneities or surgical complications (seromas and inflammation). The tumor in the case described here, occurring more than two decades after the primary treatment, is a rarity in this extent and is an unusual clinical, radiological, and histological finding. It provides a good example of the need for an individualized approach to treatment.
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Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
| | - Andreas R Günthert
- Department of Obstetrics and Gynecology, Cantonal Hospital, Lucerne, Switzerland
| | - Kristina Lössl
- Department of Radiooncology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
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Knabben L, Imboden S, Genoud S, Mueller M, Guenthert A. Risk factors for axillar recurrence after negative sentinel lymph node biopsy for invasive breast cancer: A case-control study. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30472-6] [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: 10/17/2022]
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Mohr S, Siegenthaler F, Imboden S, Kuhn A, Mueller MD. Transvaginal Excision of an Eroded Sacrocolpopexy Mesh by Using Single-Incision Laparoscopic Surgery Equipment. J Minim Invasive Gynecol 2017; 24:1079-1080. [DOI: 10.1016/j.jmig.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 11/30/2022]
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Affiliation(s)
| | - Sara Imboden
- Universitätsklinik für Frauenheilkunde
Inselspital, Universitätsspital Bern
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Trippel M, Imboden S, Papadia A, Mueller MD, Mertineit N, Härmä K, Nicolae A, Vassella E, Rau TT. Intestinal differentiated mucinous adenocarcinoma of the endometrium with sporadic MSI high status: a case report. Diagn Pathol 2017; 12:39. [PMID: 28494767 PMCID: PMC5427532 DOI: 10.1186/s13000-017-0629-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/08/2016] [Accepted: 04/21/2017] [Indexed: 11/27/2022] Open
Abstract
Background Intestinal differentiation of primary mucinous adenocarcinoma of the uterine corpus is exceedingly rare in comparison to the approximately 25% rate in endocervical and ovarian mucinous carcinoma. Additionally, little is known about the related genetic and epigenetic alterations, even though large-scale molecular characterisation of the different types of endometrial cancer took place in the TCGA project along the entities defined by the recent WHO classification. Case presentation We present a 62-year-old patient harbouring a primary mucinous carcinoma of the uterine corpus with a morphological resemblance to mucinous colorectal adenocarcinoma. The intestinal differentiation was substantiated by CDX2 and CK20 positivity in the absence of PAX8, p16, WT1, p53, ER, PgR, AFP, SALL4 and Glypican3. A high MSI status with MLH1 hypermethylation was revealed by molecular testing. Conclusion Intestinal differentiation of mucinous adenocarcinoma of the endometrium is a unique observation. Besides morphology, it obviously can share molecular features of sporadic MSI colorectal cancers. It can be speculated that either CDX2 positive morula formation or intestinal metaplasia of the endometrium as rare conditions might be the origin of carcinogenesis for this type II endometrial cancer. Both conditions were not detectable in this case. Of note, categorising endometrial cancers in genetic subgroups like MSI high cancers alone might lead to the integration of likewise morphologically different tumours like the case presented here with intestinal differentiation. Hence, careful genotype-phenotype correlations are warranted for studies of mucinous adenocarcinoma of the endometrium. Electronic supplementary material The online version of this article (doi:10.1186/s13000-017-0629-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mafalda Trippel
- Institute of Pathology, University of Bern, Murtenstr. 31, 3008, Bern, CH, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynaecology, Inselspital, University of Bern, Bern, Switzerland
| | - Andrea Papadia
- Department of Obstetrics and Gynaecology, Inselspital, University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynaecology, Inselspital, University of Bern, Bern, Switzerland
| | - Nando Mertineit
- Department of Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Kirsi Härmä
- Department of Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Alina Nicolae
- Institute of Pathology, University of Bern, Murtenstr. 31, 3008, Bern, CH, Switzerland
| | - Erik Vassella
- Institute of Pathology, University of Bern, Murtenstr. 31, 3008, Bern, CH, Switzerland
| | - Tilman T Rau
- Institute of Pathology, University of Bern, Murtenstr. 31, 3008, Bern, CH, Switzerland.
