Diagnostic value of 3 T MR spectroscopy, diffusion-weighted MRI, and apparent diffusion coefficient value for distinguishing benign from malignant myometrial tumours.

AIM: To further verify the effectiveness of diffusion-weighted (DWI) magnetic resonance imaging (MRI) and 1H magnetic resonance spectroscopy (MRS) using a 3 T MRI system to differentiate benign leiomyomas from uterine sarcoma; to investigate the benefit of adding MRS to the apparent diffusion coefficient (ADC) for improving the specificity of the benign/malignant classification. MATERIALS AND METHODS: The dataset included 21 uterine sarcoma from 14 patients and 84 benign leiomyomas from 51 patients. T1-and T2-weighted images as well as DWI were obtained using a 3-T MRI system. Approximately 60% of patients also underwent MRS. The chi-square test was used to compare the percentage of malignant lesions that showed choline peaks, lipid peaks, and restricted diffusion to the corresponding percentage of benign masses. Using the area under a receiver operating characteristic (AUC) curve, the efficacy of different parameters for distinguishing uterine sarcomas from leiomyomas was measured. RESULTS: The visual assessment of DWI images showed that 100% of malignant lesions exhibited restricted diffusion while the corresponding figure for benign leiomyomas was only 5%. The mean ADC of malignant tumours differed significantly from that of benign ones (p<0.001). The percentage of malignant lesions for which choline and lipid peaks were present was significantly higher than that of benign lesions. By combining the ADC and MRS findings, an accuracy of 98.3 (95.1-100) was achieved. CONCLUSIONS: The findings suggested that a combination of DWI and MRS could be useful in the preoperative assessment of uterine masses to differentiate benign leiomyomas from leiomyosarcoma.

Chlamydia trachomatis and cervical intraepithelial neoplasia in married women in a Middle Eastern community.

The objective of this study was to determine the association between vaginal Chlamydia infection and cervical intraepithelial neoplasia (CIN). Data were collected in a case-control study for 60 patients with CIN in biopsy and 85 control subjects with normal colposcopy and biopsy. Serum antibodies to C trachomatis were associated with an increased risk for CIN [odds ratio (OR) = 7.3; 95% confidence interval (CI) 1.5-35.2)]. There was also a significant association between presence of inclusion bodies for C. trachomatis and CIN (OR = 5.5; 95% CI 2.4-12.4). These results indicate a strong association between CIN and chlamydial cervicitis.

Chlamydia trachomatis and cervical intraepithelial neoplasia in married women in a Middle Eastern community

The objective of this study was to determine the association between vaginal Chlamydia infection and cervical intraepithelial neoplasia [CIN]. Data were collected in a case-control study for 60 patients with CIN in biopsy and 85 control subjects with normal colposcopy and biopsy. Serum antibodies to C. trachomatis were associated with an increased risk for CIN [odds ratio [OR] = 7.3; 95% confidence interval [CI] 1.5-35.2]]. There was also a significant association between presence of inclusion bodies for C. trachomatis and CIN [OR = 5.5; 95% CI 2.4-12.4]. These results indicate a strong association between CIN and chlamydial cervicitis

A cytohistologic study of atypical glandular cells detected in cervical smears during cervical screening tests in Iran.

Atypical glandular cells (AGC) often cause diagnostic uncertainty in cervicovaginal smears. To determine the incidence of significant pathologies associated with AGC on Papanicolaou test, AGC smears were correlated with subsequent biopsy diagnoses. A retrospective review of archives of our cytology files for cervicovaginal smears diagnosed as AGC from April 1998 to March 2001 was performed. In 9390 cervicovaginal smears, AGC were reported in 76 (0.81%) cases, with histologic follow-up in 42 patients (55.3%). Twenty-two patients (52.4%) had preneoplastic or neoplastic, squamous, or glandular lesions on histologic examination. Among them were cervical intraepithelial neoplasia, basal cell abnormality of undetermined significance, cervical adenocarcinoma, endometrial hyperplasia or adenocarcinoma, vaginal adenocarcinoma, endocervical glandular dysplasia, metastatic breast carcinoma, and simple nonvillous trophoblastic tissue. Therefore, presence of AGC in cervical smears may exhibit a spectrum of findings, ranging from benign/reactive changes to squamous or glandular premalignancy or malignancy. A majority of these lesions are squamous dysplasia, and a significant number of patients had glandular malignancy. The results of the current study underline the importance of follow-up for patients with the diagnosis of AGC. To our knowledge, this is the first report in Iran showing the significance of AGC diagnosis.

