Impact of the time elapsed between prostate biopsy and surgery on the accuracy of nomograms predicting lymph node invasion in patients with clinically localized prostate cancer.

We aimed to investigate whether the performance characteristics of available nomograms predicting lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy (RP) change according to the time elapsed between diagnosis and surgery. We identified 816 patients who underwent RP with extended pelvic lymph node dissection (ePLND) after combined prostate biopsy at 6 referral centers. We plotted the accuracy (ROC-derived area under the curve [AUC]) of each Briganti nomogram according to the time elapsed between biopsy ad RP. We then tested whether discrimination of the nomograms improved after accounting for the time elapsed between biopsy ad RP. The median time between biopsy and RP was 3 months. The LNI rate was 13%. The discrimination of each nomogram decreased with increasing time elapsed between biopsy and surgery, where the AUC of the 2019 Briganti nomogram was 88% vs. 70% for men undergoing surgery <2 vs. >6 months from the biopsy. The addition of the time elapsed between biopsy ad RP improved the accuracy of all available nomograms (P < 0.003), with the Briganti 2019 nomogram showing the highest discrimination. Clinicians should be aware that the discrimination of available nomograms decreases according to the time elapsed between diagnosis and surgery. The indication of ePLND should be carefully evaluated in men below the LNI cut-off who had a diagnosis more than 6 months before RP. This has important implications when considering the longer waiting lists related to the impact of COVID-19 on healthcare systems.

Breast Cancer-Related Lymphedema and its Relationship to Major Landmark Trials in Surgical Oncology and Radiation Oncology

INTRODUCTION: Many landmark trials have challenged the need for extensive axillary surgery and radiation in breast cancer patients. De-escalation of axillary treatment could potentially result in less breast cancer-related lymphedema (BCRL). Our study aims to define the incidence and trends of BRCL over the last 15 years. METHOD(S): Since 2005, our institution has prospectively screened breast cancer patients for lymphedema during and after treatment with a Perometer. 2,334 women diagnosed with breast cancer with baseline arm volume measurements and at least 2 follow-up measurements were divided into 3 cohorts based on date of surgery (Cohort 1: 2005-2010, Cohort 2:2011-2016, Cohort 3: 2016-2022). The cohorts were selected to coincide with publications of the landmark trials NSABP B-32, ASCOG Z0011, ASCOG Z1071, and EORTC 10981-22023 AMAROS which demonstrated safety in reducing the number of axillary lymph node dissections (ALND). Lymphedema was defined as a relative volume change of 10% or greater from preoperative baseline at least 3 months post-operatively. In cases of bilateral surgery, the weight-adjusted arm volume change equation was utilized. Cohort, age, BMI, axillary surgery type, chemotherapy timing, radiation type, and surgery type were all included in the multivariate analysis. RESULT(S): The overall incidence of BCRL was 12.8%, with a 29.6% incidence for those undergoing ALND and a 6.4% incidence for those undergoing sentinel lymph node biopsy. While the number of ALND performed decreased between cohorts (Figure 1), there was no significant difference in BCRL between assigned cohorts (HR 1.02 (95% CI [0.69, 1.51], p=0.930 for cohort 3 vs cohort 1). On multivariate analysis, significant associations with development of BCRL were identified with older age (HR 1.02;95% CI [1.01, 1.03], p=0.002), higher BMI (HR 1.05;95% CI [1.04, 1.07], p< 0.0001) and ALND (HR increased the risk of (HR 3.67;95% CI [2.62, 5.13], p< .0001). Regional lymph node radiation was not significantly associated with BCRL. CONCLUSION(S): Despite a reduction in the number of ALND performed over time, we did not see a dramatic reduction in the incidence of BCRL. Interestingly, between cohort 2 and cohort 3 there was a stable incidence of ALND which could be related to the COVID pandemic with an increase in more advanced cancers and a decrease in the ability to screen patients for BCRL during that time period.

