Concordance Between Intracervical and Fundal Injections for Sentinel Node Mapping in Patients With Endometrial Cancer?: A Study Using Intracervical Radiotracer and Fundal Blue Dye Injections.

OBJECTIVE: A major controversy in sentinel node (SN) biopsy of endometrial cancer is the injection site of mapping material. We compared lymphatic drainage pathways of the uterine cervix and uterine body in the same patients by head-to-head comparison of intracervical radiotracer and fundal blue dye injections. METHODS: All patients with pathologically proven endometrial cancer were included. Each patient received 2 intracervical injections of Tc-phytate. At the time of laparotomy, the uterus was exposed, and each patient was injected with 2 aliquots of patent blue V (2 mL each) in the subserosal fundal midline locations. The anatomical locations of all hot, blue, or hot/blue SNs were recorded. RESULTS: Overall, 45 patients entered the study. At least 1 SN could be identified in 75 of 90 hemipelves (83.3% overall detection rate, 82.2% for radiotracer [intracervical] alone, and 81.1% for blue dye [fundal] alone). In 71 hemipelves, SNs were identified with both blue dye (fundal) and radiotracer (intracervical) injections. In 69 of these 71 hemipelves, at least 1 blue/hot SN could be identified (97.18% concordance rate). In 10 patients, para-aortic SNs were identified. All of these nodes were identified by fundal blue dye injection, and only 2 were hot. CONCLUSIONS: Our study shows that lymphatic drainage to the pelvic area from the uterine corpus matches the lymphatic pathways from the cervix, and both intracervical and fundal injections of SN mapping materials go to the same pelvic SNs.

Genetic susceptibility in cervical cancer: From bench to bedside.

Cervical cancer (CC) is the third most common malignancy in women globally, and persistent infection with the oncogenic human papillomaviruses (HPV) is recognized as the major risk factor. The pathogenesis of CC relies on the interplay between the tumorigenic properties of the HPV and host factors. Host-related genetic factors, including the presence of susceptibility loci for cervix tumor is substantial importance. Preclinical and genome-wide association studies (GWAS) have reported the associations of genetic variations in several susceptibility loci for the development of cervical cancer. However, many of these reports are inconsistent. In this review, we discuss the findings to date of candidate gene association studies, and GWAS in cervical cancer. The associations between these genetic variations with response to chemotherapy are also discussed.

Clinical Significance and Prognosis Value of Wnt Signaling Pathway in Cervical Cancer.

Cervical cancer is among the most commonly diagnosed cancer in women, supporting the need for identification of novel prognostic and predictive biomarkers to predict the risk of developing of this malignancy or predict the prognosis of patients. Against this background, the activation of the Wingless-type (Wnt)/ß-catenin pathway has been suggested as the main dysregulated pathways, which is involved in the multistep process of cervical carcinogenesis, suggesting its value as a potential biomarker or therapeutic target. The aim of current review is to give an overview about the potential application of WNT pathway and its value which is differentially expressed in cervical cancer versus non-tumorigenic tissue as biomarker for risk stratification and predict the prognosis of patients with cervical cancer. J. Cell. Biochem. 118: 3028-3033, 2017. © 2017 Wiley Periodicals, Inc.

Is sentinel node mapping possible in surgically removed ectopic axillary breast cancer? A case report.

We reported a 24-year-old female patient with the history of ectopic axillary breast cancer which was removed surgically. Sentinel node mapping was performed for lymphatic axillary staging of this patient with two injections of the 99m-Tc-phytate in both ends of the surgical scar. Lymphoscintigraphy showed an axillary sentinel node which was harvested during surgery and was not pathologically involved. Our case showed that sentinel node mapping is possible for ectopic axillary breast cancer patients even after excisional biopsy of the index lesion.

Lymphatic mapping and sentinel node biopsy in ovarian tumors: a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging.

