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Stuebs FA, Behrens AS, Seibold A, Adler W, Geppert C, Hartmann A, Knöll A, Koch MC, Mehlhorn G, Beckmann MW, Theuser AK, Schulmeyer CE, Gass P, Dietl AK. Impact of the Corona Pandemic on Cervical Cancer Screening Assessment. In Vivo 2024; 38:734-740. [PMID: 38418110 PMCID: PMC10905465 DOI: 10.21873/invivo.13495] [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: 11/13/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM The global impact of the COVID-19 pandemic resulted in disruptions to healthcare systems throughout the world. The numbers of cytology examinations, human papillomavirus (HPV) tests, and women referred for colposcopy decreased in many countries. There have been no reports on cervical cancer screening in Germany. This study aimed to describe changes in the numbers of colposcopies, cytology examinations, HPV tests, and histological results during the pandemic compared to the pre-pandemic years in order to evaluate the impact of the COVID-19 pandemic on cervical cancer screening. PATIENTS AND METHODS The numbers of colposcopies, cytology examinations, HPV tests, and histologic results were analyzed retrospectively for the period January 2018 to December 2022. The 2 years period before the pandemic (2018 and 2019) were compared with the 3 years period of the pandemic (2020-2022). RESULTS In total, 6,518 colposcopies were performed in 5,579 women. The numbers of colposcopies, cytology examinations, and high-risk HPV (hrHPV) tests increased during the pandemic years. The number of biopsies per year taken was stable (range=450-554). The relative numbers of cervical intraepithelial neoplasia (CIN) III/HSIL findings were stable, while the numbers of cervical cancers identified increased slightly from 15 (6.6%) in 2018 to 22 (7.4%) in 2022. CONCLUSION Increases in numbers of women examined and colposcopies were observed in the years 2021 and 2022 during the pandemic, in comparison to the preceding years. These also led to increases in the figures for cytology, hrHPV, histology, and operations. The onset of the pandemic occurred in the same year as a newly organized screening program started in Germany. The increases might therefore be due to the newly organized screening system.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany;
| | - Annika S Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Anja Seibold
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, ANregiomed Ansbach Hospital, Ansbach, Germany
| | - Grit Mehlhorn
- Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC), Certified Gynecological Dysplasia Consultancy Practice, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Dawson KLD, Wildi N, Koch MC, Oevermann A, Rosato G, Grest P, Hilbe M, Seuberlich T. Virus discovery in dogs with non-suppurative encephalitis reveals a high incidence of tick-borne encephalitis virus infections in Switzerland. SCHWEIZ ARCH TIERH 2023; 165:656-666. [PMID: 37822248 DOI: doi.org/10.17236/sat00407] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Viral infections are a frequent cause of disseminated non-suppurative encephalitis in dogs. However, using routine diagnostic methods, the specific virus may remain unknown due to extensive or complete viral clearance or because the virus is unexpected or new. A metatranscriptomics-based approach of combining high-throughput sequencing (HTS) and bioinformatics analysis was used to investigate the viral etiology in archival cases of dogs with non-suppurative encephalitis. In formalin-fixed paraffin embedded (FFPE) brain material from the years 1976 to 2021 a high incidence of tick-borne encephalitis virus (TBEV) was detected. Moreover, canine distemper virus (CDV) was identified without typical demyelinating lesions and canine vesivirus (CaVV) was detected as an unexpected virus associated with non-suppurative encephalitis. We demonstrated the viral presence in brain tissues at the sites of inflammation by immunohistochemistry (IHC) and in situ hybridization (ISH). These results highlight the value of emerging sequencing technologies in veterinary diagnostics and expand our knowledge on the etiologies of encephalitis in dogs.
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Affiliation(s)
- K L D Dawson
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern
| | - N Wildi
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern
| | - M C Koch
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern
| | - A Oevermann
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern
| | - G Rosato
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich
| | - P Grest
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich
| | - M Hilbe
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich
| | - T Seuberlich
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern
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Stuebs FA, Dietl AK, Koch MC, Adler W, Geppert CI, Hartmann A, Knöll A, Mehlhorn G, Beckmann MW, Schulmeyer CE, Heindl F, Emons J, Seibold A, Behrens AS, Gass P. Cytology and HPV Co-Testing for Detection of Vaginal Intraepithelial Neoplasia: A Retrospective Study. Cancers (Basel) 2023; 15:4633. [PMID: 37760600 PMCID: PMC10526267 DOI: 10.3390/cancers15184633] [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: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Vaginal intraepithelial neoplasia (VaIN) is a rare premalignant disease caused by persistent human papillomavirus (HPV) infection. Diagnosing VaIN is challenging; abnormal cytology and positive HPV tests are usually the first signs, but published data on their accuracy for detecting it are rare and contradictory. The aim of this study is to compare the results of hrHPV and cytology co-testing with the histological findings of the vagina. (2) Methods: In the certified Dysplasia Unit at Erlangen University Hospital, cytology and HPV samples from the uterine cervix or vaginal wall after hysterectomy were obtained between 2015 and 2023 and correlated with histological findings in biopsies from the vaginal wall. Women without vaginal biopsy findings or concomitant cervical disease were excluded. (3) Results: In all, 279 colposcopies in 209 women were included. The histological results were: benign (n = 86), VaIN I/vLSIL (n = 116), VaIN II/vHSIL (n = 41), VaIN III/vHSIL (n = 33), and carcinoma (n = 3). Accuracy for detecting VaIN was higher in women with previous hysterectomies. Positive HPV testing during colposcopy increased the likelihood for VaIN II/III/vHSIL threefold. The detection rate for VaIN III/vHSIL was 50% after hysterectomy and 36.4% without hysterectomy. (4) Conclusions: Women with risk factors for VaIN, including HPV-16 infection or prior HPV-related disease, need careful work-up of the entire vaginal wall. Hysterectomy for HPV-related disease and a history of cervical intraepithelial neoplasia (CIN) also increased the risk for VaIN II/III/vHSIL.
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Affiliation(s)
- Frederik A. Stuebs
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Anna K. Dietl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Martin C. Koch
- Department of Gynecology and Obstetrics, Hospital ANregiomed Ansbach, Escherichstrasse 1, 91522 Ansbach, Germany;
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 6, 91054 Erlangen, Germany
| | - Carol Immanuel Geppert
- Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schlossgarten 4, 91054 Erlangen, Germany
| | - Grit Mehlhorn
- Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC) Certified Gynecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Carla E. Schulmeyer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Anja Seibold
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Annika S. Behrens
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
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Schulmeyer CE, Koch MC, Dietl AK, Stuebs FA, Behrens A, Renner SK, Mehlhorn G, Geppert CC, Hartmann A, Beckmann MW, Gass P. Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program. Geburtshilfe Frauenheilkd 2023; 83:1031-1042. [PMID: 37588259 PMCID: PMC10427204 DOI: 10.1055/a-1934-1686] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/25/2022] [Indexed: 08/18/2023] Open
Abstract
Introduction Gynecologic dysplasia units and dysplasia consultations are obliged to offer diagnosis and treatment in accordance with the guidelines. The organization of the consultation process, management of patient appointments, diagnosis, and treatment algorithms are heterogeneous. The legislation arising from the new Federal Joint Committee decision, dated 22 November 2018, concerning the organized cervical cancer screening program has been in force since 1 January 2020. In this article we provide an overview of the existing structures and interdisciplinary cooperation of specialized dysplasia units incorporated in certified gynecologic cancer center. Materials and Methods We carried out a retrospective database search of data collected prospectively from 1 July 2014 to 31 December 2019 at the dysplasia unit at the Department of Gynecology and Obstetrics, Erlangen University Hospital, which was the first dysplasia unit to be certified in 2014. Results A total of 5594 patients presented at the unit, and 16061 colposcopic, vulvoscopic, and anoscopic examinations were performed. Approximately 4100 examinations of the cervix, vagina, vulva, and anus are carried out each year, 1600 of these were exclusively cervix colposcopies. A total of 12197 cytology results were assessed, as well as 4850 histology results, and 8193 high-risk HPV tests. The quality indicators required by the dysplasia unit for annual recertification were met each year. Conclusion Certified dysplasia units and consultations form the central component in the algorithm for further investigating abnormal screening results; but they are also the first point of contact for a large number of patients with acute or chronic complaints in the genital region.
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Affiliation(s)
- Carla E. Schulmeyer
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Martin C. Koch
- Klinik für Gynäkologie und Geburtshilfe, ANregiomed Klinikum Ansbach, Ansbach, Germany
| | - Anna K. Dietl
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Frederik A. Stuebs
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Annika Behrens
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Simone K. Renner
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Sindelfingen-Böblingen, Böblingen, Germany
| | - Grit Mehlhorn
- Frauenarztpraxis, DKG und AGCPC zertifizierte Dysplasiesprechstunde, Frauenarztpraxis Erlangen, Erlangen, Germany
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Carol C. Geppert
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartmann
- Pathologisches Institut Erlagen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Comprehensive Cancer Center, European
Metropolitan Area Erlangen-Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W. Beckmann
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
| | - Paul Gass
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg
(CCC ER-EMN), Erlangen, Germany
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Stuebs FA, Koch MC, Dietl AK, Schulmeyer CE, Behrens AS, Seibold A, Adler W, Geppert C, Hartman A, Knoll A, Beckmann MW, Gass P, Mehlhorn G. Management of Cervical Intraepithelial Neoplasia in Pregnant Women. Anticancer Res 2023; 43:3153-3158. [PMID: 37352006 DOI: 10.21873/anticanres.16488] [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: 04/22/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIM The aims of the present study were to evaluate the accuracy of colposcopic findings, investigate the way in which untreated cervical intraepithelial neoplasia (CIN) 2/3 develops during pregnancy, and identify factors associated with regression, persistence, or progression rates. PATIENTS AND METHODS In a tertiary gynecology and obstetrics department, 655 pregnant women were seen for colposcopy. The most common reason for referral was abnormal cytology findings. The follow-up findings were analyzed retrospectively on the basis of colposcopic findings and cytological and histological tests. RESULTS The rate of accuracy for major colposcopic findings was 89.2%. Among the colposcopic findings considered "suspicious for invasion" were invasive carcinoma in 42.9% and CIN 3 in 57.1%. The persistence of CIN 3 postpartum was 80% and the rate of progression 4.1%. The rate of regression for CIN 3 was 21.9%. For CIN 2, the rate of persistence was 37.5%, with a regression rate of 31.3%. The rate of regression was higher after vaginal delivery in comparison with caesarean section. CONCLUSION The accuracy rate of colposcopy is comparatively high, at 89.2%. This might be because pregnant women are seen by more experienced examiners in our dysplasia unit. The rate of progression is comparable with that in other studies. Vaginal delivery increases the regression rate. The newborns' birth weight or birth week did not affect the rates of regression or persistence.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany;
| | - Martin C Koch
- Department of Gynecology and Obstetrics, ANregiomed Ansbach Hospital, Ansbach, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Annika S Behrens
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Anja Seibold
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Arndt Hartman
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Antje Knoll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
- Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC) certified Gynecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, Erlangen, Germany
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Tempfer C, Horn LC, Ackermann S, Dittrich R, Einenkel J, Günthert A, Haase H, Kratzsch J, Kreißl M, Polterauer S, Ebert A, Steiner E, Thiel F, Eichbaum M, Fehm T, Koch MC, Gass P. Gestational and Non-gestational Trophoblastic Neoplasia. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 032/049, April 2022). Geburtshilfe Frauenheilkd 2023; 83:267-288. [PMID: 37020431 PMCID: PMC10070003 DOI: 10.1055/a-1904-6461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 03/11/2023] Open
Abstract
Abstract
Purpose The aim was to develop and update a guideline which would improve the quality of care offered to women with gestational and non-gestational trophoblastic disease, a group of diseases characterized by their rarity and biological heterogeneity.
