Transvaginal ultrasound examination of myometrial infiltration by endometrial cancer.

The depth of myometrial infiltration by endometrial cancer is an important prognostic factor. The examination of the depth of infiltration classifies the patients in the low- and high-risk groups, which influences the therapeutic approach. Transvaginal ultrasonography represents a first-choice diagnostic test for the assessment of the depth of myometrial infiltration as the time consumption and financial demands of magnetic resonance imaging need to be taken into account. In comparison with the MRI, the diagnostic accuracy of the transvaginal ultrasound depends more on the individual experience and professional potential of the examining physician. This fact can contribute to the heterogeneity of published results of transvaginal ultrasound on the determination of infiltration depth. Having in mind the aim to verify these indicators in our local conditions and environment, we decided to prospectively study 150 endometrial cancer patients who were examined with the transvaginal ultrasound in the period 1/2009 - 10/ 2011. Correlated firstly with the preoperative and then secondly with the definitive histopathological examination was the depth-of-infiltration-related data that had been taken from the ultrasound findings. The output being monitored was the exclusion or confirmation of the invasion exceeding half the thickness of myometrium. In our study, the diagnostic accuracy of the method reached 82.67 %, while the other indicators were as follows: sensitivity 92.31 %, specificity 79.28 %, positive predictive value (PPV) 61.02 %, negative predictive value (NPV) 96.7 %, the likelihood ratio of a positive test 4.455 and the likelihood ratio of a negative test 0.097. The results of the depth of myometrial infiltration examination and their comparison with the data from similarly oriented clinical studies entitle us to include this examination in the set of standard preoperative methods used for the examination of patients with endometrial cancer (Tab. 3, Fig. 5, Ref. 20).

[Vulvar intraepithelial neoplasia]. / Vulvárna intraepiteliálna neoplázia.

HPV infections of the lower genital tract are associated with the increasing incidence of vulvar intraepithelial neoplasia. The new classification divides vulvar intraepithelial neoplasia according to its incidence into two groups: usual and differentiated type. The usual type occurs mainly in young women and is associated with HPV infection, the differentiated type is HPV-negative and occurs in older women. The diagnosis is based on biopsy from a suspicious lesion. The standard treatment involves surgical excision. Topical treatment is now being preferred in young women in order to preserve appearance of the genitalia and sexual function. The high risk of recurrence is the reason for strict monitoring of patients after treatment completion.

The detection of circulating tumor cells expressing E6/E7 HR-HPV oncogenes in peripheral blood in cervical cancer patients after radical hysterectomy.

The aim of this study was to establish the sensitive, specific and clinically acceptable method for detection of tumor cells (TCs) circulating in peripheral blood (PB) of cervical cancer patients without the clinically detectable risk of disease progression. The 7.5 ml of PB of healthy donor was spiked with 5 to 100 cells from SiHa or HeLa cell lines. The spiked tumor cells were collected without gradient centrifugation, by standard gradient centrifugation or by modified gradient centrifugation combined with immunomagnetic separation using EpCAM antibody with affinity for epithelial cell adhesion molecule. The number of collected TCs was determined by EpCAM-FITC-staining and their viability was detected by nested RT-PCR amplifying E6/E7 HR-HPV 16 or HR-HPV 18 oncogenes. For the technical validation of this approach the TCs separation and RT-PCRs were repeated several times. The recovery of viable TCs was reproducibly higher using modified gradient centrifugation combined with immunomagnetic separation in comparison with standard approach. The recovery of TCs in low number of spiked TCs (range from 5 - 20 TCs in 7.5 ml of PB) using modified gradient centrifugation was not reproducible. The recovery of TCs in higher number of spiked TCs (25 TCs and more in 7.5 ml of PB) was reproducible with average recovery about 50 %. The sensitivity of nested RT-PCR amplifying E6/E7 oncogenes was decisively influenced by the number of recovered TCs and the amount of cDNA introduced to RT-PCR, as well. Using this approach we were allowed to detect circulating TCs (CTCs) in cervical cancer patients without metastases, thus this procedure might become a tool to early estimation of disease progression. According to our knowledge, this is the first report describing the use of EpCAM antibody for CTCs detection in cervical cancer patients.

Comparison of the treatment results in the vulvar and clitoris squamous cell carcinoma.

Treatment results in 360 patients with vulvar carcinoma during the time period from 1975 to 1994 were evaluated. Out of the whole group radical vulvectomy with bilateral inguinal lymphadenectomy was performed in 215 patients. After excluding 35 patients having the Stage IV of the disease, 11 with malignant melanoma and 9 missing, in the group of remaining 160 cases with squamous cell carcinoma the survival rates of 3, 5 and 10 years were evaluated. Squamous cell carcinoma involvement of the clitoris in 40 patients out of this 160 cases has not confirmed clitoris localization as a poor prognostic factor.

[Is involvement of the clitoris in epidermoid carcinoma of the vulva an adverse prognostic sign?]. / Je postihnutie klitorisu tumorom nepriaznivým prognostickým znakom u epidermoidného karcinomu vulvy?

Retrospective evaluation of 360 patients with vulvar cancer during the period from 1975 to 1994. From this group in 215 patients radical vulvectomy with bilateral inguinal lymph node extirpation was performed. After excluding 35 patients in the IVth stage of the disease, 11 with vulvar melanoma and 9 who did not attend in the group of the remaining 160 cases 3- 5- and 10-year survival rates were evaluated. Forty of the cancers clitoris of these 160 cases do not confirm that this localisation is a bad prognostic factor.

Flow cytometry (FCM) of early radiation response in epidermoid carcinoma of uterine cervix.

DNA flow cytometry (FCM) investigation of tumor specimens before and after 30 Gy 137Cs radiation treatment was performed in 33 cases of epidermoid uterine cervix carcinoma. Distinct differences in the type of FCM response to radiation were seen when the results of DNA index (DI) in diploid and aneuploid tumors and proliferation index (PI) values in diploid tumors from pretreatment and 30 Gy irradiated specimens were compared. We observed partial or total reduction of PI in 12 of 17 diploid and near diploid tumors, and total reduction of the aneuploid population in 14 of 16 aneuploid tumors. No significant correlation was found between the type of FCM response and clinical stage of the disease or the histological degree of differentiation.