BACKGROUND: Experience on sentinel node mapping in ovarian tumors is very limited. We evaluated the sentinel node concept in ovarian tumors using intra-operativeTc-99m-Phytate injection and lymphoscintigraphy imaging. METHODS: Thirty-five patients with a pelvic mass due to an ovarian pathology were included in the study. The radiotracer was injected just after laparotomy and before removal of the tumor either beneath the normal cortex (10 patients) or in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum two injections of the radiotracer (25 patients). For malignant masses, the sentinel nodes were identified using a hand held gamma probe. Then standard pelvic and para-aortic lymphadenectomy was performed. In case of benign pathologies or borderline ovarian tumors on frozen section, lymphadenectomy was not performed. The morning after surgery, all patients were sent for lymphoscintigraphy imaging of the abdomen and pelvis. RESULTS: Sentinel node was identified only in 4 patients of the cortical injection group. At least one sentinel node could be identified in 21 patients of the sub-peritoneal group. Sentinel nodes were identified only in the para-aortic area in 21, pelvic/para-aortic areas in 2, and pelvic only area in 2 patients. Three patients had lymph node involvement and all had involved sentinel nodes (no false negative case). CONCLUSION: Sentinel node mapping using intra-operative injection of the radiotracer (in the utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum) is feasible in ovarian tumors. Technical aspects of this method should be explored in larger multicenter studies in the future.

Hormone receptor expression and clinicopathologic features in male and female breast cancer.

BACKGROUND: Male and female breast cancers were investigated for variation in the clinicopathologic characteristics and expression of steroid hormone receptors in the northeast of Iran. MATERIALS AND METHODS: Tumor specimens of 17 males and 338 females with breast cancer were collected at the hospitals of Mashhad University of Medical Sciences. Immunohistochemical expression of hormone receptors and clinicopathologic features of breast cancer were compared between two groups. RESULTS: The mean age in men was 15 years higher than women (p=0.000). Males and females were mainly in stage II and III respectively (p=0.007). Although more than 60% of male and female patients were grade II, the respective figures for grade I and III were 25% and 12.5% in men but 7.1% and 27.2% in women respectively (p=0.025). ER was significantly more positive in men against women; 82.3% versus 53.4% (p=0.016). The related measures for PR was 58.8% and 50.3%, respectively (p=0.424). Males also showed significantly more ER expression than postmenopausal females; 82.3% versus 48.9% (p=0.010). CONCLUSIONS: Breast cancer in males and females contrasted in age at diagnosis, histological type, stage, grade and ER expression which emphasize they are separate diseases with different behaviors.

Lymphatic mapping and sentinel node biopsy in endometrial cancer--a feasibility study using cervical injection of radiotracer and blue dye.

BACKGROUND: The aim of this study was to evaluate the feasibility and accuracy of sentinel lymph node (SLN) detection using preoperative lymphoscintigraphy and intra-operative gamma probe/blue dye for endometrial cancer patients. MATERIAL AND METHODS: Twenty four consecutive patients with endometrial cancer were recruited. All patients underwent lymphatic mapping and sentinel node biopsy using combined intracervical radiotracer and blue dye injections. Pelvic lymph node dissection was performed for all patients. Para-aortic lymphadenectomy was done in high risk patients. All SLNs were examined by frozen section and Hematoxylin and Eosin (H&E) permanent sections. RESULTS: Pre-operative lymphoscintigraphy showed at least one SLN in 21/24 patients. Intra-operatively, at least one SLN could be harvested by gamma probe and/or blue dye methods. A total of 95 SLNs were detected. Four SLNs were detected only by blue dye, 42 only by radiotracer, and 49 were hot/blue. Median number of SLN per patient was 3. Three patients had positive pelvic lymph nodes. All of them had positive SLN (no false negative case). Frozen section could identify SLN involvement in two of three patients with positive pathology. CONCLUSION: Lymphatic mapping and sentinel node biopsy is feasible and accurate in endometrial cancer patients using combined radiotracer and blue dye methods. Frozen section accuracy was lower and underscores the importance of expert pathologists for SLN mapping technique.

Prolonged survival of a patient with pelvic recurrence of ovarian malignant mixed mullerian tumor after chemoradiotherapy.

INTRODUCTION: Malignant Mixed Mullerian Tumor (MMMT) is a very rare tumor, accounting for less than 1% of all ovarian cancers. CASE PRESENTATION: We present a 64-year-old woman with stage III MMMT of ovary that was treated with platinum-based chemotherapy after optimal cytoreductive surgery. After 25 months of being disease free, she had a pelvic recurrence and a good response to chemoradiotherapy. CONCLUSIONS: Optimal cytoreductive surgery and chemotherapy may be the best treatment in MMMT but more discussion and experiences are needed regarding the effectiveness of radiotherapy.

Inappropriate Intra-cervical Injection of Radiotracer for Sentinel Lymph Node Mapping in a Uterine Cervix Cancer Patient: Importance of Lymphoscintigraphy and Blue Dye Injection.

