scholarly journals Clinically Significant Discrepancy between Clinical and Pathologic Stage of Early Operable Cervical Cancer

2020 ◽  
pp. 1-5
Author(s):  
Jennifer McEachron ◽  
Constantine Gorelick ◽  
Jennifer McEachron ◽  
Katherine Economos ◽  
Margaux J. Kanis ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Final Analysis ◽  
Obese Patients ◽  
Significant Discrepancy ◽  
Local Extension ◽  
Mean Error ◽  
Parametrial Invasion ◽  
Significant Difference ◽  
The Mean ◽  
Clinically Significant

Objectives: The cornerstone of the management of cervical cancer (CC) traditionally relies on clinical examination (CE) of tumor size (TS) and local extension of disease. The goal of this study is to determine the accuracy of CE in comparison to final pathology (FP) in early operable CC. Methods: This is a multi-center retrospective review of patients with early CC (FIGO 2009 Stage IB1, IIA1). CE of TS, parametrial invasion (PI), and vaginal involvement (VI) were compared to FP. Results: The final analysis included 135 patients. Overall, there was a significant difference between CE of TS compared to FP; mean error of 1.22 cm (p<0.0001). In tumors  2cm the mean error was 1.28 cm (p<0.0001). No significant discrepancy was observed in tumors <2 cm (mean error: 1.10cm; p=0.5). CE of TS of endophytic tumors was poor (mean error 1.68cm; p=0.004) compared to exophytic tumors (mean error: 1.12 cm; p=0.693). There was no significant difference in the identification of VI between CE and FP (3.7% vs. 8.89%; p=0.067). 14.07% of patients were found to have PI on FP (p<0.0001). There was no difference in the accuracy CE of TS between non-obese (<30 kg/m2 ) and obese patients (30 kg/m2 ) (p=0.061). As a result of FP, 55 patients (40.7%) received adjuvant RT and 38 patients (28.14%) were upstaged from IB1 to IB2. Conclusion: CE of TS and PI is inaccurate, especially in tumors  2cm and

Clinically significant discrepancy between clinical and pathologic stage of early-operable cervical cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5526-5526
Author(s):  
Jennifer Gibbs ◽  
Victoria Hastings ◽  
Nikita Malakhov ◽  
Katherine Economos ◽  
Margaux J Kanis
Keyword(s):  
Cervical Cancer ◽  
Final Analysis ◽  
Staging System ◽  
Figo Stage ◽  
Adjuvant Radiation ◽  
Significant Discrepancy ◽  
Mean Error ◽  
Significant Difference ◽  
Parametrial Involvement ◽  
Clinically Significant

5526 Background: The cornerstone of the management of cervical cancer (CC) traditionally relies on clinical examination assessment (CE) of tumor size (TS) and local extension of disease. Previous reports demonstrate poor accuracy of CE, with the most common discrepancy being failure to identify parametrial involvement (PI). The goal of this study is to determine the accuracy of CE in comparison to final pathology (FP) in early operable CC. Methods: This is a multi-center retrospective review of patients with early CC (FIGO stage IB1, IIA1). Data on age, race, histology, stage, CE findings, FP report and receipt of adjuvant radiation therapy (RT) were collected. CE findings included TS, PI and vaginal involvement (VI). CE of TS, PI, and VI were compared to FP. Subanalysis was also conducted based on TS ( < or ≥ 2cm) and location of tumor (exophytic vs endophytic). Analysis was performed using paired-T and Cohen’s Kappa tests. Results: Final analysis included 135 patients. Mean age was 52.6 years. The majority of patients had squamous cell carcinoma (72.6%). Overall, there was a significant difference between CE of TS compared to FP; mean error of 1.22 cm (p < 0.0001). In those with tumors ≥ 2cm the mean error was 1.28 cm (p < 0.0001). No significant discrepancy was observed in tumors < 2 cm (mean error: 1.10cm; p = 0.5). CE of TS of endophytic tumors was poor (mean error 1.68cm; p = 0.004) compared to exophytic tumors (mean error: 1.12 cm; p = 0.693). There was no significant difference in the identification of VI between CE and FP (3.7% vs 8.89%; p = 0.067). No patients with PI on CE were included in this analysis. However, 14.07% of patients were found to have PI on FP (p < 0.0001). There was no difference in the accuracy CE of TS between non-obese ( < 30 kg/m2) and obese patients (≥30 kg/m2), mean error 1.13 and 1.3, respectively (p = 0.061). As a results of FP, 55 patients (40.7%) received adjuvant RT and 38 patients (28.14%) were upstaged from IB1 to IB2. Of these 38 patients, 36 (94.7%) went on to receive adjuvant RT. Conclusions: CE of TS and PI is inaccurate, especially in tumors ≥ 2cm and endophytic tumors. This suggests imaging should be strongly encouraged, particularly in the setting of the updated FIGO 2018 staging system and recent debate over surgical approach.