Methods In accordance with the method used to compile S2k-guidelines, the guideline authors carried out a search of the literature (MEDLINE) for the period 1/2020 to 12/2021 and evaluated the recent literature. No key questions were formulated. No structured literature search with methodical evaluation and assessment of the level of evidence was carried out. The text of the precursor version of the guideline from 2019 was updated based on the most recent literature, and new statements and recommendations were drafted.
Recommendations The updated guideline contains recommendations for the diagnosis and therapy of women with hydatidiform mole (partial and complete moles), gestational trophoblastic neoplasia after pregnancy or without prior pregnancy, persistent trophoblastic disease after molar pregnancy, invasive moles, choriocarcinoma, placental site nodules, placental site trophoblastic tumor, hyperplasia at the implantation site und epithelioid trophoblastic tumor. Separate chapters cover the determination and assessment of human chorionic gonadotropin (hCG), histopathological evaluation of specimens, and the appropriate molecular pathological and immunohistochemical diagnostic procedures. Separate chapters on immunotherapy, surgical therapy, multiple pregnancies with simultaneous trophoblastic disease, and pregnancy after trophoblastic disease were formulated, and the corresponding recommendations agreed upon.
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Affiliation(s)
- Clemens Tempfer
- Universitätsfrauenklinik der Ruhr-Universität Bochum, Marienhospital Herne, Bochum/Herne, Germany
| | | | - Sven Ackermann
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Darmstadt, Darmstadt, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jens Einenkel
- Klinik für Frauenheilkunde und Geburtshilfe, Sana-Kliniken Leipziger Land, Leipzig, Germany
| | | | | | - Jürgen Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Michael Kreißl
- Universitätsklinik für Radiologie und Nuklearmedizin, Klinikum Magdeburg, Magdeburg, Germany
| | | | - Andreas Ebert
- Praxis für Gynäkologie und Geburtshilfe, Berlin, Germany
| | - Eric Steiner
- Frauenklinik, GPR-Klinikum Rüsselsheim, Rüsselsheim, Germany
| | - Falk Thiel
- Frauenklinik, Klinik am Eichert, Göppingen, Germany
| | - Michael Eichbaum
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Dr. Horst-Schmidt-Kliniken Wiesbaden, Wiesbaden, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Martin C. Koch
- Klinik für Gynäkologie und Geburtshilfe, Ansbach, Germany
| | - Paul Gass
- Frauenklinik des Universitätsklinikums Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen/Europäische Metropolregion Nürnberg (CCC ER-EMN), Erlangen, Germany
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7
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Stuebs FA, Mergel F, Koch MC, Dietl AK, Schulmeyer CE, Adler W, Geppert C, Hartman A, Knöll A, Beckmann MW, Gass P, Mehlhorn G. Cervical intraepithelial neoplasia grade 3: development during pregnancy and postpartum. Arch Gynecol Obstet 2022; 307:1567-1572. [PMID: 36271921 PMCID: PMC10110634 DOI: 10.1007/s00404-022-06815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aims of the present study were to evaluate the development of untreated cervical intraepithelial neoplasia (CIN) 3 during pregnancy and to assess persistence, progression, and regression rates postpartum to identify factors associated with regression. METHODS In a tertiary gynecology and obstetrics department, a total of 154 pregnant women with CIN 3 were treated in the dysplasia unit. The follow-up findings were analyzed retrospectively on the basis of histological, cytological, and human papillomavirus (HPV) testing of 154 pregnant women confirmed as having CIN 3 in colposcopically guided biopsies. RESULTS The rates of persistence, regression, and progression of CIN 3 in these women were 76.1%, 20% and 3.2%, respectively. Data for the delivery mode was available for 126 women. The rate of regression was almost twice as high with vaginal delivery as with cesarean section, at 27.4 vs. 15.2%, whereas the rate of progression was lower with vaginal delivery, at 2.7 vs. 6.5%. CONCLUSION The rate of persistence of CIN observed in this study is comparable to that reported in other studies. The study provides strong evidence for greater regression among women who have vaginal deliveries. Careful work-up is recommended postpartum for this group of women in order to rule out persistent CIN 3 or invasive disease.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Franziska Mergel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
- Department of Gynecology and Obstetrics, Ulm University Hospital, Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carol Geppert
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartman
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054, Erlangen, Germany
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8
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Stuebs FA, Koch MC, Dietl AK, Adler W, Geppert C, Hartmann A, Knöll A, Beckmann MW, Mehlhorn G, Schulmeyer CE, Gass P. Cytology and High-Risk Human Papillomavirus Test for Cervical Cancer Screening Assessment. Diagnostics (Basel) 2022; 12:diagnostics12071748. [PMID: 35885651 PMCID: PMC9318141 DOI: 10.3390/diagnostics12071748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background: A new nationwide screening strategy was implemented in Germany in January 2020. No data are available for women referred to certified dysplasia units for secondary clarification after primary diagnosis by a local physician. We therefore investigated combined testing with Papanicolaou smears and high-risk human papillomavirus (hrHPV) and compared the data with the final histological findings. Methods: Between January 2015 and October 2020, all referred women who underwent colposcopy of the uterine cervix in our certified dysplasia unit were included. Cytology findings were classified using the Munich III nomenclature. Results: A total of 3588 colposcopies were performed in 3118 women, along with Pap smear and hrHPV co-testing, followed by histology. Women with Pap II-p (ASC-US) and a positive hrHPV co-test had a 22.4% risk for cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesion (HSIL). The risk of CIN 3/HSIL was 83.8% in women with Pap IVa-p (HSIL) and a positive hrHPV co-test. A positive hrHPV co-test increased the risk for HSIL+ (OR 5.942; 95% CI, 4.617 to 7.649; p < 0.001) as compared to a negative hrHPV co-test. Conclusions: The accuracy of Pap smears is comparable with the screening results. A positive hrHPV test increases the risk for HSIL+ fivefold. Colposcopy is necessary to diagnose HSIL+ correctly.
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Affiliation(s)
- Frederik A. Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
- Correspondence:
| | - Martin C. Koch
- Department of Gynecology and Obstetrics, Hospital ANregiomed Ansbach, Escherichstraße 1, 91522 Ansbach, Germany;
| | - Anna K. Dietl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 6, 91054 Erlangen, Germany;
| | - Carol Geppert
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany; (C.G.); (A.H.); (G.M.)
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany; (C.G.); (A.H.); (G.M.)
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schlossgarten 4, 91054 Erlangen, Germany;
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
| | - Grit Mehlhorn
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany; (C.G.); (A.H.); (G.M.)
- Gynecology Consultancy Practice, German Cancer Society [DKG] and Committee on Cervical Pathology and Colposcopy [AG-CPC] Certified Gynaecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, Neustädter Kirchenplatz 1a, 91054 Erlangen, Germany
| | - Carla E. Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany; (A.K.D.); (M.W.B.); (C.E.S.); (P.G.)
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9
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Horn LC, Beckmann MW, Follmann M, Koch MC, Nothacker M, Pöschel B, Stübs F, Schmidt D, Höhn AK. [Revised German guidelines on the diagnosis and treatment of carcinoma of the uterine cervix-what's new for pathologists in 2021?]. Pathologie (Heidelb) 2022; 43:292-302. [PMID: 35191993 DOI: 10.1007/s00292-021-01051-3] [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] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 06/14/2023]
Abstract
In 2021, the 2015 German consensus guideline for the diagnosis and treatment of uterine cervical carcinoma was updated. The present article summarises the new recommendations for pathologists: the incorporation of the International Endocervical Adenocarcinoma Classification (IECC), which morphologically separates HPV-associated and non-HPV-associated adenocarcinomas, as well as the reporting of the prognostic relevant growth pattern of the adenocarcinoma of the endocervical subtype (Silva pattern). Histologically, multifocality has been defined as the presence of clearly invasive foci with a minimum distance between each focus of 0.2 cm. Because of its intratumoural heterogeneity, all carcinomas ≤ 2 cm in their largest dimension should be processed completely, and tumours > 2 cm should be processed with one block per centimetre of their greatest dimension. In cases of (radical) trachelectomy/hysterectomy, the distal vaginal resection margin and all parametrial tissue should be processed completely. Sentinel lymph nodes have to be processed completely by lamellation along its long axis in 0.2 cm intervals. Immunohistochemical ultrastaging is mandatory. Staging should be performed using the 2009 FIGO classification and 2017 TNM classification. Reporting the revised 2018 FIGO classification is optional. To date, molecular markers have not been relevant for prognostication and treatment decision making.
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Affiliation(s)
- Lars-Christian Horn
- Institut für Pathologie, Abteilung Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
| | - Matthias W Beckmann
- Universitätsfrauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | | | - Martin C Koch
- Klinik für Gynäkologie und Geburtshilfe, ANregiomed, Ansbach, Deutschland
| | - Monika Nothacker
- AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften), Berlin, Deutschland
| | | | - Frederik Stübs
- Universitätsfrauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | | | - Anne Kathrin Höhn
- Institut für Pathologie, Abteilung Mamma‑, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland
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10
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Beckmann MW, Stübs FA, Koch MC, Mallmann P, Dannecker C, Dietl A, Sevnina A, Mergel F, Lotz L, Hack CC, Ehret A, Gantert D, Martignoni F, Cieslik JP, Menke J, Ortmann O, Stromberger C, Oechsle K, Hornemann B, Mumm F, Grimm C, Sturdza A, Wight E, Loessl K, Golatta M, Hagen V, Dauelsberg T, Diel I, Münstedt K, Merz E, Vordermark D, Lindel K, Wittekind C, Küppers V, Lellé R, Neis K, Griesser H, Pöschel B, Steiner M, Freitag U, Gilster T, Schmittel A, Friedrich M, Haase H, Gebhardt M, Kiesel L, Reinhardt M, Kreißl M, Kloke M, Horn LC, Wiedemann R, Marnitz S, Letsch A, Zraik I, Mangold B, Möckel J, Alt C, Wimberger P, Hillemanns P, Paradies K, Mustea A, Denschlag D, Henscher U, Tholen R, Wesselmann S, Fehm T. Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) – Part 1 with Recommendations
on Epidemiology, Screening, Diagnostics and Therapy. Geburtshilfe Frauenheilkd 2022; 82:139-180. [DOI: 10.1055/a-1671-2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Aim This update of the interdisciplinary S3 guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL) was published in March 2021. This
updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German Society of
Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group on Gynecological Oncology (Arbeitsgemeinschaft Gynäkologische
Onkologie, AGO) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG).
Method The process of updating the S3 guideline dating from 2014 was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of
existing evidence-based national and international guidelines or – if evidence was lacking – on a consensus of the specialists involved in compiling the update. After an initial review of
the current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new
recommendations or statements which took account of more recently published literature and the appraisal of the new evidence.
Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, screening, diagnostic workup and therapy of patients with cervical
cancer. The most important new aspects included in this updated guideline include the newly published FIGO classification of 2018, the radical open surgery approach for cervical cancers up
to FIGO stage IB1, and use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated
radiotherapy, image-guided adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.
