Magnetic resonance spectroscopy - its added value in brain glioma multiparametric assessment.

OBJECTIVE: In this study, we analysed the results of magnetic resonance spectroscopy (MRS) in the patients with gliomas, including the error rate, MRS parameters variability, correlations with gene mutations and overall usefulness for clinical practice. MATERIAL AND METHODS: Eighty patients with glial tumours were examined by multiparametric MRI completed with single voxel MRS, as one group, then as two separate groups according to progression of the disease after the initial surgery. The error rate between the groups, MRS parameters variability, hazard ratios and correlations between metabolites, genetic markers and tumour grade were all analysed. RESULTS: Variability in Cho/Cr(h) was significantly higher in the group with a disease progression (p = 0.044). In the patients with a stable disease, strong significant negative correlations between Cho/Cr and Cho/NAA with p53 mutation (-0.945 and -0.812 respectively, p < 0.05) and between Cho/Cr and IDH1, 2 mutation (-0.796, p < 0.05) were found. In the patients with tumour progression, a significant positive correlation of NAA/Cr with 1p19q codeletion (0.486, p < 0.05) and of Cho/Cr and Cho/NAA values with p53 mutation (0.477 and 0.416, p < 0.05) were identified. Tumour grade positively correlated with Cho/Cr values (0.304, p = 0.02) in the whole patient group. CONCLUSION: MRS brings an added value to multiparametric MRI evaluation of brain tumours in the patient follow-up after an initial surgery, especially in ambiguous findings (Tab. 5, Fig. 2, Ref. 29).

Bilateral testicular germ cell tumors - 50 years experience.

OBJECTIVE: This study analysed the characteristics and outcome of the patients with bilateral germ testicular cell cancer (TC), especially synchronous. METHODS: Among 2.124 TC patients diagnosed between 1970 and 2020, 96 (4. 5%) developed the 2nd TC. Nine occurred synchronously and 87 were metachronous. Patients were analysed according to the age and histological type of bilateral TC in comparison with unilateral TC. RESULTS: The mean follow-up of all 2,124 patients was 14.9 years. Unilateral TC occurred in 2.028 patients (the mean age of 32.4 years), 707 of them had seminoma, 1.310 nonseminomatous (NS) TC and 11 spermatocytic tumours. The 1st tumour of metachronous bilateral disease was diagnosed at a significantly younger age (27.1 years) compared to the unilateral disease (32.4 years). The mean interval between the 1st and the 2nd TC was 8.2 years. Patients with NSTC had a longer mean interval (9.2 years) between the 1st and the 2nd TC in comparison with seminoma patients (6.7 years). The mean age at diagnosis for seminoma was significantly higher (31.3 years) compared to the NSTC (24.1 years). Bilateral seminoma occurred in 5 synchronous bilateral TC patients, four patients had discordant histology, none presented with bilateral NSTC. CONCLUSIONS: Bilateral TC is a rare and requires individualized management of patients (Tab. 5, Fig. 4, Ref. 32).

Extremely rare synchronous primary neoplasms in testicular cancer patients.

OBJECTIVES: This study analyzes the incidence of multiple primary malignant neoplasms (MPN) in patients with testicular cancer (TC), the results are compared with literature findings and assess the rarest subgroup of patients with MPN. PATIENTS AND METHODS: Clinical data of 1870 patients with TC treated or followed up in a single center in the period of 5/1970-12/2018 were collected and analyzed retrospectively in focus of the occurrence of MPN. RESULTS: The overall incidence of MPN was 150 (8.02 %). There were 89 cases of bilateral TC (59.3 %), of these 8 cases were synchronous (diagnosed within three months period from the primary diagnosis) and 81 metachronous (9 % and 91 % respectively). Non-testicular other primary malignancies (OPM) occurred in 61 cases (40.7 %), of which 59 cases were metachronous (96.7 %) and two cases were synchronous (3.3 %). Metachronous malignancies included mainly prostate cancer (n = 17 patients), kidney cancer (n = 13 patients) and colorectal cancer (n = 12 patients). Synchronous OPM was found in two patients. CONCLUSION: In our study we registered two cases of synchronous OPM, both histologically clear cell renal cancer. We have analyzed clinical characteristics, diagnosis and treatment strategies of synchronous OPM, in order to improve its diagnosis and therapy (Fig. 3, Ref. 22).

