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Gouveia P, Sá Pinto A, Violante L, Nunes S, Teixeira R, Petiz A, Duarte LH. 18F-FDG PET/CT in Patients with Vulvar and Vaginal Cancer: A Preliminary Study of 20 Cases. ACTA MEDICA PORT 2022; 35:170-175. [PMID: 34818510 DOI: 10.20344/amp.12510] [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: 07/04/2019] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Despite the growing evidence supporting the use of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in cervical and ovarian malignant tumours, data on vulvar and vaginal cancer is sparse. Our aim was to assess the role of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in patients with vulvar and vaginal cancer. MATERIAL AND METHODS A retrospective study was conducted on a cohort of 20 patients with biopsy-proven vulvar (n = 17) and vaginal (n = 3) cancer who performed 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography, between January 2013 and April 2018. We collected the clinical data of all patients, as well as the indication for 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography, its results, and the main lesion maximum standard uptake value (SUVmax). In addition, we correlated the results of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography with other diagnostic modalities, namely histological findings, computed tomography and magnetic resonance imaging. Patients were divided into two groups, one with newly diagnosed disease and another with recurrent disease. RESULTS Six patients had newly diagnosed disease and 14 had recurrent disease. The main lesion was detected by 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in five out of six patients with newly diagnosed disease and in all 14 patients with recurrent disease. Additional sites of 2-[F-18]-fluor-2-desoxi-D-glucose uptake were identified in inguinal and iliac lymph nodes and in distant lesions. Magnetic resonance imaging and computed tomography were performed in 12 cases. In four patients with recurrent disease, abnormalities (main lesion/ metastatic lymph nodes) identified by 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography were not detected as suspicious by computed tomography. DISCUSSION In our study, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography identified abnormalities more often than conventional computed tomography scans in recurrent disease. In comparison with histology, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography had a sensitivity of 95% and a positive predictive value of 100% in identifying the primary tumour and the recurrent main lesion. Little data is available regarding the usefulness of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in the management of vulvar and vaginal cancers. The existing evidence supports a high accuracy in detecting lymph node metastases and a change of 36.0% - 61.5% in patient management. Our findings reinforce the usefulness of this technique in vulvar and vaginal cancer. Limitations of our study include its retrospective nature and the rareness of both vulvar and vaginal cancer, which leads to a small sample size and few comparative imaging tests. CONCLUSION In this preliminary study, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography demonstrated it can be a useful method in patients with vulvar and vaginal cancers, namely in defining the extent of disease and contributing to accurate staging and restaging.
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Affiliation(s)
- Patrícia Gouveia
- Serviço de Medicina Nuclear. Centro Hospitalar do Porto. Porto. Portugal
| | - Adriana Sá Pinto
- Serviço de Medicina Nuclear. Centro Hospitalar de São João. Porto. Portugal
| | - Liliana Violante
- Serviço de Medicina Nuclear. Instituto Português de Oncologia do Porto. Porto. Portugal
| | - Sara Nunes
- Serviço de Ginecologia e Obstetrícia. Centro Hospitalar de Trás-os-Montes e Alto Douro. Vila Real. Portugal
| | - Ricardo Teixeira
- Serviço de Medicina Nuclear. Centro Hospitalar do Porto. Porto. Portugal
| | - Almerinda Petiz
- Clínica de Ginecologia. Instituto Português de Oncologia do Porto. Porto. Portugal
| | - Luís Hugo Duarte
- Serviço de Medicina Nuclear. Centro Hospitalar de São João. Porto. Portugal