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Affiliation(s)
- Matthias W. Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Frederik A. Stübs
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Martin C. Koch
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | | | | | - Anna Dietl
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Anna Sevnina
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Franziska Mergel
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Laura Lotz
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Carolin C. Hack
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Anne Ehret
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Germany
| | - Daniel Gantert
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Germany
| | | | | | - Jan Menke
- SHG-Kliniken Völklingen, Klinik für Radiologie, Völklingen, Germany
| | - Olaf Ortmann
- Arbeitsgemeinschaft Deutscher Tumorzentren, Germany
| | - Carmen Stromberger
- Charité – Universitätsmedizin Berlin, Klinik für Radioonkologie und Strahlentherapie, Berlin, Germany
| | - Karin Oechsle
- Universitätsklinikum Hamburg-Eppendorf, II. Medizinische Klinik und Poliklinik, Hamburg, Germany
| | - Beate Hornemann
- Universitätsklinikum Dresden, Psychoonkologischer Dienst, Dresden, Germany
| | - Friederike Mumm
- Medizinische Klinik und Poliklinik III und Comprehensive Cancer Center (CCC München LMU), Klinikum der Universität München, LMU München, München, Germany
| | - Christoph Grimm
- Abteilung für allgemeine Gynäkologie und gynäkologische Onkologie, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medizinische Universität Wien, Wien, Austria
| | - Alina Sturdza
- Universitätsklinikum AKH-Wien, Klinik für Radioonkologie, Wien, Austria
| | - Edward Wight
- Universitätsspital Basel, Frauenklinik, Basel, Switzerland
| | - Kristina Loessl
- Universitätsklinik Bern, Klinik für Radio-Onkologie, Bern, Switzerland
| | - Michael Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Germany
| | - Volker Hagen
- St. Johannes Hospital Dortmund, Klinik für Innere Medizin II, Dortmund, Germany
| | - Timm Dauelsberg
- Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Eberhard Merz
- Zentrum für Ultraschalldiagnostik und Pränatalmedizin Frankfurt, Frankfurt am Main, Germany
| | - Dirk Vordermark
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Katja Lindel
- Städtisches Klinikum Karlsruhe, Klinik für Radioonkologie und Strahlentherapie, Karlsruhe, Germany
| | | | | | - Ralph Lellé
- Universitätsklinikum Münster, Frauenklinik, Münster, Germany
| | - Klaus Neis
- Frauenärzte am Staden, Saarbrücken, Germany
| | | | | | | | | | | | | | | | | | | | - Ludwig Kiesel
- Universitätsklinikum Münster, Frauenklinik, Münster, Germany
| | - Michael Reinhardt
- Pius Hospital Oldenburg, Klinik für Nuklearmedizin, Oldenburg, Germany
| | - Michael Kreißl
- Universitätsklinikum Magdeburg, Klinik für Radiologie und Nuklearmedizin, Magdeburg, Germany
| | - Marianne Kloke
- Kliniken Essen-Mitte, Klinik für Palliativmedizin, Essen, Germany
| | | | - Regina Wiedemann
- Fliedner Fachhochschule Düsseldorf, Pflegewissenschaft, Düsseldorf, Germany
| | - Simone Marnitz
- Universitätsklinikum Köln, Klinik für Radioonkologie, Cyberknife- und Strahlentherapie, Köln, Germany
| | - Anne Letsch
- Universitätsklinikum Schleswig-Holstein, Klinik für Innere Medizin II, Kiel, Germany
| | - Isabella Zraik
- Kliniken Essen-Mitte, Klinik für Urologie, Essen, Germany
| | | | | | - Céline Alt
- Wolfgarten Radiologie Bonn, Bonn, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Peter Hillemanns
- Medizinische Hochschule Hannover, Frauenklinik, Hannover, Germany
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpflege (KOK), Germany
| | | | | | - Ulla Henscher
- Deutscher Verband für Physiotherapie (ZVK) e. V., Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie (ZVK) e. V., Germany
| | | | - Tanja Fehm
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Germany
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11
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Fehm T, Stübs FA, Koch MC, Mallmann P, Dannecker C, Dietl A, Sevnina A, Mergel F, Lotz L, Ehret A, Gantert D, Martignoni F, Cieslik JP, Menke J, Ortmann O, Stromberger C, Oechsle K, Hornemann B, Mumm F, Grimm C, Sturdza A, Wight E, Loessl K, Golatta M, Hagen V, Dauelsberg T, Diel I, Münstedt K, Merz E, Vordermark D, Lindel K, Wittekind C, Küppers V, Lellé R, Neis K, Griesser H, Pöschel B, Steiner M, Freitag U, Gilster T, Schmittel A, Friedrich M, Haase H, Gebhardt M, Kiesel L, Reinhardt M, Kreißl M, Kloke M, Horn LC, Wiedemann R, Marnitz S, Letsch A, Zraik I, Mangold B, Möckel J, Alt C, Wimberger P, Hillemanns P, Paradies K, Mustea A, Denschlag D, Henscher U, Tholen R, Wesselmann S, Beckmann MW. Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) – Part 2 with Recommendations
on Psycho-oncology, Rehabilitation, Follow-up, Recurrence, Palliative Therapy and Healthcare Facilities. Geburtshilfe Frauenheilkd 2022; 82:181-205. [DOI: 10.1055/a-1671-2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Aim This is an update of the interdisciplinary S3-guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL), published in March 2021. The
work on the updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German
Society of Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group on Gynecological Oncology (Arbeitsgemeinschaft
Gynäkologische Onkologie, AGO) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG).
Method The process used to update the 2014 S3-guideline was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing
evidence-based national and international guidelines or – if evidence was lacking – on the consensus of the specialists involved in compiling the update. After an initial review of the
current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new
recommendations or statements which would take account of more recently published literature and the recent appraisal of new evidence.
Recommendations The short version of this guideline consists of recommendations and statements on palliative therapy and follow-up of patients with cervical cancer. The most
important aspects included in this updated guideline are the new FIGO classification published in 2018, the radical open surgery approach used to treat cervical cancer up to FIGO stage IB1,
and the use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided
adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.
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Affiliation(s)
- Tanja Fehm
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Frederik A. Stübs
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Martin C. Koch
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | | | | | - Anna Dietl
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Anna Sevnina
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Franziska Mergel
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Laura Lotz
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Anne Ehret
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | | | - Jan Menke
- SHG-Kliniken Völklingen, Klinik für Radiologie, Völklingen, Germany
| | - Olaf Ortmann
- Arbeitsgemeinschaft Deutscher Tumorzentren, Germany
| | - Carmen Stromberger
- Charité – Universitätsmedizin Berlin, Klinik für Radioonkologie und Strahlentherapie, Berlin, Germany
| | - Karin Oechsle
- Universitätsklinikum Hamburg-Eppendorf, II. Medizinische Klinik und Poliklinik, Hamburg, Germany
| | - Beate Hornemann
- Universitätsklinikum Dresden, Psychoonkologischer Dienst, Dresden, Germany
| | - Friederike Mumm
- Medizinische Klinik und Poliklinik III und Comprehensive Cancer Center (CCC München LMU), Klinikum der Universität München, LMU München, München, Germany
| | - Christoph Grimm
- Abteilung für allgemeine Gynäkologie und gynäkologische Onkologie, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medizinische Universität Wien, Wien, Austria
| | - Alina Sturdza
- Universitätsklinikum AKH-Wien, Klinik für Radioonkologie, Wien, Austria
| | - Edward Wight
- Universitätsspital Basel, Frauenklinik, Basel, Switzerland
| | - Kristina Loessl
- Universitätsklinik Bern, Klinik für Radio-Onkologie, Bern, Switzerland
| | - Michael Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Germany
| | - Volker Hagen
- St. Johannes Hospital Dortmund, Klinik für Innere Medizin II, Dortmund, Germany
| | - Timm Dauelsberg
- Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Eberhard Merz
- Zentrum für Ultraschalldiagnostik und Pränatalmedizin Frankfurt, Frankfurt am Main, Germany
| | - Dirk Vordermark
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Katja Lindel
- Städtisches Klinikum Karlsruhe, Klinik für Radioonkologie und Strahlentherapie, Karlsruhe, Germany
| | | | | | - Ralph Lellé
- Universitätsklinikum Münster, Frauenklinik, Münster, Germany
| | - Klaus Neis
- Frauenärzte am Staden, Saarbrücken, Germany
| | | | | | | | | | | | | | | | | | | | - Ludwig Kiesel
- Universitätsklinikum Münster, Frauenklinik, Münster, Germany
| | - Michael Reinhardt
- Pius Hospital Oldenburg, Klinik für Nuklearmedizin, Oldenburg, Germany
| | - Michael Kreißl
- Universitätsklinikum Magdeburg, Klinik für Radiologie und Nuklearmedizin, Magdeburg, Germany
| | - Marianne Kloke
- Kliniken Essen-Mitte, Klinik für Palliativmedizin, Essen, Germany
| | | | - Regina Wiedemann
- Fliedner Fachhochschule Düsseldorf, Pflegewissenschaft, Düsseldorf, Germany
| | - Simone Marnitz
- Universitätsklinikum Köln, Klinik für Radioonkologie, Cyberknife- und Strahlentherapie, Köln, Germany
| | - Anne Letsch
- Universitätsklinikum Schleswig-Holstein, Klinik für Innere Medizin II, Kiel, Germany
| | - Isabella Zraik
- Kliniken Essen-Mitte, Klinik für Urologie, Essen, Germany
| | | | | | - Céline Alt
- Wolfgarten Radiologie Bonn, Bonn, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Peter Hillemanns
- Medizinische Hochschule Hannover, Frauenklinik, Hannover, Germany
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpflege (KOK), Germany
| | | | | | - Ulla Henscher
- Hochtaunus Kliniken, Frauenklinik, Bad Homburg, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie (ZVK) e. V., Germany
| | | | - Matthias W. Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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12
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Hein A, Kehl S, Häberle L, Tiemann C, Peuker R, Mereutanu D, Stumpfe FM, Faschingbauer F, Meyer-Schlinkmann K, Koch MC, Kainer F, Dammer U, Philipp H, Kladt C, Schrauder MG, Weingärtler S, Hanf V, Hartmann A, Rübner M, Schneider H, Lelieveld J, Beckmann MW, Wurmthaler LA, Fasching PA, Schneider MO. Prevalence of SARS-CoV-2 in Pregnant Women Assessed by RT-PCR in Franconia, Germany: First Results of the SCENARIO Study (SARS-CoV-2 prEvalence in pregNAncy and at biRth In
FrancOnia). Geburtshilfe Frauenheilkd 2022; 82:226-234. [PMID: 35169390 PMCID: PMC8837405 DOI: 10.1055/a-1727-9672] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose
Detection of SARS-CoV-2-infected pregnant women admitted to maternity units during a pandemic is crucial. In addition to the fact that pregnancy is a risk factor for severe
COVID-19 and that medical surveillance has to be adjusted in infected women and their offspring, knowledge about infection status can provide the opportunity to protect other patients and
healthcare workers against virus transmission. The aim of this prospective observational study was to determine the prevalence of SARS-CoV-2 infection among pregnant women in the hospital
setting.
Material and Methods
All eligible pregnant women admitted to the nine participating hospitals in Franconia, Germany, from 2 June 2020 to 24 January 2021 were included.
COVID-19-related symptoms, secondary diseases and pregnancy abnormalities were documented. SARS-CoV-2 RNA was detected by RT-PCR from nasopharyngeal swabs. The prevalence of acute SARS-CoV-2
infection was estimated by correcting the positive rate using the Rogan–Gladen method. The risk of infection for healthcare workers during delivery was estimated using a risk calculator.
Results
Of 2414 recruited pregnant women, six were newly diagnosed RT-PCR positive for SARS-CoV-2, which yielded a prevalence of SARS-CoV-2 infection of 0.26% (95% CI, 0.10 – 0.57%).
Combining active room ventilation and wearing FFP2 masks showed an estimated reduction of risk of infection for healthcare workers in the delivery room to < 1%.
Conclusions
The prevalence of newly diagnosed SARS-CoV-2 infection during pregnancy in this study is low. Nevertheless, a systematic screening in maternity units during pandemic
situations is important to adjust hygienic and medical management. An adequate hygienic setting can minimise the calculated infection risk for medical healthcare workers during patientsʼ
labour.
