Can preoperative magnetic resonance imaging replace intraoperative frozen sectioning in the evaluation of myometrial invasion for early-stage endometrial carcinoma?

Objectives: To examine the performance of preoperative magnetic resonance imaging (MRI) and intraoperative frozen sectioning in the assessment of myometrial invasion during the early stages of endometrial cancer.  Material and methods: This retrospective study employed data from patients with endometrial cancer who were operated on between January 2013 and November 2018. Patients who underwent preoperative MRI and were of FIGO 2009 stage I were included in the study. Radiological staging and intraoperative staging by frozen sectioning were carried out. The data were analyzed to assess agreement of the overall results concerning myometrial invasion.  Results: In total, 222 patients were enrolled. Their mean age was 58.3 ± 8.5 years. The accuracy of MRI for the detection of myometrial invasion was 88.7% and its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91.6%, 82.1%, 92.2%, and 80.9%, respectively, with a kappa coefficient of 0.734 (95% confidence interval [CI], 0.684–0.784; p < 0.001). The accuracy of intraoperative frozen sectioning was 94.4%, and its sensitivity, specificity, PPV, and NPV were 97.7%, 85.7%, 94.7%, and 93.4%, respectively, with a kappa coefficient of 0.856 (95% CI, 0.812–0.900; p < 0.001). No significant difference in accuracy was observed between MRI and frozen sectioning (p = 0.057). MRI and frozen sectioning were sensitive for the detection of myometrial invasion, according to receiver operating curve analyses (areas under the curve, 0.869 and 0.917, respectively; p < 0.001).  Conclusions: The assessment of myometrial invasion by preoperative MRI and intraoperative frozen sectioning during the early stages of endometrial carcinoma was highly accurate.

The effect of lymph node metastasis on overall survival and disease-free survival in vulvar cancer patients

Objectives: To examine the effect of lymphadenectomy on survival in patients with squamous cell vulvar carcinoma.Material and methods: Patients with squamous cell vulvar cancer who underwent surgery were retrospectively analyzed.All procedures were performed according to current recommendations/standard of treatment. The clinical and pathologicalfeatures were examined. Sixty-eight patients were studied. The mean age was 64.7 ± 10.9 years. Twenty-three (33.8%)patients had nodal metastasis. Most patients (60.3%) were in stage IB. Adjuvant radiotherapy and chemo-radiotherapy wereadministered to 33.8% and 25% of the patients, respectively. The median follow-up time was 28.5 (4–183) months. Recurrenceoccurred in 18 (26.5%) cases.Results: There was no significant difference between node-positive and node-negative patients in terms of age, number ofdissected lymph nodes and recurrence. Tumor diameter was significantly higher in the metastatic group. Age and surgicalmargin positivity were independent prognostic factors for overall survival (OS). Surgical margin positivity and lymph nodemetastasis had no effect on disease-free survival (DFS).Conclusions: Our results showed that age and surgical margin positivity were independent prognostic factors for OS.Although surgical margin positivity increased the risk of recurrence in univariate analysis, it was not a significant factoraffecting DFS. OS was significantly lower in patients with lymph node metastasis

Evaluation of occult uterine leiomyosarcomas

Objectives: To determine the frequency of occult uterine leiomyosarcomas following hysterectomies and myomectomies performed for benign reasons at our clinic and to draw comparisons with similar studies in the literature.  Material and methods: All hysterectomies and myomectomies that have been performed for benign reasons at our clinic between 2010 and 2017 were retrospectively examined via the hospital’s information system and the patients that were found to have leiomyosarcomas were analysed. The incidence of occult uterine leiomyosarcoma per 1000 surgeries at our clinic was calculated using the Wilson score interval.  Results: A total of 6,173 hysterectomies were performed, and occult uterine leiomyosarcoma was identified in 5 patients. The incidence of occult uterine leiomyosarcoma was calculated to be 0.08% (95% CI 0.03–0.018%). Only 1 of the 771 patients who underwent myomectomy was identified with occult uterine leiomyosarcoma, making its incidence in myomectomy 0.12% (95% CI 0.02–0.073%). When all the patients are considered, occult uterine leiomyosarcoma was identified in 6 of the 6,944 patients, and the general incidence of occult uterine leiomyosarcoma was calculated as 0.08% (95% CI 0.03–0.018%).  Conclusions: In our study, the incidence of occult uterine sarcoma following myomectomy and hysterectomy was found to be lower than that reported in the literature. The reason for this lower incidence includes not only genetic causes and racial differences but also preoperative imaging, endometrial and cervical sampling that is performed on every patient