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Cibula D, Borčinová M, Marnitz S, Jarkovský J, Klát J, Pilka R, Torné A, Zapardiel I, Petiz A, Lay L, Sehnal B, Ponce J, Felsinger M, Arencibia-Sánchez O, Kaščák P, Zalewski K, Presl J, Palop-Moscardó A, Tingulstad S, Vergote I, Redecha M, Frühauf F, Köhler C, Kocián R. Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients. Cancers (Basel) 2021; 13:cancers13102360. [PMID: 34068399 PMCID: PMC8153612 DOI: 10.3390/cancers13102360] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Lower-limb lymphedema (LLL) is a well-recognized adverse outcome of the surgical management of cervical cancer. Recently, sentinel lymph node (SLN) biopsy has emerged as an alternative procedure to systematic pelvic lymphadenectomy (PLND) aiming to decrease the risk of complications, especially LLL development. Our study represents the first prospective analysis of LLL incidence in cervical cancer patients after a uterine procedure with SLN biopsy, without systematic PLND. In an international multicenter trial SENTIX, the group of 150 patients was prospectively evaluated using both objective and subjective LLL assessments in 6 months intervals for 2 years. Contrary to the expectations, our results showed that SLN biopsy does not eliminate the risk of LLL development which occurred in a mild or moderate stage in about 26% of patients with a median interval to the onset of 9 months. Abstract Background: To prospectively assess LLL incidence among cervical cancer patients treated by uterine surgery complemented by SLN biopsy, without PLND. Methods: A prospective study in 150 patients with stage IA1–IB2 cervical cancer treated by uterine surgery with bilateral SLN biopsy. Objective LLL assessments, based on limb volume increase (LVI) between pre- and postoperative measurements, and subjective patient-perceived swelling were conducted in six-month periods over 24-months post-surgery. Results: The cumulative incidence of LLL at 24 months was 17.3% for mild LLL (LVI 10–19%), 9.2% for moderate LLL (LVI 20–39%), while only one patient (0.7%) developed severe LLL (LVI > 40%). The median interval to LLL onset was nine months. Transient edema resolving without intervention within six months was reported in an additional 22% of patients. Subjective LLL was reported by 10.7% of patients, though only a weak and partial correlation between subjective-report and objective-LVI was found. No risk factor directly related to LLL development was identified. Conclusions: The replacement of standard PLND by bilateral SLN biopsy in the surgical treatment of cervical cancer does not eliminate the risk of mild to moderate LLL, which develops irrespective of the number of SLN removed.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
- Correspondence: ; Tel.: +420-224-967-451
| | - Martina Borčinová
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
| | - Simone Marnitz
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (S.M.); (C.K.)
| | - Jiří Jarkovský
- Data Analysis Department, Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Jaroslav Klát
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 70800 Ostrava Poruba, Czech Republic;
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77900 Olomouc, Czech Republic;
| | - Aureli Torné
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain;
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain;
| | - Almerinda Petiz
- Serviço de Ginecologia, Instituto Portugues de Oncologia do Porto, 1099-023 Porto, Portugal;
| | - Laura Lay
- Department of Gynaecology, Institute of Oncology Angel H Roffo University of Bueno s Aires, Buenos Aires C1417 DTB, Argentina;
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, First Faculty of Medicine, University Hospital Bulovka, Charles University, 18081 Prague, Czech Republic;
| | - Jordi Ponce
- Department of Gynecology, Biomedical Research Institute of Bellvitge (IDIBELL), University Hospital of Bellvitge, University of Barcelona, 08908 Barcelona, Spain;
| | - Michal Felsinger
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60177 Brno, Czech Republic;
| | - Octavio Arencibia-Sánchez
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain;
| | - Peter Kaščák
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 911 71 Trencin, Slovakia;
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Jiri Presl
- Department of Obstetrics and Gynecology, Faculty of Medicine Pilsen, University Hospital in Pilsen and Charles University, 30460 Pilsen, Czech Republic;
| | - Alicia Palop-Moscardó
- Gynecology Department, Instituto Valenciano de Oncologia (IVO), 46009 Valencia, Spain;
| | - Solveig Tingulstad
- Department of Obstetrics and Gynecology, Trondheim University Hospital, 7030 Trondheim, Norway;
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Leuven Cancer Institute, University Hospital Leuven, 3000 Leuven, Belgium;
| | - Mikuláš Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 814 99 Bratislava, Slovakia;
| | - Filip Frühauf
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
| | - Christhardt Köhler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (S.M.); (C.K.)
| | - Roman Kocián
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (M.B.); (F.F.); (R.K.)
