Étude comparative randomisée évaluant le prélèvement endocervical au moyen de la curette versus de la brosse pour le diagnostic des dysplasies du col utérin (ÉTUDE CEC)"

Le but de cette étude prospective randomisé est d'évaluer si l'échantillonnage du canal endocervical lors d'une colposcopie peut être effectuée avec une brosse endocervicale à la place d'une curette de Novak, avec la même qualité du prélèvement et une meilleure acceptation de la parte des patientes et médecins. Deux-cent patientes ont été recrutées dans l'unité de colposcopie des Hôpitaux Universitaires de Genève et ont été randomisées à un prélèvement par brosse ou curette. La préférence des médecins effectuant l'évaluation, celle des patientes et la qualité des prélèvements ont été comparés. Les résultats montrent une préférence pour la technique avec la brosse de la part des médecins, associé à une meilleure qualité du prélèvement. Les patientes n'ont pas montré une préférence pour une technique ou l'autre

Dépistage des cancers gynécologiques : quels bénéfices pour les patientes ?

Every day, 5 women are diagnosed with gynecological cancer in Switzerland. Prognosis of ovarian, endometrial and cervical cancer is dependent on early diagnosis. Cervical cancer mortality has decreased since the introduction of screening. Unfortunately, screening in ovarian and endometrial cancer has not shown the same results. On the contrary, patients screened for these cancers have an increased morbidity without any additional benefit of survival. This article presents a review of the clinical benefits and harms of gynecological cancer screening

Successful in vivo retrieval of oocytes after ovarian stimulation for fertility preservation before oophorectomy by laparotomy for a young patient with ovarian cancer: Case report and review of literature

Objective: To report a case of direct in vivo oocytes retrieval for fertility preservation before oophorectomy by open surgery in a young patient with ovarian cancer. Design: case report and literature review. Setting: University hospital. Patients: A 29-year-old nulliparous patient, recently diagnosed with low grade serous ovarian carcinoma.The patient consented to the removal of her remaining ovary but wished to preserve oocytes and declined hysterectomy. Conventional trans-vaginal US-guided oocyte retrieval was contra-indicated because of the risk of malignant cell dissemination to the abdomen and the vaginal puncture sites. Interventions: Controlled ovarian stimulation with gonadotrophins was realized. Comprehensive surgical staging was performed 35 h after ovulation triggering using rHCG. The oocytes retrieval was performed in vivo with ultrasound guidance at time of laparotomy before oophorectomy without any time of ischemia. Results: Seven mature oocytes were obtained and vitrified. Conclusions: This case highlights the feasibility of in vivo oocytes retrieval of mature oocytes during open surgery for gynecologic cancers. By avoiding transvaginal follicular retrieval, the risk of malignant cell contamination to vaginal and parametrial tissues is reduced, limiting cancer upstaging

Laparoscopic management of giant ovarian cysts using the alexis laparoscopic system®: a case series

Objective: The aim of this study was to review the characteristics of patients who underwent laparoscopic removal of giant ovarian cysts using the Alexis Laparoscopic System® and confirm the safety and feasibility of this technique. Method: We conducted a retrospective review of data of women undergoing the procedure from March 2014 to February 2019. Inclusion criteria were ovarian cysts of at least 15 cm. Exclusion criteria were the presence of solid components and suspicion of neoplasia on imaging. Results: Six patients were included in the series. Median size of the cysts at imaging was 22.8 cm (range 15-30 cm), while median volume was 5.9 L (range 1.9-15.6 L). Mean age of operated women was 59 years (range 21-88 years). All patients underwent exclusive laparoscopic management except one patient who underwent a conversion into midline laparotomy. The size of the skin incision initially performed to puncture the cyst ranged from 2.5 to 4 cm. On final pathological reports, two cysts were mucinous cystadenomas, and four were serous cystadenomas. There was no epithelial ovarian cancer or borderline tumor in any of the specimen operated. Conclusion: Laparoscopic management of giant ovarian cysts using the Alexis Laparoscopic System® is safe and feasible in well-selected cases. Midline laparotomy can thus be avoided, decreasing the risk of post-operative complications and increasing quality of life of patients

Self-sampling to improve cervical cancer screening coverage in Switzerland: a randomised controlled trial

The aim of this study is to evaluate whether self-sampling can increase screening attendance of women who do not attend regular screening in Switzerland

Self-sampling to improve cervical cancer screening coverage in Switzerland ::a randomised controlled trial

Background: The aim of this study is to evaluate whether self-sampling can increase screening attendance of women who do not attend regular screening in Switzerland. Methods: Participants were proactively recruited in Geneva between September 2011 and November 2015. Women (25–69 years) who had not undergone CC screening in the last 3 years were considered eligible. Through a 1 : 1 ratio randomisation, enrolled participants were invited to either undergo liquid-based cytology, which was performed by a health-care provider (control group, CG) or to take a self-sample for HPV-testing, which was mailed to their home (intervention group, IG). Results: A total of 331 and 336 women were randomised in the CG and in the IG, respectively. Overall, 7.3% (95% CI: 4.9–10.6) women in the CG and 5.7% (95% CI: 3.6–8.7) women in the IG did not undergo the initial screening (P=0.400). There were 1.95% (95% CI: 0.8–4.3) women in the CG and 5.05% (95% CI: 3.1–8.1) women in the IG with a positive screen who did not attend triage and colposcopy (P=0.036). Conclusions: The participation in CC screening in women offered self-sampling was not higher than among those offered specimen collection by a clinician. Compliance with further follow-up for women with a positive HPV test on the self-sample requires further attention

In Ovo Progression of Borderline Ovarian Tumors

Objective: Borderline ovarian tumors (BOTs) are generally considered to be non-invasive tumors with low malignancy potential. However, studies show that BOTs have the ability to progress to low-grade carcinomas and gain the potential to invade surrounding tissue and to metastasize. Here, we investigate whether a patient derived serous BOT (SBOT) could progress in low-grade serous carcinoma (LGSC) through in vitro and in ovo characterization. Methods: Ovarian cancer cell line from a SBOT, named OCAM, were isolated and characterized by PCR, migration assay and chick chorioallantoic membrane (CAM) assay. Results: OCAM cells express carcinoma characteristics and form a tumor in CAM. Moreover, OCAM cells get into membrane of chicken suggesting invasive properties. Conclusion: SBOTs could a precursor of LGSC involving consequences in adaptation of treatment provided by clinician

Early-stage cervical cancer: is surgery better than radiotherapy?

Patients with early-stage cervical cancer may be treated appropriately with either radical surgery or radiation therapy. As most patients will be cured of their disease, side-effects of therapy and quality of life become of great importance. Individualization of treatment to reduce therapy-associated morbidity should be the main goal in cervical cancer management. Recent developments in surgical techniques, such as laparoscopy, nerve-sparing radical hysterectomy, sentinel lymph node biopsy, trachelectomy and 'less radical' hysterectomy, have contributed to reduce the morbidity of the surgical treatment. The use of postoperative radiotherapy or chemoradiation leads to more pronounced side effects than after either surgery or irradiation alone. Therefore, prognostic factors should be used to select patients for either surgery or radiotherapy alone to minimize the increased toxicities associated with the combination. The objectives of this review are to discuss the evidence supporting radical surgery, 'less radical' surgery and radiotherapy with regard to complication rate and quality of life

Is imaging relevant for treatment choice in early stage cervical uterine cancer?

Improvement in the selection of patients with early cervical cancer eligible for different therapeutic options is expected from imaging