Multimodal hyperspectral imaging for the noninvasive diagnosis of cervical neoplasia.

OBJECTIVE: To determine the ability of Multimodal Hyperspectral Imaging (MHI) to noninvasively detect, localize and diagnose cervical neoplasia. MATERIALS AND METHODS: The cervical epithelium was interrogated by MHI using tissue fluorescence and reflectance measurements after the probe was placed on the ectocervix. A Papanicolaou smear was taken, and a colposcopic examination was performed and cervical histologic specimens were collected, when indicated. MHI and Pap smear sensitivity and specificity data were compared with colposcopic and histologic results. RESULTS: Nineteen patients had CIN2 or higher, 30 had CIN1, 34 had benign cellular changes or metaplasia, and 28 were normal by both Pap smear and colposcopic examination. At equal specificity (70%) for both tests, the sensitivity of MHI was 97%, compared to 72% for the Pap smear. CONCLUSION: MHI detected cervical cancer precursors at a rate greater than that obtained by a simultaneously collected Pap smear.

Colorectal and gynecological malignancies: comparison of B72.3 monoclonal antibody imaging, CT, and serum tumor antigens.

Noninvasive B72.3 monoclonal antibody imaging provides beneficial information that may influence therapeutic and surgical decisions, and may clarify other clinical, laboratory, and CT scan findings. Intraoperative localization of tumor sites with a hand-held gamma probe holds promise as a further advantage of this technique.

Invasive cervical cancer in young women. Clinicopathologic correlation and demonstration of human papillomavirus by in situ hybridization.

It has been suggested that invasive cervical carcinoma is biologically more aggressive in young patients than in older patients. The clinicopathologic characteristics and human papillomavirus (HPV) status of women < or = 35 years of age with invasive cervical carcinoma treated at Emory University Hospital from 1985-1989, were evaluated in a retrospective study. The group consisted of 23 patients, 35% of all patients with invasive cervical carcinoma. Age at diagnosis, clinical stage, histologic classification, lymph node status, treatment and clinical follow-up were obtained from medical records. HPV status was evaluated by colorimetric in situ hybridization for HPV types 6, 11, 16, 18, 31, 33 and 35 in archival formalin-fixed paraffin-embedded tumor material available from 16 of the patients. This study found that the young patients had lower survival and greater extent of disease than predicted by clinical staging. The rate of detection of HPV (69% positive) and HPV typing (type 16 predominated) in these young patients showed no difference from other series of cervical carcinomas from all age groups. Although a higher proportion of patients who died of disease had HPV-negative tumors (3/7, 43%) than those patients who were alive and free of disease (2/9, 22%), this difference was not statistically significant (P = .73, Fisher's Exact T-Test).

Early diagnosis of vulvar neoplasia as a result of vulvar self-examination.

Vulvar self-examination was used to facilitate early diagnosis and treatment of vulvar neoplasia in eight patients. Five of them were found to have invasive squamous cell carcinoma of the vulva, two had carcinoma in situ, and one had a vulva melanoma. All eight patients benefited from early diagnosis, which allowed definitive treatment and vulvar conservation.

Pelvic exenteration for recurrent or persistent gynecologic malignancies: a 10-year review of the Memorial Sloan-Kettering Cancer Center experience (1972-1981).

From January 1, 1972 to December 31, 1981, sixty-five patients underwent pelvic exenteration as treatment for recurrent or persistent gynecologic malignancy at Memorial Sloan-Kettering Cancer Center. Cervical carcinoma was the disease most commonly treated by exenteration. The operative mortality of 9.2% represents an improvement over previous reports from this institution. After routine use of prophylactic minidose heparin, no cases of thrombophlebitis or pulmonary embolus occurred postoperatively. A 5-year survival rate of 23% warrants continued use of exenteration in carefully selected patients. The significant mortality and morbidity associated with pelvic exenteration preclude its use as a palliative procedure.

Bilateral ovarian hemangiomas associated with diffuse abdominopelvic hemangiomatosis.

A case of bilateral ovarian hemangiomas and abdominopelvic hemangiomatosis associated with thrombocytopenia is reported. After total abdominal hysterectomy and excision of a hemangioma adhered to the colon, the platelet count returned to normal, and the patient has remained asymptomatic for five years. A review of three previous cases of bilateral hemangiomas associated with abdominopelvic hemangiomatosis reveals only one patient living two years after diagnosis. The etiology of the hemangiomas is unknown. The thrombocytopenia appears to be secondary to the hemangiomas. The recommended treatment is removal of all resectable hemangioma masses.

Computerized drug dosing in renal failure: a real problem and a practical solution.

In the presence of impaired renal function a number of pharmacologic agents require dose adjustments to avoid toxicity. Physician dose variations of a wide range of pharmaceuticals, 237 orders for 30 drugs for 107 patients, were compared to doses recommended by a computer program which considers renal function in calculating its dose. Disagreement in dose regimens was evaluated by comparison of physician-dose to computer-dose for three classes of drugs: wide range, narrow range, and 80% renally excreted. With true renal impairment (serum creatinine greater than or equal to 1.2 mg/100 ml and creatinine clearance less than 80 ml/m) significant overdosing occurred for narrow range and 80% renally-excreted agents, 83 and 77% respectively. There is a great potential hazard observed to be avoided. It is recommended that dose adjustments for nephrotoxic or renally-excreted agents be implemented using creatinine clearance (estimated or measured) with, at the very least, manufacturer's recommendations.