Adjunctive use of the uterine artery resistance index in the preoperative prediction of myometrial invasion in endometrial carcinoma

Bu çalışma, 21-24 Ekim 1997 tarihleri arasında Japonya'da düzenlenen 6. Uluslararası Jinekolojik Kanser Cemiyeti Toplantısında bildiri olarak sunulmuştur.Objective. The aim of this study was to evaluate the value of transvaginal ultrasonography (TVUS) and uterine artery flow velocimetry indices in the preoperative detection of deep myometrial invasion in endometrial carcinoma (EC). Methods. Thirty-nine patients with EC underwent TVUS and Doppler flow velocimetry studies, during which endometrial, myometrial, and uterine measurements, presence and depth of myometrial invasion, and pulsatility and resistance indices (PI and RI, respectively) of uterine arteries were noted. TVUS and Doppler findings were correlated with pathological findings obtained by surgical staging. The respective diagnostic accuracies of these variables, and of age and grade, in detecting deep myometrial invasion were assessed with the use of histological findings as the standard. Results. All patients with Grade 3 tumors had deep myometrial invasion, compared to 19% of patients with Grade 1 tumors. The mean age of patients with deep invasion was significantly higher, and their mean PI and RI were significantly lower, than patients with lesser degrees of invasion. While the sensitivity and specificity of TVUS in detecting deep invasion were 37 and 90%, respectively, the corresponding figures for age, grade, and uterine artery RI, found to be independent discriminators of deep invasion, were in the range of 58-84% and 60-70%. The combined use of the latter three parameters resulted in a sensitivity of 100% and specificity of 95%. Conclusions. Our findings indicate that TVUS is unreliable in diagnosing deep myometrial invasion. Detection rates of this pathological feature can be greatly improved, however, with the concomitant use of age, tumor grade, and uterine artery RI.Int Gynecol Cancer So

The Demographics of Patients with Skin Cancer who Underwent Surgery in Diyarbakır and Performed Surgical Techniques

Objective: The major factor for developing malignant skin cancers is sunlight exposure. This study aimed to evaluate the demographics of patients with skin cancers who underwent surgery in Diyarbakır where the population is exposed to more sunlight than most other Turkish cities. Methods: The medical records of patients who underwent surgery for malignant skin cancer excision between 2011 and 2016 were searched using University Hospital’s patient database program. Data about patients’ demographics, cancer features, and the surgical techniques performed were collected. Results: Over a 5-year period, 190 patients underwent surgical excision. The male to female ratio was 1.56, and the mean age was 65.8 ± 15.7 (range, 20-94) years. The most common skin cancer was basal cell carcinoma (n=138, 72.7%), followed by squamous cell carcinoma (n=45, 23.7%) and malignant melanoma (n=5, 2.6%). The most common surgery was primary excision, which was performed in 90 of 190 patients (47.36%); tissue reconstruction with a skin graft or flap surgery was required for the remaining 100 (52.63%), showing a significant difference (p<0.001). Conclusion: Basal cell carcinoma is the most common skin cancer, and less than half of the patients sought treatment immediately after they recognized the lesion. The public should be educated about skin cancers to increase early diagnosis and encourage timely treatment, thereby decreasing morbidity and mortality from skin cancer

Investigation of Human Papillomavirus Prevalence in Women in Eskişehir, Turkey by Pap Smear, Hybrid Capture 2 Test and Consensus Real-Time Polymerase Chain Reaction and Typing with Pyrosequencing Method