scholarly journals Assessment of necessity of neuronavigation in localization of calvarial extra-axial lesions in the setting of limited resources

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hussein Soffar ◽  
Mohamed F. Alsawy
Keyword(s):  
Conventional Method ◽  
Linear Measurement ◽  
Limited Resources ◽  
Linear Measurements ◽  
Surgical Interventions ◽  
Localization Method ◽  
Mean Error ◽  
Significant Difference ◽  
The Mean ◽  
Mean Time

Abstract Background Neuronavigation is a very beneficial tool in modern neurosurgical practice. However, the neuronavigation is not available in most of the hospitals in our country raising the question about its importance in localizing the calvarial extra-axial lesions and to what extent it is safe to operate without it. Methods We studied twenty patients with calvarial extra-axial lesions who underwent surgical interventions. All lesions were preoperatively located with both neuronavigation and the usual linear measurements. Both methods were compared regarding the time consumed to localize the tumor and the accuracy of each method to anticipate the actual center of the tumor. Results The mean error of distance between the planned center of the tumor and the actual was 6.50 ± 1.762 mm in conventional method, whereas the error was 3.85 ± 1.309 mm in IGS method. Much more time was consumed during the neuronavigation method including booting, registration, and positioning. A statistically significant difference was found between the mean time passed in the conventional method and IGS method (2.05 ± 0.826, 24.90 ± 1.334, respectively), P-value < 0.001. Conclusion In the setting of limited resources, the linear measurement localization method seems to have an accepted accuracy in the localization of calvarial extra-axial lesions and it saves more time than neuronavigation method.

The influence of overall treatment time to the efficiency of chemo-radiotherapy for locally advanced cervical cancer

2017 ◽  
Vol 17 (1) ◽  
pp. 124-130
Author(s):  
Ekkasit Tharavichitkul ◽  
Panupat Rugpong ◽  
Nisa Chawapun ◽  
Razvan M. Galalae
Keyword(s):  
Cervical Cancer ◽  
Treatment Time ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Intracavitary Brachytherapy ◽  
Treatment Results ◽  
Overall Treatment Time ◽  
Free Survival ◽  
Significant Difference ◽  
The Mean

AbstractPurposeThis study aims to clarify the influence of overall treatment time (OTT) on the efficiency of combined chemo-radiotherapy in cervical cancer.Material and methodsThis retrospective study enrolled 122 cervical cancer patients who had squamous cell carcinoma and had undergone definitive chemo-radiotherapy from 2009 to 2013. All patients received whole pelvic radiotherapy (WPRT) with the dose of 50 Gy in 25 fractions (with central shielding after 44 Gy) plus intracavitary brachytherapy with the dose of 28 Gy in four fractions. During WPRT, all patients received concurrent chemotherapy with weekly platinum-based regimen. The data of patient characteristics, OTT, treatment results and toxicities were collected and evaluated.ResultsThe mean follow-up time was 36 months. The mean age of patients was 52 years old; 68% of patients were stage IIB related to International Federation of Gynaecology and Obstetrics staging. Pelvic control (PC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) rates did not differ significantly in the data-derived cut points of 55·8 and 53 days. No statistically significant difference in treatment results between the two groups of OTT<49 and OTT≥62 days was observed.ConclusionsIn our data-derived cut point, OTT did not influence to PC, DMFS, DFS and OS. The influence of OTT on treatment results may be found in longer periods.

scholarly journals Dentofacial Changes after Orthodontic Intervention with Eruption Guidance Appliance in the Early Mixed Dentition

2008 ◽  
Vol 78 (2) ◽  
pp. 324-331 ◽  
Author(s):  
Katri Keski-Nisula ◽  
Leo Keski-Nisula ◽  
Hannu Salo ◽  
Kati Voipio ◽  
Juha Varrela
Keyword(s):  
Treatment Group ◽  
Mixed Dentition ◽  
Class I ◽  
Control Group ◽  
Significant Shift ◽  
Facial Height ◽  
Significant Difference ◽  
The Mean ◽  
Maxillary Incisors ◽  
Clinically Significant

