Up to date there is no internationally agreed consensus on the ultrasound assessment of lymph nodes in any condition. The lack of standardised ultrasound nomenclature to describe lymph nodes makes it difficult to compare results from different ultrasound studies and to find reliable ultrasound features for distinguishing non-infiltrated LNs from LNs infiltrated by cancer or lymphoma cells. The VITA collaborative group consists of gynecologists, gynecologic oncologists and radiologists with expertise in treating patients with vulvar cancer and staging of vulvar cancer using ultrasound. The here-presented abstract is a consensus statement on terms, definitions and measurements that may be used to describe inguino-femoral LNs on gray-scale and colour/power Doppler sonography. The proposed nomenclature need not be limited to the description of inguinal lymph nodes as part of vulvar cancer staging. It can be used to describe superficial lymph nodes in general, as well as parietal or visceral LNs if the LNs can be clearly visualised. VITA terms and definitions lay the basis for prospective studies aiming to identify ultrasound features typical of metastases and other pathology and to elucidate the role of ultrasound for staging vulvar cancer and other cancers. Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Usage of sentinel lymph-node (SLN) concept in locally advanced cervical cancers might help to individualise management. According to SLN status could be patients refered to neoadjuvant chemotherapy (NAC) with subsequent surgery or to primary chemoradiation. The aim of our study was to evaluate sensitivity of SLN detection in locally advanced cervical cancers and to assess the impact of NAC on frequency of their metastatic involvement.Retrospective clinical study.Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.Included were patients with cervical cancer stages FIGO IB1 (> 3 cm), IB2, IIA2 and selected cases of stages IIB with incipient parametrial involvement. Patients were distributed into two different protocols - patients in group NAC-SLN were refered to radical hysterectomy with SLN biopsy after 3 cycles of NAC, other patients (group SLN) underwent SLN biopsy and NAC was administered only in SLN-negative cases.Altogether 101 patients were included (group SLN = 62, group NAC-SLN = 39). Detection of SLN in whole cohort reached 90.1% per patient and 68.3% bilaterally. No differences were found between SLN group and NAC-SLN group in frequency of per patient SLN detection (90.3% vs 89.7%) and bilateral detection (69.4% vs 66.7%). Prevalence of macrometastases, micrometastases and ITC in the SLN group was 37.1% (23/62), 11.3% (7/62) and 8.1% (5/62), respectively. In the NAC-SLN group macrometastases in SLN were detected in 17.9% (7/39) patients, in 1 patient was detected micrometastis in SLN and no patient had ITC. Difference in frequency of metastases in SLN was significant (p = 0,013). No patient had progressed during NAC, complete response was seen in 15.1% (11/73) patients and reduction of tumour volume > 30% in 84.9% (62/73) patients.Detection of SLN in locally advanced cervical cancers reached comparable results to early stages. NAC did not influence frequency of SLN detection, but it significantly decreased prevalence of metastatic SLN involvement.
The need for a combined treatment composed of radical surgery followed by adjuvant radiotherapy can be decreased by abandoning radical surgery in patients with intraoperatively detected lymph node (LN) involvement. The aim of the study was to analyze efficacy of the algorithm using intraoperative pathological assessment of sentinel LN (SLN).
Methodology
Cervical cancer patients were included into the study who had stage T1a - T2b squamous, adeno- or adenosquamous carcinoma, were referred for primary surgical treatment, and had at least one SLN detected and submitted for frozen section evaluation. In the case of intraoperatively detected SLN involvement, parametrectomy (radical hysterectomy or trachelectomy) was abandoned and the patient was referred for primary chemoradiation. Radical surgery was completed in patients with intraoperatively negative SLNs. Indications for postoperative adjuvant radiotherapy included LN involvement from final pathology, parametrial involvement, or positive resection margins.
Results
The trial included 309 patients (table 1). LN positivity was intraoperatively detected in 18 (6%) patients in whom radical hysterectomy was abandoned. Adjuvant radiotherapy after completed radical surgery was given to 29 (9%) cases, including 20 cases with macrometastases (MAC; 8) or micrometastases (MIC; 12) reported from the final histology, 8 cases with positive parametria (all ≤ 3 mm), and 1 case with a positive vaginal resection margin (figure 1).
Conclusion
Out of 47 (15%) patients with high-risk prognostic risk factors (LN, parametria or surgical margin involvement), in only 19 (38%) of them was a combined treatment successfully avoided. This was due to the low sensitivity of frozen section in the detection of MIC and low accuracy of clinical staging in the detection of microscopic parametrial involvement.