Idiopathic Granulomatous Mastitis - a new approach in diagnostics and treatment.

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking carcinoma and puerperal or non-puerperal mastitis. The primary purpose of this prospectively performed case control study was to compare clinical and imaging signs of IGM with the reference group of nonspecific, non- puerperal mastitis (NM) to identify the most typical clinical and imaging signs essential for a correct differential diagnosis. The secondary purpose was to present a new approach to non-invasive treatment. Thirty-nine women with histologically proven IGM and twenty-six patients with nonspecific mastitis underwent clinical examination, breast ultrasound (US), mammography (MG) and MRI examination. The most typical signs were selected for each group, and method and were statistically evaluated. The effectivity of colchicine, vitamin E and ribwort plantain tincture in treatment was assessed by clinical examination and imaging. Typical clinical signs of IGM included unilateral acute onset of breast edema, redness, palpable masses, missing fever, lymphadenopathy, no response to antibiotics or surgical interventions. Ultrasound revealed: "finger-like" structures (100%), ductectasias (76.9%), abscesses (76.9%), and lymphadenopathy (15.4%), while in MRI skin and tissue edema (100%), multicentric lesions (100%), abscesses (76.9%), ring enhancement (84.6%), lymphadenopathy (15.4%) and small enhancing lymph nodes (38.5%) were observed. Among the clinical signs, fistulas, hypoechoic mass, ductectasias and diffusion weighted images (DWI) restriction were significantly more frequent in patients with IGM than in those with NM. Treatment effectivity yielded 100% with a complete response between 6-19 months, depending on the disease extent. Targeted questions together with imaging can speed up selection for proper treatment with colchicine, vitamin E and local treatment. Long lasting use of antibiotics and repeated surgical interventions should be avoided.

Multiparametric MRI analysis of morphologico-functional features of DCIS - correlation with grade of nuclear atypia.

The aim was to analyze morphologico-functional characteristics of ductal carcinoma in situ (DCIS) in breast MRI to assess signs correlating with the degree of nuclear atypia. From 636 malignant lesions, 114 were DCIS (17.92%): 44 cases of high-grade (38.60%), 37 intermediate (32.45%), 33 low-grade (28.95%). MRI characteristics - T2 signal intensity (SI), shape, margins, contrast enhancement, peripheral/ductal enhancement, kinetic curve, presence of restriction of diffusion were correlated with the nuclear grade of DCIS. Statistical analysis was performed, statistical significance and Odds ratio (OR) were calculated. Signs of high-grade lesions were low SI in T2w (p=0.042), nonhomogeneous contrast enhancement (p=0.012), wash-out phenomenon (p=0.04), high SI in diffusion weighted imaging (DWI) (p<0.0001), restriction of diffusion in apparent diffusion coefficient map (p<0.0001). DWI and wash-out phenomenon reached the highest OR (56.00, 9.76). Breast MRI using DWI and multiparametric analysis provides important information about the degree of nuclear atypia.

Pitfalls of Contrast Enhanced Ultrasound (CEUS) in determination of breast tumor biological dignity.