İnsan papillomavirus (HPV) enfeksiyonları, subklinik veya asemptomatik enfeksiyonlardan anogenital kanserlere kadar değişen geniş bir klinik spektruma sahiptir. Önlenebilir bir hastalık olarak düşünülen servikal kanser (SK), dünyada, kadınlarda üçüncü en sık görülen kanser türü olduğundan, SK taramalarında HPV-DNA'sının saptanması ve risk grubunun belirlenmesi büyük önem taşımaktadır. Bu çalışmada, Eskişehir'de, kadınlarda HPV-DNA varlığının iki farklı moleküler yöntemle araştırılarak, moleküler yöntem sonuçlarının hem birbirleriyle hem de sitoloji sonuçlarıyla karşılaştırılması amaçlanmıştır. Araştırmaya, Eskişehir Kanser Erken Teşhis, Tarama ve Eğitim Merkezi'ne (KETEM) tarama amaçlı başvuran, 30-65 yaş arası 1081 kadın dahil edilmiştir. Katılımcılardan Pap yayması ve moleküler yöntemler için, eş zamanlı üç ayrı servikal sürüntü örneği alınmıştır. Araştırmanın ilk aşamasında, tüm servikal örneklerde HPV-DNA varlığı Hybrid Capture 2 (HC2; Qiagen, Almanya) yöntemiyle araştırılmış; ikinci aşamada ise HPVDNA'sı pozitif bulunan kadınların dahil edildiği, geri kalanının ise rastgele seçildiği toplam 152 kadının örnekleri konsensus gerçek zamanlı polimeraz zincir reaksiyonu (RT-PCR) ile tekrar çalışılmış (Takara Bio Inc., Japonya) ve HPV-DNA varlığı saptanan örneklerde pirodizilemeye dayalı ticari sistem (Diatech Pharmacogenetics S.R.L, İtalya) ile genotip tayini yapılmıştır. Çalışmanın ilk basamağında; kadınların %3 (32/1081)'ünde HC2 testi, 47 (%4.4)'sinde ise sitoloji sonucu tek başına ve/veya birlikte pozitif olarak raporlanmıştır. Beş (%0.5) örnekte her iki test ile de pozitif sonuç alınmış, bunların dördünde yüksek riskli HPV-DNA saptanmıştır. HC2 testi ile yüksek riskli HPV varlığı saptanan 23 (23/1081, %2.1) kadının 19'unda sitoloji sonuçları negatif olarak raporlanmıştır. Sitoloji sonucu pozitif olarak saptanan 42 (42/1081, %3.9) örnekte ise HC2 testi ile HPV-DNA varlığı saptanmamıştır. Çalışmanın ikinci aşamasına dahil edilen 152 örnekten 32 (%21.1)'si HC2 testi ile, 40 (%26.3)'ı Pap yayması ile, 53 (%34.9)'ü de konsensus RT-PCR ile tek başına ve/veya birlikte pozitif bulunmuştur. HC2 testi ile pozitif saptanan 32 örneğin tamamı konsensus RT-PCR ile de pozitif olarak saptanmış; ancak RT-PCR ile pozitif saptanan 21 örnek HC2 testi ile negatif sonuç vermiştir. Sitolojisinde anomali saptanan 40 örneğin ise dokuzunda (%22.5) RT-PCR ile ve beşinde (%12.5) HC2 ile HPV-DNA varlığı gösterilirken 31 (%77.5) örnekte her iki yöntemle de HPV-DNA saptanmamıştır. Genotip tayini yapılabilen 44 örnekte en sık saptanan tip, HPV tip 16 (n=15, %34.1) olmuş, bunu tip 90 (n=11, %25) ve tip 18 (n=4, %9.1) izlemiştir. Çalışmamızda, FDA (U.S. Food and Drug Administration) onaylı HC2 testi esas alındığında, Pap yaymasının duyarlılık, özgüllük, pozitif ve negatif prediktif değerleri, sırasıyla %16.1, %96, %10.6 ve %97.5 olarak saptanmıştır. HC2 ve konsensus RT-PCR yöntemleri arasında ise önemli derecede uyumluluk (Cohen's kappa: 0.665) bulunmuştur. Sonuç olarak, ülkemizdeki sitopatolog sayısının yetersizliği ile birlikte, ASCCP (American Society for Colposcopy and Cervical Pathology) ve FDA'nın da önerileri göz önüne alındığında; SK taramasının tam ve etkin şekilde yapılabilmesi için, Pap testine ilave olarak moleküler tanı yöntemlerinin uygulanmasına ihtiyaç olduğu bir kez daha ortaya konmuşturHuman papillomavirus (HPV) infections have a broad range of clinical spectrum from subclinical or asymptomatic infection to anogenital carcinoma. The detection of HPV-DNA and determination of the risk groups in cervical cancer (CC) screening is very important because CC is considered to be a preventable illness which is the third most common cancer type of women in the world. The aims of this study were to investigate the presence of HPV-DNA in women by two different molecular methods and to compare their results together with the results of cytology, in Eskişehir, Central Anatolia, Turkey. A total of 1081 women aged between 30-65 years, who applied to Eskişehir Early Diagnosis, Screening and Training of Cancer Center (KETEM) for screening were included in the study. Three separate cervical samples were collected simultaneously from the participants for cytologic examination and molecular studies. In the fi rst step of the study, all cervical samples were investigated for the presence of HPV-DNA by Hybrid Capture 2 (HC2; Qiagen, Germany) method. In the second part of the study, consensus real-time polymerase chain reaction (RT-PCR) (Takara Bio Inc., Japan) was performed in 152 samples which included HC2 positive and randomly selected negative samples, and then the HPV genotypes were detected by using a commercial kit based on pyrosequencing method (Diatech Pharmacogenetics S.R.L, Italy). In the fi rst part of the study, HC2 test was found positive in 3% (32/1081) of the women, while in 4.4% (47/1081) Pap smear was positive alone or with HC2 test. Five (0.5%) samples yielded positive results with both of the methods, and four of them were positive for high risk HPV types. Cytology results were negative in 19 out of 23 (23/1081, 2.1%) samples that were reported as high risk HPV by HC2 test. On the other hand, 42 (42/1081, 3.9%) samples that were positive by cytology yielded negative results by HC2 test. In the second part of the study, 32 (21.1%) of 152 selected samples were positive by HC2 test, 40 (26.3%) were positive by Pap smear, and 53 (34.9%) were positive by consensus RT-PCR. All of the 32 samples that were positive by HC2 were also positive by RT-PCR, however 21 samples that were positive by RT-PCR were negative by HC2 test. Among 40 samples that were positive (abnormal) by Pap smear, HPV-DNA was positive in nine (22.5%) by RT-PCR and in fi ve (12.5%) by HC2 test, but HPV-DNA was not detected in 31 (77.5%) samples by both of the tests. Genotyping of the strains could be performed in 44 samples, and the most common type detected was HPV type 16 (n=15, 34.1%), followed by type 90 (n=11, 25%) and type 18 (n= 4, 9.1%). In our study, the sensitivity, specifi city, positive and negative predictive values of Pap smear method were estimated as 16.1%, 96%, 10.6% and 97.5%, respectively, based on the HC2 results which was approved by U.S. Food and Drug Administration (FDA). In addition, a signifi cant degree of concordance was detected between HC2 and concensus RT-PCR methods (Cohen's kappa: 0.665). In conclusion, regarding the insuffi cient number of cytopathologists in our country and according to the recommendations of American Society for Colposcopy and Cervical Pathology (ASCCP) and FDA, it was once again demonstrated that, the implementation of molecular diagnostic methods in addition to the Pap smear for effective screening of CC are neede

