Cáncer de vulva

En la actualidad, debido al mayor conocimiento del cuidado de la salud en la población general, empiezan a diagnosticarse tumores en etapas más tempranas y, muchas veces, subclínicos. Basado en que los métodos complementarios de diagnóstico empleados en el preoperatorio de las pacientes con cáncer demuestran poca especificidad para la detección de la invasión linfática, lo que incluye la ecografía, la tomografía computada, la resonancia magnética e incluso la tomografía con emisión de positrones (FDGPET), surge como un avance en la estadificación del cáncer de vulva la biopsia del ganglio centinela. Desde que en los últimos años se introdujo el concepto de cirugía conservadora del órgano, diferentes tumores comenzaron a extirparse con resección local radical, es decir, la extirpación del tumor con un margen de tejido macroscópicamente sano de por lo menos 1 cm en todo su perímetro. En lo referente al manejo quirúrgico de los ganglios, también hubo replanteos. El concepto de la biopsia del ganglio centinela (GC) está basado en dos principios básicos: a) la existencia de un ordenado y predecible patrón de drenaje linfático de un tumor primario a un ganglio regional; b) el funcionamiento de este primer ganglio como filtro efectivo para las células tumorales, siendo éste representativo del resto de los ganglios de la región. Conceptualmente, los ganglios centinelas son predictivos de la red linfática regional y, en teoría, la identificación y su estado histopatológico son utilizados para determinar la extensión de la linfadenectomía. La finalidad de la correcta detección y estudio del ganglio centinela es cumplir con un paso imprescindible en el manejo del cáncer, la estadificación, un eslabón entre el diagnóstico y el tratamiento que nos permite hablar un idioma común, definir la o las modalidades terapéuticas, evaluar resultados y predecir un pronóstico. Lo descripto hasta la actualidad es que el drenaje linfático de la vulva es sistemático y constante, en primera instancia, hacia los ganglios inguinales superficiales, para pasar en una segunda etapa a los ganglios inguinales profundos dentro de la misma área anatómica topográfica, región inguinocrural (triángulo femoral o de Scarpa). Con el advenimiento del estudio del ganglio centinela, se incorpora una nueva modalidad de búsqueda ganglionar y empezamos a hablar del mapeo linfático, o sea, del estudio de áreas anatómicas más extensas, siendo esto posible gracias al empleo de un radiocoloide, tecnecio99, y la linfocentellografía. Se adiciona un colorante vital, azul patente, con la finalidad de darle tinción y reconfirmar que ese fuese realmente el primer ganglio; es decir, empleamos un método combinado para mayor eficacia del procedimiento. En la práctica quirúrgica he constatado, luego de varios mapeos linfáticos en cáncer de vulva, que la región inguinocrural no es la única región a la que puede drenar esta patología.Facultad de Ciencias Médica

Central Pathology Review in SENTIX, a Prospective Observational International Study on Sentinel Lymph Node Biopsy in Patients with Early-Stage Cervical Cancer (ENGOT-CX2)

The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review

Voiding recovery after radical parametrectomy in cervical cancer patients: An international prospective multicentre trial – SENTIX

OBJECTIVE: Voiding dysfunctions represent a leading morbidity after radical hysterectomy performed in patients with early-stage cervical cancer. The aim of this study was to perform ad hoc analysis of factors influencing voiding recovery in SENTIX (SENTinel lymph node biopsy in cervIX cancer) trial. METHODS: The SENTIX trial (47 sites, 18 countries) is a prospective study on sentinel lymph node biopsy without pelvic lymphadenectomy in patients with early-stage cervical cancer. Overall, the data of 300 patients were analysed. Voiding recovery was defined as the number of days from surgery to bladder catheter/epicystostomy removal or to post-voiding urine residuum ≤50 mL. RESULTS: The median voiding recovery time was three days (5th–95th percentile: 0–21): 235 (78.3%) patients recovered in 30 days. In the multivariate analysis, only previous pregnancy (p = 0.033) and type of parametrectomy (p 7 days post-surgery. Type-B parametrectomy was associated with a higher risk of delayed voiding recovery than type-C1 (OR = 4.69; p = 0.023 vs. OR = 3.62; p = 0.052, respectively), followed by type-C2 (OR = 5.84; p = 0.011). Both previous pregnancy and type C2 parametrectomy independently prolonged time to voiding recovery by two days. CONCLUSIONS: Time to voiding recovery is significantly related to previous pregnancy and type of parametrectomy but it is not influenced by surgical approach (open vs minimally invasive), age, or BMI. Type B parametrectomy, without direct visualisation of nerves, was associated with longer recovery than nerve-sparing type C1. Importantly, voiding dysfunctions after radical surgery are temporary, and the majority of the patients recover in less than 30 days, including patients after C2 parametrectomy

Central Pathology Review in SENTIX, a Prospective Observational International Study on Sentinel Lymph Node Biopsy in Patients with Early-Stage Cervical Cancer (ENGOT-CX2)

The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review.status: publishe