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Affiliation(s)
- Alexander Hein
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Kehl
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Rebecca Peuker
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Denise Mereutanu
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Florian M. Stumpfe
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Martin C. Koch
- Department of Gynaecology and Obstetrics, ANregiomed Klinikum Ansbach, Ansbach, Germany
| | - Franz Kainer
- Department of Gynaecology and Obstetrics, Klinik Hallerwiese, Nürnberg, Germany
| | - Ulf Dammer
- Department of Gynaecology and Obstetrics, St. Theresien-Krankenhaus, Nürnberg, Germany
| | - Hanna Philipp
- Department of Gynaecology and Obstetrics, REGIOMED Klinikum Coburg, Coburg, Germany
| | - Carolin Kladt
- Department of Gynaecology and Obstetrics, Clinic Bayreuth, Bayreuth, Germany
| | - Michael G. Schrauder
- Department of Gynaecology and Obstetrics, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Stefan Weingärtler
- Department of Gynaecology and Obstetrics, Klinikum Forchheim-Fränkische Schweiz, Forchheim, Germany
| | - Volker Hanf
- Department of Gynaecology and Obstetrics, Klinikum Fürth, Fürth, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Rübner
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Holm Schneider
- Department of Pediatrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Matthias W. Beckmann
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lena A. Wurmthaler
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter A. Fasching
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael O. Schneider
- Department of Gynaecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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13
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Haile L, van de Roemer N, Gemzell-Danielsson K, Perelló Capó J, Lete Lasa I, Vannuccini S, Koch MC, Hildebrandt T, Calaf J. The global pandemic and changes in women's reproductive health: an observational study. EUR J CONTRACEP REPR 2022; 27:102-106. [PMID: 35040737 DOI: 10.1080/13625187.2021.2024161] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The COVID-19 global pandemic has led to the death of millions around the world and impacted the overall health of many people. In this article we aim to compare reproductive health indicators in the first 6 months of 2020 to the prior year, as well as explore stress and quality of life during this time. METHODS This retrospective observational study examined the menstrual cycles of 1159 women who were using a fertility tracking device to record their menstrual cycle and BBT data. We utilised a supplemental mobile application to administer a supplemental survey to collect data on stress and quality of life. Descriptive analyses were conducted with t-tests for two-group comparisons. RESULTS Study participants from 15 countries contributed to a total of 13,194 cycles. 23.1% (268/1159) responded to the survey focussed on assessing psychosocial distress. 44.4% (119/268) of the study participants reported that they had noticed a change in their menstrual cycle, temperature curve, or menstruation in the past 12 months. Cycle analysis found the average cycle length and pre-ovulation phase length was longer in the first 6 months of 2019, while the average days of menstruation was slightly longer in 2020. DISCUSSION Our findings indicate that menstrual cycle indicators changed only slightly in the first 6 months of 2020 but were still statistically significant. We were also able to understand that these study participants had some level of awareness of changes to their menstrual health.
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Affiliation(s)
- Liya Haile
- Independent Contractor, Arlington, VA, USA
| | | | | | - Josep Perelló Capó
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health, Hospital de Sant Pau, Barcelona, Spain
| | - Iñaki Lete Lasa
- Department of Obstetrics and Gynecology, Araba University Hospital, Jose Atxotegui s/n, Vitoria-Gasteiz, Spain
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Florence, Italy, Florence, Italy
| | - Martin C Koch
- Department of Obstetrics and Gynecology, Anregiomed Ansbach Klinikum, Ansbach, Germany
| | - Thomas Hildebrandt
- Frauenklinik, Universitätsklinikum Erlangen, Universitaetsstrasse 21-23, Erlangen, Germany
| | - Joaquim Calaf
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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14
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Woelber L, Hampl M, zu Eulenburg C, Prieske K, Hambrecht J, Fuerst S, Klapdor R, Heublein S, Gass P, Rohner A, Canzler U, Becker S, Bommert M, Bauerschlag D, Denecke A, Hanker L, Runnebaumn I, Forner DM, Schochter F, Klar M, Schwab R, Koepke M, Kalder M, Hantschmann P, Ratiu D, Denschlag D, Schroeder W, Tuschy B, Baumann K, Mustea A, Soergel P, Bronger H, Bauerschmitz G, Kosse J, Koch MC, Ignatov A, Sehouli J, Dannecker C, Mahner S, Jaeger A. Risk for Pelvic Metastasis and Role of Pelvic Lymphadenectomy in Node-Positive Vulvar Cancer-Results from the AGO-VOP.2 QS Vulva Study. Cancers (Basel) 2022; 14:cancers14020418. [PMID: 35053582 PMCID: PMC8773532 DOI: 10.3390/cancers14020418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary In node-positive vulvar squamous cell cancer, questions of when and how to perform pelvic lymphadenectomy (LAE) as well as the optimal extent of pelvic treatment in general have been surrounded by considerable controversy. In Germany, systematic pelvic LAE is currently recommended as a staging procedure in patients at risk for pelvic nodal involvement in order to prevent morbidity caused by pelvic radiotherapy (RT) in patients without histologically-confirmed pelvic involvement. However, the population at risk for pelvic metastases remains insufficiently described, resulting in the potential overtreatment of a considerable proportion of patients with groin-positive disease. This applies to the indication to perform surgical staging but also to adjuvant RT of the pelvis without previous pelvic staging. Our study aims to describe the risk for pelvic lymph node metastasis with regard to positive groin nodes and to clarify the indication criteria for pelvic treatment in node-positive vulvar cancer. Abstract The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.
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Affiliation(s)
- Linn Woelber
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
- Colposcopy Center at the Jerusalem Hospital Hamburg, 20357 Hamburg, Germany
- Correspondence:
| | - Monika Hampl
- Department of Gynecology, University Medical Center Duesseldorf, 40225 Duesseldorf, Germany;
| | - Christine zu Eulenburg
- Department of Epidemiology, UMCG, Universität Groningen, 9713 Groningen, The Netherlands;
| | - Katharina Prieske
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
- Colposcopy Center at the Jerusalem Hospital Hamburg, 20357 Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
| | - Johanna Hambrecht
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
| | - Sophie Fuerst
- Department of Obstetrics and Gynecology, University Hospital, LMU—University of Munich, 80377 Munich, Germany; (S.F.); (S.M.)
| | - Ruediger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, 30625 Hannover, Germany;
| | - Sabine Heublein
- Department of Obstetrics and Gynecology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
| | - Paul Gass
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Annika Rohner
- Department of Gynecology, University Medical Center Tuebingen, 72076 Tuebingen, Germany;
| | - Ulrich Canzler
- Department of Gynecology and Obstetrics, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany & National Center for Tumor Diseases (NCT), Partner Site Dresden, 01307 Dresden, Germany;
| | - Sven Becker
- Department of Gynecology and Obstetrics, University Medical Center Frankfurt, 60590 Frankfurt, Germany;
| | - Mareike Bommert
- Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, 45136 Essen, Germany;
| | - Dirk Bauerschlag
- Department of Gynecology, University Medical Center Kiel, 24105 Kiel, Germany;
| | - Agnieszka Denecke
- Department of Gynecology, Medical Center Wolfsburg, 38440 Wolfsburg, Germany;
| | - Lars Hanker
- Department of Gynecology and Gynecologic Oncology, University Medical Center Luebeck, 23562 Luebeck, Germany;
| | - Ingo Runnebaumn
- Department of Gynecology, Jena University Hospital, 07743 Jena, Germany;
| | - Dirk M. Forner
- Department of Gynecology, Evangelisches Krankenhaus Kalk, 51103 Cologne, Germany;
| | - Fabienne Schochter
- Department of Obstetrics and Gynecology, University of Ulm Medical Center, 89081 Ulm, Germany;
| | - Maximilian Klar
- Department of Gynecology, University Medical Center Freiburg, 79106 Freiburg, Germany;
| | - Roxana Schwab
- Department of Gynecology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Melitta Koepke
- Department of Obstetrics and Gynaecology, University Hospital Augsburg, 86156 Augsburg, Germany; (M.K.); (C.D.)
| | - Matthias Kalder
- Department of Gynecology and Obstetrics, University Hospital Marburg, 35043 Marburg, Germany;
| | - Peer Hantschmann
- Department of Gynecology and Obstetrics, Medical Center Altoetting, 84503 Altoetting, Germany;
| | - Dominik Ratiu
- Department of Gynecology, University Medical Center Koeln, 50937 Koeln, Germany;
| | - Dominik Denschlag
- Department of Gynecology, Hochtaunuskliniken, 61352 Bad Homburg, Germany;
| | - Willibald Schroeder
- Department of Gynecology, Medical Center Gynaecologicum Bremen, 28209 Bremen, Germany;
| | - Benjamin Tuschy
- Department of Gynecology, University Medical Center Mannheim, 68167 Mannheim, Germany;
| | - Klaus Baumann
- Department of Gynecology, Medical Center Ludwigshafen, 67063 Ludwigshafen, Germany;
| | - Alexander Mustea
- Department of Gynecology and Gynecologic Oncology, University Medical Center Bonn, 53127 Bonn, Germany;
| | - Philipp Soergel
- Department of Gynecology, University Medical Center Minden, 32429 Minden, Germany;
| | - Holger Bronger
- Department of Gynecology and Obstetrics, Technical University of Munich, 81675 Munich, Germany;
| | - Gerd Bauerschmitz
- Department of Gynecology, University Medical Center Goettingen, 37075 Goettingen, Germany;
| | - Jens Kosse
- Department of Gynecology, Sana Klinikum Offenbach, 63069 Offenbach am Main, Germany;
| | - Martin C. Koch
- Department of Gynecology, Medical Center Ansbach, 91522 Ansbach, Germany;
| | - Atanas Ignatov
- Department of Obstetrics and Gynecology, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological SurgeryNOGGO e.V., Charite Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany;
| | - Christian Dannecker
- Department of Obstetrics and Gynaecology, University Hospital Augsburg, 86156 Augsburg, Germany; (M.K.); (C.D.)
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU—University of Munich, 80377 Munich, Germany; (S.F.); (S.M.)
| | - Anna Jaeger
- Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg—Eppendorf, 20246 Hamburg, Germany; (K.P.); (J.H.); (A.J.)
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15
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Fleisch MC, Bader W, Balzer K, Bennefeld L, Boeing C, Bremerich D, Gass P, Geissbuehler V, Koch MC, Nothacker MJ, Pietzner K, Renner SP, Römer T, Roth S, Schütz F, Schulte-Mattler W, Sehouli J, Lippach K, Tamussino K, Teichmann A, Tempfer C, Thill M, Tinneberg HR, Zarras K. The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020). Geburtshilfe Frauenheilkd 2021; 81:447-468. [PMID: 33867563 DOI: 10.1055/a-1378-4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 10/21/2022] Open
Abstract
Purpose Positioning injuries are relatively common, forensically highly relevant complications of gynecologic surgery. The aim of this official AWMF S2k-guideline is to provide statements and recommendations on how to prevent positioning injuries using the currently available literature. The literature was evaluated by an interdisciplinary group of experts from professional medical societies. The consensus on recommendations and statements was achieved in a structured consensus process. Method The current guideline is based on the expired S1-guideline, which was updated by a systematic search of the literature and a review of relevant publications issued between February 2014 and March 2019. Statements were compiled and voted on by a panel of experts. Recommendations The guideline provides general and specific recommendations on the prevention, diagnosis and treatment of positioning injuries.
