Detection of cervical lesions by multivariate analysis of diffuse reflectance spectra: a clinical study.

Diffuse reflectance (DR) spectroscopy is a non-invasive, real-time, and cost-effective tool for early detection of malignant changes in squamous epithelial tissues. The present study aims to evaluate the diagnostic power of diffuse reflectance spectroscopy for non-invasive discrimination of cervical lesions in vivo. A clinical trial was carried out on 48 sites in 34 patients by recording DR spectra using a point-monitoring device with white light illumination. The acquired data were analyzed and classified using multivariate statistical analysis based on principal component analysis (PCA) and linear discriminant analysis (LDA). Diagnostic accuracies were validated using random number generators. The receiver operating characteristic (ROC) curves were plotted for evaluating the discriminating power of the proposed statistical technique. An algorithm was developed and used to classify non-diseased (normal) from diseased sites (abnormal) with a sensitivity of 72 % and specificity of 87 %. While low-grade squamous intraepithelial lesion (LSIL) could be discriminated from normal with a sensitivity of 56 % and specificity of 80 %, and high-grade squamous intraepithelial lesion (HSIL) from normal with a sensitivity of 89 % and specificity of 97 %, LSIL could be discriminated from HSIL with 100 % sensitivity and specificity. The areas under the ROC curves were 0.993 (95 % confidence interval (CI) 0.0 to 1) and 1 (95 % CI 1) for the discrimination of HSIL from normal and HSIL from LSIL, respectively. The results of the study show that DR spectroscopy could be used along with multivariate analytical techniques as a non-invasive technique to monitor cervical disease status in real time.

Secondary cytoreduction in epithelial ovarian cancer recurrence: a perspective from a regional cancer center in India.

OBJECTIVE: To assess the impact of secondary cytoreduction on survival in our patients with recurrent epithelial ovarian cancer. STUDY DESIGN: Between January 2001 and December 2006 all patients who underwent surgical resection of documented epithelial ovarian cancer recurrence were identified from the hospital tumor registry database. Criteria for inclusion were disease-free interval >6 months after completion of primary treatment with clinical and/or radiographic findings suggestive of recurrence. Patients with borderline histology and those operated for malignant bowel obstruction were excluded. All patients were followed until August 2008 or death. Survival analysis was done using the Kaplan-Meir method. RESULTS: Forty-eight patients, aged 28-68 years (mean, 50) satisfied the inclusion criteria. The majority had advanced disease at initial diagnosis. The most common histology was serous. Optimal cytoreduction was attained in 29 patients (60.4%). Estimated 5-year overall survival was 32.25% CONCLUSION: The present data show that a macroscopically complete salvage surgical cytoreduction is possible for most patients with recurrent epithelial ovarian cancer and confers a definite survival benefit to the patient.

Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting.

OBJECTIVE: To evaluate the effectiveness and safety of the loop electrosurgical excision procedure (LEEP) to treat cervical intraepithelial neoplasia (CIN) in a low-resource setting. METHODS: Women participating in a cervical screening study in India with histologically confirmed CIN unsuitable for cryotherapy were advised to undergo LEEP. One year after treatment the cervix was visually inspected with acetic acid, followed by colposcopy and biopsy taken from abnormal areas. Cure was defined as no clinical or histologic evidence of CIN. Factors influencing cure rates were evaluated by chi(2) tests. RESULTS: Of the 311 women who underwent LEEP, 283 reported for 1-year follow-up and 248 (87.6%) were disease free. Cure rates were 93.0% for CIN 1, 85.5% for CIN 2, and 72.7% for CIN 3. Minor adverse effects were observed in 34 women and complications were seen in 5 women. CONCLUSION: LEEP was associated with minimal complications and acceptable cure rates in a low-resource setting, although women with larger lesions had lower cure rates.