Computed tomography as a predictor of the extent of the disease and surgical outcomes in ovarian cancer

Objectives: The aim of the present study is to determine the predictive value of Computed Tomography (CT), alone or in combination with serum CA-125 levels, for preoperative staging, detection of the extent of the disease, and surgical complications in patients with ovarian carcinoma. Material and methods: One hundred and fourteen patients diagnosed with ovarian carcinoma following an exploratory laparotomy with a preoperative CT scan, performed between January 2007 and June 2013, were enrolled in the study. Preoperative CT and intraoperative surgical findings were compared using 14 parameters and predictions of CT for gas­trointestinal, genitourinary, and cardiovascular complications. All radiological features and clinical characteristics were analyzed statistically. Results: CT and surgical findings correlated (sensitivity/ specificity) as follows: uterine and tubal spread (66%/89%), cervical involvement (100%/80%), peritoneal nodulesincreased density-carcinomatosis (57%/93%), omental involvement (68%/95%), retroperitoneal involvement (25%/84%), ascites (85%/87%), perirectal and perivesical fat plan obliteration (43%/94%), liver metastasis (50%/91%), small and large bowel involvement (47%/95%), adnexal mass (94%/70%), and other metastases (47%/86%). Also, CT findings were found to be statistically insignificant for prediction of mesenteric involvement, bladder metastasis, and diaphragmatic involvement. The overall CT sensitivity and specificity at detecting intraoperative findings was 91% and 71%, respectively. We found a statistically significant correlation between intestinal involvement on CT and the necessity of additional surgical procedures. Conclusions: CT is a widely used imaging method in the preoperative evaluation of ovarian cancer. However, its predictive value, sensitivity and specificity differ, depending on the anatomical region

Therapeutic efficacy of dilatation and curettage in endometrial polyps: is it a valuable method?

Rezumat. Efi cacitatea terapeutică a dilatării și chiuretajului în polipii endometriali. Studiul a fost efectuat în perioada iunie 2008 – martie 2011, la Spitalul de Educaţie și Cercetare Ataturk din Izmir, Turcia. 36 de femei cu sângerare uterină anormală, care au suferit o dilatare și chiuretaj și la care evaluarea histopatologica a diagnosticat polip endometrial, au fost incluse în studiu. Toate pacientele au suportat histeroscopie imediat după menstruaţie. Au fost evaluate rezultatele şi ratele. Nouă (25%) dintre paciente au fost vindecate prin dilatare și chiuretaj și 27 (75%) au fost tratate cu succes prin histeroscopie. Diagnosticul a fost dovedit, polipii fiind eliminaţi prin histeroscopie de birou. În caz de hemoragii uterine anormale, cum ar fi polipul endometrial, histeroscopia de birou este o metodă mult mai utilă decât dilatarea și chiuretajul, pentru că este o metodă simplă prin care pacientul poate fi tratat la momentul diagnosticării.Резюме. Терапевтическая эффективность расширения и кюретажа в эндометрических полипах: действительно ли это ценный метод? Исследование проводилось с июня 2008 до марта 2011 года в Измир Ататюрк учебной и научной больнице, отделение гинекологии и акушерской помощи, Измир, Турция. Тридцать шесть женщин с аномальными маточными кровотечениями, которые прошли диагностическое выскабливание и у которых был поставлен диагноз полип эндометрия, были включены в исследование. Всем пациенткам проводилась амбулаторно-офисная гистероскопия сразу же после их очередной менструации. Результаты диагностического выскабливания и гистероскопии были оценены. Девять (25%) пациенток могут быть полностью вылечены при помощи диагностического выскабливания и 27 (75%) пациенток были успешно пролечены офисной гистероскопией. Диагноз был гистологически доказан, а полипы были удалены посредством офисной гистероскопии. В случаях патологии матки, которые вызывают аномальные кровотечения, как полип эндометрия, офисная гистероскопия является более полезной, чем метод диагностического выскабливания, потому, что это простой метод, который позволяет лечить пациента на момент постановки диагноза

