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1.
Eur J Gynaecol Oncol ; 37(2): 211-5, 2016.
Article in English | MEDLINE | ID: mdl-27172747

ABSTRACT

UNLABELLED: Summary OBJECTIVE: Uterine serous carcinoma (USC) is an aggressive, histological subtype of endometrial cancer with a poor prognosis. This study evaluates the additional effect of staging surgery above total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO) on the use of adjuvant therapy and subsequent survival outcomes in clinical early-stage USC patients. MATERIALS AND METHODS: This retrospective cohort study includes 75 women treated for clinical early-stage USC. RESULTS: In 33 (44%) clinical early-stage patients surgical staging was performed and 15 patients (45%) proved to have lymphatic or abdominal metastasis. Use of adjuvant therapy was similar in patients, both staged with no metastasis (n = 18) and patients who underwent TAH and BSO only (n = 42, p = 0.17). No significant survival difference was found between surgically staged and TAH+BSO patients. CONCLUSIONS: Surgical staging proved to be important to determine stage of disease and hence prognosis. Surgical staging did not lead to selective avoidance of adjuvant therapy in patients with no metastasis.


Subject(s)
Chemoradiotherapy, Adjuvant/methods , Chemotherapy, Adjuvant/methods , Endometrial Neoplasms/therapy , Hysterectomy/methods , Neoplasms, Cystic, Mucinous, and Serous/therapy , Ovariectomy/methods , Radiotherapy, Adjuvant/methods , Salpingectomy/methods , Aged , Aged, 80 and over , Cohort Studies , Disease-Free Survival , Endometrial Neoplasms/pathology , Female , Humans , Kaplan-Meier Estimate , Lymph Node Excision , Middle Aged , Neoplasm Staging , Neoplasms, Cystic, Mucinous, and Serous/pathology , Retrospective Studies , Uterine Neoplasms/pathology , Uterine Neoplasms/therapy
2.
Gynecol Oncol ; 140(1): 8-14, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26428940

ABSTRACT

OBJECTIVE: In 2008 GROINSS-V-I, the largest validation trial on the sentinel node (SN) procedure in vulvar cancer, showed that application of the SN-procedure in patients with early-stage vulvar cancer is safe. The current study aimed to evaluate long-term follow-up of these patients regarding recurrences and survival. METHODS: From 2000 until 2006 GROINSS-V-I included 377 patients with unifocal squamous cell carcinoma of the vulva (T1, <4 cm), who underwent the SN-procedure. Only in case of SN metastases an inguinofemoral lymphadenectomy was performed. For the present study follow-up was completed until March 2015. RESULTS: Themedian follow-up was 105 months (range 0­179). The overall local recurrence ratewas 27.2% at 5 years and 39.5% at 10 years after primary treatment, while for SN-negative patients 24.6% and 36.4%, and for SN-positive patients 33.2% and 46.4% respectively (p = 0.03). In 39/253 SN-negative patients (15.4%) an inguinofemoral lymphadenectomy was performed, because of a local recurrence. Isolated groin recurrence rate was 2.5% for SN-negative patients and 8.0% for SN-positive patients at 5 years. Disease-specific 10-year survival was 91% for SN-negative patients compared to 65% for SN-positive patients (p b .0001). For all patients, 10-year disease-specific survival decreased from 90% for patients without to 69% for patients with a local recurrence (p b .0001).


Subject(s)
Carcinoma, Squamous Cell/pathology , Sentinel Lymph Node Biopsy/methods , Vulvar Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/diagnosis , Disease-Free Survival , Female , Follow-Up Studies , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/pathology , Reproducibility of Results , Sentinel Lymph Node Biopsy/standards , Vulvar Neoplasms/diagnosis
3.
Gynecol Oncol ; 131(3): 720-5, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24051219