Herein, we report a case of sentinel lymph node mapping in a uterine cervix cancer patient, referring to the nuclear medicine department of our institute. Lymphoscintigraphy images showed inappropriate intra-cervical injection of radiotracer. Blue dye technique was applied for sentinel lymph node mapping, using intra-cervical injection of methylene blue. Two blue/cold sentinel lymph nodes, with no pathological involvement, were intra-operatively identified, and the patient was spared pelvic lymph node dissection. The present case underscores the importance of lymphoscintigraphy imaging in sentinel lymph node mapping and demonstrates the added value of blue dye injection in selected patients. It is suggested that pre-operative lymphoscintigraphy imaging be considered as an integral part of sentinel lymph node mapping in surgical oncology. Detailed results of lymphoscintigraphy images should be provided for surgeons prior to surgery, and in case the sentinel lymph nodes are not visualized, use of blue dye for sentinel node mapping should be encouraged.

Pelvic kidney visualization on the lymphoscintigraphy images of a patient with uterine cervix cancer: importance of the delayed imaging.

We reported an unusual visualization of a pelvic kidney on the lymphoscintigraphy images of a patient with uterine cervix cancer, which was mistaken with para-aortic sentinel nodes. Delayed imaging clearly showed the nature of this activity. Our case underscores the importance of delayed pelvic lymphoscintigraphy imaging in the sentinel node mapping of gynecological cancers.

Diagnostic performance of fluorine 18 fluorodeoxyglucose positron emission tomography imaging for detection of primary lesion and staging of endometrial cancer patients: systematic review and meta-analysis of the literature.

OBJECTIVES: Fluorine 18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) imaging has been used for staging of endometrial cancer. In the current study, we systematically searched the available literature on the accuracy of (18)F-FDG PET imaging for staging of endometrial cancer. METHODS: PubMed, SCOPUS, ISI Web of Knowledge, Science Direct, and Springer were searched using "endometr* AND PET" as the search terms. All studies evaluating the accuracy of (18)F-FDG PET in the staging of endometrial carcinoma were included. Statistical pooling of diagnostic accuracy indices was done using random-effects model. Cochrane Q test and I(2) index were used for heterogeneity evaluation. RESULTS: Sixteen studies (807 patients in total) were included in the meta-analysis. Sensitivity and specificity for detection of the primary lesions were 81.8% (77.9%-85.3%) and 89.8% (79.2%-96.2%); for lymph node staging were 72.3% (63.8%-79.8%) and 92.9% (90.6%-94.8%); and for distant metastasis detection were 95.7% (85.5%-99.5%) and 95.4% (92.7%-97.3%). CONCLUSIONS: Because of low sensitivity, diagnostic utility of (18)F-FDG PET imaging is limited in primary tumor detection and lymph node staging of endometrial cancer patients. However, high specificities ensure high positive predictive values in these 2 indications. Diagnostic performance of (18)F-FDG PET imaging is much better in detection of distant metastases. Larger studies with better design are needed to draw any more definite conclusion.

Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography imaging in uterine sarcomas: systematic review and meta-analysis of the literature.

OBJECTIVE: We reviewed the medical literature on the application of fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) imaging in the management of uterine sarcomas and presented the results in systematic review and meta-analysis format. METHODS: Medline, SCOPUS, and ISI Web of Knowledge were searched electronically with "PET AND (Uterine OR Uterus)" as key words. All studies evaluating the accuracy of (18)F-FDG imaging in the staging or restaging of uterine sarcomas were included if enough data could be extracted for calculation of sensitivity and/or specificity. RESULTS: Eight studies were included in the systematic review. Only 2 studies reported the accuracy of (18)F-FDG PET imaging in the primary staging of uterine sarcoma with low sensitivity for lymph node staging. For restaging (detection of recurrence), all 8 included studies had quantitative data, and the patient-based pooled sensitivity and specificity were 92.1% (95% confidence interval [95% CI], 82.4-97.4) and 96.2% (95% CI, 87-99.5), respectively. On a lesion-based analysis, sensitivity was 86.3% (95% CI, 76.7-92.9), and specificity was 94.4% (95% CI, 72.7-99.9). Device used (PET vs PET/CT), spectrum of studied patients, and histology of the sarcoma seem to be factors influencing the overall accuracy of (18)F-FDG PET imaging. CONCLUSIONS: (8)Fluorine-18-fluorodeoxyglucose PET and PET/CT seem to be accurate methods for detection and localization of recurrence in patients with uterine sarcoma. Further large multicenter studies are needed to validate our results and to correlate both sarcoma type and spectrum of patients to the diagnostic performance of (18)F-FDG PET imaging in recurrence detection. The studies evaluating the accuracy of (18)F-FDG PET imaging for the primary staging of uterine sarcoma are very limited, and no definite conclusion can be made in this regard.

Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer during pregnancy: case report and review of literature.

For pregnant patients with cervical cancer, treatment recommendations are individualized and dependent on the stage of the disease, gestational age at the time of diagnosis, and the patient's desire as to the cosntinuation of the pregnancy. The aim of this study is to describe the outcome of neoadjuvant chemotherapy with radical surgery and pelvic lymphadenectomy in a woman with cervical cancer who wished to maintain her pregnancy. This is a report of a 26-week pregnant woman with locally advanced cervical cancer stage I(b2) (FIGO) who was successfully treated with neoadjuvant chemotherapy Paclitaxel plus platinum, followed by C/S and radical surgery. Her neonate was healthy and had no abnormalities. This case was the first cervical cancer during pregnancy that was treated using this method at the tumor clinic, Mashhad University of Medical Sciences, Iran. Neoadjuvant chemotherapy is an effort to allow time for the fetal to reach viability by preventing the progression of the disease.

Accuracy of 18-F-FDG PET imaging in the follow up of endometrial cancer patients: systematic review and meta-analysis of the literature.

OBJECTIVES: We reviewed the available literature on the accuracy of 18-F-FDG PET imaging in the follow up of the endometrial cancer patients and presented the results in systematic review and meta-analysis format METHODS: Medline, SCOPUS, ISI web of knowledge, Springer, and Science direct were searched with "PET AND Endometr*" as key words. All studies that evaluated the accuracy of 18-F-FDG imaging in the follow up of treated endometrial carcinoma were included if enough data could be extracted for calculation of sensitivity and/or specificity. RESULTS: Eleven studies (541 patients in total) were included in the analysis. Pooled diagnostic indices (patient basis) for detection of overall recurrence were as follows: sensitivity 95.8% [92.2-98.1], specificity 92.5% [89.3-94.9], positive likelihood ratio (LR+) 9.53 [6.52-13.91], negative likelihood ratio (LR-) 0.075 [0.044-0.128], and diagnostic odds ratio (DOR) 204 [91.97-453.5]. 18-F-FDG performance was better in studies conducted by PET/CT as compared to PET. The treatment plan changed in 22-35% of the studied patients. CONCLUSION: 18-F-FDG PET is an accurate method for detection and localization of recurrence in post-therapy follow up of endometrial carcinoma. It can also change the treatment planning by localizing the recurrent lesions.

Concurrent Chemoradiotherapy without Brachytherapy in Locally Advanced Cervical Cancer.

BACKGROUND: Concurrent chemoradiotherapy (EBRT + cisplatin) plus intracavitary brachytherapy is the standard of care in patients with advanced cervical cancer. However, a number of patients could not undergone brachytherapy due to massive residual tumor or anatomical distortion. In this study, we have evaluated the treatment outcome in patients with locally advanced cervical cancer, undergone conventional EBRT plus cisplatin based chemotherapy. METHODS: IN THIS STUDY, WE HAVE SELECTED PATIENTS WITH LOCALLY ADVANCED CERVICAL CARCINOMA (STAGE: IIB to IIIB) undergone external beam radiotherapy and chemotherapy without brachytherapy at our institute between October of 2007 and October of 2009. The patients have received 50 Gy within 5 weeks to whole pelvic that has followed by a localized boost dose on tumor to 70 Gy concurrently with cisplatin 35 mg/m2 weekly. The treatment has related toxicities, and survival (overall and disease free) have evaluated. RESULTS: 30 cases with a median age of 55 (range; 40 to 73) have been studied. According to FIGO classification, the clinical stages were as follows: stage: IIB 23, IIIA 4, and IIIB 3 cases. Three months after treatment, 19 patients (63.3%) have achieved complete response. With a median follow up time of 18 months (range; 10-33 months), 8/23 cases (34.7%) with stage IIB and 2/7 (28.5%) among stage IIIA-IIIB remained disease free at the end of follow up. Data have shown a 2-year overall survival rate of 58.7% ± 9% and 2- year disease free survival of 37.7% ± 9% . Most toxicities were grade I and II. 2 (6.6%) grade III diarrhea and 4 (13.3%) grade III neutropenia have recorded. CONCLUSION: Although a considerable number of patients have achieved complete response using concurrent chemoradiotherapy without brachytherapy, the overall treatment outcomes especially for stage IIIA-IIIB were unsatisfactory. Using modern radiation therapy techniques with increased delivered boost dose could improve treatment results.