Recruitment, clinical equipoise, patient acceptance and compliance in the UK-ANZ POSNOC trial

Background: POSNOC is a UK-ANZ multicentre, non-inferiority, randomised trial comparing systemic therapy alone with systemic therapy plus Axillary Treatment (Axillary radiotherapy or ALND) for women with <=2 macrometastases at SNB. The primary outcome is axillary recurrence within 5 years. This paper describes screening, recruitment and compliance data. Method(s): Sites were requested on a monthly basis to upload screening data and provide reasons for nonrecruitment of eligible patients into the trial. Sites entered in the online database whether the patients were compliant with their randomisation allocation. Result(s): The study opened in July 2014 and completed target recruitment of 1900 women (24% of those screened) in July 2021, at 95 sites in the UK and 20 sites in Australia and New Zealand. The reason for non-enrolment was unknown in 1300 women. Of the remaining 4774 women with known reasons, who were screened but not randomised, the most common reasons for non-recruitment were due to either patients (n=2219, 46.5%) or their clinicians (n=782, 16.4%) favouring axillary treatment, or patients (n=490, 10.3%) or their clinicians (n=170, 3.6%) not wishing to have axillary treatment. Over the course of the study, there was an increase in the proportion of patients wanting axillary treatment and declining the trial (Mean % patients declined 2015 - 17.9%, 2021 - 39.1%). Mean number of participants recruited per site per month was 0.24 (SD 0.18) overall, 0.25 (SD 0.19) in the UK, and 0.19(SD 0.15) in ANZ. The mean was < 0.3 in 79 sites and >0.9 in only one site. Recruitment rate remained consistent throughout the study (mean 25.3 per month) except for during the first 6 months of recruitment (5.7) and during the COVID pandemic Apr-Sep 2020 (7.5). Of 89 (4.8%) participants non-compliant with allocation, n=45 (50.6%) received systemic therapy alone and n=44 (49.4%) received systemic therapy plus axillary treatment. There was no fluctuation in the direction of non-compliance during the study duration. There was increasing uptake of axillary radiotherapy to treat the axilla instead of ALND over the course of the study in patients receiving axillary treatment (Number who had ART of all who had axilla treatment2014-2017 - 248/454 (54.6 %);2018-2021 - 315/449 (70.2%)). Conclusion(s): Recruitment and compliance with randomised allocation remained consistent over a seven-year period. POSNOC with in-built radiotherapy QA will provide definitive data on axillary management in patients undergoing mastectomy or BCS with <=2 macrometastases on SNB.

27th National IMI Congress

The proceedings contain 25 papers. The topics discussed include: altitude effect on melanoma epidemiology in the Veneto region: a pilot study;novel predisposition genes double a decreasing CDKN2A mutation rate: five years of (tele)- counselling and gene panel testing for hereditary melanoma within the Italian melanoma intergroup;genetic profiling of atypical deep penetrating NEVI (DPN);ultra-high frequency ultrasound monitoring of melanomas arising in congenital melanocytic nevi: a case series;a segmentation algorithm for skin melanoma regression;impact of the COVID-19 pandemic on primitive melanoma diagnoses at the IDI-IRCCS of Rome;a novel-algorithm combining static and dynamic features to identify melanoma in digital dermoscopy monitoring;and non-sentinel lymph node detection meanwhile sentinel lymph node biopsy in not-complete lymph node dissection era: a new technique for better staging and treating melanoma patients.

A Case Report of Non-puerperal Uterine Inversion

Objective: Non-puerperal uterine inversion is a rare occurrence. The common etiology for this condition is uterine sarcoma, endometrial carcinoma, and myoma. Case Presentation: This case is a 44-year-old woman with a protruding malodorous vaginal mass, abdominal pain, and urinary retention. Total hysterectomy with bilateral salpingectomy was per-formed. Conclusion: Diagnosis of uterine inversion might be difficult and requires a high index of suspicion. © 2023 Bentham Science Publishers.

