Carbonic anhydrase IX (CA-IX) and high-risk human papillomavirus (H-HPV) as diagnostic biomarkers of cervical dysplasia/neoplasia in Japanese women with a cytologic diagnosis of atypical glandular cells (AGC): a Gynecologic Oncology Group (GOG) Study

BackgroundHigh-risk human papillomavirus (H-HPV) infection is linked to cervical neoplasia but its role in detecting cervical glandular lesions (GLs) is unclear. Carbonic anhydrase IX (CA-IX) is a hypoxic biomarker that is highly expressed in neoplastic cervical GLs. The diagnostic utility of these biomarkers was evaluated by the Gynecologic Oncology Group in Japanese women with a cytological diagnosis of atypical glandular cells.MethodsImmunostaining was used to detect CA-IX in a conventional Pap smear. Immunoreactivity of CA-IX was interpreted by a panel of pathologists blinded to the histological diagnosis. Polymerase chain reaction was used to detect H-HPV in a liquid-based cytology specimen.ResultsSignificant cervical lesions (SCLs), defined as cervical intraepithelial neoplasia (CIN2, CIN3), adenocarcinoma in situ or invasive carcinoma, were observed in 37/88 (42%) of women. CA-IX testing alone (n=88) had a sensitivity of 89, 100 or 73% for SCLs, GLs or significant squamous lesions (SLs), respectively, with a false negative rate (FNR) of 14%. Testing for H-HPV (n=84) had a sensitivity of 65, 53 or 80% for SCLs, GLs or SLs, respectively, with a FNR of 22%. The combination of CA-IX and H-HPV testing had a sensitivity of 97, 100 or 93% for SCLs, GLs or SLs, respectively, with a FNR of 5%. Among eight H-HPV-negative GLs, six (75%) had a diagnosis of lobular endocervical glandular hyperplasia (LEGH).ConclusionThe combination of CA-IX and HPV testing improved the diagnostic accuracy. The low rate of H-HPV positivity in the GLs was associated with coexisting LEGH independent of H-HPV

The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

The aim of the study is to determine the role of lymphadenectomy in advanced epithelial ovarian cancer. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) program reported between 1988 and 2001. Kaplan–Meier estimates and Cox proportional hazards regression models were used for analysis. Of 13 918 women with stage III–IV epithelial ovarian cancer (median age: 64 years), 87.9% were Caucasian, 5.6% African Americans, and 4.4% Asians. A total of 4260 (30.6%) underwent lymph node dissections with a median number of six nodes reported. For all patients, a more extensive lymph node dissection (0, 1, 2–5, 6–10, 11–20, and >20 nodes) was associated with an improved 5-year disease-specific survival of 26.1, 35.2, 42.6, 48.4, 47.5, and 47.8%, respectively (P<0.001). Of the stage IIIC patients with nodal metastases, the extent of nodal resection (1, 2–5, 6–10, 11–20, and >20 nodes) was associated with improved survivals of 36.9, 45.0, 47.8, 48.7, and 51.1%, respectively (P=0.023). On multivariate analysis, the extent of lymph node dissection and number of positive nodes were significant independent prognosticators after adjusting for age, year at diagnosis, stage, and grade of disease. The extent of lymphadenectomy is associated with an improved disease-specific survival of women with advanced epithelial ovarian cancer

Lymphatic Mapping and Sentinel Lymph Node Biopsy in Women With Squamous Cell Carcinoma of the Vulva: A Gynecologic Oncology Group Study

To determine the safety of sentinel lymph node biopsy as a replacement for inguinal femoral lymphadenectomy in selected women with vulvar cancer

Is bilateral lymphadenectomy for midline squamous carcinoma of the vulva always necessary? An analysis from Gynecologic Oncology Group (GOG) 173

To determine which patients with near midline lesions may safely undergo unilateral groin dissection based on clinical exam and lymphoscintigraphy (LSG) results

59 Prognosis of cervical cancer when diagnosed during pregnancy

Objectives: Cervical cancer (CC) occurs in 0.1–12 per 10,000 pregnancies. Management of these patients is largely based on case reports and expert opinion. While data suggests that pregnancy does not adversely affect oncologic outcomes, timing and treatment modality are often impacted by pregnancy. In non-pregnant patients diagnosed with CC the mean reported recurrence rate is 5–10%. We report treatment patterns as well as obstetric and oncologic outcomes in patients undergoing treatment for CC in pregnancy. Methods: Following IRB approval, a retrospective review of all patients with cervical cancer during pregnancy who delivered at our institution between 2009 and 2023 was performed. Data on demographics, histology, stage, treatment, obstetric and oncologic outcomes were analyzed using descriptive statistics. Results: We identified 19 patients who met the inclusion criteria. Mean age at diagnosis was 30.6 years, mean parity was 2.2 (range 0–5). The majority (79%) identified as Hispanic, 10.5 % as black and 10.5% as non-Hispanic white. One patient was diagnosed prior to pregnancy, 10 (53%) were diagnosed prior to 20 weeks and 8 (42%) after 20 weeks gestation. Seventeen patients were diagnosed with stage I disease, one patient with stage II and one patient with stage III. Fourteen patients delivered viable infants at an average gestational age of 37w3d. Cancer was the most common indication for delivery (57%) and 43% delivered for OB indications. Sixteen of 19 patients were treated during pregnancy or at delivery, 5 were treated prior to EGA <22 weeks. 15/17 stage I CC patients were treated withradical hysterectomy, one was treated with LEEP in pregnancy and laparoscopic hysterectomy after delivery and one was treated with postpartum pelvic radiation. Patients with stage II and III CC were treated with chemoradiation. 15/19 patients are NED at median FU of 33 months. Four of 19 (21%) patients had disease recurrence. 18% (3/17) with stage I disease recurred. Two patients died of disease. Conclusions: Cervical cancer recurrence rates are significantly worse in patients with cancer during pregnancy, despite most patients presenting with stage I disease