Hyperspectral imaging for the in vivo detection of ovarian cancer

Introduction For women diagnosed with advanced-stage epithelial ovarian cancer, complete cytoreductive surgery (CRS) is the most powerful independent parameter for prolonged survival. An intraoperative imaging technique to detect tumor deposits could help achieve complete CRS. Hyperspectral imaging (HSI) provides information on tissue composition, including tissue oxygenation, hemoglobin-, and tissue water and fat indices. In an earlier ex-vivo study it was shown that HSI can be used for ex-vivo tumor detection. Currently, we are evaluating whether HSI can be used in-vivo to distinguish tumor from healthy tissue.Methods HSI data of healthy and tumorous peritoneum, omentum, ovary, and mesentery were obtained in-vivo and preprocessed by image calibration and glare removal. The data were correlated to histopathology and used to train classifiers. The ability to delineate tumorous from healthy tissues was determined using leave-one-out cross-validation.Results A total of 18 images from 12 patients were included. In total 302.258 data points were extracted based on the knowledge of the surgeons and histopathological information. Our data shows that different organs that are affected by ovarian cancer yield different spectra. Additionally, we observe a difference in the spetra of tumor and non-tumor tissue.Conclusion/Implications HSI enables the classification of various tissue types, including tumor and non-tumor tissue. To improve classification outcomes, it is crucial to obtain more data and to make separate groups of healthy and tumorous tissues for each of these tissue types. HSI is a promising technique to differentiate between healthy tissue and ovarian cancer lesions and eventually help surgeons to achieve complete CRS

Small Cell Carcinoma of the Ovary, Hypercalcemic Type (SCCOHT):Patient Characteristics, Treatment, and Outcome—A Systematic Review

Background: Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare aggressive ovarian malignancy mainly affecting children, adolescents, and young adults. Since the discovery of mutations in the SMARCA4 gene in 2014, SCCOHT has become the subject of extensive investigation. However, international uniform treatment guidelines for SCCOHT are lacking and the outcome remains poor. The aim of this systematic review is to generate an overview of all reported patients with SCCOHT from 1990 onwards, describing the clinical presentation, genetic characteristics, treatment, and outcome. Methods: A systematic search was performed in the databases Embase, Medline, Web of Science, and Cochrane for studies that focus on SCCOHT. Patient characteristics and treatment data were extracted from the included studies. Survival was estimated using Kaplan–Meier’s methodology. To assess the difference between survival, the log-rank test was used. To quantify the effect of the FIGO stage, the Cox proportional hazard regression model was estimated. The chi-squared test was used to study the association between the FIGO stage and the surgical procedures. Results: Sixty-seven studies describing a total of 306 patients were included. The median patient age was 25 years (range 1–60 years). The patients mostly presented with non-specific symptoms such as abdominal pain and sometimes showed hypercalcemia and elevated CA-125. A great diversity in the diagnostic work-up and therapeutic approaches was reported. The chemotherapy regimens were very diverse, all containing a platinum-based (cisplatin or carboplatin) backbone. Survival was strongly associated with the FIGO stage at diagnosis. Conclusions: SCCOHT is a rare and aggressive ovarian cancer, with a poor prognosis, and information on adequate treatment for this cancer is lacking. The testing of mutations in SMARCA4 is crucial for an accurate diagnosis and may lead to new treatment options. Harmonization and international collaboration to obtain high-quality data on diagnostic investigations, treatment, and outcome are warranted to be able to develop international treatment guidelines to improve the survival chances of young women with SCCOHT.</p

The lack of clinical value of peritoneal washing cytology in high risk patients undergoing risk-reducing salpingo-oophorectomy: a retrospective study and review

Background: To assess the clinical value of peritoneal washing cytology (PWC) in women with BRCA1 or BRCA2 mutations and women from a family with hereditary breast and/or ovarian cancer (HBOC) undergoing risk-reducing salpingo-oophorectomy (RRSO) in detecting primary peritoneal cancer (PPC) or occult ovarian/fallopian tube cancer. Methods: A retrospective study of patients with known BRCA1 or BRCA2 mutation or HBOC who underwent RRSO at the Erasmus Medical Centre, Rotterdam, The Netherlands between January 2000-2014. Patients with an elevated risk of malignancy prior to the procedure were excluded from primary analysis (elevated CA-125, an ovarian mass, abdominal pain or another gynecological malignancy). A review of the literature was conducted. Results: Of the 471 patients who underwent RRSO, a total of 267 cytology samples were available for analysis. Four samples showed malignant cells, all four patients were diagnosed with ovarian and/or fallopian tube cancer at histologic examination. A fifth patient, of whom no cytology sample was obtained during RRSO, developed primary peritoneal cancer 80 months post RRSO. Conclusions: This study failed to show that cytology is of value during RRSO in detecting primary peritoneal cancer, however 36 % of patients with concomitant ovarian or fallopian tube cancer had positive cytology. Therefore, the routine sampling of peritoneal washings during RRSO is not found to be useful to detect subsequent PPC