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Affiliation(s)
- Markus C Fleisch
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Werner Bader
- Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld, Germany
| | - Kai Balzer
- Klinik für Gefäßchirurgie, GFO Kliniken, Bonn, Germany
| | - Luisa Bennefeld
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Carsten Boeing
- Klinik für Gynäkologie und Geburtshilfe, AMEOS Klinikum St. Clemens Oberhausen, Oberhausen, Germany
| | | | | | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Monika J Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Universität Marburg, Marburg, Germany
| | - Klaus Pietzner
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | | | - Thomas Römer
- Frauenklinik, Evangelisches Krankenhaus Weyertal, Köln, Germany
| | - Stephan Roth
- Klinik für Urologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | | | - Jalid Sehouli
- Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Lippach
- Pflegewissenschaften und Praxisentwicklung, LMU München, München, Germany
| | - Karl Tamussino
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria
| | - Alexander Teichmann
- Sichuan Center for Gynaecology and Breast Surgery, Dept. of Perinatal Medicine, Medical University of Southwest China, Luzhou (Sichuan), China
| | - Clemens Tempfer
- Klinik für Frauenheilkunde und Geburtshilfe, Marienhospital Herne, Universitätsklinikum Bochum, Bochum/Herne, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | - Konstantinos Zarras
- Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie des VVKD Marienhospitals Düsseldorf, Düsseldorf, Germany
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16
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van de Roemer N, Haile L, Koch MC. The performance of a fertility tracking device. EUR J CONTRACEP REPR 2021; 26:111-118. [PMID: 33555223 DOI: 10.1080/13625187.2021.1871599] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Fertility tracking devices offer women direct-to-user information about their fertility. The objective of this study is to understand how a fertility tracking device algorithm adjusts to changes of the individual menstrual cycle and under different conditions. METHODS A retrospective analysis was conducted on a cohort of women who were using the device between January 2004 and November 2014. Available temperature and menstruation inputs were processed through the Daysy 1.0.7 firmware to determine fertility outputs. Sensitivity analyses on temperature noise, skipped measurements, and various characteristics were conducted. RESULTS A cohort of 5328 women from Germany and Switzerland contributed 107,020 cycles. Mean age of the sample was 30.77 [SD 5.1] years, with a BMI of 22.07 kg/m^2 [SD 2.4]. The mean cycle length reported was 29.54 [SD 3.0] days. The majority of women were using the device 80-100% of the time during the cycle (53.1%). For this subset of women, the fertility device identified on average 41.4% [SD 6.4] possibly fertile (red) days, 42.4% [SD 8.7] infertile (green) days and 15.9% [SD 7.3] yellow days. The number of infertile (green) days decreases proportionally to the number of measured days, whereas the number of undefined (yellow) days increases. CONCLUSION Overall, these results showed that the fertility tracker algorithm was able to distinguish biphasic cycles and provide personalised fertility statuses for users based on daily basal body temperature readings and menstruation data. We identified a direct linear relationship between the number of measurements and output of the fertility tracker.
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Affiliation(s)
| | - Liya Haile
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | - Martin C Koch
- Gynaecological Clinic, Ansbach Hospital, Ansbach, Germany
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Stuebs FA, Gass P, Dietl AK, Schulmeyer CE, Adler W, Geppert C, Hartmann A, Knöll A, Beckmann MW, Koch MC. Human papilloma virus genotype distribution in women with premalignant or malignant lesions of the uterine cervix. Arch Gynecol Obstet 2021; 304:751-758. [PMID: 33538863 DOI: 10.1007/s00404-021-05986-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/24/2020] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Cervical cancer is caused by persistent infection with high-risk human papillomavirus (hrHPV). Cytology-based national screening programs have reduced the incidence and mortality of cervical cancer. Different hrHPV subtypes have different carcinogenic potentials. This study evaluated the distribution of different types of hrHPV relative to age in cervical cancer and its precursor lesions. METHODS HPV testing was performed between November 2018 and February 2020 using the Abbott RealTime high-risk HPV assay on an Abbott m2000sp instrument. This assay separately detects HPV-16, HPV-18, and a pool of 12 additional hrHPV types (HPV-31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68). RESULTS The study included 652 women with HPV samples and biopsies of the cervix or histology samples obtained during surgery. In all, 30.8% (95% CI, 27.3-34.6%) were HPV-negative. Among HPV-positive women, HPV-16, HPV-18, and "HPV other" types were found in 33.5, 4.4, and 49.4%, respectively. Cervical intraepithelial neoplasia (CIN) 3/high-grade squamous intraepithelial lesions (HSILs) in women ≤ 34 years were positive for HPV-16 in 54.5% of cases and in those ≥ 35 years in 45.4% of cases. Among women with cervical cancer, 75.8% were infected with HPV-16 or had coinfection with HPV-16 and "HPV other". CONCLUSIONS HPV-16 is the most common type of hrHPV in HSIL + lesions. It is more common in women diagnosed with CIN 3/HSIL who are aged ≤ 35 and is decreasing with age. Therefore, women age ≥ 35 with persistent infection with this type of hrHPV need careful surveillance, as they are at high risk of progression to cervical cancer.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Anna K Dietl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 6, 91054, Erlangen, Germany
| | - Carol Geppert
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Krankenhausstrasse 8-10, 91054, Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Schlossgarten 4, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany
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18
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Stübs FA, Mehlhorn G, Gass P, Schulmeyer CE, Adler W, Strehl J, Hartmann A, Beckmann MW, Renner SK, Koch MC. Accuracy of vulvoscopic findings in detecting early vulvar neoplasia. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717195] [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: 10/23/2022] Open
Affiliation(s)
- FA Stübs
- Universitätsklinikum Erlangen, Frauenklinik
| | - G Mehlhorn
- Universitätsklinikum Erlangen, Frauenklinik
| | - P Gass
- Universitätsklinikum Erlangen, Frauenklinik
| | | | - W Adler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE)
| | | | - A Hartmann
- Universitätsklinikum Erlangen, Pathologie
| | | | - SK Renner
- Kliniken Böblingen, Frauenklinik, Böblingen
| | - MC Koch
- Universitätsklinikum Erlangen, Frauenklinik
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19
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FA S, Adler W, MW B, Gass P, Hartmann A, Mehlhorn G, SK R, CE S, Strehl J, Koch MC. Accuracy of colposcopic findings in detecting vaginal intraepithelial neoplasia: a retrospective study. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718187] [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: 10/23/2022] Open
Affiliation(s)
- Stübs FA
- Universitätsklinikum Erlangen, Frauenklinik
| | - W Adler
- Universitätsklinikum Erlangen, Frauenklinik
| | | | - P Gass
- Universitätsklinikum Erlangen, Frauenklinik
| | - A Hartmann
- Universitätsklinikum Erlangen, Pathologie
| | - G Mehlhorn
- Universitätsklinikum Erlangen, Frauenklinik
| | | | | | | | - MC Koch
- Universitätsklinikum Erlangen, Frauenklinik
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20
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Schulmeyer C, Stübs F, Gaß P, Beckmann MW, Renner SK, Mehlhorn G, Koch MC. Standards für die Diagnostik und Therapie von Patientinnen mit Dysplasien oder Erkrankungen der Zervix, Vulva und Vagina an einer zertifizierten Dysplasie-Einheit. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717173] [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: 10/23/2022] Open
Affiliation(s)
| | - F Stübs
- Frauenklinik des Universitätsklinikums Erlangen
| | - P Gaß
- Frauenklinik des Universitätsklinikums Erlangen
| | - MW Beckmann
- Frauenklinik des Universitätsklinikums Erlangen
| | - SK Renner
- Klinikum Sindelfingen-Böblingen, Frauenklinik
| | | | - MC Koch
- Frauenklinik des Universitätsklinikums Erlangen
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21
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Stuebs FA, Mehlhorn G, Gaß P, Schulmeyer CE, Adler W, Strehl J, Hartman A, Beckmann MW, Renner SK, Koch MC. Genauigkeit der klinischen Einschätzung in der Diagnostik vulvärer Neoplasien. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713986] [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: 10/23/2022] Open
Affiliation(s)
- F A Stuebs
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
| | - G Mehlhorn
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
| | - P Gaß
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
| | - C E Schulmeyer
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
| | - W Adler
- Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE) der Friedrich-Alexander-Universität Erlangen, Erlangen
| | | | - A Hartman
- Pathologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
| | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
| | - S K Renner
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
- Frauenklinik des Klinikums Sindelfingen-Böblingen, Böblingen
| | - M C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen
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Wunderle M, Ruebner M, Häberle L, Schwenke E, Hack CC, Bayer CM, Koch MC, Schwitulla J, Schulz-Wendtland R, Kozieradzki I, Lux MP, Beckmann MW, Jud SM, Penninger JM, Schneider MO, Fasching PA. RANKL and OPG and their influence on breast volume changes during pregnancy in healthy women. Sci Rep 2020; 10:5171. [PMID: 32198488 PMCID: PMC7083828 DOI: 10.1038/s41598-020-62070-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/01/2019] [Accepted: 03/03/2020] [Indexed: 01/12/2023] Open
Abstract
Breast cancer risk is reduced by number of pregnancies and breastfeeding duration, however studies of breast changes during or after pregnancy are rare. Breast volume changes - although not linked to breast cancer risk - might be an interesting phenotype in this context for correlative studies, as changes of breast volume vary between pregnant women. Serum receptor activator of nuclear factor kappa B ligand (RANKL) and its antagonist osteoprotegerin (OPG) were measured prospectively before gestational week 12, and three-dimensional breast volume assessments were performed. A linear regression model including breast volume at the start of pregnancy, RANKL, OPG, and other factors was used to predict breast volume at term. The mean breast volume was 413 mL at gestational week 12, increasing by a mean of 99 mL up to gestational week 40. In addition to body mass index and breast volume at the beginning of pregnancy, RANKL and OPG appeared to influence breast volume with a mean increase by 32 mL (P = 0.04) and a mean reduction by 27 mL (P = 0.04), respectively. Linking the RANKL/RANK/OPG pathway with breast volume changes supports further studies aiming at analysing breast changes during pregnancy with regard to breast cancer risk.
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Affiliation(s)
- Marius Wunderle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Eva Schwenke
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian M Bayer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Judith Schwitulla
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ruediger Schulz-Wendtland
- Institute of Diagnostic Radiology, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ivona Kozieradzki
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada.,Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna, Austria
| | - Michael P Lux
- Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Josef M Penninger
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada.,Institute of Molecular Biotechnology of the Austrian Academy of Sciences (IMBA), Vienna, Austria
| | - Michael O Schneider
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
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23
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Stuebs FA, Mehlhorn G, Gass P, Schulmeyer CE, Adler W, Strehl J, Hartman A, Beckmann MW, Renner SK, Koch MC. Concordance rate of vulvoscopic findings in detecting early vulvar neoplasia. Gynecol Oncol 2020; 157:463-468. [PMID: 32107046 DOI: 10.1016/j.ygyno.2020.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Colposcopy-guided punch biopsy is a cornerstone method for diagnosing vulvar diseases. The aim of this study was to evaluate the concordance rate of clinical findings in vulvar diseases during examinations, in comparison with colposcopy-directed punch biopsy. We also developed a new classification to simplify the categorization of vulvoscopic findings. METHODS The concordance rate of the clinical findings was compared with the final histology results from punch biopsies. The data were collected between January 2014 and May 2017 at the Erlangen University Hospital. RESULTS A total of 482 colposcopy-directed punch biopsies of the vulva were obtained in 420 women. The overall concordance rate of the clinical findings in comparison with the histological vulvar punch-biopsy findings was 53.9% for all entities - benign lesions, lichen, low- and high-grade squamous intraepithelial lesions (LSIL/HSILs), and vulvar carcinoma. The concordance rate for detecting LSILs was 64.3% (45/70). The concordance rate for detecting HSILs was 62.3% and for Vulvar carcinoma 65.2%. CONCLUSIONS Punch biopsy of suspicious lesions continues to be a cornerstone in diagnosing HSILs and carcinoma of the vulva. Careful work-up of the vulva is recommended when patients have symptoms such as pruritus or pain. The new classification is more specific for diagnosing lesions in the vulva.
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Affiliation(s)
- Frederik A Stuebs
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany.
