Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma.
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Female↗
Biomedical subjects
Emile Darai
Publications and source records attributed to Emile Darai.
Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease.
PURPOSE: To prospectively evaluate the accuracy of magnetic resonance (MR) imaging for the preoperative diagnosis of deep pelvic endometriosis and extension of the disease. MATERIALS AND METHODS: One hundred ninety-five patients (mean age, 34.2 years; range, 20-71 years) who were suspected of having pelvic endometriosis were recruited at two institutions. Two experienced radiologists evaluated the MR images independently. Deep pelvic endometriosis was defined as implants or tissue masses that appeared as hypointense areas and/or hyperintense foci on T1- or T2-weighted MR images in the following locations: torus uterinus, uterosacral ligaments (USLs), vagina, rectovaginal septum, rectosigmoid, and bladder. MR imaging results were compared with surgical and pathologic findings. Sensitivity, specificity, predictive values, and accuracy of MR imaging for prediction of deep pelvic endometriosis were assessed. RESULTS: Pelvic endometriosis was confirmed at pathologic examination in 163 (83.6%) of 195 patients. Endometriomas, peritoneal lesions, and deep pelvic endometriosis were diagnosed on the basis of surgical findings, alone or combined with pathologic findings, in 111 (68.1%), 83 (50.9%), and 103 (63.2%) of 163 patients, respectively. Torus uterinus and USL were the most frequent sites of deep pelvic endometriosis. The sensitivity, specificity, positive and negative predictive values, and accuracy of MR imaging for deep pelvic endometriosis were 90.3% (93 of 103), 91% (84 of 92), 92.1% (93 of 101), 89% (84 of 94), and 90.8% (177 of 195), respectively. The sensitivity, specificity, and accuracy, respectively, of MR imaging for the diagnosis of endometriosis in specific sites were as follows: USL, 76% (57 of 75), 83.3% (100 of 120), and 80.5% (157 of 195); vagina, 76% (16 of 21), 95.4% (166 of 174), and 93.3% (182 of 195); rectovaginal septum, 80% (eight of 10), 97.8% (181 of 185), and 96.9% (189 of 195); rectosigmoid, 88% (53 of 60), 97.8% (132 of 135), and 94.9% (185 of 195); and bladder, 88% (14 of 16), 98.9% (177 of 179), and 97.9% (191 of 195). CONCLUSION: MR imaging demonstrates high accuracy in prediction of deep pelvic endometriosis in specific locations.
Adult↗
Prognostic value of von Willebrand factor, CD34, CD31, and vascular endothelial growth factor expression in women with uterine leiomyosarcomas.
BACKGROUND AND OBJECTIVES: To compare uterine leiomyosarcomas (LMS) and leiomyomas (LM) with normal myometrium in terms of microvessel density (MVD), and to correlate this parameter with vascular endothelial growth factor (VEGF) expression and clinical/pathological parameters. METHODS: An immunohistochemical technique, using antibodies against von Willebrand factor (FvW), CD34, CD31, and VEGF, was applied to formalin-fixed paraffin-embedded samples of 32 normal myometria, 32 uterine LM, and 12 LMS. MVD was calculated by a digital image analyzer. RESULTS: Using anti-FvW, mean +/- SD MVD in myometrium, LM, and LMS was 107.0 +/- 53.6, 66.2 +/- 55.4, and 64.4 +/- 44.2, respectively (P = 0.001). MVD was lower in LMS (P = 0.021) and in LM (P = 0.0004) than in normal myometrium. Using anti-CD34, mean +/- SD MVD in myometrium, LM, and LMS was 187.6 +/- 91.2, 106.1 +/- 55.5, and 114.2 +/- 98.8, respectively (P = 0.001). MVD was lower in LMS (P = 0.012) and LM (P = 0.0004) than in normal myometrium. No such differences were found using anti-CD31 and anti-VEGF. No correlation was found between MVD and VEGF expression. In women with uterine LMS, low MVD (assessed with anti-FvW) correlated with recurrence (P = 0.04) and poor overall survival (P = 0.03). CONCLUSIONS: Uterine smooth muscle tumors exhibit a lower MVD than normal myometrium, as assessed using anti-FvW or anti-CD34 antibodies. A reduced MVD, as assessed by FvW staining, has prognostic value in uterine LMS.
