scholarly journals Occult parametrial metastasis in operable cancer cervix: is a routine radical hysterectomy justified?

2017 ◽  
Vol 6 (7) ◽  
pp. 2867
Author(s):  
Tony Jose ◽  
Sushil Chawla ◽  
Atul Seth
Keyword(s):  
Risk Factors ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Frozen Section ◽  
Significant Risk ◽  
Pelvic Lymphadenectomy ◽  
Low Risk ◽  
Type I ◽  
Tumor Diameter ◽  
Radical Procedure

Background: Operable Ca cervix is treated by a Type III Radical hysterectomy(RH) with pelvic lymphadenectomy and comprises of a complex parametrial resection (PR) due to the possibility of occult parametrial metastasis(OPM) leading to high post-operative and delayed morbidity especially after adjuvant radiotherapy(RT). If risk factors for OPM were known, a less radical procedure could be performed in low risk patients thus minimizing the morbidity.Methods: A retrospective study was carried out to evaluate the incidence of OPM in operated patients and to study the risk factors associated with OPM and explore the theoretical feasibility of doing a type I hysterectomy in low risk patients.Results: The incidence of OPM was 16.1% in all stages (0% in IA, 10.71% in IB1, 33.3% in Stage IB2 and 18.8 % in IIA1). Primary tumor diameter (PTD) and LNM were the most statistically significant risk factors for OPM. 90% of patients with OPM also had lymph node metastasis (LNM). In this study, all patients with OPM had other risk factors for adjuvant treatment.Conclusions: Small size early stage tumors may be considered for less radical surgery in the absence of obvious intermediate risk factors. A node dissection with negative frozen section during surgery can finally select patients for a simple hysterectomy(SH). More evidence from randomized trials are needed to evaluate the oncological safety of a less radical procedure and define the type of surgery to be done.

Comparison of the Prognoses of FIGO Stage I to Stage II Adenosquamous Carcinoma and Adenocarcinoma of the Uterine Cervix Treated With Radical Hysterectomy

2012 ◽  
Vol 22 (8) ◽  
pp. 1389-1397 ◽  
Author(s):  
Seiji Mabuchi ◽  
Mika Okazawa ◽  
Yasuto Kinose ◽  
Koji Matsuo ◽  
Masateru Fujiwara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
High Risk ◽  
Uterine Cervix ◽  
Radical Hysterectomy ◽  
Adenosquamous Carcinoma ◽  
Early Stage ◽  
Univariate Analysis ◽  
Low Risk ◽  
Histological Subtype

ObjectivesTo evaluate the significance of adenosquamous carcinoma (ASC) compared with adenocarcinoma (AC) in the survival of surgically treated early-stage cervical cancer.MethodsWe retrospectively reviewed the medical records of 163 patients with International Federation of Gynecology and Obstetrics stage IA2 to stage IIB cervical cancer who had been treated with radical hysterectomy with or without adjuvant radiotherapy between January 1998 and December 2008. The patients were classified according to the following: (1) histological subtype (ASC group or AC group) and (2) pathological risk factors (low-risk or intermediate/high-risk group). Survival was evaluated using the Kaplan-Meier method and compared using the log-rank test. Multivariate analysis of progression-free survival (PFS) was performed using the Cox proportional hazards regression model to investigate the prognostic significance of histological subtype.ResultsClinicopathological characteristics were similar between the ASC and AC histology groups. Patients with the ASC histology displayed a PFS rate similar to that of the patients with the AC histology in both the low-risk and intermediate/high-risk groups. Neither the recurrence rate nor the pattern of recurrence differed between the ASC group and the AC group. Univariate analysis revealed that patients with pelvic lymph node metastasis and parametrial invasion achieved significantly shorter PFS than those without these risk factors.ConclusionsCharacteristics of the patients and the tumors as well as survival outcomes of ASC were comparable to adenocarcinoma of early-stage uterine cervix treated with radical hysterectomy. Our results in part support that the management of ASC could be the same as the one of AC of the uterine cervix.