Budget impact model for magnetic tracers in the detection of sentinel lymph nodes for operable breast cancer

Objective: The aim of this study was to evaluate the excepted budgetary impact of gradually adopting a magnetic tracer (MT) over a radioisotope tracer in the detection of sentinel lymph nodes (SLN) in operable breast cancer ((BC) from the perspective of one French hospital without a nuclear medicine department. Material(s) and Method(s): This study was conducted in a population of patients with operable breast cancer with SLN dissection. A budget impact model based on a prospective study conducted between April 2020 and March 2021 at Saint Joseph Hospital was developed. The model estimates the costs and revenues associated with an increase in the use of the strategy of SLN detection with a MT versus an isotope over a three-year time horizon. Result(s): Fifty-four patients were included: 20 in the isotope group and 34 in the MT group. The operating time was not statistically different between the two groups (67 minutes for the MT versus 68 minutes for the isotope, p = 0.89). Secretarial time was higher in the isotope group (25 min more than for the TM group). On the basis of 383 patients who underwent surgery the first year and assuming an increase in activity of 10% per year for the standard-of-care strategy and 11.5% for the innovative strategy, the revenues and costs for the hospital are projected to increase for both strategies. However, the increased use of MT would result in an estimated cost to the hospital of 11,639 (9.06 per patient undergoing surgery) over a three-year period. Conclusion(s): The MT detection method provides autonomy to the surgeon in SNL detection. Its cost must be weighed against the simplification of the preoperative patient journey. Its use during the COVID-19 health crisis helped make patient journeys safer by avoiding visits to nuclear medicine departments, thus limiting the risk of infection. No conflict of interest. Copyright © 2022 Elsevier Ltd. All rights reserved

Epidemiology and Choice of Treatment in the Adjuvant Setting of Hormone Receptor Positive Her2 Negative (Hr+/Her2-) Breast Cancer (Bc), Evidence from Administrative Databases, with a Focus on the Sarscov2 Pandemic

Background: Real-world evidence through secondary use of data (SUD) in oncology is gaining increasing interest, to better understand cancer epidemiology and provide insights into treatment patterns in daily practice. This study evaluates incidence of HR+/HER2- early BC (eBC) and its management in clinical practice through SUD and gauge the impact of the SARS-COV2 pandemic. Method(s): This observational retrospective analysis integrates administrative databases for healthcare resources consumption (pharmaceuticals, hospitalizations, diagnostic tests and specialist visits databases) from a sample of Italian Local Health Units, based on 15 million inhabitants across Italy. Patients with >=1 hospitalization discharge diagnosis for BC, with surgical intervention and HR+ status (determined by coding for HR+ status or by presence of endocrine therapy) between 01/2010-06/2021 were included. Patients with at least one prescription of anti- HER2 monoclonal antibodies were excluded. Patients were classified by menopausal state through prescription for the gonadotropin-releasing hormone analogues (GnRHa). Incidence was calculated during all study period. Result(s): Incidence rate has a slight upwards trend, as expected, ranging from 53.9 in 2013 to 62.7 in 2019 per 100,000 health-assisted subjects. Incidence in 2020 is 49.2 per 100,000 (table 1 for quarter split). As for adjuvant therapies, 31,836 patients were included in the analysis of which 5343 (16.8%) were classified as premenopausal. Mean age was 64.5 years. Most patients (78.8%) were treated with only adjuvant endocrine therapy (ET). 16.5% of the sample received adjuvant chemotherapy (CT). CT treatment was more prescribed in premenopausal patients. CT treatment was started within 12 weeks of surgery for 3.9% of the sample. Most patients (12.7%) started it between 12 weeks and 24 weeks. Conclusion(s): SUD can provide lots of information with the right queries. The analysis confirms the slight increase in incidence observed by national registries and provides an estimate of the impact of SARS-COV2 with a 22% reduction of breast surgery in 2020. Administrative data can be used to assess clinical variables (e.g. premenopause through GnRHa prescription), and could be further explored for disease stage through axillary dissection, and recurrence through prescription of therapies used in metastatic setting.