The aim of this prospective study was to identify characteristics of breast lesions on contrast enhanced ultrasound (CEUS) that can be a source of diagnostic ambiguity and cause under- or overestimation of examined breast lesions. 215 women (range 23-76 y., mean age 53.16 y) with 215 breast lesions were examined by B-mode ultrasound, followed by CEUS and core biopsy. CEUS parameters: degree of opacification, character of washout and preliminary CEUS result (suspicious, non-suspicious, uncertain) were subsequently correlated with histopathological outcomes. Observed qualitative variables, CEUS results and their analysis with respect to histological type were evaluated using Pearson χ2 square test, p<0.05 was statistically significant. Differences in mean lesion size, mean age of patients, mean size between groups (malignant/benign) with respect to CEUS result were evaluated by t-test. 215 tumors, 116 (53.93%) benign and 99 (46.05%) malignant lesions. 17 (14.66%) benign and 15 (15.15%) malignant lesions expressed atypical washout, 5 (4.31%) benign lesions had early washout and 38 (38.38%) had continuous washout (p<0.0001). 56 (48.28%) benign and 55 (55.56%) malignant lesions had middle degree of opacification, 19 (16.38%) benign had high and 5 (5.05%) malignant lesions low degree of opacification (p<0.0001). Finally, 38 (32.72%) benign and 20 (20.20%) malignant were marked CEUS uncertain. As risk lesions are considered fibroadenomas, fibrocystic lesions, papillomas and low grade DCIS or invasive breast tumors, especially lesions smaller than 10 mm.Identification of CEUS pitfalls with respect to problematic histopathologic entities can reduce the risk of misdiagnosis and improve further management of breast lesions.

MR-mammography - impact on disease extent determination and surgical treatment of invasive ductal and lobular breast cancers.

UNLABELLED: The aim of this study is to assess the impact of multiparametric MR imaging to an exact determination of the extent of invasive ductal and lobular breast cancers in routine clinical practice.180 women aged 27-74 years (median 52.4 years) with newly diagnosed invasive ductal and lobular breast cancers confirmed by core-cut or vacuum-assisted biopsy were examined by all three imaging modalities, i.e. digital X-ray mammography, ultrasonography and 3T MR-mammography. In case of MR-mammography an extended protocol, i.e. combination of morphological breast MRI + DCE + DWI was used. For overall detection and determination of the extent of invasive breast cancers (IDC + ILC) MRmammography alone reached the diagnostic accuracy of 72.48%, while X-ray mammography 69.12% and ultrasonography 59.87%. In cases of ILC combination of X-ray mammography and MR- mammography with sensitivity of 96.15% was the most effective. In comparison with X-ray mammography and ultrasonography MR-mammography had higher sensitivity (96.15%, versus 90.28%) in the diagnosis of multifocal/ multicentric invasive lobular carcinoma and invasive ductal carcinoma with extensive intraductal component, as well. 3T MR-mammography is an effective complementary consulting modality to digital X-ray mammography and ultrasonography, and it is particularly beneficial in the detection of additional mammographically and ultrasonografically occult breast lesions, as well as in the determination of the real extent of pathological changes in the ipsilateral and contralateral breast. KEYWORDS: MR-mammography, occult breast cancer, invasive ductal cancer, invasive lobular cancer, multifocality, multicentricity.

Analysis of radiation-induced angiosarcoma of the breast.

Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. Both primary and secondary angiosarcomas may present with bruise like skin discoloration, which may delay the diagnosis. Imaging findings are nonspecific. In case of high-grade tumours, MRI may be used effectively to determine lesion extent by showing rapid enhancement, nevertheless earliest possible diagnostics is crucial therefore any symptoms of angiosarcoma have to be carefully analysed. The case analysed here reports on results of 44-year old premenopausal woman who was treated for a T1N1M0 invasive ductal carcinoma. After a biopsy diagnosis of carcinoma, the patient underwent quadrantectomy with axillary lymph node dissection. She received partial 4 cycles of chemotherapy with adriamycin and cyclophosphamide, followed by radiation treatment. Thereafter, a standard postoperative radiotherapy was applied at our institution four months after chemotherapy (TD 46 Gy in 23 fractions followed by a 10 Gy electron boost to the tumour bed). Adjuvant chemotherapy was finished six months after operation, followed by tamoxifen. Follow up: no further complications were detected during regular check-ups. However, 12-years later, patient reported significant changes at breast region which was exposed to radiation during treatment of original tumour. In this article, we describe the clinical presentation, imaging and pathological findings of secondary angiosarcoma of the breast after radiotherapy (Fig. 2, Ref. 26).