Surgical and Pathological Outcomes of Laparoscopic Versus Abdominal Radical Hysterectomy With Pelvic Lymphadenectomy and/or Para-aortic Lymph Node Sampling for Bulky Early-Stage Cervical Cancer

2017 ◽  
Vol 27 (6) ◽  
pp. 1222-1227 ◽  
Author(s):  
Tao Zhu ◽  
Xi Chen ◽  
Jianqing Zhu ◽  
Yaqing Chen ◽  
Aijun Yu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Tumor Diameter ◽  
Laparoscopic Radical Hysterectomy ◽  
Lymph Node Sampling ◽  
Aortic Lymph Node ◽  
Early Stage Cervical Cancer

Background and ObjectivesThe aim of this study was to compare the feasibility, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (LRH) with those of abdominal radical hysterectomy (ARH) for bulky early-stage cervical cancer.MethodsWe performed a retrospective cohort study of 112 patients with stage IB1 or IIA2 cervical cancer in which the tumor diameter was 3 cm or greater. All patients underwent LRH (n = 30) or ARH (n = 82) with pelvic lymphadenectomy and/or para-aortic lymph node sampling between May 2011 and November 2014. Perioperative outcomes were compared between the 2 surgical groups.ResultsThe laparoscopic approach consisted of 4 trocar insertions. Age, tumor diameter, and pelvic lymph nodes significantly differed between the 2 cohorts. Body mass index, International Federation of Gynecology and Obstetrics stage, histologic type and grade, deep stromal invasion, lymphovascular space invasion, positive margins, and adjuvant therapy were not significantly different between the 2 cohorts. Laparoscopic radical hysterectomy exhibited favorable results compared with ARH in terms of operating time, blood loss, intestinal exhaust time, and length of hospital stay. In addition, recurrence was observed in 5 LRH patients (16.7%) and 9 ARH patients (11.7%).ConclusionsThe surgical outcomes of LRH with pelvic lymphadenectomy and/or para-aortic lymph node sampling exhibited a similar therapeutic efficacy to those of the ARH approach.

scholarly journals Factors associated with misdiagnosis of frozen section of mucinous borderline ovarian tumor

2018 ◽  
Vol 47 (1) ◽  
pp. 96-104 ◽  
Author(s):  
Wen Zhang ◽  
Shuangzheng Jia ◽  
Yang Xiang ◽  
Junjun Yang ◽  
Congwei Jia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Frozen Section ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Diagnostic Value ◽  
Ovarian Tumors ◽  
Borderline Ovarian Tumor ◽  
Tumor Diameter ◽  
Pathological Features ◽  
Cancer Antigen 125

Objective This study was performed to investigate the diagnostic accuracy of frozen section (FS) of mucinous borderline ovarian tumors (mBOTs) and the diagnostic value of various risk factors for misdiagnosis. Methods Patients with either an FS or permanent pathologic diagnosis of mBOT were included. Optimum cut-off values for serum tumor markers and maximal tumor diameter were determined, and risk factors for underdiagnosis of mucinous malignant ovarian tumors (mMOTs) were evaluated. The sensitivity, specificity, Youden’s index, and diagnostic odds ratio of the risk factors were assessed to determine their diagnostic value for mMOTs. Results Of 121 included patients, 97 were diagnosed with mBOTs by FS. Relatively abnormal cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) levels; bilateral tumors; and specific pathological features showed significant associations with underdiagnosis of mMOTs in the univariate analysis. The presence of specific pathological features was the only significant risk factor in the multivariate analysis. The CA125, CA19-9, and CEA levels and specific pathological features demonstrated certain diagnostic value in detecting malignant cases among FS-diagnosed mBOTs. Conclusions In patients with FS-diagnosed mBOT, significant predictors of malignancy were relatively higher CA125, CA19-9, and CEA levels; bilateral tumors; and tumors with specific pathological features.

scholarly journals Results from Survey to Assess Current Trends in Surgical Practice in the Management of Women with Early Stage Cervical Cancer within the BGCS Community with an Emphasis on Routine Frozen Section Examination

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Kumar Gubbala ◽  
Alexandros Laios ◽  
Thulumuru Kavitha Madhuri ◽  
Pubudu Pathiraja ◽  
Krishnayan Haldar ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Frozen Section ◽  
Pelvic Lymphadenectomy ◽  
Frozen Section Examination ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Early Cervical Cancer ◽  
The Uk