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Mohr S, Marthaler C, Imboden S, Monga A, Mueller MD, Kuhn A. Bulkamid (PAHG) in mixed urinary incontinence: What is the outcome? Int Urogynecol J 2017; 28:1657-1661. [DOI: 10.1007/s00192-017-3332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
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Knabben L, Kanagalingam G, Imboden S, Günthert AR. Acellular Dermal Matrix (Permacol ®) for Heterologous Immediate Breast Reconstruction after Skin-Sparing Mastectomy in Patients with Breast Cancer: A Single-Institution Experience and a Review of the Literature. Front Med (Lausanne) 2017; 3:72. [PMID: 28105410 PMCID: PMC5213735 DOI: 10.3389/fmed.2016.00072] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/16/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Skin-sparing mastectomy (SSM) with immediate heterologous reconstruction is a safe oncological option in surgical therapy of early breast cancer. Permacol® is an acellular dermal matrix (ADM) placed between the implant and the skin to improve lower pole projection and implant coverage. The aim of our study was to evaluate the outcome with a focus on patient satisfaction after 6 months and to analyze physical changes of ADM. METHODS 10 patients who underwent SSM with Permacol® were analyzed retrospectively. All patients were followed using a satisfaction questionnaire and an ultrasound evaluation of the tissue thickness of the pectoralis muscle and the Permacol®. RESULTS No intraoperative complications were observed. One patient required removal of the implant for necrosis after 3 months. Half of the patients underwent secondary corrective surgery. A statistically significant thinning of the pectoralis muscle was observed, compared to the thickening of the Permacol®. A majority of the patients were satisfied with the operation, and we found a correlation between lower body mass index and patient satisfaction. CONCLUSION In our small case series Permacol®-assisted immediate reconstruction is shown to be an option for selected cases. Physical changes of Permacol® result in a symmetrical coverage of the implant, which may improve cosmetic outcome.
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Affiliation(s)
- Laura Knabben
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Gowthami Kanagalingam
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynaecology, University Hospital of Berne, University of Berne , Berne , Switzerland
| | - Andreas R Günthert
- Department of Obstetrics and Gynaecology, Cantonal Hospital of Lucerne , Lucerne , Switzerland
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Buda A, Papadia A, Zapardiel I, Vizza E, Ghezzi F, De Ponti E, Lissoni AA, Imboden S, Diestro MD, Verri D, Gasparri ML, Bussi B, Di Martino G, de la Noval BD, Mueller M, Crivellaro C. From Conventional Radiotracer Tc-99(m) with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach. Ann Surg Oncol 2016; 23:2959-65. [PMID: 27126631 DOI: 10.1245/s10434-016-5227-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The credibility of sentinel lymph node (SLN) mapping is becoming increasingly more established in cervical cancer. We aimed to assess the sensitivity of SLN biopsy in terms of detection rate and bilateral mapping in women with cervical cancer by comparing technetium-99 radiocolloid (Tc-99(m)) and blue dye (BD) versus fluorescence mapping with indocyanine green (ICG). METHODS Data of patients with cervical cancer stage 1A2 to 1B1 from 5 European institutions were retrospectively reviewed. All centers used a laparoscopic approach with the same intracervical dye injection. Detection rate and bilateral mapping of ICG were compared, respectively, with results obtained by standard Tc-99(m) with BD. RESULTS Overall, 76 (53 %) of 144 of women underwent preoperative SLN mapping with radiotracer and intraoperative BD, whereas 68 of (47 %) 144 patients underwent mapping using intraoperative ICG. The detection rate of SLN mapping was 96 % and 100 % for Tc-99(m) with BD and ICG, respectively. Bilateral mapping was achieved in 98.5 % for ICG and 76.3 % for Tc-99(m) with BD; this difference was statistically significant (p < 0.0001). CONCLUSIONS The fluorescence SLN mapping with ICG achieved a significantly higher detection rate and bilateral mapping compared to standard radiocolloid and BD technique in women with early stage cervical cancer. Nodal staging with an intracervical injection of ICG is accurate, safe, and reproducible in patients with cervical cancer. Before replacing lymphadenectomy completely, the additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be explored and confirmed by ongoing controlled trials.
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Affiliation(s)
- Alessandro Buda
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
| | - Andrea Papadia
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
| | - Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Enrico Vizza
- Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy
| | - Elena De Ponti
- Department of Medical Physics, San Gerardo Hospital, Monza, Italy
| | - Andrea Alberto Lissoni
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
| | | | - Debora Verri
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Beatrice Bussi
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giampaolo Di Martino
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Michael Mueller
- Department of Obstetrics and Gynecology, University of Berne, Bern, Switzerland
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Papadia A, Mohr S, Imboden S, Lanz S, Bolla D, Mueller MD. Laparoscopic Indocyanine Green Sentinel Lymph Node Mapping in Pregnant Cervical Cancer Patients. J Minim Invasive Gynecol 2016; 23:270-3. [DOI: 10.1016/j.jmig.2015.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
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