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Carla E Schulmeyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Waldstrasse 6, 91054 Erlangen, Germany
| | - Johanna Strehl
- Department of Gynecology and Obstetrics, Fürth Hospital, Jakob-Henle-Strasse 1, 90766 Fürth, Germany
| | - Arndt Hartman
- Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
| | - Simone K Renner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany; Department of Gynecology and Obstetrics, Klinikum Sindelfingen-Böblingen, Bunsenstrasse 120, 71032 Böblingen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Universitätsstrasse 21-23, 91054 Erlangen, Germany
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Clarifications concerning the commentary “Published analysis of contraceptive effectiveness of Daysy and DaysyView app is fatally flawed”. Reprod Health 2019; 16:83. [PMID: 31208442 PMCID: PMC6572732 DOI: 10.1186/s12978-019-0746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schnürch HG, Ackermann S, Alt-Radtke CD, Angleitner L, Barinoff J, Beckmann MW, Böing C, Dannecker C, Fehm T, Gaase R, Gass P, Gebhardt M, Gieseking F, Günthert A, Hack CC, Hantschmann P, Horn LC, Koch MC, Letsch A, Mallmann P, Mangold B, Marnitz S, Mehlhorn G, Paradies K, Reinhardt MJ, Tholen R, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up of Vaginal Cancer and Its Precursors. Guideline of the DGGG and the DKG (S2k-Level, AWMF Registry No. 032/042, October 2018). Geburtshilfe Frauenheilkd 2019; 79:1060-1078. [PMID: 31680701 DOI: 10.1055/a-0919-4959] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose This is an official guideline, published and coordinated by the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG) and the German Society for Gynecology and Obstetrics (DGGG). Vaginal cancers are rare tumors, which is why there is very little evidence on these tumors. Knowledge about the optimal clinical management is limited. This first German S2k guideline on vaginal cancer has aimed to compile the most current expert knowledge and offer new recommendations on the appropriate treatment as well as providing pointers about individually adapted therapies with lower morbidity rates than were previously generally available. The purpose of this guideline is also to set up a register to record data on treatment data and the course of disease as a means of obtaining evidence in future. Methods The present S2k guideline was developed by members of the Vulvar und Vaginal Tumors Commission of the AGO in an independently moderated, structured, formal consensus process and the contents were agreed with the mandate holders of the participating scientific societies and organizations. Recommendations To optimize the daily care of patients with vaginal cancer: 1. Monitor the spread pattern; 2. Follow the step-by-step diagnostic workup based on initial stage at detection; 3. As part of individualized clinical therapeutic management of vaginal cancer, follow the sentinel lymph node protocol described here, where possible; 4. Participate in the register study on vaginal cancer.
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Affiliation(s)
| | | | - Celine D Alt-Radtke
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf, Germany
| | | | - Jana Barinoff
- St.-Gertrauden-Krankenhaus GmbH Berlin, Berlin, Germany
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Carsten Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen, Germany
| | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität München, Campus Großhadern, München, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Gaase
- Gemeinschaftspraxis für Frauenheilkunde Gaase+Hugger, Worms, Germany
| | - Paul Gass
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | | | - Friederike Gieseking
- Dysplasiesprechstunde/Gynäkologisches Laserzentrum in der Frauenarztpraxis Heussweg, Hamburg, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Peer Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting, Germany
| | | | - Martin C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité Berlin, Berlin, Germany
| | - Peter Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität Köln, Köln, Germany
| | | | - Simone Marnitz
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | | | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Berlin, Germany
| | | | - Reina Tholen
- Deutscher Verband für Physiotherapie, Köln, Germany
| | - Uwe Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Wolfgang Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz, Germany
| | - Linn Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Hampl
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Retraction Note: Improving usability and pregnancy rates of a fertility monitor by an additional mobile application: results of a retrospective efficacy study of Daysy and DaysyView app. Reprod Health 2019; 16:54. [PMID: 31088503 PMCID: PMC6515608 DOI: 10.1186/s12978-019-0728-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Martin C Koch
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany.
| | - Johannes Lermann
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Niels van de Roemer
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Simone K Renner
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Stefanie Burghaus
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Janina Hackl
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Patricia G Oppelt
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Thomas Hildebrandt
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Caroline C Hack
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Uwe G Pöhls
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Stefan P Renner
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
| | - Falk C Thiel
- Frauenklinik, Universitätsklinikum, Erlangen, Universitaetsstrasse 21-23, 91,054, Erlangen, Germany
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Schulmeyer CE, Stübs F, Gaß P, Renner SK, Mehlhorn G, Geppert C, Adler W, Beckmann MW, Koch MC. Correlation of referring cytology and in-house cytology in detection of early cervical neoplasia. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671334] [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: 10/28/2022] Open
Affiliation(s)
- CE Schulmeyer
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Erlangen, Deutschland
| | - F Stübs
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Erlangen, Deutschland
| | - P Gaß
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Erlangen, Deutschland
| | - SK Renner
- Frauenklinik Klinikum Sindelfingen-Böblingen, Böblingen, Deutschland
| | - G Mehlhorn
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - C Geppert
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - W Adler
- Department of Medical Informatics, Biometry and Epidemiology, Erlangen, Deutschland
| | - MW Beckmann
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Erlangen, Deutschland
| | - MC Koch
- Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Frauenklinik, Erlangen, Deutschland
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Affiliation(s)
- F Araújo
- Serviço de Imuno-Hemoterapia, Hospital S. Joã, 4200 Porto, Portugal
| | - M C Koch
- Serviço de Imuno-Hemoterapia, Hospital S. Joã, 4200 Porto, Portugal
| | - Isabel Henriques
- Serviço de Imuno-Hemoterapia, Hospital S. Joã, 4200 Porto, Portugal
| | - A R Araújo
- Serviço de Imuno-Hemoterapia, Hospital S. Joã, 4200 Porto, Portugal
| | - L Cunha-Ribeiro
- Serviço de Imuno-Hemoterapia, Hospital S. Joã, 4200 Porto, Portugal
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Jesinghaus M, Strehl J, Boxberg M, Brühl F, Wenzel A, Konukiewitz B, Schlitter AM, Steiger K, Warth A, Schnelzer A, Kiechle M, Beckmann MW, Noske A, Hartmann A, Mehlhorn G, Koch MC, Weichert W. Introducing a novel highly prognostic grading scheme based on tumour budding and cell nest size for squamous cell carcinoma of the uterine cervix. J Pathol Clin Res 2018; 4:93-102. [PMID: 29665323 PMCID: PMC5903696 DOI: 10.1002/cjp2.95] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/12/2018] [Accepted: 01/21/2018] [Indexed: 01/08/2023]
Abstract
A novel histopathological grading system based on tumour budding and cell nest size has recently been shown to outperform conventional (WHO‐based) grading algorithms in several tumour entities such as lung, oral, and oesophageal squamous cell carcinoma (SCC) in terms of prognostic patient stratification. Here, we tested the prognostic value of this innovative grading approach in two completely independent cohorts of SCC of the uterine cervix. To improve morphology‐based grading, we investigated tumour budding activity and cell nest size as well as several other histomorphological factors (e.g., keratinization, nuclear size, mitotic activity) in a test cohort (n = 125) and an independent validation cohort (n = 122) of cervical SCC. All parameters were correlated with clinicopathological factors and patient outcome. Small cell nest size and high tumour budding activity were strongly associated with a dismal patient prognosis (p < 0.001 for overall survival [OS], disease‐specific survival, and disease‐free survival; test cohort) in both cohorts of cervical SCC. A novel grading algorithm combining these two parameters proved to be a highly effective, stage‐independent prognosticator in both cohorts (OS: p < 0.001, test cohort; p = 0.001, validation cohort). In the test cohort, multivariate statistical analysis of the novel grade revealed that the hazard ratio (HR) for OS was 2.3 for G2 and 5.1 for G3 tumours compared to G1 neoplasms (p = 0.010). In the validation cohort, HR for OS was 3.0 for G2 and 7.2 for G3 tumours (p = 0.012). In conclusion, our novel grading algorithm incorporating cell nest size and tumour budding allows strongly prognostic histopathological grading of cervical SCC superior to WHO‐based grading. Therefore, our data can be regarded as a cross‐organ validation of previous results demonstrated for oesophageal, lung, and oral SCC. We suggest this grading algorithm as an additional morphology‐based parameter for the routine diagnostic assessment of this tumour entity.
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Affiliation(s)
- Moritz Jesinghaus
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Johanna Strehl
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Melanie Boxberg
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Frido Brühl
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Adrian Wenzel
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Björn Konukiewitz
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Anna M Schlitter
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Arne Warth
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Schnelzer
- Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Aurelia Noske
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
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Koch MC, Lermann J, van de Roemer N, Renner SK, Burghaus S, Hackl J, Dittrich R, Kehl S, Oppelt PG, Hildebrandt T, Hack CC, Pöhls UG, Renner SP, Thiel FC. Improving usability and pregnancy rates of a fertility monitor by an additional mobile application: results of a retrospective efficacy study of Daysy and DaysyView app. Reprod Health 2018; 15:37. [PMID: 29499716 PMCID: PMC5833051 DOI: 10.1186/s12978-018-0479-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Daysy is a fertility monitor that uses the fertility awareness method by tracking and analyzing the individual menstrual cycle. In addition, Daysy can be connected to the application DaysyView to transfer stored personal data from Daysy to a smartphone or tablet (IOS, Android). This combination is interesting because as it is shown in various studies, the use of apps is increasing patients´ focus on their disease or their health behavior. The aim of this study was to investigate if by the additional use of an App and thereby improved usability of the medical device, it is possible to enhance the typical-use related as well as the method-related pregnancy rates. RESULT In the resultant group of 125 women (2076 cycles in total), 2 women indicated that they had been unintentionally pregnant during the use of the device, giving a typical-use related Pearl-Index of 1.3. Counting only the pregnancies which occurred as a result of unprotected intercourse during the infertile (green) phase, we found 1 pregnancy, giving a method-related Pearl-Index of 0.6. Calculating the pregnancy rate resulting from continuous use and unprotected intercourse exclusively on green days, gives a perfect-use Pearl-Index of 0.8. CONCLUSION It seems that combining a specific biosensor-embedded device (Daysy), which gives the method a very high repeatable accuracy, and a mobile application (DaysyView) which leads to higher user engagement, results in higher overall usability of the method.
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Affiliation(s)
- Martin C Koch
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany.
| | - Johannes Lermann
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | | | - Simone K Renner
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Stefanie Burghaus
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Janina Hackl
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Ralf Dittrich
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Sven Kehl
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Patricia G Oppelt
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Thomas Hildebrandt
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Caroline C Hack
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Uwe G Pöhls
- Praxis, Kaiserstraße 26, 97070, Würzburg, Germany
| | - Stefan P Renner
- Universitätsklinikum Erlangen, Frauenklinik, Universitaetsstrasse 21-23, 91054, Erlangen, Germany
| | - Falk C Thiel
- Klinik am Eichert, Frauenklinik, Eichertstraße 3, 73035, Göppingen, Germany
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Koch MC, van de Roemer N, Beckmann MW, Renner SP. Einfluss einer mobilen Applikation (App) auf die Anwendungs-Sicherheit (Pearl-Index) eines Zykluscomputers, der zur Familienplanung verwendet wird. Ergebnisse einer retrospektiven Studie. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602283] [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: 10/19/2022] Open
Affiliation(s)
- MC Koch
- Frauenklinik Universitätsklinikum Erlangen, Universitätsstrasse 21 – 23
| | - N van de Roemer
- Frauenklinik Universitätsklinikum Erlangen, Universitätsstrasse 21 – 23
| | - MW Beckmann
- Frauenklinik Universitätsklinikum Erlangen, Universitätsstrasse 21 – 23
| | - SP Renner
- Frauenklinik Universitätsklinikum Erlangen, Universitätsstrasse 21 – 23
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Schnürch HG, Ackermann S, Alt CD, Barinoff J, Böing C, Dannecker C, Gieseking F, Günthert A, Hantschmann P, Horn LC, Kürzl R, Mallmann P, Marnitz S, Mehlhorn G, Hack CC, Koch MC, Torsten U, Weikel W, Wölber L, Hampl M. Diagnosis, Therapy and Follow-up Care of Vulvar Cancer and its Precursors. Guideline of the DGGG and DKG (S2k-Level, AWMF Registry Number 015/059, November 2015. Geburtshilfe Frauenheilkd 2016; 76:1035-1049. [PMID: 27765958 DOI: 10.1055/s-0042-103728] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: This is an official guideline, published and coordinated by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Study Group for Gynecologic Oncology) of the Deutsche Krebsgesellschaft (DKG, German Cancer Society) and the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG, German Society for Gynecology and Obstetrics). The number of cases with vulvar cancer is on the rise, but because of the former rarity of this condition and the resulting lack of literature with a high level of evidence, in many areas knowledge of the optimal clinical management still lags behind what would be required. This updated guideline aims to disseminate the most recent recommendations, which are much clearer and more individualized, and is intended to create a basis for the assessment and improvement of quality care in hospitals. Methods: This S2k guideline was drafted by members of the AGO Committee on Vulvar and Vaginal Tumors; it was developed and formally completed in accordance with the structured consensus process of the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). Recommendations: 1. The incidence of disease must be taken into consideration. 2. The diagnostic pathway, which is determined by the initial findings, must be followed. 3. The clinical and therapeutic management of vulvar cancer must be done on an individual basis and depends on the stage of disease. 4. The indications for sentinel lymph node biopsy must be evaluated very carefully. 5. Follow-up and treatment for recurrence must be adapted to the individual case.