Pineal germ cell tumors: review.

BACKGROUND: Primary intracranial germ cell tumors represent a rare category of neoplasms, which occur in children and young adults. The WHO classification divides intracranial tumors into germinomas and non-germinomas. The most frequent locality of these tumors is pineal and suprasellar region. Clinical signs and symptoms depend on the localization of the tumour - they most commonly include signs of increased intracranial pressure, Parinauds syndrome, bitemporal hemianopsy and signs of endocrine deficiency. Gadolinium enhanced MRI scan of the brain is the imagining examination of choice in the diagnostic strategy of intracranial germ cell tumors. However, the imagining studies do not provide sufficient information about histological type; therefore, biopsy is necessary. The exception represents cases with characteristically increased levels of tumor markers (AFP and ß-HCG) measured in the serum and cere-brospinal fluid. CASE: A pineal germ cell tumor was observed in a 26-year-old male with presentation of an eye-sight disorder with focusing difficulty and photophobia, accompanied by intensive fatigue and sleepiness, nausea with occasional vomiting, intermittent headaches and Parinauds syndrome. MRI examination of the brain showed tumor expansion in the pineal region and in the right part of the mesencephalon. Radical extirpation of the tumor in the pineal region was performed. The follow-up MRI scan of the brain revealed relapse of the disease. The patient underwent craniospinal radiation therapy with subsequent postoperative chemotherapy (regimen cisplatin and etoposide), three cycles in total. Currently, the patient is 30 months after finishing of oncological treatment in clinical remission of the disease. CONCLUSION: The treatment and prognosis of this neoplasm differ between particular categories. Germinomas have better survival rates than non-germinomas. A 5-year survival rate of germinoma patients after application of radiotherapy alone was > 90% of cases. The addition of chemotherapy lead to a decrease of the dose and minimalization of the irradiated area, with achievement of fewer side effects without a decrease of the curability. Non-germinomas are less radiosensitive than germinomas, but after the application of the adjuvant chemotherapy, survival benefit was achieved. However, the optimal management of these tumors remains controversial.

Stereotactic vacuum-assisted breast biopsy: our experience and comparison with stereotactic automated needle biopsy.

OBJECTIVES: To evaluate and compare the outcome of stereotactically guided percutaneous, directional, vacuum-assisted breast biopsy (VAB) with the outcome of those performed with 14-gauge automated gun. METHODS: Between January 2008 and January 2011, altogether 257 stereotactic biopsies were performed in our institute; 193 with the 14-gauge automated needle and 64 with a directional, vacuum-assisted instrument. Patients with malignant or high risk lesions were encouraged to undergo an excisional biopsy. We evaluated and compared concordance between the biopsy results and subsequent examinations (surgical excision or follow up) for both methods. RESULTS: VAB demonstrated 57 (89 %) benign lesions, 2 (3 %) high risk and 5 (8 %) malignant lesions. We obtained post-bioptic mammographic or histological evaluation for altogether 51 lesions, with one (12.5 %) false negative case, one case of underestimation of borderline lesion, and no false positive cases. Clusters of microcalcifiation were completely removed in 18 lesions (28 %). CONCLUSION: Vacuum-assisted biopsy outperformed the 14-gauge automated needle biopsy with a lower disease underestimation, sensitivity and false-negative rates; however these differences were not statistically significant due to small data files and relatively small number of identified malignant lesions in the vacuum-assisted biopsy group.VAB completely removed significantly more clusters of microcalcifications in comparison to the automated needle biopsy, which significantly reduced the need for surgery in benign lesions (Tab. 7, Fig. 3, Ref. 32).

