ABSTRACT
PURPOSE: Molecular classification of endometrial cancer (EC) has become a promising information to tailor preoperatively the surgical treatment. We aimed to evaluate the rate of lymph node metastases (LNM) in patients with EC according to molecular profile. METHODS: A systematic review and meta-analysis were performed according to PRISMA guidelines by searching in two major electronic databases (PubMed and Scopus), including original articles reporting lymph node metastases according to the molecular classification of EC as categorized in the ESGO-ESMO-ESP guidelines. RESULTS: Fifteen studies enrolling 3056 patients were included. Pooled prevalence LNM when considering only patients undergoing lymph node assessment was 4% for POLE-mutated (95%CI: 0-12%), 22% for no specific molecular profile (95% CI: 9-39%), 23% for Mismatch repair-deficiency (95%CI: 10-40%) and 31% for p53-abnormal (95%CI: 24-39%). CONCLUSIONS: The presence of LNM seems to be influenced by molecular classification. P53-abnormal group presents the highest rate of nodal involvement, and POLE-mutated the lowest.
Subject(s)
Endometrial Neoplasms , Lymphatic Metastasis , Humans , Endometrial Neoplasms/genetics , Endometrial Neoplasms/pathology , Female , Tumor Suppressor Protein p53/genetics , Mutation , Poly-ADP-Ribose Binding Proteins/genetics , DNA Polymerase II/genetics , Lymph Nodes/pathology , Biomarkers, Tumor/geneticsABSTRACT
Sentinel lymph node biopsy has proven safe and feasible in a number of gynecologic cancers such as vulvar cancer, cervical cancer, and endometrial cancer. The proposed aim of lymphatic mapping and sentinel node identification is to decrease the associated morbidity of a complete lymphadenectomy, particularly the rate of lymphedema, while also increasing the detection of small tumor deposits in the node. Different tracers have been shown to be useful, including technetium-99 and blue dye, with a detection reported in 66% to 86%. Recently, there has been increasing interest in the use of fluorescent dies such as indocyanine green (ICG). In this report we provide a review of the existing literature regarding the use of ICG in cervical or endometrial cancer with the goal to provide details on its utility and compare it with other tracers.
Subject(s)
Coloring Agents , Genital Neoplasms, Female/pathology , Indocyanine Green , Lymph Nodes/pathology , Optical Imaging , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy/standards , Endometrial Neoplasms/pathology , Female , Humans , Lymph Node Excision , Uterine Cervical Neoplasms/pathology , Uterine Neoplasms/pathology , Vulvar Neoplasms/pathologyABSTRACT
The standard management of advanced-stage ovarian cancer has been a subject of debate, and much controversy remains as to whether patients should have primary cytoreductive surgery followed by chemotherapy or neoadjuvant chemotherapy followed by interval cytoreductive surgery. In addition, there is increasing evidence that the patients who ultimately gain the most benefit from surgery are those with no residual disease at the completion of surgery (R0 resection). Therefore, to determine the best therapeutic strategy (primary cytoreductive surgery vs. neoadjuvant chemotherapy) for an individual patient, it is critically important to estimate the likelihood that primary cytoreductive surgery will leave no macroscopic residual disease. A number of studies have evaluated the use of serologic markers, such as CA-125, and imaging modalities, such as computed tomography (CT) or positron emission tomography/CT (PET/CT), to determine which patients are ideal candidates for primary cytoreductive surgery. More recently, laparoscopy has been proposed as a reliable predictor of R0 resection. In this report, we provide a review of the existing literature on the proposed criteria to predict the outcome of cytoreductive surgery and the role of laparoscopy-based scores in the management of advanced ovarian cancer.
Subject(s)
Cytoreduction Surgical Procedures/methods , Neoplasms, Glandular and Epithelial/surgery , Ovarian Neoplasms/surgery , Carcinoma, Ovarian Epithelial , Cytoreduction Surgical Procedures/standards , Female , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/standards , Humans , Laparoscopy/methods , Laparoscopy/standards , Neoplasm Staging , Neoplasms, Glandular and Epithelial/pathology , Ovarian Neoplasms/pathology , Prospective Studies , Standard of CareABSTRACT
Ovarian transposition has proven to be a safe method for preserving ovarian function in young premenopausal women who require pelvic irradiation for treatment of early stage malignancies. We report 2 cases of ovarian torsion after laparoscopic ovarian transposition in 2 young women scheduled for chemotherapy and radiation therapy for treatment of cervical or vaginal cancer. We believe these are the first such cases reported in the literature. In discussions with patients regarding the risks and potential benefits of ovarian transposition, ovarian torsion should be included as a possible, although rare, complication.