In the UK, more than 3,200 new cases of cervical cancer are diagnosed each year. Early stage cervical cancer (IA2-IB1) treatment comprises central surgery mainly in the form of radical hysterectomy or fertility sparing surgery including trachelectomy as well as systematic pelvic lymphadenectomy to detect metastases and adjust treatment accordingly. Given the variation in determining the lymph node (LN) status, a major prognosticator, we reviewed the current UK practice of LN assessment in women undergoing surgery for early cervical cancer. A 7-question, web-based survey, screened by the BGCS committee, was circulated amongst BGCS members. The overall response rate was 51%. Only 12.5% of the respondents routinely performed frozen section examination (FSE); the main reasons for not doing FSE were the pressure on theatre time (54.5%) and the lack of available facilities (48.5%). When positive pelvic nodal disease was detected, in 21 out of 50 (42%) the planned radical hysterectomy (RH) was aborted. More than 70% of the respondents routinely performed RH without any prior resort to pelvic lymphadenectomy. Pretreatment surgical para-aortic LN assessment was performed by 20% of the respondents. The survey confirms the diversity of the UK practice patterns in the surgical treatment of early cervical cancer.

Combination of sentinel lymph node mapping and uterine frozen section examination to reduce side-specific lymphadenectomy rate in endometrial cancer: a Turkish Gynecologic Oncology Group study (TRSGO-SLN-002)

2020 ◽  
Vol 30 (7) ◽  
pp. 1005-1011
Author(s):  
Duygu Altin ◽  
Salih Taşkın ◽  
Ilker Kahramanoglu ◽  
Dogan Vatansever ◽  
Nedim Tokgozoglu ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Frozen Section ◽  
Myometrial Invasion ◽  
Pelvic Lymphadenectomy ◽  
Low Risk ◽  
Tumor Diameter ◽  
Diagnostic Efficacy ◽  
Frozen Section Examination

ObjectiveThis study aimed to find out whether side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy according to “reflex frozen section” analysis of the uterus in case of sentinel lymph node (SLN) mapping failure.MethodsPatients who underwent surgery for endometrial cancer with an SLN algorithm were stratified as low-risk or high-risk according to the uterine features on the final pathology reports. Two models for low-risk patients were defined to omit side-specific pelvic lymphadenectomy: strategy A included patients with endometrioid histology, grade 1–2, and <50% myometrial invasion irrespective of the tumor diameter; strategy B included all factors of strategy A with the addition of tumor diameter ≤2 cm. Theoretical side-specific pelvic lymphadenectomy rates were calculated for the two strategies, assuming side-specific pelvic lymphadenectomy was omitted if low-risk features were present on reflex uterine frozen examination, and compared with the standard National Comprehensive Cancer Network (NCCN) SLN algorithm.Results372 endometrial cancer patients were analyzed. 230 patients (61.8%) had endometrioid grade 1 or 2 tumors with <50% myometrial invasion (strategy A), and in 123 (53.4%) of these patients the tumor diameter was ≤2 cm (strategy B); 8 (3.5%) of the 230 cases had lymphatic metastasis. None of them were detected by side-specific pelvic lymphadenectomy and metastases were limited to SLNs in 7 patients. At least one pelvic side was not mapped in 107 (28.8%) cases in the entire cohort, and all of these cases would require a side-specific pelvic lymphadenectomy based on the NCCN SLN algorithm. This rate could have been significantly decreased to 11.8% and 19.4% by applying reflex frozen section examination of the uterus using strategy A and strategy B, respectively.ConclusionReflex frozen section examination of the uterus can be a feasible option to decide whether side-specific pelvic lymphadenectomy is necessary for all the patients who failed to map with an SLN algorithm. If low-risk factors are found on frozen section examination, side-specific pelvic lymphadenectomy can be omitted without compromising diagnostic efficacy for lymphatic spread.

scholarly journals Risk Factors for Pelvic Lymph Node Metastasis and Recurrence in Patients Undergoing Radical Hysterectomy for Cervical Cancer