Abstract Objective: To evaluate skeletal and dentoalveolar changes induced by the eruption guidance appliance in the early mixed dentition. Materials and Methods: Pre- and posttreatment cephalometric radiographs of 115 consecutively treated children, 62 boys and 53 girls, were compared with those obtained from a control group of 104 children, 52 boys and 52 girls. Pretreatment radiographs were taken at the deciduous-mixed dentition interphase (T1) and after full eruption of all permanent incisors and first molars (T2). The mean age of the children in both groups was 5.1 years at T1 and 8.4 years at T2. Results: A significant difference between the groups at T2 was found in the mandibular length, midfacial length, and maxillomandibular differential. The increase in mandibular length was 11.1 mm in the treatment group and 7.2 mm in the control group. No differences were found in measurements of maxillary position or size. There was a significant shift toward a Class I relationship in the treatment group. Labial tipping and linear protrusion of the mandibular incisors was evident in the treatment group at T2. There was no effect on the inclination or position of the maxillary incisors. Conclusions: Occlusal correction was achieved mainly through changes in the dentoalveolar region of the mandible. In addition, the appliance enhanced condylar growth resulting in a clinically significant increase in mandibular length. No effect was observed on maxillary position, maxillary size, inclination or protrusion of the maxillary incisors, or facial height.

scholarly journals PD-L1 protein expression and copy number gains in HIV-positive locally advanced cervical cancer

2020 ◽  
Vol 12 ◽  
pp. 175883592096300
Author(s):  
Kongsak Loharamtaweethong ◽  
Napaporn Puripat ◽  
Niphon Praditphol ◽  
Jidapa Thammasiri ◽  
Siriwan Tangitgamol
Keyword(s):  
Cervical Cancer ◽  
Copy Number ◽  
Locally Advanced ◽  
Hiv Positive ◽  
Hiv Status ◽  
Free Survival ◽  
Parametrial Invasion ◽  
Programmed Death ◽  
Significant Difference ◽  
Hiv Negative

Background: The programmed death-1/programmed death-ligand-1 (PD-1/PD-L1) axis may represent a target for cervical cancer; however, it is poorly understood in human immunodeficiency virus (HIV)-infected patients. Methods: We evaluated HIV-positive ( n = 42) and HIV-negative ( n = 110) women with locally advanced cervical cancer regarding their PD-L1 expression, determined by combined positive score (CPS) ⩾ 1 and tumor proportion score (TPS) ⩾ 25%, and PD-L1 copy number alterations, assessed by fluorescence in situ hybridization. Results: Regardless of HIV status, 84.9% and 44.8% of cases were PD-L1-positive according to CPS ⩾ 1 and TPS ⩾ 25%. Per CPS ⩾ 1, PD-L1 positive rate was similar between HIV-positive and HIV-negative women, whereas a significant difference was seen per TPS ⩾ 25%. Tumor size and parametrial invasion were correlated with PD-L1 positivity in HIV-negative women, whereas anti-retroviral therapy (ART) was correlated with TPS < 25%. Low CD4-positive cell counts were associated with CPS < 1 in HIV-positive women. No significant difference was observed in PD-L1 copy number status between HIV-positive and HIV-negative women. PD-L1 amplification and polysomy were independently associated with TPS ⩾ 25%, whereas the presence of parametrial invasion was independently associated with CPS ⩾ 1. Cancer stage and PD-L1 amplification were identified as independent predictors of recurrence-free survival [hazard ratio (HR) = 2.40 (1.32–4.36) and HR = 5.33 (1.94–14.61)] and cancer-specific survival [HR = 13.62 (5.1–36.38) and HR = 3.53 (1.43–8.69)]. PD-L1 polysomy was an independent predictor of locoregional recurrence-free survival [HR = 3.27 (1.27–8.41)]. HIV status and PD-L1 expression (CPS ⩾ 1 or TPS ⩾ 25%) were not associated with poor patient outcomes. Conclusion: PD-L1 amplification and polysomy are the strongest drivers of PD-L1 expression in cervical cancer, and could represent prognostic biomarkers for anti-PD-1/PD-L1 therapy. Cervical cancer biology may be modulated by HIV infection, CD4-positive cells, and HIV treatments.

scholarly journals Measurement of Iris Thickness at Different Regions in Healthy Chinese Adults

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Qingchen Li ◽  
Yuan Zong ◽  
Huiming Wen ◽  
Jian Yu ◽  
Changbo Zhou ◽  
...  
Keyword(s):  
Anterior Segment ◽  
Final Analysis ◽  
Middle Part ◽  
Chinese Adults ◽  
Swept Source ◽  
Significant Difference ◽  
The Mean ◽  
Healthy Chinese ◽  
And Gender ◽  
The Right