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Affiliation(s)
| | | | - C D Alt
- Institut für Diagnostische und Interventionelle Radiologie, Universität Düsseldorf, Düsseldorf
| | - J Barinoff
- Klinik für Gynäkologie und Geburtshilfe, Markus Krankenhaus, Frankfurt am Main
| | - C Böing
- Katholisches Klinikum Oberhausen, Frauenklinik St. Clemens-Hospital, Oberhausen
| | - C Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität München, Campus Großhadern, München, Munich
| | - F Gieseking
- Dysplasiezentrum in der Frauenarztpraxis Heussweg, Hamburg
| | - A Günthert
- Frauenklinik Luzerner Kantonsspital, Lucerne, Switzerland
| | - P Hantschmann
- Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting - Burghausen, Altötting
| | - L C Horn
- Institut für Pathologie des Universitätsklinikums Leipzig, Leipzig
| | - R Kürzl
- ehem. Universitätsfrauenklinik Maistraße, Munich
| | - P Mallmann
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität Köln, Cologne
| | - S Marnitz
- Klinik und Poliklinik für Radioonkologie und Strahlentherapie der Universität Köln, Cologne
| | - G Mehlhorn
- Universitätsfrauenklinik Erlangen, Erlangen
| | - C C Hack
- Universitätsfrauenklinik Erlangen, Erlangen
| | - M C Koch
- Universitätsfrauenklinik Erlangen, Erlangen
| | - U Torsten
- Klinik für Gynäkologie und Zentrum für Beckenbodenerkrankungen, Vivantes Klinikum Neukölln, Berlin
| | - W Weikel
- Klinik für Gynäkologie und gynäkologische Onkologie, Universitätsfrauenklinik Mainz, Mainz
| | - L Wölber
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - M Hampl
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf, Düsseldorf
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Horn LC, Beckmann MW, Follmann M, Koch MC, Mallmann P, Marnitz S, Schmidt D. [S3 guidelines on diagnostics and treatment of cervical cancer: Demands on pathology]. Pathologe 2016; 36:585-93. [PMID: 26483249 DOI: 10.1007/s00292-015-0114-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Between 2011 and the end of 2014 the former consensus S2k guidelines for the diagnostics and treatment of cervical cancer were updated and upgraded to S3 level, methodologically based on the regulations of the German Cancer Society (DKG). The present article summarizes the relevant aspects for the sectioning, histopathological workup, diagnostics and reporting for the pathology of invasive cancer of the uterine cervix. The recommendations are based on the most recent World Health Organization (WHO) and TNM classification systems and consider the needs of the clinician for appropriate surgical and radiotherapeutic treatment of patients. Detailed processing rules of colposcopy-guided diagnostic biopsies, conization and trachelectomy as well as for radical hysterectomy specimens and lymph node resection (including sentinel lymph node resection) are given. In the guidelines deep stromal invasion in macroinvasive cervical cancer is defined for the first time as tumor infiltration of > 66% of the cervical stromal wall. Furthermore, morphological prognostic factors for microinvasive and macroinvasive cervical cancer are summarized.
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Mehlhorn G, Hautmann SK, Koch MC, Strehl JD, Hartmann A, Hilfrich R, Beckmann MW, Griesser H. HPV16-L1-specific antibody response is associated with clinical remission of high-risk HPV-positive early dysplastic lesions. Anticancer Res 2014; 34:5127-5132. [PMID: 25202103] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIM The present study was aimed at clarifying if use of a rapid human papillomavirus type 16 L1-specific antibody test could be used to improve clinical management of high-risk HPV-positive low-grade squamous intraepithelial lesion (LSIL)/high-grade squamous intraepithelial lesion (HSIL). PATIENTS AND METHODS The study was nested within a prospective study of 801 patients with early dysplastic high-risk HPV-positive lesions to examine the prognostic significance of HPV-L1 protein detection. Serum samples of 87 patients were tested with a rapid HPV16-L1-specific antibody test. The results were correlated with the clinical outcome during 66 months of follow-up. RESULTS A combined analysis of the 22 antibody-positive women showed that 17 were also L1 protein-positive, and 5 were L1 capsid protein-negative. An HPV-specific immune competence strongly correlates with clinical remission of low-grade squamous intraepithelial lesion (76.6%). For L1 antigen and HPV16-L1 antibody double-positive women, the risk of progression to cervical intraepithelial neoplasia grade 3 was low (5.8%). CONCLUSION The rapid anti-HPV16-L1 test could be a promising tool to improve risk assessment and appropriate clinical management of high-risk HPV-positive early dysplastic lesions.
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Affiliation(s)
- Grit Mehlhorn
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Simone K Hautmann
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Martin C Koch
- Department of Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Johanna D Strehl
- Institute of Pathology, Erlangen University Hospital, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Erlangen University Hospital, Erlangen, Germany
| | | | | | - Henrik Griesser
- Department of Pathology and Cytodiagnostics, Laboratory Medicine, Cologne, Germany
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Dammer U, Weiss C, Raabe E, Heimrich J, Koch MC, Winkler M, Faschingbauer F, Beckmann MW, Kehl S. Introduction of Inhaled Nitrous Oxide and Oxygen for Pain Management during Labour - Evaluation of Patients' and Midwives' Satisfaction. Geburtshilfe Frauenheilkd 2014; 74:656-660. [PMID: 25100880 DOI: 10.1055/s-0034-1368606] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022] Open
Abstract
Aim: Effective pain management during labour is important because pain affects the birth experience. Epidural analgesia is effective but often it may not be possible; however, inhaled analgesia offers another option. Use of inhaled nitrous oxide and oxygen for pain management in labour is well established in obstetrics but is still not used much in Germany. This study aimed to investigate the acceptance of the inhaled analgesia of inhaled nitrous oxide and oxygen by midwives and pregnant women during labour. Material and Methods: In this observational study carried out between April and September 2013, a total of 66 pregnant women received inhaled nitrous oxide and oxygen during labour on request and after prior assessment of suitability. After the birth, all of the women and the responsible midwives were interviewed about their experience and satisfaction with the inhaled analgesia. Results: A statistically significant reduction of pain was achieved with nitrous oxide and oxygen. The inhaled analgesia was mostly used by women who refused epidural analgesia. The likelihood of using inhaled nitrous oxide and oxygen again was reported as higher for patients who tolerated it well (p = 0.0129) and used it in the second stage of labour (p = 0.0003) and when bearing down (p = 0.0008). Conclusion: Inhaled nitrous oxide and oxygen is an effective method for pain management during labour and is accepted well by women in labour and by midwives.
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Affiliation(s)
- U Dammer
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - C Weiss
- Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim
| | - E Raabe
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - J Heimrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M C Koch
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Winkler
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | | | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - S Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
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Mehlhorn G, Kage A, Münzenmayer C, Benz M, Koch MC, Beckmann MW, Wittenberg T. Computer-assisted diagnosis (CAD) in colposcopy: evaluation of a pilot study. Anticancer Res 2012; 32:5221-5226. [PMID: 23225419] [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
BACKGROUND A prototype system for computer-assisted colposcopic diagnosis (CAD) currently achieves a high level of accuracy of 80% (sensitivity 85%, specificity 75%) for the automatic assessment of colposcopic images. This pilot study investigated whether this type of CAD system is, in principle, capable of influencing the quality of the examiner's assessment. MATERIALS AND METHODS In this observer study, 24 digitized colposcopic images from patients attending a dysplasia clinic were assessed by 90 participants. All participants had attended a colposcopy training workshop so that they acquired the same basic information and skills. RESULTS Wide variation was seen among the non-experts, in contrast to the experts. An overall improvement in diagnostic accuracy was noted when the CAD system was used (non-experts: sensitivity 78%, specificity 70%; experts: sensitivity 74%, specificity 70%). CONCLUSION The CAD system may serve as an aid in the further diagnosis of cervical intraepithelial neoplasia, and has the potential to improve the diagnostic process.
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Affiliation(s)
- Grit Mehlhorn
- Department of Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054 Erlangen, Germany.
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Koch MC, Follmann M, Mallmann P, Brandl A, Thomas M, Beckmann MW. Methodische Entwicklung von evidenzbasierten Leitlinien am Beispiel der S3-Leitlinie „Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom“. Geburtshilfe Frauenheilkd 2012. [DOI: 10.1055/s-0032-1318537] [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: 10/28/2022] Open
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Abstract
Syndactyly type II or synpolydactyly (SPD) is the second most frequent syndactyly type and is inherited in an autosomal dominant fashion. The cardinal features of this malformation are the cutaneous or bony fusion of third and fourth fingers, and fourth and fifth toes associated with additional digital elements within the web. It shows incomplete penetrance and high inter- and intrafamilial phenotypic variability. Two loci are known for SPD (MIM 186000, MIM 608180) associated with mutations in HOXD13 and FBLN1, respectively. Here, we report further genetic heterogeneity for SDP. Employing a whole genomic screen, we demonstrate, in a large Pakistani kindred, that the classical phenotype of SPD maps on a new locus at chromosome 14q11.2-q12. The highest LOD score (Z(max) = 4.06) was obtained with microsatellite marker D14S264, and the multipoint LOD score reached a maximum of 5.01. Haplotype analysis revealed that the disease interval is flanked by microsatellite markers D14S283 and D14S1060, encompassing a physical distance of 10.72 Mb. We propose to allocate to this locus the symbol SPD3 (synpolydactyly 3), and to name the loci associated with HOXD13 or FBLN1 mutations SPD1 and SPD2, respectively.
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Affiliation(s)
- S Malik
- Zentrum für Humangenetik, Philipps-Universität Marburg, Germany
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39
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Emmrich P, Ogunlade V, Gradistanac T, Daneschnejad S, Koch MC, Schober R. [Facioscapulohumeral muscle dystrophy and heart disease]. ACTA ACUST UNITED AC 2005; 94:348-54. [PMID: 15868364 DOI: 10.1007/s00392-005-0223-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 08/10/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
Cardiac involvement is well known in a number of skeletomuscular diseases but not in facio-scapulohumeral muscular dystrophy (FSHD). We report on a 71 year old woman with progressive cardiac insufficiency in FSHD, which was also confirmed by molecular analysis in one of the two daughters affected by the disease. Autopsy of the deceased patient showed the typical changes in skeletal muscles including focal inflammatory infiltrates in the diaphragm and, in addition, cardiac muscular involvement. The histological changes resembled those seen in primary cardiomyopathy despite the normal muscle mass volume. Both clinically and morphologically, the cardiac disease was the cause of death in this patient with FSHD.
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MESH Headings
- Aged
- Cardiac Output, Low/diagnosis
- Cardiac Output, Low/genetics
- Cardiac Output, Low/pathology
- Cardiomyopathies/diagnosis
- Cardiomyopathies/genetics
- Cardiomyopathies/pathology
- Chromosome Aberrations
- Chromosome Deletion
- Chromosomes, Human, Pair 4
- Female
- Genes, Dominant
- Heart Failure/diagnosis
- Heart Failure/genetics
- Heart Failure/pathology
- Humans
- Muscle, Skeletal/pathology
- Muscular Dystrophy, Facioscapulohumeral/diagnosis
- Muscular Dystrophy, Facioscapulohumeral/genetics
- Muscular Dystrophy, Facioscapulohumeral/pathology
- Myocardium/pathology
- Pedigree
- Pulmonary Embolism/diagnosis
- Pulmonary Embolism/genetics
- Pulmonary Embolism/pathology
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/pathology
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Affiliation(s)
- P Emmrich
- Selbst. Abt. für Neuropathologie, Institut für Pathologie des Universitätsklinikums Leipzig (AöR), Liebigstr. 26, 04103 Leipzig, Germany
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40
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Malik S, Ahmad W, Grzeschik KH, Koch MC. A simple method for characterising syndactyly in clinical practice. Genet Couns 2005; 16:229-38. [PMID: 16261692] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Non-syndromic syndactyly is a heterogeneous group of limb malformations involving webbing of fingers and/or toes. There are at least nine non-syndromic types described in the literature. For the clinician and the genetic counsellor not having gathered experience with this malformation, it is rather tedious to identify the correct subtype for the patient's phenotype. We therefore present a protocol for clinical use, which visualises the malformation in a graphical way and thereby simplifies typing. In addition, this protocol provides a simple documentation system for reporting clinical data for new syndactyly families. It might encourage clinicians to report families that are still unclassifed and thus, helping to extend and improve the existing classification system.