2021 ◽  
Author(s):  
Xinmei Wang ◽  
Hongyuan Zhang ◽  
Juan Xu ◽  
Pengpeng Qu
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Figo Stage ◽  
Pelvic Lymphadenectomy ◽  
Tumor Diameter ◽  
Preoperative Hemoglobin ◽  
Node Metastasis ◽  
Pelvic Lymph Node Metastasis ◽  
Preoperative Hemoglobin Level

Abstract Background: Radical hysterectomy and bilateral pelvic lymphadenectomy are standard treatments for early-stage cervical cancer. Pelvic lymph node metastasis (PLNM) is one of the critical factors affecting the postoperative prognosis of patients. Therefore, the identification of preoperative risk factors for PLNM will minimize its occurrence and improve prognosis. The purpose of this study was to investigate the risk factors for PLNM and its recurrence in patients undergoing radical hysterectomy for cervical cancer.Methods: Medical records of 245 patients who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment for the International Federation of Gynaecology and Obstetrics (FIGO) stage IA-IIA cervical cancer between January 2010 and December 2015 at our hospital were reviewed. Age, FIGO stage, preoperative hemoglobin level, depth of stromal invasion, lymphovascular space invasion (LVSI), human papillomavirus(HPV) infection, parametrial infiltration, tumor diameter, number of lymphadenectomies, and pathological type were retrospectively analyzed. All patients were followed up for 5–10 years.Results: Among the 245 patients, 185 (75.51%) had no PLNM, whereas 60 (24.49%) had PLNM. Preoperative hemoglobin level, FIGO stage, LVSI, parametrial infiltration, and tumor diameter differed significantly between the two groups (P<0.05). Multivariate analysis revealed preoperative hemoglobin <110 g/L, FIGO stage II, LVSI, parametrial infiltration, and tumor diameter ≥4 cm as significant risk factors for PLNM and recurrence of cervical cancer after surgery (P<0.05). PLNM was identified as the independent risk factor for recurrence in patients with cervical cancer after surgery (P<0.05).Conclusions: PLNM is an important prognostic indicator for the clinical treatment of cervical cancer. Patients at a high risk of recurrence, especially PLNM patients, should be followed up closely after surgery to ensure the timely detection of recurrence and treatment.

Papillomaviral infection and cervical diseases in pregnant women. Risk factors of social status, reproductive and contraceptive behavior

GYNECOLOGY ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 74-79
Author(s):  
Tamara N. Bebneva ◽  
Galina B. Dikke
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Social Status ◽  
Significant Risk ◽  
Hpv Infection ◽  
Low Risk ◽  
Contraceptive Behavior ◽  
Regular Screening ◽  
History Of ◽  
Cervical Diseases

Aim. To determine the risk factors for human papillomavirus of high carcinogenic risk (HPV HCR) and cervical diseases (CD) in pregnant women associated with the social status, reproductive and contraceptive behavior. Materials and methods. Design: open-label comparative non-interventional cohort study in parallel groups. The total number of patients 330 people, of whom 148 women were negative for HPV and 182 women were positive. They were divided into 4 groups depending on the presence or absence of CD. Methods: analysis of anamnesis data, general clinical, test Kvant-21 to determine HPV, cytological examination, extended colposcopy. Results. The most significant risk factors for HPV HRS infection were identified: history of mycoplasma infection (OR 5.9) and BV (OR 5.3), alcohol consumption (OR 4.0). A history of STIs (trichomoniasis and chlamydial infection), as well as more than 3 sexual partners (OR 2.7) were also significant. The most significant risk factors for CD in HPV-infected women were: age over 35 years (OR 3.8), a history of bacterial vaginosis (OR 3.0), and lack of regular screening (OR 2.4). The coitarche earlier than 16 years old (OR 2.2) also mattered. There were also found factors indicating a low risk of HPV infection the use of condoms (OR 0.3), and a low risk of CD was indicated by age under 25 years (OR 0.2) and regular screening (OR 0.3). Conclusion. HPV infection with HRS and the prevalence of CMC in pregnant women against the background of HPV infection is associated mainly with social risk factors, to a lesser extent with factors of reproductive and contraceptive behavior.

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