Purpose. To study the variation of iris thicknesses in different regions and explore the possible correlations with age and gender. Methods. Healthy Chinese adults were recruited; the anterior segment of their eyes was imaged by swept-source optical coherence tomography (SS-OCT). The horizontal scan of the right eye was selected, and the thicknesses of both the nasal and temporal irises were measured at 199 evenly spaced points. Results. A total of 233 subjects with an average age of 36.79 ± 10.04 years (range 19 to 62) were included in the final analysis. The mean iris thicknesses of the temporal and nasal sides were 364.79 ± 47.58 μm and 372.44 ± 43.75 μm, respectively. The mean nasal iris thickness was positively correlated with age (β = 0.9 μm/year; P  = 0.002), but the temporal one was not (β = 0.077 μm/year; P  = 0.806). At 139 points of the nasal iris and 146 points of the temporal iris, the iris thickness was significantly correlated with age ( P  < 0.05). The thicknesses of the peripheral and pupillary parts were positively correlated with age, while the middle part was negatively correlated with age. No significant difference was observed in the mean iris thickness between genders (temporal: t = 1.597, P  = 0.112; nasal: t = 1.870, P  = 0.063), but females had a thicker iris than males at 50 points in the temporal side and 49 points in the nasal side ( P  < 0.05); no point in males was observed to have thicker iris compared to females. Conclusion. Using SS-OCT and the novel method, thicknesses of the iris at different regions were measured. The thicknesses of the peripheral and pupillary irises increase with age, while the thicknesses of the middle part decrease.

scholarly journals Evaluating the Effect of an educational program on increasing cervical cancer screening behavior among rural women in Guilan, Iran

2020 ◽  
Author(s):  
Sedighe Bab Eghbal ◽  
Mahmood Karimy ◽  
parisa Kasmaei ◽  
Zahra Atrkar Roshan ◽  
Roghieh Valipour ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Rural Women ◽  
Rural Areas ◽  
Pap Test ◽  
Health Belief ◽  
Educational Programs ◽  
Cervical Cancer Prevention ◽  
Control Group ◽  
Significant Difference ◽  
The Mean

Abstract Background: Cervical cancer is one of the major health problems and the third prevalent cancer in women all around the world. As a simple, inexpensive, and with no side-effects test, Pap test is a reliable way to screen cervical cancer. This study aimed to investigate, the effects of educational intervention based on the Health Belief Model (HBM) on doing pap tests in the women living in the rural areas of the north of Iran.Methods: In a quasi-experimental study, 160 rural women were randomly divided into control and experiment groups to experience a three session’s intervention. The experiment group received, educational programs based on the HBM constructs through personal consultation, asking/answering questions, and an educational pamphlet. The control group, received the routine educational programs of the health center. The post-test data were collected two months after the intervention and analyzed on SPSS-18.Results: Before the intervention, there was no significant difference between the control and experiment groups in terms of the mean score of knowledge, performance, and the constructs of the HBM. After the intervention, however, there was a significant difference in the mean scores of knowledges, performance, and all constructs of the HBM of the two groups (p<0.001). The rate of doing a pap test in the experimental group increased from 18.7% to 78.7% in the intervention group.Conclusions: The findings supported the effectiveness of cervical cancer prevention programs based on the HBM. Therefore, conducting similar programs in other regions is recommended.

Does Obesity Influence Lymph Node Harvest among Patients Undergoing Colectomy for Colon Cancer?

2008 ◽  
Vol 74 (11) ◽  
pp. 1073-1077 ◽  
Author(s):  
Amir A. Damadi ◽  
Lucas Julien ◽  
Rodrigo Arrangoiz ◽  
Manish Raiji ◽  
David Weise ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Correlation Coefficients ◽  
Sigmoid Colectomy ◽  
Obese Patients ◽  
Lymph Node Harvest ◽  
Significant Difference ◽  
The Mean ◽  
Nonobese Patients

Adequate lymph node harvest among patients undergoing colectomy for cancer is critical for staging and therapy. Obesity is prevalent in the American population. We investigated whether lymph node harvest was compromised in obese patients undergoing colectomy for cancer. Medical records of patients who had undergone colectomy for colon cancer were reviewed. We correlated the number of lymph nodes with body mass index (BMI) and compared the number of lymph nodes among patients with BMI less than 30 kg/m2 to those with BMI of 30 kg/m2 or greater (“obese”). Among all 191 patients, the correlation coefficient was 0.04 (P > 0.2). The mean number of nodes harvested from 122 nonobese patients was 12.4 ± 6 and that for 69 obese patients 12.8 ± 6 (P > 0.2). Among 130 patients undergoing right colectomy and 35 patients undergoing sigmoid colectomy, the correlation coefficients were 0.02 (P > 0.2) and 0.16 (P > 0.2), respectively. There was not a statistically significant difference in lymph node harvest between obese and nonobese patients (14.1 ± 7 vs 13.8 ± 6, P > 0.2; and 11.8 ± 6 vs 8.6 ± 5, P > 0.2), respectively. Obesity did not compromise the number of lymph nodes harvested from patients undergoing colectomy for colon cancer.

