Value of preoperative transvaginal sonography (TVS) in the description of tumor pattern in ovarian cancer patients: results of a prospective study.

BACKGROUND: This prospective study evaluates the predictive value of preoperative staging by transvaginal sonography (TVS) in ovarian cancer. PATIENTS AND METHODS: In 39 patients presenting with clinical signs and symptoms of ovarian cancer, preoperative systematic staging regarding tumor size (T), presence of ascites (A), peritoneal carcinomatosis (PC), bladder invasion (BI), intestinal invasion (II) as well as pelvic lymph node involvement (LN), were evaluated by TVS. Findings combining conventional B-mode ultrasound and Color Doppler imaging were compared to preoperative findings and final histology results. RESULTS: Preoperative staging was correctly achieved by TVS for T in 87%, for A in 97% (95% CI: 90-100), for PC in 96% (95% CI: 86-100), for BI in 99% (95% CI: 95-100), for II in 98% (95% CI: 93-100). The predictive value of TVS for LN was minor (sensitivity: 8%, 95% CI: 7-24). CONCLUSION: TVS is a sensitive and noninvasive method for preoperative staging of suspected ovarian cancer regarding tumor size, ascites, invasion of adjacent organs and peritoneal carcinomatosis, but not for detection of malignant lymph nodes. The need for invasive or more elaborate diagnostic tools such as CT and MRI, cystoscopy, rectoscopy and diagnostic ascites punction can potentially be reduced by systematic use of TVS.

Epidermal growth factor receptor changes during breast cancer metastasis.

BACKGROUND: Since the anti-HER2 monoclonal antibody trastuzumab made its triumphant advance into breast cancer therapy, new selective agents, including pan-HER inhibitors are entering clinical practice. MATERIALS AND METHODS: This study investigates the expression of the four HER-family members, HER1-4, in 48 primary breast carcinomas (PBC) and corresponding distant metastases (CDM) by immunohistochemistry and fluorescence in situ hybridisation. RESULTS: Concordance rate between PBC and CDM was 79% for HERI and HER2, 67% for HER3 and 56% or HER4. Expression of HER1-3 was associated with poor prognosis compared to HER-negative disease (p = 0.036). HER4 overexpression was associated with a better outcome (p = 0.003). CONCLUSION: Though most tumours demonstrate a stable HER expression pattern, both loss and acquisition of HER receptor overexpression can occur during metastasis. HER4 overexpression predicts prolonged survival compared to receptor negative disease, while the opposite is true for HER1-3. Consequences for modem antibody therapy are discussed.

Etiology and prognosis of fetal ascites.

OBJECTIVE: To examine the prenatal course and outcomes of neonates with isolated fetal ascites. METHODS: A retrospective analysis (from 1990 through 2000) was performed on 26 consecutive cases presenting with fetal ascites. A systematic diagnostic protocol which included fetal blood sampling for karyotyping, serology and serial ultrasound examinations to determine etiology was followed in all cases after diagnosis. Pregnancy outcome was assessed by a chart report or autopsy reports. RESULTS: The majority of cases were associated with fetal malformations (n = 11). Five fetuses had malformations with associated syndromes. Less commonly associated were intrauterine infections (n = 3), intestinal perforation (n = 2), genetic disorders (n = 2), neoplasm (n = 1) and growth retardation (n = 1). In only 1 case (4%) was the etiology idiopathic. Secondary generalized hydrops occurred only in 4 of 26 cases. Only 13 of 16 liveborn infants survived past the neonatal period and only 4 cases are doing well at childhood age without any sequelae. CONCLUSION: A wide range of etiologies were associated with isolated fetal ascites. Those with malformations had the worst pregnancy outcome. Prenatal diagnosis was made in 92% utilizing a systematic diagnostic workup. The diagnosis of idiopathic ascites has become rare due to the improvement in prenatal diagnosis.

Advantages of and applications for extended field-of-view ultrasound in obstetrics.

We evaluated the use of extended field-of-view (EFOV) ultrasound imaging in obstetrics and the possible advantages and applications. From July 2000 to May 2001, 57 randomly selected pregnancies and two woman postdelivery referred for routine and targeted ultrasound examination were studied by conventional B-mode and EFOV ultrasound. We subjectively compared conventional B-mode and EFOV by judging the general visualization as perceived by the operator and by the referring doctor. EFOV imaging provides better visualization of structures too large for a conventional sector image by creating one image of the entire structure and showing the relationship to or within the uterus. The EFOV images were easier to interpret by the referring or another nonexamining doctor. Fetal movements interfere with EFOV imaging, but not with the surrounding organs. A list of obstetrical applications for the use of EFOV is proposed. The use of EFOV imaging appears to be a reliable method to visualize the uterus in its entirety as well as genital tract tumors, the placental implantation and fetal structures throughout pregnancy. EFOV imaging of the fetus is limited by fetal movements.

Transvaginal and transabdominal extended field-of-view (EFOV) and power doppler EFOV sonography in gynecology: advantages and applications.

OBJECTIVE: To evaluate the possible advantages, applications, and usefulness of real-time transabdominal and transvaginal extended field-of-view sonography combined with power Doppler sonography in gynecology. METHODS: A series of 63 gynecologic patients, referred for preoperative sonographic examination and for whom the examiner thought that extended field-of-view sonography might be helpful in imaging pathologic findings, were selected. Patients were examined with conventional vaginal and abdominal B-mode sonography, extended field-of-view sonography, and power Doppler extended field-of-view sonography. A sonographic system with 3.5- to 7-MHz transducers was used to study and document pathologic findings. RESULTS: Extended field-of-view sonography provided a superior overview of pathologic findings and topography by creating a single image showing the relationship to reference structures. The combination of power Doppler extended field-of-view sonography provided additional information on the perfusion pattern in huge masses. In comparison with conventional sonographic images, the extended field-of-view sonographic images were easier to interpret by the referring or nonexamining physician. A list of proposed gynecologic applications for the use of extended field-of-view sonography was compiled. CONCLUSIONS: The extended field-of-view and power Doppler extended field-of-view sonographic technique provides documentation of surroundings, topographic orientation, and perfusion patterns in large pelvic masses and findings that exceed the limitations of the conventional sonographic sector. The clinical applications and advantages of extended field-of-view and power Doppler extended field-of-view imaging in gynecologic sonography are illustrated.

Complete spontaneous resolution of severe nonimmunological hydrops fetalis with unknown etiology in the second trimester--a case report.

The incidence of nonimmunological fetal hydrops is between 1 in 1500 and 1 in 4000. Overall mortality for this condition is about 80%. This report describes a case of prenatally diagnosed hydrops fetalis with severe generalized edema, ascites and pleural effusion of unknown origin at 19 weeks of gestation. No symptoms were found of infections or anemia, no variabilities were observed in fetal blood analysis or in karyotyping. All signs of hydrops resolved completely after 6 weeks without treatment. The pregnancy continued with normal fetal development; labor was induced at 41 weeks of gestation. After vaginal delivery with vacuum extraction the child was completely healthy and demonstrated no signs of remaining hydrops fetalis or any other pathological parameters except an uncritical atrial septal defect type II which healed without any complications within 3 months post delivery.