The role of dynamic contrast-enhanced MRI in differentiation of local recurrence and residual soft-tissue tumor versus post-treatment changes.

OBJECTIVES: To evaluate the reliability of dynamic contrast-enhanced MRI in the diagnosis of local recurrence of malignant soft-tissue tumors after receiving treatment. METHODS: From March 2002 till December 2009 we performed dynamic contrast enhanced MRI in 95 patients with soft-tissue tumor after receiving treatment (surgery, radiotherapy, chemotherapy). Patients were classified according to five types of TIC. RESULTS: The recurrent disease was suspected in 47 patients and the biopsy was recommended. In 8 cases (TIC II), the biopsy was performed due to long-term post-treatment changes. Histological results proved STT recurrence in 45 patients; in 10 patients (8 with TIC II), biopsy revealed hypervascular granulation tissue, florid inflammation and reactive changes. The sensitivity for dynamic contrast-enhanced MR examination was 100 %, specificity 80 %, positive predictive value (PPV) 95.7 % and negative predictive value (NPV) 100 %. CONCLUSION: Our results indicate that TICs III, IV and V raise high suspicion of local tumor recurrence and require percutaneous imaging-guided biopsy. TIC of type II usually represents a pseudomass and the biopsy should be performed only in selected cases with increased risk of recurrent disease based on multidisciplinary approach. On the basis of literature review as well as our experiences we created a reliable algorithm proposed for diagnosing the residual or recurrent soft-tissue tumors (Tab. 2, Fig. 6, Ref. 20).

[Ductal carcinoma in situ (DCIS) and biopsy of the sentinel lymph node]. / DCIS a biopsia sentinelovej uzliny.

INTRODUCTION: Ductal carcinoma in situ (DCIS) is the disease with increasing incidence. Nowadays, approximately 80% DCIS are diagnosed via mammography and represent more than 20% of all types of breast cancer. The acceptance of surgical procedures with this type of breast carcinoma is controversial as primary diagnosis of non-invasive carcinoma is often underestimated and in the end, histopathological examination reveals invasive carcinoma with biological potential to metastasize. In cases of "risk" patient groups with DCIS, several studies report lymph node metastases. The aim of the study has been to assess the incidence of sentinel lymph node metastatic involvement in high-risk patient group with DCIS and in ductal carcinoma in situ with microinvasion (DCISMI), to note the incidence of invasive carcinoma in definitive histopathology in patients with pre-operative diagnosis of DCIS and to analyze some predictors of invasivity. STUDY TYPE AND PATIENT GROUP: In retrospective analysis, we evaluated the setting of 119 patients who have been operated on at our Clinic from January, 1st 2008 until December, 31th 2010 for the diagnosis of DCIS. Prospectively, we have created the setting of 44 patients with high-risk DCIS with sentinel lymph node biopsy (SLNB) performed. METHODS AND RESULTS. Metastatic involvement of sentinel lymph node in high-risk DCIS has been found in 4 cases (9.0%)--in 1 patient (2.2%) with correct diagnosis of DCIS and in 3 patients (6.8%) with invasive carcinoma according to final histopathology. In the patient with DCIS, a micrometastasis of 0.4 mm was found in one sentinel lymph node. After complete axillary dissection, non-sentinel axillary lymph nodes metastatic involvement was not demonstrated (14/0). In 6 cases (5.0%), we identified DCISMI and did not find metastasis in sentinel lymph node. In the high-risk DCIS group, in 4 patients (9.0%) DCISMI and in 12 patients (27.2%) invasive carcinoma was found after definitive histopathologic examination. In this group, the overall ratio of invasive lesions was 36.2%. As for predictors of invasivity, high-grade carcinoma (OR 4.2; 95% CI 1,40-12,58) has more than 4-fold higher influence and lesion size

Digital mammography--a new trend in breast carcinoma diagnostics.