ABSTRACT

INTRODUCTION: Conventional sentinel node (SN) mapping is performed by injecting a radiocolloid followed by lymphoscintigraphy (and SPECT/CT imaging). An extra intraoperative injection with blue dye can then allow for optical identification of the SN. In order to improve the current clinical standard, the hybrid tracer indocyanine green (ICG)-(99m)Tc-nanocolloid was introduced, a tracer that is both radioactive and fluorescent. This feasibility study aimed to evaluate the value of a multimodal-based SN biopsy in vulvar cancer. MATERIALS AND METHODS: Fifteen patients with vulvar cancer (29 groins) scheduled for SN biopsy were peritumorally injected with ICG-(99m)Tc-nanocolloid followed by lymphoscintigraphy and SPECT/CT imaging to identify the SNs. In thirteen patients, shortly before the start of the operation, blue dye was intradermally injected around the lesion. SNs were harvested using a combination of radiotracing, fluorescence imaging, and optical blue dye detection. A portable gamma camera was used before and after SN excision to confirm excision of the preoperatively defined SNs. RESULTS: Preoperative lymphoscintigraphy and SPECT/CT imaging visualized drainage to 39 SNs in 28 groins. During the operation, 98% (ex vivo 100%) of the SNs were radioactive. With fluorescence imaging 96% of the SNs (ex vivo 100%) could be visualized. Only 65% of the SNs had stained blue at the time of excision. CONCLUSION: ICG-(99m)Tc-nanocolloid can be used for preoperative SN identification and enables multimodal (radioactive and fluorescent) surgical guidance in patients with vulvar cancer. The addition of fluorescence-based optical guidance offers more effective SN visualization compared to blue dye.


Subject(s)
Lymph Nodes/pathology , Lymph Nodes/surgery , Vulvar Neoplasms/pathology , Vulvar Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Indocyanine Green , Lymph Nodes/diagnostic imaging , Middle Aged , Multimodal Imaging , Neoplasm Staging , Radiopharmaceuticals , Sentinel Lymph Node Biopsy/methods , Technetium Tc 99m Aggregated Albumin , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Vulvar Neoplasms/diagnostic imaging , Young Adult
4.
Cancer Imaging ; 13(3): 314-22, 2013 Jul 22.
Article in English | MEDLINE | ID: mdl-23876490

ABSTRACT

BACKGROUND: Approximately 72% of endometrial cancers are FIGO stage I at diagnosis and about 10% have lymph node metastases. An ideal diagnostic test for nodal disease would be able to prevent both overtreatment (i.e. unnecessary lymphadenectomy) and undertreatment (i.e. withholding lymphadenectomy or adjuvant postoperative treatment to patients with lymph node metastases). OBJECTIVES: In this review we compare the accuracy of preoperative tests (computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography, CA-125 serum levels, and ultrasonography) for the detection of lymph node metastases in endometrial cancers with the final histopathologic diagnosis after complete pelvic and para-aortic lymphadenectomy as the gold standard. METHOD: A systematic search in MEDLINE (using PubMed), Embase and The Cochrane Library was performed up to 23 July 2012. RESULTS: We found one article that met our inclusion criteria for computed tomography, none for magnetic resonance imaging, 2 for positron emission tomography/computed tomography), 2 for CA-125 and none for ultrasonography. CONCLUSIONS: Due to the lack of high-quality articles on a preoperative test for lymph node status in endometrial cancer, no proper comparison between these modalities can be made.


Subject(s)
Endometrial Neoplasms/pathology , CA-125 Antigen/blood , Endometrial Neoplasms/diagnosis , Female , Humans , Lymphatic Metastasis , Magnetic Resonance Imaging , Positron-Emission Tomography , Tomography, X-Ray Computed
5.
Ned Tijdschr Geneeskd ; 151(24): 1330-2, 2007 Jun 16.
Article in Dutch | MEDLINE | ID: mdl-17665623

ABSTRACT

The Dutch College of General Practitioners (NHG) revised their practice guideline on vaginal discharge. From a gynaecological point of view, relocation of cervix problems from this guideline to the NHG guideline 'The STD consultation' is not practical. Moreover, the role of simple, but effective diagnosis with a microscope in the primary-care setting cannot be overemphasized. The reluctance to oral treatment is rather inopportune, because once-only ingestion has the advantage of promoting compliance. As physical examination is not always necessary in a recurrent Candida infection, treatment performed by the patient with imidazole compounds is a possibility that does not always result in abuse or increased resistance.


Subject(s)
Antifungal Agents/therapeutic use , Candidiasis, Vulvovaginal/diagnosis , Gynecology/standards , Practice Guidelines as Topic , Practice Patterns, Physicians' , Vaginal Discharge/diagnosis , Candidiasis, Vulvovaginal/drug therapy , Candidiasis, Vulvovaginal/microbiology , Candidiasis, Vulvovaginal/pathology , Female , Humans , Netherlands , Secondary Prevention , Vaginal Discharge/drug therapy , Vaginal Discharge/microbiology , Vaginal Discharge/pathology
6.
Urol Res ; 29(1): 57-9, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11310217