Life quality of endometrioid endometrial cancer survivors: a cross-sectional study

Endometrial cancer is the most common gynaecologic malignancy in developed countries with increasing incidence worldwide. A total of 201 patients were enrolled and a cross-sectional study was performed using the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and Female Sexual Functioning Index (FSFI) after the approval by an institutional review board (University of Health Sciences, Tepecik Education and Research Hospital, Turkey, March 13, 2019, Approval no. 2019/4-27). Morbidly obese patients (body mass index (BMI) ≥40 kg/m2) had lower physical functioning scores compared to non-obese (BMI < 30 kg/m2; p = .008) and non-morbidly obese patients (BMI < 40 kg/m2; p = .011). The overall sexual dysfunction rate was high (94.5%). No significant sexual function differences were observed among the study groups.IMPACT STATEMENT What is already known on this subject? Previous efforts to assess the influence of obesity and BMI on endometrial cancer patient quality of life have indicated that obesity adversely affects physical function and the effects of obesity on sexual function remains vague. In addition, the influence of patient age, surgical approach, adjuvant therapy type and time after diagnosis on quality of life and sexual function have not been clearly defined. What do the results of this study add? Increased BMI is associated with impaired physical function in endometrial cancer patients. However, BMI does not appear to affect sexual function in this population. What are the implications of these findings for clinical practice and/or further research? After endometrial cancer treatment, lifestyle interventions aimed at weight loss should be implemented to improve the quality of life

Does ovarian preservation have an effect on recurrence of early stage low-grade endometrial stromal sarcoma?

Surgical treatment of low-grade endometrial stromal sarcoma consists of hysterectomy. The role of oophorectomy is yet to be established. We aimed to examine the effect of preserving the ovaries on the pattern of recurrences in patients with stage I disease. Thirty-four patients with stage I low-grade endometrial stromal sarcoma were retrospectively analysed. Based on ovarian preservation the whole cohort was divided into two groups. Recurrence (liver, lung, groin and bone) was detected in 4 (11.8%) cases. No significant differences in overall survival or disease-free survival (DFS) were observed between the ovarian preservation and bilateral salpingo-oophorectomy (BSO) groups. Subset analysis revealed no significant difference in DFS between the ovarian preservation and BSO groups in the premenopausal arm. And also, the performance of pelvic (n = 2) or para-aortic lymphadenectomy (n = 6) or adjuvant hormonal therapy did not alter DFS significantly. The 5-year DFS rate for the group which received adjuvant radiotherapy was 62.5 and 94.4% for those which did not (p = .014). Preserving the ovaries had no adverse effect on the recurrence of stage I disease.IMPACT STATEMENT What is already known on this subject? Due to the rarity of the disease and the common postoperative diagnosis, only retrospective studies have been reported on low-grade endometrial stromal sarcoma. This disease is commonly diagnosed in premenopausal patients during the early stage. There is no consensus on preserving the ovaries, particularly in young patients, due to the tumour’s hormonal characteristics and the risk of late recurrences. What do the results of this study add? Ovarian preservation had no effect on the recurrence of stage I low-grade endometrial stromal sarcoma. Lymphadenectomy and adjuvant hormonal treatment had no effect on DFS, and adjuvant radiotherapy decreased DFS in the current study. What are the implications of these findings for clinical practice and/or further research? Ovarian preservation should be considered, to prevent the negative effects of surgical menopause, particularly in young patients