SMARCA4-DEFICIENT UNDIFFERENTIATED TUMOR: A RARE THORACIC MALIGNANCY

SESSION TITLE: Rare Malignancies SESSION TYPE: Case Reports PRESENTED ON: 10/17/2022 03:15 pm - 04:15 pm INTRODUCTION: SMARCA4 deficient undifferentiated tumors (SMARCA4-DUT) are rare and aggressive neoplasms that are most commonly encountered in young male smokers and portend a poor prognosis (1,2). They are characterized by loss of SMARCA4, a subunit of chromatin remodeling complexes, and loss of the tumor suppressor brahma-related gene 1 (BRG1). We present a case of an elderly female with an extensive smoking history who was diagnosed with SMARCA4-DUT. CASE PRESENTATION: An 84 year old female with approximately 70 pack year smoking history, emphysema, ischemic cardiomyopathy, and coronary artery disease, presented to the emergency room with upper abdominal pain which started one day prior to admission. She endorsed an unintentional 10 pound weight loss in the past two months. The patient was admitted for an incarcerated ventral hernia for which she underwent repair. Of note, one and a half years ago, she was found to have a right lower lobe 7mm nodule but was unable to follow up due to the COVID pandemic. On this admission, a CT chest revealed a 4.2 x 3.8 x 3.7cm mediastinal mass and subcarincal lymphadenopathy. She underwent an EBUS with biopsy of the mediastinal mass and subcarinal lymph node. Cytology showed highly atypical epitheloid cells, concerning for a neoplasm with neuroendocrine differentiation and granulomas. Given the high suspicion for malignancy, she had a PET CT (figure 1) which showed FDG activity (SUV 11) in the mass with areas of necrosis and was referred to thoracic surgery. She underwent thoracoscopy with mediastinal mass resection and lymph node dissection and pathology showed diffuse sheets of epithelioid cells with large foci of necrosis. Neoplastic cells showed preserved INI (SMARCB1) expression, non-reactivity for NUT, and complete loss of BRG1 (SMARCA4) expression, consistent with a SMARCA4-DUT with positive margins (figure 2). She was referred to Radiation Oncology with plans to pursue further therapy thereafter. DISCUSSION: SMARCA4-DUT is a new and distinctive clinicopathological entity of aggressive thoracic tumors (1). The novelty of this class of tumors poses challenges in terms of treatment. Immune checkpoint inhibitors have shown compelling outcomes in case reports (3), however larger studies are needed to delineate optimal treatment regimens. CONCLUSIONS: SMARCA4-DUT are are rare but highly aggressive thoracic neoplasms. They present as large tumors and are smoking related. Prompt recognition may aid in early diagnosis. No definitive therapy exists but immunotherapy has shown promising results. Reference #1: Chatzopoulos, K., Boland, J.M. Update on genetically defined lung neoplasms: NUT carcinoma and thoracic SMARCA4-deficient undifferentiated tumors. Virchows Arch 478, 21–30 (2021). Reference #2: Roden AC. Thoracic SMARCA4-deficient undifferentiated tumor-a case of an aggressive neoplasm-case report. Mediastinum. 2021;5:39. Published 2021 Dec 25. Reference #3: Henon C, Blay JY, Massard C, Mir O, Bahleda R, Dumont S, Postel-Vinay S, Adam J, Soria JC, Le Cesne A. Long lasting major response to pembrolizumab in a thoracic malignant rhabdoid-like SMARCA4-deficient tumor. Ann Oncol. 2019 Aug 1;30(8):1401-1403. DISCLOSURES: No relevant relationships by Sathya Alekhya Bukkuri No relevant relationships by Erin Meier No relevant relationships by Mangalore Amith Shenoy No relevant relationships by Alexandra Zavin