OBJECTIVES: To determine the advantages of digital mammography in early detection of breast carcinoma. BACKGROUND: A new full field digital mammograph was installed at St. Elisabeth Oncology Institute in Bratislava 13 months ago. During this period we gained experience using this equipment and compared it to the foreign countries. METHOD: Comparison of digital and conventional mammography. RESULTS: During the period of 13 months 11 799 patients were examined, 5664 with conventional and 6135 with digital mammograph. We diagnosed 98 cases of breast carcinoma (1.6%, p = 0.67) with digital mammography, out of which 17 (17.3%, p = 0.47) were in stage of carcinoma in situ. Using a conventional mammography 68 cases (1.2%) of breast carcinoma were diagnosed, 9 cases (13.2%) as carcinoma in situ. Recall rate differed significantly--for digital mammography it reached 6.9% in comparison to conventional mammography where the recall rate was 9.5%, p < 0.05. Digital mammography seems to be more sensitive in the detection of early stages of breast carcinoma as well as it is selectively advantageous in women with dense breast, perimenopausal women, patients with hormonal replacement therapy. CONCLUSION: Digital mammography is the state-of-the-art method of the early stages breast carcinoma detection especially when enhanced with a CAD system. A considerable contribution of digital mammography will find its use in interventional mammodiagnostic methods (Tab. 1, Fig.5, Ref. 7).

[Significance of the sentinel lymph node biopsy in early breast carcinomas]. / Význam biopsie sentinelovej uzliny pri vcasnom karcinóme prsníka.

We present our experience regarding sentinel lymph node biopsy (SLNB) at St. Elizabeth Institute of Oncology during 48 months. From January 1st, 2006 until December 31st, 2009, we had performed SLNB in 269 patients. Primary tumour size was 0.3-3.5cm including non-invasive breast carcinoma (i.e. TIS, T1 and T2 of TNM classification). Invasive carcinoma accounted for 255 (94.8%) cases, while non-invasive carcinoma for 14 (5.2%) cases. From total of 269 patients with invasive carcinoma, we used validation method in 157 (72.7%). In 255 patients with invasive carcinoma, sentinel node was not identified in 4 (1.6%) cases--in 1 patient with T1 invasive carcinoma and in 3 patients with T2 tumours. False negativity of sentinel node in T1 tumours was 4.3%. The incidence of macrometastases in sentinel nodes was confirmed using standard histopathologic examination with hematoxylin-eosin stain. In negative instances, the examination was then completed with serial sections and immunohistochemistry using cytoskeletal antibodies for confirmation of presence of micrometastases. In 6 (2.4%) cases, we found micrometastase in originally negative sentinel lymph node. Subsequent axillary dissection has not confirmed non-sentinel nodes involvement.

Digital and manual cephalometric analysis.

OBJECTIVES: To compare the manual and digital cephalometric analyses and to research a new procedure of analog cephalogram digitalization. METHODS: 40 repeated measurements were used to evaluate the reproducibility and reliability of both methods. The analog x-ray was CHIRALUX2, the digital camera used was Canon PowerShot G5 and the digital tracing was done by Dolphin imaging version 10. The sample dispersion has been evaluated for each of the monitored cephalometric variables (SNA, SNB, ANB, PP/ML, inter-incisal angle and Wits). The difference of sample dispersion was tested (Morgan-Pitman). Four doctors processed 100 random analog cephalograms in total and evaluated them in a way established by Bland and Altman. RESULTS AND CONCLUSION: Validity and reproducibility of analyses carried out manually and digitally is in high mutual correlation and therefore the software analysis can fully substitute the manual method. The dispersion of values in repeated measurements was higher in manual method and therefore we consider the digital method more accurate (Fig. 4, Tab. 1, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Digitalization in radiology--6 years in the St. Elisabeth Oncology Institute.