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Affiliation(s)
- S Malik
- Zentrum für Humangenetik, Klinikum der Philipps-Universität Marburg, Germany.
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41
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Day JW, Ricker K, Jacobsen JF, Rasmussen LJ, Dick KA, Kress W, Schneider C, Koch MC, Beilman GJ, Harrison AR, Dalton JC, Ranum LPW. Myotonic dystrophy type 2: molecular, diagnostic and clinical spectrum. Neurology 2003; 60:657-64. [PMID: 12601109 DOI: 10.1212/01.wnl.0000054481.84978.f9] [Citation(s) in RCA: 253] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Myotonic dystrophy types 1 (DM1) and 2 (DM2/proximal myotonic myopathy PROMM) are dominantly inherited disorders with unusual multisystemic clinical features. The authors have characterized the clinical and molecular features of DM2/PROMM, which is caused by a CCTG repeat expansion in intron 1 of the zinc finger protein 9 (ZNF9) gene. METHODS Three-hundred and seventy-nine individuals from 133 DM2/PROMM families were evaluated genetically, and in 234 individuals clinical and molecular features were compared. RESULTS Among affected individuals 90% had electrical myotonia, 82% weakness, 61% cataracts, 23% diabetes, and 19% cardiac involvement. Because of the repeat tract's unprecedented size (mean approximately 5,000 CCTGs) and somatic instability, expansions were detectable by Southern analysis in only 80% of known carriers. The authors developed a repeat assay that increased the molecular detection rate to 99%. Only 30% of the positive samples had single sizeable expansions by Southern analysis, and 70% showed multiple bands or smears. Among the 101 individuals with single expansions, repeat size did not correlate with age at disease onset. Affected offspring had markedly shorter expansions than their affected parents, with a mean size difference of -17 kb (-4,250 CCTGs). CONCLUSIONS DM2 is present in a large number of families of northern European ancestry. Clinically, DM2 resembles adult-onset DM1, with myotonia, muscular dystrophy, cataracts, diabetes, testicular failure, hypogammaglobulinemia, and cardiac conduction defects. An important distinction is the lack of a congenital form of DM2. The clinical and molecular parallels between DM1 and DM2 indicate that the multisystemic features common to both diseases are caused by CUG or CCUG expansions expressed at the RNA level.
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Affiliation(s)
- J W Day
- Institute of Human Genetics, Department of Neurology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA.
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Araújo FM, Henriques I, Monteiro F, Meireles E, Koch MC, Celeste R, Cunha-Ribeiro LM. The first case of HCV seroconversion in Portugal after the introduction of HCV NAT screening. Transfusion 2001; 41:848-9. [PMID: 11399834 DOI: 10.1046/j.1537-2995.2001.41060848.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Richter B, Stegmann K, Röper B, Böddeker I, Ngo ET, Koch MC. Interaction of folate and homocysteine pathway genotypes evaluated in susceptibility to neural tube defects (NTD) in a German population. J Hum Genet 2001; 46:105-9. [PMID: 11310576 DOI: 10.1007/s100380170096] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neural tube defects (NTD) are likely to result from an interaction of several genes and environmental factors. Because periconceptional folate intake reduces the NTD risk in the fetus, and because mothers of children with NTD showed elevated plasma homocysteine levels, gene polymorphisms of the folate and homocysteine pathway, such as 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C-->T, MTHFR 1298A-->C and cystathionine beta-synthase (CBS) 844ins68, have been implicated in the etiology of NTD. Several studies have demonstrated that these polymorphisms may indeed be associated with NTD in some populations. In order to evaluate the role of these polymorphisms and their interaction in NTD, we genotyped 417 individuals for case-control studies and 129 families for transmission disequilibrium tests. We are the first to present detailed data on MTHFR haploid genotypes in combination with CBS 844ins68. The MTHFR risk genotype 677CT/1298AC, known to be associated with decreased enzyme activity and increased homocysteine, was found significantly more often in patients than in controls (P = 0.02). A CBS insertion allele in addition to MTHFR 677CT/ 1298AC heterozygosity or MTHFR 677TT/1298AA homozygosity did not result in an increased risk for NTD. This is in agreement with the recently reported homocysteine-lowering effect of the CBS 844ins68 allele in carriers of MTHFR variants.
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Affiliation(s)
- B Richter
- Zentrum für Humangenetik, Marburg, Germany
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45
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Stegmann K, Boecker J, Richter B, Capra V, Finnell RH, Ngo ET, Strehl E, Ermert A, Koch MC. A screen for mutations in human homologues of mice exencephaly genes Tfap2alpha and Msx2 in patients with neural tube defects. Teratology 2001; 63:167-75. [PMID: 11320527 DOI: 10.1002/tera.1031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Very little is known about the identity of genetic factors involved in the complex etiology of nonsyndromic neural tube defects (NTD). Potential susceptibility genes have emerged from the vast number of mutant mouse strains displaying NTD. Reasonable candidates are the human homologues of mice exencephaly genes Tfap2alpha and Msx2, which are expressed in the developing neural tube. METHODS A single-strand conformation analysis (SSCA) mutation screen of the coding sequences of TFAP2alpha and MSX2 was performed for 204 nonsyndromic NTD patients including cases of anencephaly (n = 10), encephalocele (n = 8), and spina bifida aperta, SBA (n = 183). A selected number of SBA patients was additionally tested for specific mutations in MTHFD, FRalpha, and PAX1 already shown to be related to NTD. RESULTS Two TFAP2alpha point mutations in individual SBA patients were silent on the amino acid level (C308C, T396T). On nucleic acid level, these mutations change evolutionary conserved codons and thus may influence mRNA processing and translation efficiency. One SBA patient displayed an exonic 9-bp deletion in MSX2 leading to a shortened and possibly less functional protein. None of these mutations was found in 222 controls. Seven polymorphisms detected in TFAP2alpha and MSX2 were equally distributed in patients and controls. Patients with combined heterozygosity of an exonic MSX2 and an intronic TFAP2alpha polymorphism were at a slightly increased risk of NTD (OR 1.71; 95% CI 0.57-5.39). CONCLUSIONS Although several new genetic variants were found in TFAP2 and MSX2, no statistically significant association was found between NTD cases and the new alleles or their combinations. Further studies are necessary to finally decide if these gene variants may have acted as susceptibility factors in our individual cases.
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Affiliation(s)
- K Stegmann
- Medizinisches Zentrum für Humangenetik, Philipps-Universität Marburg, 35033 Marburg, Germany
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46
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Kölker S, Degen I, Koch MC, Lindner M, Haas D, Hoffmann GF. Myotonic dystrophy associated with VACTERL? A case report. Neuropediatrics 2001; 32:53-4. [PMID: 11318010 DOI: 10.1055/s-2001-12220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- S Kölker
- Department of General Pediatrics, University Children's Hospital, Heidelberg, Germany
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48
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Kress W, Mueller-Myhsok B, Ricker K, Schneider C, Koch MC, Toyka KV, Mueller CR, Grimm T. Proof of genetic heterogeneity in the proximal myotonic myopathy syndrome (PROMM) and its relationship to myotonic dystrophy type 2 (DM2). Neuromuscul Disord 2000; 10:478-80. [PMID: 10996776 DOI: 10.1016/s0960-8966(00)00129-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recently, myotonic dystrophy type 2 has been described as a separate disease entity that is distinctive from classical Steinert's disease since it lacks a CTG repeat expansion on chromosome 19q. A gene locus for myotonic dystrophy type 2 has been mapped to chromosome 3q. Independently, proximal myotonic myopathy has been recognized as yet another form of a multisystem myotonic disorder. Its relationship to myotonic dystrophy type 2 remains to be clarified. In our linkage study of 17 German proximal myotonic myopathy families nine of them mapped to the myotonic dystrophy type 2 locus (LOD score 18.9). However, two families with a typical proximal myotonic myopathy phenotype were excluded from this locus (LOD score -7.4). These results confirm genetic heterogeneity in the proximal myotonic myopathy syndrome. Furthermore, in the majority of the proximal myotonic myopathy families the disease phenotype may be caused by allelic mutations in the putative myotonic dystrophy type 2 gene.
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Affiliation(s)
- W Kress
- Division of Medical Genetics, University of Würzburg, Würzburg, Germany
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Busse K, Köhler J, Stegmann K, Pongratz D, Koch MC, Schreiber H. An inherited 4q35-EcoRI-DNA-fragment of 35 kb in a family with a sporadic case of facioscapulohumeral muscular dystrophy (FSHD). Neuromuscul Disord 2000; 10:178-81. [PMID: 10734264 DOI: 10.1016/s0960-8966(99)00102-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of an adult male patient showing clinical, neurophysiological and histological signs consistent with the phenotype of facioscapulohumeral muscular dystrophy. On molecular testing with a 4q35-DNA-probe p13E-11 (D4F104S1), the patient, his clinically unaffected mother and two sisters shared a 4q35-EcoRI-DNA-fragment of 35 kb on the transition between FSHD1A-associated and polymorphic fragments. Explanatory hypotheses, such as reduced penetrance in females or a phenotype unlinked to the 4q35-locus are considered. Alternatively, additional changes in the unidentified FSHD1A gene could have caused the phenotype. Thus, in such rare cases, the diagnostic evidence of 4q35-EcoRI-fragments is still limited.
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Affiliation(s)
- K Busse
- Klinik für Neurologie, Universität Ulm, Steinhövelstrasse 9, D-89075, Ulm, Germany
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50
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Stegmann K, Ziegler A, Ngo ET, Kohlschmidt N, Schröter B, Ermert A, Koch MC. Linkage disequilibrium of MTHFR genotypes 677C/T-1298A/C in the German population and association studies in probands with neural tube defects(NTD). Am J Med Genet 1999; 87:23-9. [PMID: 10528242] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A number of studies have demonstrated that the common polymorphism 677C-->T in the gene encoding 5, 10-methylenetetrahydrofolate reductase (MTHFR) leads to a thermolabile variant with decreased enzyme activity and to mildly elevated plasma homocysteine. 677TT homozygosity was shown to be more frequent in NTD probands compared with controls in some studies. Recently, another polymorphism, 1298A-->C, in the MTHFR gene was described and combined heterozygosity 677CT/1298AC was suggested to be an additional risk factor for NTD. The present study examines the genotype and haplotype distribution of the two polymorphisms in the German population and evaluates the impact on NTD individuals and their relatives. To determine the haplotype of all individuals tested, we developed an easy-to-perform ARMS-RFLP test. Our data show that the two polymorphisms are in linkage disequilibrium in the general population and in NTD individuals. There was no statistically significant difference in allele and genotype frequency between probands (patients, fetuses) and controls (P > 0.10) and between observed and expected values for mother-child pairs (P > 0.80). Taking into account gender, an increased rate of 677CT heterozygotes was found in affected and unaffected males compared to affected and unaffected females. A family-based association study using a multiallelic transmission disequilibrium test (TDT) also shows that transmission rates do not deviate significantly from equilibrium (P > 0.50). Thus, our data provide no evidence for an association between NTD phenotype and MTHFR 677C/T-1298A/C genotypes and haplotypes.
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Affiliation(s)
- K Stegmann
- Medizinisches Zentrum für Humangenetik, Philipps-Universität Marburg, Marburg, Germany
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