Adult↗
Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography.
OBJECTIVE: The purpose of this study was to evaluate the impact of colorectal resection for endometriosis on symptoms and quality of life or on potential side effects. STUDY DESIGN: After magnetic resonance imaging and rectal endoscopic sonographic evaluations of symptomatic colorectal endometriosis, 27 consecutive women who underwent colorectal resection were included in this prospective study. They completed symptom questionnaires before and after the procedure. Linear pain scores for several gynecologic and digestive symptoms and impact on quality of life were recorded. RESULTS: The sensitivity and positive predictive value of magnetic resonance imaging and rectal endoscopic sonographic evaluation for the diagnosis of colorectal endometriosis were 92.6% and 100% and 89% and 100%, respectively. Nonmenstrual pelvic pain (P = .001), dysmenorrhea (P < .0001), dyspareunia (P = .0002), and pain on defecation (P < .005) were improved by colorectal resection. No correlation was found between symptom intensity and lesion size, as evaluated by magnetic resonance imaging, rectal endoscopic sonographic evaluation, or histologic examination of the surgical specimen. Respectively, the conditions of 14, 11, 0, and 2 women were cured, improved, unchanged, or worsened. Median overall pre- and postoperative quality-of-life scores were 9 (range, 4-10) and 0 (range, 0-10), respectively (P < .0001). CONCLUSION: Colorectal resection for endometriosis appears to relieve some symptoms. However, women should be informed that some symptoms may persist and that there is a risk of urinary and digestive side effects.
Adult↗
Value of intraoperative imprint cytology of sentinel nodes in patients with cervical cancer.
OBJECTIVE: The purpose of this study was to evaluate intraoperative imprint cytology (IC) for the detection of sentinel node (SN) involvement in patients with cervical cancer. METHODS: Thirty-six consecutive patients with cervical cancer underwent a laparoscopic SN procedure with intraoperative IC, followed by complete laparoscopic pelvic lymphadenectomy, with or without laparoscopic para-aortic lymphadenectomy. The SN was bisected and both cut surfaces were applied to the surface of glass slides. Permanent sections were stained with H&E and immunohistochemical methods. The IC results were compared with the final histological results. RESULTS: At least one SN (mean: 2 SN per patient, range: 1-5) was detected in 34 of the 36 patients. Eight patients (22.2%) had a total of 12 metastatic SNs (four macrometastatic, five micrometastatic, and three with isolated tumor cells). No false-negative results of SN biopsy were obtained. Only one metastasis was identified by IC. No false-positive findings were obtained with IC. The overall sensitivity, specificity, accuracy, and positive and negative predictive values of IC were 8.3%, 100%, 85.7%, 100%, and 85.5%, respectively. CONCLUSION: These results suggest that intraoperative imprint cytology of sentinel nodes is unreliable in patients with cervical cancer.
Adult↗
Relevance of the sentinel node procedure in endometrial cancer.
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Endometrial Neoplasms↗
Lymphatic mapping for gynecologic malignancies.
In gynecologic malignancies, regional lymph node status is a major prognostic factor and a decision criterion for adjuvant therapy. This is the basis for lymphadenectomy. The sentinel node (SN) procedure has emerged as an alternative to systematic lymphadenectomy in various cancers, reducing treatment-related morbidity. In melanoma and breast cancer, SN biopsy is the standard procedure for determining nodal stage. Use of the SN procedure is also well established in vulvar cancer. In small series, combined SN detection based on blue dye and radiocolloid was suitable for the evaluation of lymph node status in cervical cancer. Although some investigators have reported the feasibility of the SN procedure in endometrial cancer, further studies and standardization are required before its routine use can be recommended.
