Biomedical subjects
J Mikuta
Publications and source records attributed to J Mikuta.
The specialty of gynecologic oncology as perceived by the public.
The purpose of this study was to obtain information about the public's awareness and perception of the discipline of gynecologic oncology. The marketing of cancer care and related services has resulted in substantial funding being allocated to market individual institutions. However, little has been done to educate patients to the fact that there are physicians specifically trained who possess special expertise in the care of specific types of malignancy. The members of The Division of Gynecologic Oncology at The Hospital of the University of Pennsylvania asked each new patient to complete an anonymous questionnaire hoping to learn more about her prior knowledge of the specialty of gynecologic oncology and her perceptions of our discipline. Presented is the analysis of the answers provided by the 200 participants. The conclusion is that the public in general is poorly informed of gynecologic oncology as a specialty and consequently may not be taking advantage of optimal cancer care already available. Thus, as a specialty we must institute programs to educate and enlighten patients.
The ability to evaluate prognostic variables on frozen section in hysterectomies performed for endometrial carcinoma.
The purpose of this study was to evaluate the ability of the pathologist to assess intraoperatively the hysterectomy specimen in patients with endometrial carcinoma. The past few years have seen the definition of prognostic variables that predict the ultimate outcome of patients with endometrial carcinoma. As a result, the International Federation of Gynecology and Obstetrics (FIGO) revised the staging system to take into account such prognostic factors as grade, depth of myometrial penetration by tumor, cervical involvement, adnexal metastasis, peritoneal cytology, and involvement of pelvic and para-aortic lymph nodes. The need for node evaluation has led to considerable controversy as to whether all hysterectomies for Stage I disease should be performed by gynecologic oncologists. To help predict which patients will need node sampling, several published studies have shown that determination of depth of myometrial penetration can be accomplished by gross evaluation of the uterine specimen, and even more accurately on frozen section. These studies recorded excellent results, but were limited to evaluation by pathologists with specific expertise in gynecologic pathology. The current study evaluated the ability to assess tumor grade, depth of invasion, and presence of cervical invasion by intra-operative evaluation of sixty hysterectomy specimens from patients with clinical Stage I disease. The gross and frozen section reports used for this study were produced by anatomic pathologists ranging in experience level from lecturer to professor, with varying levels of experience in gynecologic pathology. Our results indicate that the level of experience of the pathologist does not affect the ability to accurately assess the specimen for the parameters described. This, in turn, allows the surgeon to correctly determine the need for lymph node sampling in 94% of cases.
Treatment of para-aortic nodes in carcinoma of the cervix.
Thirty-six cases of carcinoma of the cervix with positive pelvic or para-aortic nodesdiagnosed by lymph node scan, lymphangiogram, and/or biopsy have received radiation therapy to the para-aortic nodal area at the Hospital of the University of Pennsylvania. Megavoltage radiation delivering a tumor dose of approximately 5000 rads in 5 weekshas been used. Of 26 patients avaiable for foloowup for 2 years, 11 were alive; of 8 followed for 5 years, 4 were alive. The severe complication rate was 19.5%, with a 5.5% mortality. Conclusions an- implications for further therapy are discussed.