MEDULLARY THYROID CANCER IN COMBINATION WITH AUTOIMMUNE THYROIDITIS AFTER COVID-19

Background. Coronavirus disease 2019 (COVID-19) is a pandemic of the new millennium. COVID-19 can cause both pulmonary and systemic inflammation, and can rapidly progress to multiple organ failure. Data on the relationship between COVID-19 and the thyroid gland have been available since March 2020. The thyroid gland and viral infection as well as associated inflammatory-immune reactions participate in a complex interaction. The most common autoimmune disease is chronic autoimmune thyroiditis (chronic lymphocytic thyroiditis, Hashimoto thyroiditis). The majority of medullary thyroid cancers present as a thyroid nodule. Cervical lymph nodes and distant metastases are often detected at the time of diagnosis. The development of autoantibodies may be part of a more complex protective antitumor mechanism, the purpose of which is to eliminate the precursors of future tumor cells. The purpose of the study was to describe a clinical case of diagnosing medullary thyroid cancer in the patient who had COVID-19. Case description. We present the case of a 43-year-old woman who had coronavirus pneumonia (COVID-19), which was accompanied by an increase in serum procalcitonin (PC) level, which required additional examination. Since 2020, she had been observed for autoimmune thyroiditis, which was manifested by a thyroid nodular of a small size. After discharge from the COVID hospital, an ultrasound examination of the thyroid gland revealed an increase in the left lobe thyroid nodule up to 15 mm. The level of calcitonin was 681 pg/ml. Fine needle aspiration (FNA) biopsy of the thyroid gland showed suspicion for medullary thyroid cancer. Thyroidectomy with central lymph node dissection (level VI) was performed. A planned histological examination of the surgical specimen confirmed medullary thyroid cancer. Conclusion. In the present clinical case, medullary thyroid cancer was detected in the patient who had COVID-19 with elevated PC level, which was the basis for a diagnostic search.

Pre-Pandemic Sentinel Lymph Node Biopsy In Vulvar Cancer: 4-Year Single Centre Audit

Introduction and aims of the study: In early vulvar cancer, lymph node status is the most important prognostic factor. Sentinel lymph node biopsy (SLNB) is the minimally invasive procedure that lead to the most significant reduction in the classical high morbidity associated with the sistematic inguinal-femoral lymphadenectomy. Besides quality control, the aim of this study is to document the overall experience around SLNB at this referral Centre before the Covid pandemic, in order to monitor and possibly prevent future related changes. Methods: Retrospective analysis of patient files in cases where SLNB was performed as part of the treatment for vulvar cancer at the authors’ Department, from January, 2016 to December, 2019. A single surgeon performed the SLNB with the combined technique (technetium and patent blue). Data collected included demographics, pathology, accuracy, surgery and perioperative results, feasibility and survival. Results: 18 patients with vulvar squamous cell cancer were enrolled in the study. Median age was 68 years, average BMI 27.5kg/m2, 61.1% were married and Charlson score ≥5 was 55.6%. Primary site was labia majora in 44.4% and mid-line was affected in 27.8%. FIGO stage IB in 72.2% of cases, mean tumour diameter was 20.2 (7-39)mm. SLNB was bilateral in 27.8%, 1 out of 38 nodes removed was positive and average number of nodes per patient was 2.1. Mean hospital stay was 13.2 days, blood loss 72ml and no surgical complications. There was a single case of groin recurrence in 45.1 months mean follow-up time and 2 cases of non-related deaths. 33.3% and 5.6% patients had short and long-term postoperative complications, respectively, mostly infectious. Conclusions: SLNB is a reliable and safe minimally invasive technique that should be performed by experienced gynaecological oncologists in well-equipped and multidisciplinary Centres. The Covid pandemic is believed to be causing severe difficulties in the management of patients with vulvar cancer, from diagnosis to follow-up and treatment of recurrences. This study allows a future comparison with positive results at this Centre, possibly reflecting other similar scenarios in Europe.