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3
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Cibula D, Kocian R, Plaikner A, Jarkovsky J, Klat J, Zapardiel I, Pilka R, Torne A, Sehnal B, Ostojich M, Petiz A, Sanchez OA, Presl J, Buda A, Raspagliesi F, Kascak P, van Lonkhuijzen L, Barahona M, Minar L, Blecharz P, Pakiz M, Wydra D, Snyman LC, Zalewski K, Zorrero C, Havelka P, Redecha M, Vinnytska A, Vergote I, Tingulstad S, Michal M, Kipp B, Slama J, Marnitz S, Bajsova S, Hernandez A, Fischerova D, Nemejcova K, Kohler C. Sentinel lymph node mapping and intraoperative assessment in a prospective, international, multicentre, observational trial of patients with cervical cancer: The SENTIX trial. Eur J Cancer 2020; 137:69-80. [PMID: 32750501 DOI: 10.1016/j.ejca.2020.06.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 05/13/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND SENTIX (ENGOT-CX2/CEEGOG-CX1) is an international, multicentre, prospective observational trial evaluating sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. We report the final preplanned analysis of the secondary end-points: SLN mapping and outcomes of intraoperative SLN pathology. METHODS Forty-seven sites (18 countries) with experience of SLN biopsy participated in SENTIX. We preregistered patients with stage IA1/lymphovascular space invasion-positive to IB2 (4 cm or smaller or 2 cm or smaller for fertility-sparing treatment) cervical cancer without suspicious lymph nodes on imaging before surgery. SLN frozen section assessment and pathological ultrastaging were mandatory. Patients were registered postoperatively if SLN were bilaterally detected in the pelvis, and frozen sections were negative. TRIAL REGISTRATION ClinicalTrials.gov (NCT02494063). RESULTS We analysed data for 395 preregistered patients. Bilateral detection was achieved in 91% (355/395), and it was unaffected by tumour size, tumour stage or body mass index, but it was lower in older patients, in patients who underwent open surgery, and in sites with fewer cases. No SLN were found outside the seven anatomical pelvic regions. Most SLN and positive SLN were localised below the common iliac artery bifurcation. Single positive SLN above the iliac bifurcation were found in 2% of cases. Frozen sections failed to detect 54% of positive lymph nodes (pN1), including 28% of cases with macrometastases and 90% with micrometastases. INTERPRETATION SLN biopsy can achieve high bilateral SLN detection in patients with tumours of 4 cm or smaller. At experienced centres, all SLN were found in the pelvis, and most were located below the iliac vessel bifurcation. SLN frozen section assessment is an unreliable tool for intraoperative triage because it only detects about half of N1 cases.
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Affiliation(s)
- David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Roman Kocian
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava Poruba, Czech Republic
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - Aureli Torne
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marcela Ostojich
- Department of Gynecology, Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires Autonomous City, Argentina
| | - Almerinda Petiz
- Department of Gynecology, Francisco Gentil Portuguese Oncology Institute, Porto, Portugal
| | - Octavio A Sanchez
- Department of Gynecologic Oncology, University Hospital of the Canary Islands, Las Palmas de Gran Canaria, Spain
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, Monza, Italy
| | | | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, Trencin, Slovakia
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marc Barahona
- Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pawel Blecharz
- Department of Gynecologic Oncology, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Department, Cracow, Poland
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, Poland
| | - Leon C Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland
| | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Pavel Havelka
- Department of Obstetrics and Gynecology, KNTB a.s Zlin, Czech Republic
| | - Mikulas Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, Bratislava, Slovakia
| | | | - Ignace Vergote
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, Ceske Budejovice, Czech Republic
| | - Barbara Kipp
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jiri Slama
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simone Marnitz
- Department of Radiation Oncology, CyberKnife and Radiotherapy University Hospital Cologne, Cologne, Germany
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava Poruba, Czech Republic
| | - Alicia Hernandez
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
| | - Daniela Fischerova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
