Colposcopy: Gynecological vision in viewing oral lesions.

Context: The diagnosis of malignant and potentially malignant epithelial lesions of the oral mucosa cannot be based solely on clinical fi ndings. The histologic evaluation of a representative biopsy specimen thus becomes necessary. The site for biopsy however is always a subjective choice that sometimes raises doubts about its representativeness. So far, no simple and reliable method is available for the selection of the most appropriate area for biopsy. Colposcopy is helpful in the selection of these sites of epithelial dysplasia depending upon the vascular patterns. Aims: This study was planned to assess the role of Colposcopic examination in the selection of biopsy site in patients with varying grades of oral epithelial dysplasia at various sites. Settings and Design: One hundred and eighty patients between the ages of 30 and 60 years clinically diagnosed with leukoplakia and carcinoma buccal mucosa were included in the study. Materials and Methods: For each of the subjects, a thorough clinical examination followed by Colposcopic assessment was carried out for the selection of biopsy site from the involved mucosa. The histopathological fi ndings were then compared in the two cases and results analyzed. Statistical Analysis Used: The statistical analysis was performed using a paired t-test. Results: In our study, sensitivity and specifi city for the selection of biopsy site by Colposcopic examination was found to be higher for leukoplakia than for carcinoma buccal mucosa. Conclusions: It was concluded that Colposcopic examination was found to be signifi cant in the selection of biopsy site for leukoplakia while clinical criterion was found to be more appropriate for carcinoma buccal mucosa cases.

A retrospective clinicopathological study of 131 cases with endometrial cancers - Is it possible to define the role of retroperitoneal lymphadenectomy in low-resource settings.

AIM: The study objectives were evaluation of clinicopathological characteristics, correlations between the preoperative and postoperative tumor grades, and their implications on lymph node metastasis. MATERIALS AND METHODS: We conducted a retrospective descriptive study of 131 cases of endometrial cancer examined and treated at a tertiary regional cancer institute between the years 2003 and 2009. We reviewed the oncology database as well as the clinical records and surgico‑pathological registry of all these patients. STATISTICAL METHODS USED: All the summary measure computation and Chi‑square test for comparing more than one proportion was done in spreadsheet (Excel). RESULTS: The multiparity association with endometrial cancer was commonly seen 113/131 (86.2%). Twelve (9.7%) patients preoperatively diagnosed as Grade 1 tumors upgraded to Grade 3 changes in postoperative specimens and six of these 12 patients (50%) had lymph node metastasis. A total of 14/131 (10.6%) cases had lymph nodes metastasis. CONCLUSIONS: There is a poor correlation between the preoperative and the postoperative tumor grades. Routine pelvic lymphadenectomy may be a valuable method in low‑risk cases and para‑aortic lymphadenectomy may be limited to high‑risk endometrial cancers.

Accuracy rate of frozen section studies in ovarian cancers: A regional cancer institute experience.

Background: Frozen section is a valuable diagnostic procedure in the categorization of ovarian tumors as benign, borderline and malignant. Thus, it guides in tailoring surgical therapy, particularly in young women. Aim: This study was undertaken to determine the accuracy of frozen section in ovarian neoplasms. Materials and Methods: A retrospective analysis was done of intraoperative frozen sections for suspected ovarian neoplasms. The frozen and permanent section reports were compared and overall accuracy, sensitivity, specificity, positive and negative predictive values were determined. Results: The study included 135 patients and the overall accuracy of frozen section in determining malignancy was 84.25%. Twenty cases were incorrectly diagnosed, of which 16 cases were under-diagnosed and four were over-diagnosed. With respect to malignant potential, the sensitivity for malignant tumors was highest (91.5%) with specificity of 98.2%. For benign tumors, the sensitivity and specificity were 90.4% and 82.6%, respectively. Borderline tumors had the lowest sensitivity of 31.2% with specificity of 94%. Sensitivity for benign, borderline and malignant tumors in the non-mucinous group was 91.3%, 60% and 95% respectively, whereas the sensitivity was 75%, 18% and 57%, respectively, for mucinous tumors revealing low sensitivity in borderline, mucinous tumors. The low sensitivity rates were due to restriction in the sampling of an adequate number of bits in the large sized tumors. Conclusion: The present study concurs that frozen section is an accurate test for diagnosis of benign and malignant tumors. However, accuracy rates for borderline and mucinous tumors are low.

Correlation of endometrial ultrasonography and endometrial histopathology in patients with postmenopausal bleeding.

A retrospective study of 49 cases with persistent postmenopausal vaginal bleeding undergoing hysterectomy in the absence of postoperatively evident diagnosis of genital malignancy was carried out. Normal endometrium was the source of bleeding in 24 cases (48.9%) while 11 cases (22.4%) had evidence of endometritis. Endometrial hyperplasia and polyps were present in 12 cases (24.4%). Two cases were found to have malignancy in the surgical specimen, which were not evident on pre-operative endometrial biopsy. However, there was high degree of suspicion of malignancy in these 2 cases based on the endometrial histopathology and ultrasonographic endometrial thickness. By careful correlation of clinical findings, endometrial histopathology and ultrasound measurement of endometrial thickness, most cases with postmenopausal bleeding can be managed conservatively.