Dysphagia rehabilitation after partial epiglottectomy for a combined squamous and neuroendocrine carcinoma of the larynx

Introduction: A 67 year old man presented dysphagia after a right partial epiglottectomy for a cT1N2bM0 supraglottic squamous cell carcinoma. Immunohistological assessment showed a mixed cellularity: a neuroendocrine (CK-20 +, S100 +, Ki67 90%) and squamous cell carcinoma. Margin ampliation to the right glossoepiglottic fold and a bilateral cervical lymphadenectomy was performed. Tracheostomy was needed after surgery because of laryngeal edema. Materials and Methods: Nasolaryngoscopy showed no glottic closure, saliva retention with aspiration and an absent answer to stimuli in the right supraglottic space. After a 5 ml pudding texture was given, methylene blue remained in the right pyriform sinus, aspiration and an absence of cough reflex. No oxygen desaturation or oral residuewas evidenced during exploration. Fractioned swallowing was needed. Results: A multidisciplinary evaluation of the patient in our Dysphagia Department took place. Logopedic restitutive techniques were a pillar in the rehabilitation of the patient. Sensory stimulation with heat foam, increase in muscular tone with direct stimulation to the tongue/pharynx and compensatory swallowing techniques were taught to the patient. After a 6 month follow up the same test with 5 ml pudding was performed. Glottic closure returned, with no evidence of aspiration to 5 ml pudding texture. Aspiration to nectar texture, fractioned swallowing and a right absence to stimuli remained. Conclusions: Dysphagia after head and neck cancer surgery is a common occurrence, given the most common location of appearance for squamous cell carcinoma is the supraglottis. Multidisciplinary approach to the patient that develops dysphagia remains key in the improvement of their quality of life and reduces the number of comorbidities after treatment. In this case the patient needed a tracheostomy after surgery, increasing their chances of dysphagia. After a closely followed multidisciplinary rehabilitation the patient was able to improve glottic closure and never had an episode of aspiration pneumonia until their death this past March 2021 from COVID-19.

Evaluation of the impact of the COVID-19 pandemic on the practice of axillary node dissection

Goals: The Association of Breast Surgery published “COVID-altered” guidance for the management of breast cancer during the COVID-19 pandemic, including that neoadjuvant chemotherapy was only to be used only in inoperable disease and not to downstage the axilla or facilitate breast conserving surgery. In addition, there has been concern over delayed cancer presentation with increased axillary node involvement. This observational study aims to establish if the practice of axillary node dissection (AND) has increased in the context of the COVID-19 pandemic. Methods: Patients undergoing operative management for breast cancer were identified retrospectively from theatre coding in a UK breast unit. Pre-COVID (March 2018 - February 2020) and COVID pandemic (March - September 2020) cohorts were defined and compared. For those undergoing AND the following data was ascertained: indication, tumour biology, neoadjuvant therapy, deviation from routine practice and histological outcomes.Results: AND was performed in 20.2% (23/114) of all breast cancer operations during the COVID pandemic compared with 18.9% (78/ 411) pre-COVID. Indication for AND during COVID pandemic and pre- COVID respectively: clinically node positive 82.6%/79.4%;positive sentinel node biopsy 4.3%/17.9%;recurrence or metastases from contralateral cancer 13%/2.5%. Neoadjuvant chemotherapy preceded AND in 30% of cases in both cohorts. Case review identified one patient in whom neoadjuvant chemotherapy for a clinically node positive HER2+ was omitted due to the pandemic and one other who had adjuvant chemotherapy omitted for a HER2+ cancer with a single positive sentinel node mandating an AND which yielded no further positive nodes. Conclusion(s): The COVID-19 pandemic has not had a major impact on rates of AND in our practice. However, we identified 2 patients who may have avoided AND had there not been deviation from routine neoadjuvant and adjuvant chemotherapy practice. Conflict of Interest: No significant relationships.