Effect of Syndesmotic Implant Removal on Dorsiflexion

2019 ◽  
Vol 40 (5) ◽  
pp. 499-505 ◽  
Author(s):  
Jorge Briceno ◽  
Timilien Wusu ◽  
Philip Kaiser ◽  
Patrick Cronin ◽  
Alyssa Leblanc ◽  
...  
Keyword(s):  
Final Analysis ◽  
Ankle Dorsiflexion ◽  
Implant Removal ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Level Ii ◽  
Significant Difference ◽  
Before And After ◽  
The Mean

Background: There is limited evidence that syndesmotic implant removal (SIR) is beneficial. However, many surgeons advocate removal based on studies suggesting improved motion. Methodologic difficulties make the validity and applicability of previous works questionable. The purpose of this study was to examine the effect of ankle dorsiflexion after SIR using radiographically measured motion before and after screw removal utilizing a standardized load. Methods: All patients undergoing isolated SIR were candidates for inclusion. Dorsiflexion was measured radiographically: (1) immediately before implant removal intraoperatively, (2) immediately after removal intraoperatively, and (3) 3 months after removal. A standardized torque force was applied to the ankle and a perfect lateral radiograph of the ankle was obtained. Four reviewers independently measured dorsiflexion on randomized, deidentified images. A total of 29 patients met inclusion criteria. All syndesmotic injuries were associated with rotational ankle fractures. There were 11 men (38%) and 18 women (62%). The mean, and standard deviation, age was 50.3 ± 16.9 years (range 19-80). Results: The mean ankle dorsiflexion pre-operatively, post-operatively, and at a 3-month follow-up was 13.7 ± 6.6 degrees, 13.3 ± 7.3 degrees and 11.8 ± 11.3 degrees, respectively ( P = .466). For subsequent analysis, 5 patients were excluded because of the potential confounding effect of retained suture button devices. Analysis of the remaining 24 patients (and final analysis of 21 patients who had complete 3-month follow-up) demonstrated similar results with no statistically significant difference in ankle dorsiflexion at all 3 time points. Conclusion: Removal of syndesmotic screws may not improve ankle dorsiflexion motion and should not be used as the sole indication for screw removal. Level of Evidence: Level II, prospective cohort study.

scholarly journals Transabdominal Doppler ultrasound evaluation of blood flow patterns of the uterine arteries in cervical cancer patients in Zaria, North-Western Nigeria

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
I. Garba ◽  
M.Z. Ibrahim ◽  
S. Lawal ◽  
N.D. Chom ◽  
P.O. Ibinaiye
Keyword(s):  
Cervical Cancer ◽  
Doppler Ultrasound ◽  
Peak Systolic Velocity ◽  
Doppler Flow ◽  
Uterine Arteries ◽  
Flow Parameters ◽  
Ultrasound Evaluation ◽  
Diastolic Velocity ◽  
Significant Difference ◽  
The Mean

Cervical cancer remains an important health issue especially in the developing countries that account for about 85% of the world burden of cervical cancer. Finding a role for Doppler ultrasound in the evaluation of these patients, may reduce the cost and improve access to management. This study was aimed at evaluating the Doppler flow parameters in patients with cervical cancer when compared to normal subjects. This was a prospective case control, descriptive and observational study conducted in radiology department, ABU Teaching Hospital, Zaria, Nigeria. Eighty-one patients with cervical cancer and 81 age-matched controls had transabdominal Doppler ultrasound examination of the main uterine arteries. The data was analyzed using SPSS version 20.0 Chicago Illinois USA. Difference between two groups was tested using student ttest and P<0.05 considered as statistically significant. The mean Resistivity Index (RI) and Pulsatility Index (PI) were significantly lower in patients with cervical cancer than the control (P<0.0001). The mean end diastolic velocity was significantly higher in patients than the control (P<0.0001). There was however no significant difference in the mean peak systolic velocity in patients and control (P=0.97). The findings have demonstrated that significant differences exist in the uterine artery Doppler flow parameters in patients with cervical cancer compared to the healthy controls. This emphasizes the role of Doppler scan in the evaluation and management of patients with cervical cancer.

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