Can we substitute brush cytology for biopsy in the evaluation of cervical lesions under the guidance of colposcopy?

In cervical cancer screening, colposcopically directed biopsy is the gold standard method for identifying intraepithelial and occult invasive lesions of the uterine cervix. As biopsy needs special expertise and the procedure is not convenient for the patients, we sought to evaluate colposcopically directed brush cytology as a substitute for biopsy of cervical lesions. We studied a series of 150 women who were referred for colposcopic evaluation. Colposcopically directed brush cytology and biopsy were performed for all patients with abnormal colposcopic findings. A total of 40 samples were excluded due to unsatisfactory report of brush cytology. Of the remaining 110 samples, 34 abnormal pathologies were reported in biopsy evaluations, while only 9 abnormal cytologies were reported in brush cytology specimens. Brush cytology sensitivity and specificity were 26% and 97%, respectively. We conclude that colposcopically directed brush cytology is not a safe substitute for biopsy in the evaluation of cervical lesions.

Borderline ovarian tumours: clinical analysis of 38 cases.

Thirty-eight patients with ovarian tumours of low malignant potential (borderline) were diagnosed and treated in Tehran University Gynecology Oncology Department from 1991 to 2002, and have been reviewed. In this study age, clinical behavior, symptoms, surgical stage, type of tumour, surgery, adjuvant treatment, survival and recurrences were evaluated. A retrospective chart review was performed on these 38 patients who were treated for histopathologically confirmed tumours of low malignant potential between 1991-2002. The mean age was 34.4 years, range (14-83) (SD: 18.33). Post surgical FIGO staging was: Stage I=93.75%, stage III 6.25%. Histologic subtypes were: Serous 76.31% (29 patients), Mucinous 21.05% (8 patients), Mixed types 2.63% (1 patient). Mean pre-operative CA125 value was 114.90 (SD: +/- 90.30). Thirty-three percent of patients had only a simple cyst in ultrasonography. Conservative surgery was performed in 76.32% (29 patients). More radical surgery (TAH + BSO) was performed in 9 patients (23.68%). There were 6 recurrences. Three patients with recurrence and invasive implants received chemotherapy and secondary surgery was performed. Survival rate was 100% at 3 years for all stages and 89% at 5 years. One patient died of recurrent disease at 48 months after initial diagnosis. Our data suggest that LMP tumours are most frequently diagnosed in stage I. Most common histological type was serous, and 5 of the recurrences of (6 patients) were initially diagnosed at stage I, and had been treated with conservative surgery with no adjuvant therapy.

First-line chemotherapy with 5-FU and platinum for advanced and recurrent cancer of the cervix: a phase II study.

This study was designed to assess the role of first-line chemotherapy with 5-fluorouracil (5-FU) and platinum in the treatment of advanced or recurrent cervical cancer. Ten patients with advanced or recurrent cancer of the cervix with no prior chemotherapy were entered in a phase II trial from October 2000 to November 2001. Eight patients were treated with Cis-platinum (50 mg/m2 over 60 minutes on the first day) followed by 5-FU (1 g/m2 over 24 hours for 4 days) and two patients with impaired renal function were treated with carboplatin (300 mg/m2 over 15 minutes on the first day) followed by 5-FU (1 g/m2 over 24 hours for 4 days) every 3 weeks until progression of disease or prohibitive toxicity had been observed. Median age was 52 years (range 28-70 years). Ten patients received a total of 42 cycles of chemotherapy. The mean number of chemotherapy cycles was 4.2 (median 4, range 3-7). Three patients had a partial response (30%, 95% CI, 1.7-58.5%). Mean duration of response was 198 days (range 122-273 days). Four patients required red blood cell transfusions; three of them had Grade II and one of the Grade III nausea and vomiting. Two had fever and neutropenia (one developed acute renal insufficiency), and there were no treatment related mortalities. First-line chemotherapy with platinum and 5-FU for advanced and recurrent cervical cancer is promising and deserves consideration for a larger phase III trial.