Characteristics and Patterns of Care of Endometrial Cancer before and during COVID-19 pandemic

Background: COVID-19 outbreak has correlated with the disruption of screening activities, regular follow up visits, and diagnostic assessments. The risk of misdiagnosis and delayed diagnosis has consequently increased during the pandemic. Endometrial cancer is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms (e.g. abnormal vaginal bleeding). Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of endometrial cancer patients. Material and methods: This is a retrospective study involving 53 centers in Italy. We evaluated patterns of presentation and treatment of endometrial cancer patients before (i.e. period 1: from 03/01/2019 to 02/29/2020) and during (i.e. period 2: from 01/04/2020 to 3/31/2021) the COVID-19 outbreak. Results: Medical records of 5,117 endometrial cancer patients have been retrieved: 2,688 and 2,429 women treated in period 1 and period 2, respectively. The prevalence of endometrioid International Federation of Obstetrics and Gynecologists (FIGO) grade 1, 2, and 3 was consistent over the study period (p=0.769). However, the prevalence of non-endometrioid endometrial cancer was lower in period 1 than in period 2 (15.7% vs. 17.9%;p=0.015). The characteristics and pattern of different surgical approaches were consistent in the two study periods (p=0.664). Before COVID-19 pandemic, 1,838 (73.2%), 647 (25.7%), and 25 (0.9%) patients had minimally invasive, open and vaginal surgery, respectively. During the COVID-19 pandemic, 1,661 (73.2%), 567 (24.9%), and 41 (1.8%) patients had minimally invasive, open, and vaginal surgery, respectively. Nodal assessment was omitted in 684 (27.3%) and 478 (21%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.8% in period 1 vs. 53.1% in period 2;p<0.001). Adjuvant therapy was omitted in 1,269 (50.5%) and 1,019 (44.9%) patients receiving treatment in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during the COVID-19 pandemic (p<0.001). Conclusions: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of endometrial cancer patients. These findings highlight the need to implement healthcare services during the pandemic.

The Effects of Modified Lymphoscintigraphy Techniques on Sentinel Lymph Node Biopsy Success During the COVID-19 Pandemic Period.

BACKGROUND AND OBJECTIVE: Sampling of the sentinel lymph node (SLN) in breast cancer provides accurate information about the condition of the axilla in 95% of cases. Technically in detecting SLN; radioactive substance, dyers or both are used. During the COVID-19 (Coronavirus disease 2019) pandemic, delayed images were not taken in lymphoscintigraphy to reduce the risk of transmission by shortening the waiting time in our center. In this study, the effects of early and delayed lymphoscintigraphic images and only early images on our clinical practice were evaluated. METHODS: We investigated the data of 147 patients in this study who underwent SLNB due to early-stage breast cancer at our institute during the COVID-19 pandemic period (PP) (March/April/May 2020) and within 3 months before the pandemic were evaluated. RESULTS: Patients were divided into two groups, before pandemic (BP) and PP. BP consisted of patients whose early and delayed images were taken in lymphoscintigraphy whereas PP consisted of those with early images only. There were 74 patients in the BP group and 73 patients in the PP group. Early phase increased uptake was not observed in 23 patients, and increased uptake was obtained from 22 of these patients with delayed imaging in BP period. In PP, increased uptake was not observed in 12 patients. SLN was not detected in 2 patients in the BP group and 7 in the PP group. It was found that the sensitivity, NPV and accuracy of the SLNB procedure performed after taking delayed images was higher. CONCLUSIONS: In the present study, we believe that if technically possible, delayed images taken during the lymphoscintigraphy can assist the surgeon in terms of SLN detection and the number of SLNs removed.