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Peixoto A, Pinto P, Guerra J, Pinheiro M, Santos C, Pinto C, Santos R, Escudeiro C, Bartosch C, Canário R, Barbosa A, Gouveia A, Petiz A, Abreu MH, Sousa S, Pereira D, Silva J, Teixeira MR. Tumor Testing for Somatic and Germline BRCA1/ BRCA2 Variants in Ovarian Cancer Patients in the Context of Strong Founder Effects. Front Oncol 2020; 10:1318. [PMID: 32850417 PMCID: PMC7412538 DOI: 10.3389/fonc.2020.01318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/20/2019] [Accepted: 06/24/2020] [Indexed: 12/21/2022] Open
Abstract
Deleterious variants in the BRCA1/BRCA2 genes and homologous recombination deficiency (HRD) status are considered strong predictors of response to poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi). The introduction of PARPi in clinical practice for the treatment of patients with advanced ovarian cancer imposed changes in the molecular diagnosis of BRCA1/BRCA2 variants. BRCA1/BRCA2 tumor testing by next-generation sequencing (NGS) can detect simultaneously both somatic and germline variants, allowing the identification of more patients with higher likelihood of benefiting from PARPi. Our main goal was to determine the frequency of somatic and germline BRCA1/BRCA2 variants in a series of non-mucinous OC, and to define the best strategy to be implemented in a routine diagnostic setting for the screening of germline/somatic variants in these genes, including the BRCA2 c.156_157insAlu Portuguese founder variant. We observed a frequency of 19.3% of deleterious variants, 13.3% germline, and 5.9% somatic. A higher prevalence of pathogenic variants was observed in patients diagnosed with high-grade serous ovarian cancer (23.2%). Considering the frequencies of the c.3331_3334del and the c.2037delinsCC BRCA1 variants observed in this study (73% of all BRCA1 pathogenic germline variants identified) and the limitations of NGS to detect the BRCA2 c.156_157insAlu variant, it might be cost-effective to test for these founder variants with a specific test prior to tumor screening of the entire coding regions of BRCA1 and BRCA2 by NGS in patients of Portuguese ancestry.
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Affiliation(s)
- Ana Peixoto
- Department of Genetics, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Pedro Pinto
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Joana Guerra
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Manuela Pinheiro
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Catarina Santos
- Department of Genetics, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Carla Pinto
- Department of Genetics, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Rui Santos
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Carla Escudeiro
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Cancer Biology and Epigenetics Group, CI-IPOP, IPO Porto, Porto, Portugal
| | - Rita Canário
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Cancer Biology and Epigenetics Group, CI-IPOP, IPO Porto, Porto, Portugal.,Epithelial Interactions in Cancer Lab, Instituto de Investigação e Inovação em Saúde (I3S)/Instituto de Patologia e Imunologia Molecular da Universidade Do Porto (IPATIMUP), University of Porto, Porto, Portugal.,Graduate Program in Areas of Basic and Applied Biology, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Ana Barbosa
- Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Alfredo Gouveia
- Department of Gynecology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Almerinda Petiz
- Department of Gynecology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Miguel Henriques Abreu
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Susana Sousa
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Deolinda Pereira
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - João Silva
- Department of Genetics, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Manuel R Teixeira
- Department of Genetics, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Cancer Genetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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5
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Nemejcova K, Kocian R, Kohler C, Jarkovsky J, Klat J, Berjon A, Pilka R, Sehnal B, Gil-Ibanez B, Lupo E, Petiz A, Arencibia Sanchez O, Kascak P, Martinelli F, Buda A, Presl J, Barahona M, van Lonkhuijzen L, Szatkowski W, Minar L, Pakiz M, Havelka P, Zorrero C, Misiek M, Snyman LC, Wydra D, Vergote I, Vinnytska A, Redecha M, Michal M, Tingulstad S, Kipp B, Szewczyk G, Toth R, de Santiago Garcia FJ, Coronado Martin PJ, Poka R, Tamussino K, Luyckx M, Fastrez M, Staringer JC, Germanova A, Plaikner A, Bajsova S, Dundr P, Mallmann-Gottschalk N, Cibula D. Central Pathology Review in SENTIX, A Prospective Observational International Study on Sentinel Lymph Node Biopsy in Patients with Early-Stage Cervical Cancer (ENGOT-CX2). Cancers (Basel) 2020; 12:cancers12051115. [PMID: 32365651 PMCID: PMC7281480 DOI: 10.3390/cancers12051115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/16/2020] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review.
