Validity of frozen section in cervical conization.

Objective: To evaluate the validity of pathological diagnosis of cervical cone specimens prepared by frozen section compared with paraffin section. Study design: Diagnostic test evaluation. Setting: Pathology division, Department of Obstetrics and Gynecology, faculty of Medicine Siriraj Hospital, Mahidol University. Methods: Cervical cone specimens from 78 patients who underwent cold knife conization at Siriraj Hospital from October 1997 to September 1998 were processed by frozen section technique and the pathological diagnoses were made immediately. The remaining cone tissue from each specimen was processed to produce permanent paraffin sections for a final diagnosis. The frozen and permanent pathological diagnoses were compared. Results: The pathological diagnosis from frozen section was in complete agreement with the permanent section in 60.26% of patients. When the subjects were divided into three groups; normal and CIN I, CIN II-III and MIC and invasive cancer, the Kappa analysis for agreement of the pathological diagnoses between the two methods was 0.46 (fair agreement). For the diagnosis of invasive cancer by frozen section, the sensitivity, specificity, positive and negative predictive value, false negative and false positive were 62.5, 97, 71.4, 95.8, 37.5 and 1.9%, respectively. There were three cases of invasive cancer on permanent paraffin section which were diagnosed by frozen section as MIC in tow cases and CIN III in the other. Conclusion: Frozen section evaluation of a cervical cone specimen carries only a moderate degree of agreement with permanent paraffin section. For the diagnosis of invasive cancer in this study, frozen section has a low sensitivity and a high false negative rate. The diagnosis of microinvasive cancer was subject to significant error. The diagnosis of microinvasive cancer by frozen section needs additional careful review of the permanent section.

Outcome of the ovarian epithelial Cancer stage I-II treated with cyclophosphamide plus cisplatinum or carboplatin.

The retrospective study outcome of the ovarian epithelial cancer stage I-II treated in Obstetrics and Gynaecological Department, Siriraj Hospital during June 1989 – June 1997, received postoperative chemotherapy cyclophosphamide plus cisplatinum (CP) or cyclophosphamide plus carboplatin (C-CP). Stage I disease of unfavourable prognosis 66 cases treated with CP and 25 cases of C-CP, achieved the 5-years disease free survival 82% and 86% respectively (P>0.05). Stage II disease of CP group, 21 cases and C-CP group, 7 cases achieved the 5-years disease-free survival 80% and 82% respectively (P>0.05). The toxicities of chemotreatment were manageble.

Additional megestrol acetate with cis-platinum combination regimens in treatment of advanced ovaian epithelial cancer.

Patients with advanced ovarian epithelial cancer were randomized for additional oral megestrol acetate 160 mg/day for 3 weeks and repeated simultaneously every cycle of the three cis-platinum combination regimens. Fifteen patients of AP and 18 cases of AP plus megestrol acetate showed a higher incidence of weight gain 26.66% versus 94.44% (P<0.05), lower incidence of nausea-vomiting 73.33% versus 22.22% (P<0.05), increase of appetite and sense of well being 26.66% versus 77.77% (P<0.05), and incidence of good performance 53.33% versus 66.66% (P>0.05). Fifteen cases of EP and 17 cases of EP plus megestrol acetate achieved a higher incidence of weight gain 20.00% versus 88.23% (P<0.05), incidence of nausea-vomiting 73.33% versus 41.17% (P>0.05), better incidence of good appetite and sense of well being 20.00% versus 70.58% (P<0.05), and incidence of good performance 26.66% versus 64.70% (P>0.05). Nineteen cases of CAP and 15 cases of CAP plus megestrol acetate achieved a higher incidence of weight gain 31.57% versus 86.66% (P<0.05), lower incidence of nausea-vomiting 89.47% versus 40.00% (P>0.05), incidence of good appetite and sense of well being 47.36% versus 80.00% (P>0.05), and incidence of good performance 57.89% versus 66.66% (P>0.05). The response rate of disease to the additional megestrol acetate of the three regimens showed no significant change.

Tumor-associated antigen Ca - 125 in ovarian cancer.

Determinations of the serum Ca-125 levels were carried out on 45 samples from healthy women, 22 samples of benign ovarian tumors including tumor-like conditions, 33 samples of ovarian cancer and 14 cases of common epithelial cancer at second-look laparotomy. The Ca-125 levels were measured by enzyme immunoassay using a commercial kit by Fujirebio Inc. Japan. The cut off levels of Ca-125 values were set at > 30 IU/ml, which made the specificity, sensitivity and positive predictive values 80.0, 84.8 and 75.7 percent respectively. The demonstrable ovarian cancer gave positive Ca-125 values among serous cystadenocarcinoma in all case while endometrioid adenocarcinoma and mucinous cystadenocarcinoma were 80.0 and 66.6 percent respectively. Two sex cord tumors and 2 of 3 malignant germ cell tumors had positive Ca-125 values in low levels. Those with small residual cancer at second-look laparotomy, 1-2 cm in diameter, had positive Ca-125 values, and one of 12 patients had false-negative value despite the presence of microresidual cancer. Ovarian endometriosis had positive Ca-125 values about 55.5 percent but in low levels.

Conservation surgery in borderline and malignant ovarian tumours.

Thirty four patients with borderline and frankly malignant ovarian tumours treated primarily with conservative surgeries, were studied. There were 8 cases of borderline tumours and 26 cases of frank malignancy, with 19 cases of epithelial cancers and 6 cases of malignant germ cell tumours. All the conservative surgical procedure were not adequate due to unrecognition of the malignant lesions. Postoperative chemotherapy was inevitably necessary in all. There were two recurrences in this series, one clear cell adeno-carcinoma who expired with disease and one immature teratoma who still survived after complete surgery and successful chemotherapy. The outcome in this study reassures that adequate conservative surgery in a woman with a unilateral borderline malignancy or malignant ovarian tumours can perform further childbearing, however a close follow up must be possible.

Update results of intrabifurcations of aorta infusion by high dosage mitomycin-C in uterine cervical squamous cell carcinoma stage II, III (Report of 35 cases).

Thirty-five new patients with squamous cell carcinoma of the cervix stage II and III, with refusal of radiation therapy were treated with a single dose of mitomycin-C 35 mg/m2 intrabifurcation of the aorta infusion. 85.7 percent had clinically complete regression and 5.71 percent had partial regression. Twenty-seven cases of the clinically complete regression were treated by radical hysterectomy and pelvic nodes dissection. There were 10 cases (37.03%) showing pathologically complete regression, 11 cases (40.74%) showing small residual cancer in the cervix and 6 cases (22.22%) showing residual cancer in the cervix and pelvic nodes. The follow up performed after 18-30 months, revealed recurrence or metastases in 18.51 percent of the cases. Mild nausea, alopecia, weakness, anorexia, moderately depressed in the second week after treatment.

Cyclophosphamide, adriamycin and cis-platinum in treatment of ovarian common epithelial cancer stage III-IV.

Twelve patients with ovarian common epithelial cancer stage III, IV were treated by post operative chemotherapy; combination of cyclophosphamide, adriamycin and cis-diamminedichloroplatinum. Their revealed overall response rate was 83.3%, clinical complete remission was 66.6%, with a follow-up period of 10.0-23.5 months, and was negative on second look operation 83.3%. The response rate was 77.7%, for residual cancer > 5.0 cm. with a clinical complete remission 55.5%, and was negative on second look operation 66.6%.