ABSTRACT

The purpose of this paper was to examine whether ultrasound abnormalities of the prostate and seminal vesicles, which may be related to male accessory gland infection, are reproducible. Forty-seven men attending an infertility clinic were studied. Imaging findings of transrectal ultrasonography were recorded. Kappa (kappa)-values to determine the intra- and inter-observer variation were assessed. Calcifications have good intra-observer (kappa = 0.77; 95% CI: 0.59-0.96) and good inter-observer reproducibility (kappa = 0.73; 95% CI: 0.54-0.93). Dilatation of the peri-prostatic plexus had moderate intra-observer (kappa = 0.57; 95% CI: 0.33-0.80) and good inter-observer reproducibility (kappa = 0.74; 95% CI: 0.55-0.94). Other ultrasound abnormalities of the prostate were not reproducible. None of the ultrasound abnormalities of the seminal vesicles were reproducible. In our study the prevalence of ultrasound abnormalities which may be related to male accessory gland infection was as high as 96%. However, only calcifications and dilatation of the venous plexus had good reproducibility. Other observed ultrasound abnormalities of the prostate and seminal vesicles were poorly reproducible and are therefore of no use in the diagnosis of male accessory gland infection.


Subject(s)
Infertility, Male/diagnostic imaging , Infertility, Male/pathology , Prostate/pathology , Seminal Vesicles/pathology , Adult , Humans , Male , Middle Aged , Observer Variation , Prostate/diagnostic imaging , Rectum , Reproducibility of Results , Seminal Vesicles/diagnostic imaging , Ultrasonography/standards , Ultrasonography/statistics & numerical data , Urinary Bladder Neck Obstruction/diagnostic imaging
7.
Int J Androl ; 23(1): 43-5, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10632761

ABSTRACT

The accuracy of the PACE2 DNA hybridization assay of the cervix and cervical culture in female partners for the diagnosis of male subclinical genital tract infection were assessed in a male infertility population. A total of 184 men were screened for the presence of Chlamydia trachomatis, Ureaplasma urealyticum and Mycoplasma hominis. Seventy-one men were identified with a positive test for one or more of the above mentioned micro-organisms. The overall prevalence of bacterial infection was 39%. Female partners of all men were tested with the PACE2 DNA hybridization assay to detect a C. trachomatis infection. Sensitivity was 100% and specificity was 100%. In 67 female partners (94%) of men who tested positive for U. urealyticum and/or M. hominis, a cervical swab culture was performed. The sensitivity of the cervical swab culture was 100%. In view of the high prevalence of U. urealyticum and M. hominis in the male genital tract and the role these sexually transmitted pathogens may play in infertility, one might question whether all couples should be screened for the presence of these pathogens. Transurethral swab culture after digital prostatic massage is disincentive to men. The cervical culture in their female partner, performed as part of the routine fertility work-up, is a suitable alternative to detect the presence of these micro-organisms in the male genital tract.


Subject(s)
Cervix Uteri/microbiology , DNA, Bacterial/genetics , Genital Diseases, Male/diagnosis , Sexual Partners , Sexually Transmitted Diseases/diagnosis , Adult , Chlamydia trachomatis/genetics , Chlamydia trachomatis/isolation & purification , Female , Genital Diseases, Male/microbiology , Humans , Male , Mycoplasma hominis/genetics , Mycoplasma hominis/isolation & purification , Sensitivity and Specificity , Sexually Transmitted Diseases/microbiology , Ureaplasma urealyticum/genetics , Ureaplasma urealyticum/isolation & purification
8.
Fertil Steril ; 70(2): 315-9, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9696227

ABSTRACT

OBJECTIVES: To evaluate whether detection of leukocytospermia in a routine semen analysis is of diagnostic value in selecting men with an "actual" microbial infection and to assess the association between leukocytospermia and a history of bacterial and viral infections. DESIGN: Prospective clinical study. SETTING: Infertility clinic at the Center for Reproductive Medicine, Academic Medical Center, Amsterdam, the Netherlands. PATIENT(S): One hundred eighty-four men among subfertile couples attending our infertility clinic. INTERVENTION(S): The number of leukocytes was assessed in three semen samples. Serologic tests were performed, as was transurethral culture after digital prostatic massage. MAIN OUTCOME MEASURE(S): Diagnosis of actual bacterial and viral infections in relation to seminal leukocyte concentrations. The association of a history of sexually transmitted diseases with seminal leukocyte concentration. RESULT(S): An actual bacterial infection was present in 39% of men, and 11% of men had an actual viral infection. The area under the receiver operating curve, which was used to determine whether detection of leukocytospermia was of diagnostic value in identifying men with actual bacterial or viral infections, was 0.55 and 0.56 for bacterial and viral infection, respectively. A past infection with N. gonorrhoeae was associated with the presence of leukocytospermia. A past viral infection was not associated with leukocytospermia. CONCLUSION(S): Detection of leukocytospermia appears to be of no diagnostic value for selection of men with actual microbial infections, but leukocytospermia is associated with a history of gonorrhea.