OBJECTIVES: To determine advantages and specific problems of film-free digital hospital focused on radiology department. BACKGROUND: In the St. Elisabeth Oncology Institute in Bratislava we have more than 6-year experience with digital modalities and the PACS system. During this period many difficulties occurred and are expected to rise with an increasing number of digital modalities. METHODS: Statistical evaluation of a 6-year period in numerous graphs and schemes. RESULTS: The amount of data can be seen in graphs, which show the amount of examinations and data volume from different modalities for specific time period to October 2007 and present volumes and increase of data amount in megabytes (MB) in the last 6 years. CONCLUSION: Despite of systematic capacity increase it is a long-term archiving and economical problem. It is crucial to solve the daily amount of data, backup copies, type of archiving media, and priority of data accessibility (Tab. 1, Fig. 5, Ref. 9). Full Text (Free, PDF) www.bmj.sk.

Soft-tissue tumors--role of diagnostic imaging.

The radiologic evaluation of soft-tissue masses has changed dramatically within the last two decades. Before the introduction of computer-assisted imaging, assessment of clinically suspicious soft-tissue masses was usually limited to radiographs. Although radiographs were sensitive to the identification of adipose tissue and soft-tissue mineralization, they provided little other diagnostic information. The emergence of CT improved this situation dramatically. Masses could be not only delineated with a great confidence but well staged with excellent depiction of anatomic detail. However, diagnosis remained problematic, with images sufficiently suggesting the correct histology in only a minority of cases: typically, lipomas and hemangiomas. The introduction of MR imaging markedly improved soft-tissue contrast and multiplanar image acquisition capabilities. Depiction of anatomic detail is of high importance in the evaluation of soft-tissue tumors. Attempts were made to develop rules analogous to those for bone tumors, for differentiating benign and malignant processes on the basis of lesion morphology and signal intensity.

New approach to human high-risk papillomavirus (HR-HPV) genotyping.

Human high-risk papillomaviruses (HR-HPVs) are involved in the induction of invasive cervical cancer. The aim of this study was to introduce a simple, semi-automated and reproducible approach suitable for HR-HPV detection in clinical practice. The procedure is based on DNA isolation, nested polymerase chain reaction, single strand conformational polymorphism and evaluation of HR-HPV genotypes with Gel-Pro software. The clinical performance of the new approach was assessed in two different patient materials: 1) cervical smears with cytological classification Pap2-3 or Pap3 lacking nuclear atypia (anisonucleosis and polychromasia) or koilocytotic atypia and without any previous therapy 2) formalin-fixed, paraffin-embedded cervical carcinoma and lymph node sections. Using the new approach we detected HR-HPV DNA in 64% patient samples cytologically classified as Pap2-3 or Pap3 respectively and in 80% formalin-fixed, paraffin-embedded lymph node sections histologically classified as lymph nodes without carcinoma cell infiltration. The combination of methods described in this study results in increased sensitivity of HR-HPV identification allowing detection of HPV DNA in a very small amount of target DNA so that it can be widely used in distinguishing the pre- malignant lesions and in determination of invading carcinoma cells to lymph nodes in patients with advanced cervical cancer. The new approach is useful in unambiguous HR-HPV genotyping even in double-HPV infection.

Doppler flowmetry in the differentiation of biological characteristics of ovarian cancer.

On basis of ultrasonographic structural criteria and Doppler flowmetry in a group of 76 patients with ovarian cancer, benign lesions were discovered in 59 patients and malignant lesions in 17 patients (77.6% and 22.4%, respectively). Surgical intervention was indicated according to the clinical findings and following of the trend of organ-specific oncomarkers in 32 out of 76 patients (42.1%). The stratification involved 17 patients with sonomorphologically/Doppler-flowmetry - diagnosed malignancy as well as 15 patients with sonographically diagnosed benign ovarian tumor. The clinical findings were histologically verified in all 32 patients. Histology confirmed malignant tumor in 16 patients, 1 histologically borderline malignancy and 15 benign tumors. The Doppler-flowmetry showed 94.1% sensitivity, 93.3% specificity, 93.3% positive predictive value, and 93.75% accuracy.