Endometrial Neoplasms↗
Laparoscopic sentinel node procedure using a combination of patent blue and radiocolloid in women with endometrial cancer.
BACKGROUND: We assessed the feasibility of a laparoscopic sentinel node (SN) procedure based on the combined use of radiocolloid and patent blue labeling in patients with endometrial cancer. METHODS: Seventeen patients (median age, 69 years) with endometrial cancer of stage I (16 patients) or stage II (1 patient) underwent a laparoscopic SN procedure based on combined radiocolloid and patent blue injected pericervically. After the SN procedure, all patients underwent complete laparoscopic pelvic lymphadenectomy and either laparoscopically assisted vaginal hysterectomy (16 patients) or laparoscopic radical hysterectomy (1 patient). RESULTS: SNs (mean number per patient, 2.6; range, 1-4) were identified in 16 (94.1%) of the 17 patients. Macrometastases were detected in three SNs from two patients by hematoxylin and eosin staining. In three other patients, immunohistochemical analysis identified six micrometastatic SNs and one SN containing isolated tumor cells. No false-negative SN results were observed. CONCLUSIONS: An SN procedure based on a combination of radiocolloid and patent blue is feasible in patients with early endometrial cancer. Combined use of laparoscopy and this SN procedure permits minimally invasive management of endometrial cancer.
Aged↗
Laparoscopic sentinel node procedure for cervical cancer: impact of neoadjuvant chemoradiotherapy.
BACKGROUND: SN detection based on combined blue dye and radiocolloid labeling can reliably show lymph node status in cervical cancer, but the influence of prior neoadjuvant chemoradiotherapy has not yet been reported. The aim of this study was to evaluate the effect of neoadjuvant chemoradiotherapy on the accuracy of a dual-labeling laparoscopic sentinel node (SN) procedure in patients with cervical cancer. METHODS: Between July 2001 and June 2003, 26 patients (mean age, 50.3 years) with cervical cancer underwent a laparoscopic SN procedure based on dual labeling with patent blue and radiocolloid. After the SN procedure, all the patients underwent complete laparoscopic pelvic lymphadenectomy and laparoscopic radical hysterectomy (n=19), the Schauta-Amreich operation (n=5), or trachelectomy (n=2). The results of the SN procedure were compared between 11 patients who received neoadjuvant chemoradiotherapy and 15 patients who did not receive neoadjuvant treatment. RESULTS: The SN identification rates were 100% in the 11 patients who underwent neoadjuvant chemoradiotherapy and 93.3% in the 15 patients who did not receive adjuvant therapy. A total of 59 SNs were removed. Eight SNs (13.6%) from five patients (19.2%) were found to be metastatic at the final histological assessment. Three SN involvements were detected by hematoxylin and eosin staining of the SN. Immunohistochemical studies identified five metastatic SNs in three patients. There were no false-negative SN results. CONCLUSIONS: This study suggests that SN detection with a combination of radiocolloid and patent blue is feasible and accurate in patients with cervical cancer undergoing neoadjuvant chemoradiotherapy or primary surgery. The combination of laparoscopy and the SN procedure permits minimally invasive management of cervical cancer.
Chi-Square Distribution↗
Sentinel lymph nodes.
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False Negative Reactions↗
Laparoscopic sentinel lymph node procedure using a combination of patent blue and radioisotope in women with cervical carcinoma.