Subject(s)
Bacterial Infections/pathology , Genital Diseases, Male/pathology , Infertility, Male/pathology , Semen/cytology , Virus Diseases/pathology , Adult , Bacterial Infections/epidemiology , Female , Genital Diseases, Male/epidemiology , Humans , Infertility, Female/pathology , Leukocyte Count , Male , Prevalence , Virus Diseases/epidemiology
9.
Hum Reprod ; 11(6): 1232-5, 1996 Jun.
Article in English | MEDLINE | ID: mdl-8671430

ABSTRACT

Three non-invasive methods for the detection of a varicocele were evaluated in 63 men presenting with infertility. Physical examination, varicoscreen contact thermography and colour Doppler ultrasound were compared with spermatic venography as reference strategy. Physical examination had a sensitivity of 71%. Whether the non-palpable varicoceles are all subclinical is questionable since the specificity of physical examination was 69%. Varicoscreen proved be quick, easy and cheap but of no clinical value (sensitivity 97%, specificity 9%). Colour Doppler ultrasound using strict criteria was a good diagnostic tool (sensitivity 97%, specificity 94%). No imaging difference was seen with colour Doppler ultrasound among clinical and subclinical varicoceles. Since the debate on treating all degrees of varicocoeles is ongoing, we suggest that Doppler sonography should be a routine examination in infertile men.


Subject(s)
Varicocele/diagnosis , Humans , Infertility, Male/diagnostic imaging , Infertility, Male/physiopathology , Male , Palpation , Phlebography , Predictive Value of Tests , Thermography , Ultrasonography, Doppler, Color , Varicocele/diagnostic imaging
10.
Ned Tijdschr Geneeskd ; 133(37): 1844-7, 1989 Sep 16.
Article in Dutch | MEDLINE | ID: mdl-2552334

ABSTRACT

Three patients are presented who developed periampullary carcinoma after colectomy for adenocarcinoma. The combination of colonic carcinoma and periampullary carcinoma is rare, although wellknown in patients with colonic polyposis or Gardner's syndrome. Perhaps genetic research might help select patients with a high risk of developing multiple carcinomas in the gastrointestinal tract. The five-year survival rate for periampullary carcinoma after subtotal colectomy is higher than for pancreatic carcinoma.


Subject(s)
Adenocarcinoma/surgery , Adenomatous Polyposis Coli/surgery , Ampulla of Vater , Colonic Neoplasms/surgery , Common Bile Duct Neoplasms/diagnostic imaging , Neoplasms, Multiple Primary , Adult , Common Bile Duct Neoplasms/surgery , Humans , Male , Middle Aged , Radiography
11.
Hepatogastroenterology ; 36(2): 109-12, 1989 Apr.
Article in English | MEDLINE | ID: mdl-2543616

ABSTRACT

Forty-four patients with familial adenomatous polyposis coli treated with colectomy and ileorectal anastomosis were studied. Mean age at operation was 27 years. The mean follow-up period was 10 years (median 8 years). Three patients (7%) developed rectal cancer 1, 4, and 24 years after the initial operation, respectively. Proctectomy with ileostomy was performed in one patient, and 7 patients underwent a conversion to an ileoanal procedure for an increasing number of rectal polyps in the rectum stump. Although frequent bowel actions and episodes of diarrhea were common findings in patients after colectomy and ileorectal anastomosis, almost all patients (96%) were more or less satisfied with their quality of life after the procedure. On the basis of our results and the results reported in the literature, colectomy with ileorectal anastomosis is still the operation of choice in selected patients with familial adenomatous polyposis coli. An initial ileal pouch - anal anastomosis, or a conversion to such a procedure after colectomy and ileorectal anastomosis is indicated, depending on the number and size of rectal polyps.


Subject(s)
Adenomatous Polyposis Coli/surgery , Colectomy , Ileum/surgery , Rectum/surgery , Adolescent , Adult , Anastomosis, Roux-en-Y , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies
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