Risk factors, locations of the thrombus, prophylaxis, and treatment of the deep venous thrombosis patients in the İzmir City and Aegean Region: Results of a multicenter study

Objective: To determine whether there is a relationship between the risk factors and the locations of the thrombi, pharmacological prophylaxis, and the treatment modalities in patients with deep venous thrombosis (DVT) in the İzmir City and Aegean Region. Material and Method: We enrolled 531 consecutive patients with DVT which are confirmed by Doppler ultrasound and reviewed records of 13 hospitals in the Izmir City and Aegean Region, in this multicenteric cross-sectional study. The data of the patients were recorded on a questionnaire form and analyzed by using confidence intervals for odds ratios, Chi-square test and Student-t tests. Results: 85.3% of the patients were outpatients while 14.7% were inpatients. The most frequently encountered medical risk factors were chronic venous insufficiency-varices, immobilization and family history respectively. The most frequently seen surgical risk factors were lung cancer surgery and knee surgery, followed by gastrointestinal surgery in the surgical group. While DVT were seen more frequent in males who had lung cancer, chronic obstructive pulmonary disease and under chemotherapy receiving patients for a malignancy; otherwise, DVT was seen more frequently in females who were obese and had a hip fracture. Conclusion: Advanced age is a crucially important risk factor in population for DVT and be able to treat with low molecular weight heparin without hospitalization as outpatient settings especially, for pregnant or mothers in lactation period. Malignity and its related surgery are at the forefronts of DVT causes. The obese females are in danger for DVT if any surgery is planned. The population-based studies are needed to be planned to detect for the true prophylaxis rates. Copyright © 2011 by Türkiye Klinikleri

Prevalence of cervical cytological abnormalities in Turkey

Objective: To evaluate retrospectively the prevalence of cervical cytological abnormalities in patient records obtained from healthcare centers in Turkey. Method: Demographic characteristics and data on cervical cytological abnormalities were evaluated from patients who underwent flap tests in healthcare centers in 2007. Results: Data were collected from 33 healthcare centers totaling 140 334 patients. Overall, the prevalence of cervical cytological abnormalities was 1.8%; the prevalence of ASCUS, ASC-H, LSIL, HSIL, and AGC was 1.07%, 0.07%, 0.3%, 0.17%, and 0.08%, respectively. The prevalence of preinvasive cervical neoplasia was 1.7% and the prevalence of cytologically diagnosed invasive neoplasia was 0.06%. Conclusion: The abnormal cervical cytological prevalence rate in Turkey is lower than in Europe and North America. This might be due to sociocultural differences, lack of population-based screening programs, or a lower HPV prevalence rate in Turkey