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Affiliation(s)
- Kristyna Nemejcova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | - Roman Kocian
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Jiri Jarkovsky
- Institute for Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Jaroslav Klat
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Alberto Berjon
- Department of Pathology, La Paz University Hospital, 28046 Madrid, Spain;
- Molecular Pathology and Therapeutic Targets Group, IdiPAZ, 28046 Madrid, Spain
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, 77520 Olomouc, Czech Republic;
| | - Borek Sehnal
- Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University, 18081 Prague, Czech Republic;
| | - Blanca Gil-Ibanez
- Unit of Gynecological Oncology, Institute Clinic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic of Barcelona, 08036 Barcelona, Spain;
| | - Ezequiel Lupo
- Department of Pathology, Institute of Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires Autonomous City 1214, Argentina;
| | - Almerinda Petiz
- Department of Gynecology, Francisco Gentil Portuguese Oncology Institute, 4200-072 Porto, Portugal;
| | - Octavio Arencibia Sanchez
- Departments of Gynecologic Oncology, University Hospital of the Canary Islands, 35016 Las Palmas de Gran Canaria, Spain;
| | - Peter Kascak
- Department of Obstetrics and Gynecology, Faculty Hospital Trencin, 91171 Trencin, Slovakia;
| | - Fabio Martinelli
- IRCCS Foundation National Cancer Institute in Milan, 20133 Milan, Italy;
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology Surgery, San Gerardo Hospital, 20900 Monza, Italy;
| | - Jiri Presl
- Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, 30460 Prague, Czech Republic;
| | - Marc Barahona
- Department of Gynecology, University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge, University of Barcelona, 08907 Barcelona, Spain;
| | - Luc van Lonkhuijzen
- Center for Gynecologic Oncology, Academic Medical Centre, 1100DD Amsterdam, The Netherlands;
| | - Wiktor Szatkowski
- Department of Gynecologic Oncology, Centre of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Department, 31-115 Cracow, Poland;
| | - Lubos Minar
- Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, 60200 Brno, Czech Republic;
| | - Maja Pakiz
- University Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | | | - Cristina Zorrero
- Gynecology Department, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain;
| | - Marcin Misiek
- Department of Gynecologic Oncology, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Leon Cornelius Snyman
- Gynaecologic Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria 0001, South Africa;
| | - Dariusz Wydra
- Department of Gynecology, Gynecologic Oncology and Gynecologic Endocrinology, Medical University of Gdansk, 80-402 Gdansk, Poland;
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, University Hospital Leuven, Leuven Cancer Institute, 3000 Leuven, Belgium;
| | - Alla Vinnytska
- LISOD-Israeli Oncological Hospital, 08720 Plyuty, Ukraine;
| | - Mikulas Redecha
- Department of Gynaecology and Obstetrics, University Hospital, Comenius University, 82101 Bratislava, Slovakia;
| | - Martin Michal
- Department of Obstetrics and Gynaecology, Hospital Ceske Budejovice, JSC, 37001 Ceske Budejovice, Czech Republic;
| | | | - Barbara Kipp
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland;
| | - Grzegorz Szewczyk
- Department of Obstetrics and Gynecology, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Robert Toth
- Oncology Institute of East Slovakia, 04191 Košice, Slovakia;
| | | | | | - Robert Poka
- Institute of Obstetrics and Gynaecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | | | - Mathieu Luyckx
- Department of Gynecology, Universite catholique de Louvain, Cliniques Universitaires St Luc, 1200 Brussels, Belgium;
| | - Maxime Fastrez
- Department of Obstetrics and Gynaecology, St Pierre University Hospital, Universite Libre de Bruxelles, 1000 Brussels, Belgium;
| | - Juan Carlos Staringer
- Department of Gynecology and Obstetrics, Hospital Español de Buenos Aires, Buenos Aires 2975, Argentina;
| | - Anna Germanova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
| | - Andrea Plaikner
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, 22763 Hamburg, Germany; (C.K.); (A.P.)
| | - Sylva Bajsova
- Department of Obstetrics and Gynecology, University Hospital Ostrava, 708 52 Ostrava Poruba, Czech Republic; (J.K.); (S.B.)
| | - Pavel Dundr
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (K.N.); (P.D.)
| | | | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, 12000 Prague, Czech Republic; (R.K.); (A.G.)