The impact of uterine adenomyosis on the histopathological risk factors and survival in patients with endometrial adenocarcinoma

A retrospective cohort study was performed on patients diagnosed with endometrial adenocarcinoma (EC) during a 9-year period to investigate the impact of co-existing adenomyosis on patients with EC. Group A included women with EC and adenomyosis and Group B EC cases without the presence of adenomyosis. Group A was more likely to have early-stage disease, tumours without deep myometrial invasion, low-grade tumours and tumours with negative lymphovascular space invasion when compared to Group B (p = 0.012, p = 0.004, p < 0.001, p = 0.02). There were no statistically significant difference between Group A and Group B for lymph node metastasis (p = 0.064). There was no significant relation between the adenomyosis and survival outcomes in the multivariant analysis (p = 0.437). As a conclusion, patients with adenomyosis were more likely to accompany good histopathologic prognostic factors. Multivariate analysis showed no significant effect of adenomyosis on recurrence and survival parameters.IMPACT STATEMENT What is already known on this subject? Adenomyosis is one of the most common accompanying benign histopathological findings of type 1 endometrial carcinomas (EC). Adenomyosis comprises some characteristics similar to malignant tumours, such as invasion, abnormal tissue growth and angiogenesis. Despite concerns have arisen due to both their high incidence and similar molecular links, the possible relation between EC and adenomyosis is still not well grounded. What the results of this study add? We presented a 9-year period retrospective cohort of a tertiary referring single centre and evaluated the prognostic effect of adenomyosis in patients with EC as well as the survival outcomes of these patients. The co-occurrence of adenomyosis was more likely to accompany early-stage (stages 1–2) disease, low-grade tumours (grades 1–2) and tumours with negative LVSI in patients with EC. However, multivariate and survival analysis showed no significant effect of adenomyosis on recurrence and survival parameters. What the implications are of these findings for clinical practice and/or further research? Based on these findings, we suggest that the presence of adenomyosis should not be considered as a prognostic factor in EC. Our results support the overriding opinion about the prognostic value of co-occurrence of adenomyosis and EC. However, further studies exploring the molecular and genomic markers in these two groups are needed to uncover the exact relation of adenomyosis on the prognosis of EC

Lymph Node Involvement in Endometrial Cancer

Objectives: The aim of this study was to evaluate the outcome of pelvic and/or para-aortic lymph node dissection in patients with endometrial cancer with regard to lymph node positivity.Materials and Methods: Retrospective chart review of 125 women with pathologically proven endometrial carcinoma who underwent a systematic surgical staging including lymphadenectomy between January 2006 and January 2011 was performed. Patients’ characteristics, histological findings, lymph node localization and involvement were analyzed. Detailed description of the extirpated and affected lymph nodes divided by area in the 125 patients with endometrial cancer were done.Results: The medical records for 125 patients were eligible for analysis. The mean number of all lymph nodes removed in operation was 38.9±14.194 (range 9 to 81 nodes). The mean number of pelvic lymph nodes (PLN) removed was 32±11.747 (range 9 to 75 nodes) and the mean number of para-aortic lymph nodes (PALN) removed was 7±5.123 (range 0 to 20 nodes). In the 24 patients with nodal metastasis, the mean number of all lymph nodes removed was 37.88±17.501 (range 9 to 81 nodes). The mean number of PLNs removed was 30.71±14.79 (range 9 to 66 nodes) and the mean number of PALNs removed was 7.17±4.198 (range 0 to 16 nodes).Nodal metastasis was shown in 24 (19.2%) patients. Isolated pelvic lymph node metastasis was shown in nine (37%) patients; isolated para-aortic lymph node metastasis was shown in one (4%) patient; both pelvic and para-aortic lymph node metastasis was shown in 14 (59%) patients. The most affected lymph node area was left external iliac artery with a ratio of 14%.Conclusions: In the field of gynecologic cancer surgery, for the determination of adequate number of lymph nodes to be retrieved, lymph node mapping plays a crucial role, and this issue should be investigated in studies performed with larger number of cases in order to standardize procedure of lymphadenectomy