BACKGROUND: The authors evaluated the feasibility of a laparoscopic sentinel lymph node (SN) procedure with combined radioisotopic and patent blue labeling in patients with cervical carcinoma. METHODS: Thirteen women (median age, 52.5 years) with cervical carcinoma (Stage Ia2 in 1 patient, Stage Ib1 in 10 patients, Stage Ib2 in 1 patient, and Stage IIa in 1 patient) underwent a laparoscopic SN procedure using an endoscopic gamma probe after both radioactive isotope and patent blue injections. After the procedure, all patients underwent complete laparoscopic pelvic lymphadenectomy and either laparoscopic radical hysterectomy (eight patients) or the Schauta-Amreich operation (five patients). RESULTS: SNs (mean, 1.7 SNs per patient; range, 1-3 SNs per patient) were identified in 12 of 13 patients. A median of 10.5 pelvic lymph nodes per patient (range, 4-17 pelvic lymph nodes per patient) were removed. No lymph node involvement was detected in SNs with hematoxylin and eosin staining. Immunohistochemical studies identified four metastatic SNs in two patients, with micrometastases in two SNs from the first patient and isolated tumor cells in two SNs from the second patient. No false-negative SN results were obtained. CONCLUSIONS: The results of this study suggest that SN detection with a combination of radiocolloid and patent blue is feasible in patients with cervical carcinoma. The combination of laparoscopy and the SN procedure permitted minimally invasive management of early-stage disease.
Adult↗
Massive ovarian edema revealing gastric carcinoma: a case report.
Tumor-like enlargement of the ovaries due to accumulation of edema fluid within the ovarian stroma is referred to as massive ovarian edema (MOE). The pathogenesis of MOE is thought to be intermittent torsion of the ovary on its pedicle, causing partial obstruction of venous and lymphatic drainage. The diagnosis of MOE is based on imaging techniques. The case described here due to ovarian lymphatic vessel obstruction by carcinoma cells shows that metastatic disease may be a cause of MOE.
Adult↗
Serum concentrations of interleukin-2R (IL-2R), IL-6, IL-8, and tumor necrosis factor alpha in patients with ectopic pregnancy.
OBJECTIVE: To investigate the diagnostic relevance of serum cytokine concentrations in ectopic pregnancy (EP). DESIGN: Cohort study. SETTING: University hospital. PATIENT(S): Seventeen women with EP, 22 women with miscarriage, and 33 women with normal intrauterine pregnancy, at comparable stages of gestation. INTERVENTION(S): Interleukin (IL)-2 receptor, IL-6, IL-8, and tumor necrosis factor alpha (TNF-alpha) determination by immunoradiometric assay. MAIN OUTCOME MEASURE(S): Serum concentrations of progesterone, beta-hCG, IL-2R, IL-6, IL-8, and TNF-alpha. RESULT(S): Serum levels of IL-6 were higher in women with EP than in those with miscarriage and normal pregnancy. Serum levels of TNF-alpha were higher in women with EP than in those with miscarriage and normal pregnancy. Serum levels of IL-8 were higher in women with EP than in those with miscarriage and normal pregnancy. An IL-8 cutoff of >40 pg/mL predicted EP with a sensitivity of 82.4%, a specificity of 81.8%, and positive and negative predictive values of 58.3% and 93.8%. No difference in serum IL-2R levels was found among the groups. CONCLUSION(S): Serum IL-8, IL-6, and TNF-alpha concentrations are higher in women with EP than in those with miscarriage and normal pregnancy. Further studies are needed to determine their diagnostic value.
Abortion, Spontaneous↗
Anatomic and functional results of laparoscopic-perineal neovagina construction by sigmoid colpoplasty in women with Rokitansky's syndrome.
BACKGROUND: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital cause of primary amenorrhea, due to utero-vaginal agenesis. Several surgical techniques have been used to create a neovagina. Neovagina construction with a sigmoid graft appears to be the best option, as it offers adequate length and natural lubrication, allowing early intercourse. However, few data are available on the complications, anatomic and functional results of laparoscopic-perineal neovagina construction by sigmoid colpoplasty. METHODS: From September 1995 to November 2002, seven women with the MRKH syndrome underwent laparoscopic-perineal neovagina construction by sigmoid grafting. RESULTS: The mean operating time was 312 min (range 220-450 min). The mean fall in haemoglobin was 3.6 g/dl (range 2-4.4 g/dl). Blood transfusion was never necessary. The only perioperative complications were one urinary tract infection and one vulvar haematoma not requiring drainage. The mean hospital stay was 7.7 days (range 6-12 days). The mean length of the neovagina was 11.5 cm (range 7-15 cm), and no shrinkage occurred during follow-up. The neovaginal introitus admitted two fingers in breadth in five of the seven patients. Dilation of the introitus was required in the other two women. None of the four women who had intercourse experienced dyspareunia or discomfort. CONCLUSION: Our results confirm the feasibility of laparoscopic-perineal neovagina construction by sigmoid colpoplasty, when performed by surgeons with extensive experience in both gynaecological and gastrointestinal laparoscopic surgery. The anatomic and functional results were good.