To summarize recent data and knowledge of laparoscopic power morcellation.Review of articles.Laparoscopic morcellation has been introduced to gynecologic surgery in 90s. In 2014, Food and Drug Administration announced negative statement about the morcellation use due to the risk of potential spreading of malignant tumor cells. This statement reduced utilization of morcellation, especially in the United States. Since that, many health institutions and organizations started new researches focused on the safety of this surgical technique. After a couple of years, the morcellation is considered as a useful tool if certain rules are followed.Morcellation has a place in laparoscopic operative procedures even in 2022, in condition of correct selection of patients and possible utilization of contained in-bag morcellation.
There are multiple classifications in imaging and surgery of endometriosis and in this article, we offer a review of the main evaluation systems. The International Deep Endometriosis Analysis group consensus is the leading document for ultrasound assessment, while magnetic resonance imaging is guided by the European Society for Urogenital Radiology recommendations on technical protocol. In surgery, the revised American Society for Reproductive Medicine classification is the oldest system, ideally combined with newer classifications, such as Enzian or Endometriosis Fertility Index. Recently, The World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project introduced detailed proforma for clinical and intraoperative findings. There is still no universal consensus, so the initial emphasis should be on the uniform reporting of the disease extent until research clarifies more the correlations between extent, symptoms and progression in order to develop a reliable staging system.Impact StatementWhat is already known on this subject? There have been several reviews of surgical classifications, comparing their scope and practical use, while in the imaging the attempts for literature review has been scarce.What do the results of this study add? This is the first up to date review offering detailed analysis of the main classification systems across the three main areas involved in endometriosis care - ultrasound, MRI and surgery. The mutual awareness of the radiological classifications for surgeons and vice versa is crucial in an efficient multidisciplinary communication and patient care. On these comparisons we were able to demonstrate the lack of consensus in description of the extent of the disease and even further lack of prognostic features (with the exemption of one surgical system).What are the implications of these findings for clinical practice and/or further research? Future attempts of scientific societies should focus on defining uniform nomenclature for extent description. In the second step the staging classification should encompass prognostic value (risk of disease and symptoms recurrence).
Based on current knowledge the criteria for diagnosing nonviability in early intrauterine pregnancy and diagnostic algorithm in pregnancies of unknown location have changed. For either an intrauterine pregnancy of uncertain viability or a pregnancy of unknown location, the consequences of false positive diagnosis of nonviability or false negative diagnosis of ectopic pregnancy may be dire: harming of a potentially normal intrauterine pregnancy or a life-threatening rupture from tubal pregnancy. This review aims to present the most important results of current studies on this topic with their recommendations and to improve patient care reducing the risk of inadvertent harm to potentially normal pregnancies.
The aim of the study was to evaluate diagnostic accuracy of ultrasound in preoperative assessment of pelvic lymph nodes (LNs) in cervical cancer patients.
Methodology
Patients were retrospectively included if they met following inclusion criteria: 1) histologically verified cervical cancer; 2) preoperative ultrasound examination performed by one of three experienced sonographers (transvaginal or transrectal and transabdominal approach); 3) surgical lymph node staging (sentinel lymph node biopsy, SLNB and/or systematic pelvic lymphadenectomy, PLND or pelvic lymph node debulking). The final pathological examination served as the reference standard. Lymph nodes with macrometastases (the largest diameter > 2 mm) were considered positive, while LNs with isolated tumour cells (ITC) and micrometastases (MIC) were considered negative.
Result(s)*
394 patients meeting the inclusion criteria between 2009 a 2019 were enrolled into the study. The characteristics of study population are shown in table 1. Squamous cell carcinomas were most common (298/394) and the majority of cases was represented by early stage cancers (274/394), specifically IB1 FIGO 2009 (236/394). Macrometastes in pelvic LNs were pathologically confirmed in 53 patients (13.5%) and micrometastases solely in 23 patients (5.8%). Ultrasound failed to detect pelvic lymph node macrometastases in 15 patients (3.8%) and median largest diameter of these unidentified metastases was 6 mm (range 3 – 11 mm). There were 27 false positive ultrasound findings (6.9%). Ultrasound reached sensitivity 71.7%, specificity 92.1%, PPV 58.5%, NPV 95.4% and overall accuracy 89.3%.
Conclusion*
Transvaginal/transrectal ultrasound is a reliable method for preoperative assessment of pelvic LNs in cervical cancer patients. It showed similar accuracy in detection of nodal macrometastases as reported for other imaging modalities. Similarly to all imaging methods, it had low sensitivity in detection of small volume macrometastases and micrometastases. Key words: cervical cancer, lymph nodes, ultrasound, diagnostic accuracy Klikněte nebo klepněte sem a zadejte text.