- Correspondence: ; Tel.: +420-224967451
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Igreja J, Ribas P, Petiz A. Advanced stage cervical cancer in pregnancy – A clinical challenge. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.143] [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: 10/27/2022]
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Affiliation(s)
- A Melo
- Department of Gynaecological Oncology, Oporto Portuguese Institute of Oncology, Francisco Gentil, Portugal.
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Freitas D, Rodrigues F, Fernandes D, Petiz A. [Wertheim-Meigs operation for cervical cancer and complementary therapy: critical analysis of 5 years]. ACTA MEDICA PORT 2011; 24 Suppl 2:557-564. [PMID: 22849947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Review and critical analysis of the Wertheim-Meigs Operations performed at our institution in the context of cervical cancer and to assess the proportion who underwent treatment with adjuvant radiotherapy (with or without chemotherapy) and the main indications. MATERIAL AND METHODS Retrospective review of Wertheim-Meigs operations, conducted in the context of carcinoma of the cervix, between 01.01.2005 and 31.12.2010, through consultation with clinical processes. It was later performed a descriptive statistical analysis of the cases. RESULTS During this period 119 Wertheim-Meigs Operations were performed. Four were excluded: two, for primary indication for adjuvant therapy due to histological subtype; two for the inability to exclude invasive disease preoperatively and the invasion was not confirmed after surgery. A total of 115 cases were reviewed and analyzed, and of these 50 (43.5%) underwent complementary therapy, the main indication being the presence of lymphovascular invasion in 21 cases (42% of cases submitted to complementary therapy ). CONCLUSIONS The mean age of patients undergoing radical surgery is 49 years, with stage IB1 most often determining its performance. Complementary therapy was performed in 43.5% of cases, the main indication being lymphovascular invasion (42%) followed by lymph node invasion (16%). Internal audit to the Service is satisfactory, with 16.5% surgical complication rate and high technical performance.
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Affiliation(s)
- Daniela Freitas
- Serviço de Ginecologia e Obstetrícia, Hospital São João, Porto, Portugal
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Pinelo S, Petiz A, Domingues C, Lopes C, Alves A, Fael R. [Pelvic exenterations for gynaecological cancer--a 10 year institutional review]. ACTA MEDICA PORT 2006; 19:99-104. [PMID: 17187709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
UNLABELLED Pelvic exenteration consists in a radical surgical procedure for patients with advanced cancer but limited to central pelvis. It is used for treatment of primary or recurrent tumours, or, more usually in treatment of recurrent cervical cancer. MATERIAL AND METHODS Retrospective study of medical charts of patients underwent pelvic exenteration for gynaecological cancer between January 1995 and April 2005. RESULTS Twenty-one pelvic exenterations were performed in this period. The mean age of the patients was 55.7 years. Indication for surgery included 14 (67%) recurrent cervical cancers; 2 uterine cancers (recurrent), 2 vulvar cancer (one recurrent and one primary), 2 vagina carcinoma (one primary and one recurrent) and one patient with synchronous recto and uterine tumours. Exenteration was nine anterior, 3 posterior and 9 totals. The median length of hospitalization was 27 days. Most common postoperative complications were associated with urinary diversion. After surgery 19% of patients develops persistent lesion, 24% develops recurrent lesion with a middle free interval of 12.4 months. After a median follow-up of 29 months, 10 patients (47%) are alive and free of disease. CONCLUSION Pelvic exenteration can be offered as a surgical salvage therapy to patients with locally advanced gynaecological cancer.
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Affiliation(s)
- Sueli Pinelo
- Serviço de Ginecologia, Instituto Português de Oncologia, Porto
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