Abnormalities, Multiple↗
Laparoscopic sentinel node procedure in patients with cervical cancer.
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Coloring Agents↗
Expression of von Willebrand's factor, CD34, CD31, and vascular endothelial growth factor in uterine leiomyomas.
OBJECTIVE: To compare the vascular parameters of uterine leiomyomas and normal myometrium, to correlate these parameters with vascular endothelial growth factor (VEGF) expression and clinical/pathological parameters, and to compare vascular parameters according to the endothelial markers used. DESIGN: An immunohistochemical technique was applied to formalin-fixed paraffin-embedded tissue samples, using antibodies against von Willebrand's factor (FvW), CD34, CD31, and VEGF. The intratumoral vascular area (VA), microvessel density (MVD), and vascular luminal area (VLA) were determined with an image analyser. SETTING: University teaching hospital. PATIENT(S): Thirty-two patients with uterine leiomyomas underwent conservative surgery. Twenty leiomyoma-free patients undergoing hysterectomy were the controls. INTERVENTION(S): Immunohistochemical and morphometrical analysis. MAIN OUTCOME MEASURE(S): Measurements of VA, MVD, and VLA. RESULT(S): The CD34 labeling showed decreased VA in myomas compared with myometrium. Decreased MVD and an increased VLA in myomas were found with FvW and CD34 labeling. The VA, MVD, and VLA were not related to VEGF expression or to clinical/pathological parameters. Similar results for VA and MVD were obtained with FvW and CD34 labeling. CONCLUSION(S): Leiomyomas have a smaller vascular area, a lower microvessel density, and a higher vascular luminal area than normal myometrium.
Antigens, CD↗
Determinants of patient dissatisfaction after a tension-free vaginal tape procedure for urinary incontinence.
PURPOSE: We identified the determinants of patient satisfaction after a tension-free vaginal tape procedure. MATERIALS AND METHODS: We retrospectively analyzed the records of 187 consecutive women with genuine stress (133) and mixed (54) incontinence. The objective cure rate was determined by clinical and urodynamic examination, and the subjective cure rate was assessed by a visual analog scale and the Contilife questionnaire. RESULTS: Mean followup was 27 months (range 6 to 34). The overall complication rate was 35.3%. The major perioperative and postoperative complications were bladder injury in 9.6% of cases, urinary retention in 6.4%, difficult voiding in 10.7% and new onset urge symptoms in 21.3%. The overall objective and subjective cure rates were 90.4% and 70.6%, respectively. The mean preoperative and postoperative visual analog scale score plus or minus standard deviation was 6.2 +/- 2.4 and 0.9 +/- 2.2, respectively (p = 0.0001). The subjective cure rate was significantly lower in women who underwent the procedure under general or spinal anesthesia than in those who received local anesthesia (p = 0.01). This difference was related to the rate of new onset urge symptoms. The mean postoperative visual analog scale score in women with and without new onset urge symptoms was 2.2 +/- 3.2 and 0.2 +/- 0.7, respectively (p = 0.0001). No difference in the subjective cure rate was detected according to patient age, menopausal status, previous incontinence surgery, the body mass index, additional procedures associated with tension-free vaginal tape surgery or the Ingelman-Sundberg classification. CONCLUSION: These results confirm that the tension-free vaginal tape procedure is associated with a high objective but lower subjective cure rate. The procedure performed using local anesthesia was associated with a lower incidence of difficult voiding and new onset urge symptoms.
Adult↗