Risk of incidental finding of endometrial cancer at the time of hysterectomy for benign condition.

STUDY OBJECTIVE: To assess the risk of unanticipated endometrial carcinoma during hysterectomy to treat a presumed benign condition. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: Tertiary referral center, university hospital. PATIENTS: All women who underwent hysterectomy to treat presumed benign indications at our center from January 2000 to December 2011 were identified. We analyzed all pathologic reports and identified cases of unexpected endometrial carcinoma. INTERVENTIONS: Hysterectomy by any approach to treat presumed benign indications. MEASUREMENTS AND MAIN RESULTS: At our institution, 2179 hysterectomies were performed to treat presumed benign indications. Nine (0.4%) revealed unexpected endometrial carcinoma (95% confidence interval, 0.2-0.7). CONCLUSION: Our data suggest that the rate of unanticipated endometrial carcinoma during hysterectomy to treat benign conditions is low.

Uterine pseudoaneurysm after abdominal myomectomy: A case report.

We present the case of a young woman with abnormal vaginal bleeding two weeks after an abdominal myomectomy. The intervention was initially considered uncomplicated. Transvaginal sonography detected a pulsatile cystic area, just above the endometrium in the anterior wall of the lower uterine segment. Color Doppler analysis revealed the communication between an artery and a vein. Although, the ultrasound was completely sufficient for diagnosis, computed tomographic angiography was performed and confirmed the diagnosis of uterine pseudoanevrysm within the uterine myometrium. Selective arterial embolization was performed with complete recovery.

Assessment of Lymph Node Involvement with PET-CT in Advanced Epithelial Ovarian Cancer. A FRANCOGYN Group Study.

The objective of our study is to evaluate the diagnostic performance of positron emission tomography/computed tomography (PET-CT) for the assessment of lymph node involvement in advanced epithelial ovarian, fallopian tubal or peritoneal cancer (EOC). This was a retrospective, bicentric study. We included all patients over 18 years of age with a histological diagnosis of advanced EOC who had undergone PET-CT at the time of diagnosis or prior to cytoreduction surgery with pelvic or para-aortic lymphadenectomy. We included 145 patients with primary advanced EOC. The performance of PET-CT was calculated from the data of 63 patients. The sensitivity of PET-CT for preoperative lymph node evaluation was 26.7%, specificity was 90.9%, PPV was 72.7%, and NPV was 57.7%. The accuracy rate was 60.3%, and the false-negative rate was 34.9%. In the case of primary cytoreduction (n = 16), the sensitivity of PET-CT was 50%, specificity was 87.5%, PPV was 80%, and NPV was 63.6%. The accuracy rate was 68.8%, and the false negative rate was 25%. After neoadjuvant chemotherapy (n = 47), the sensitivity of PET-CT was 18.2%, specificity was 92%, PPV was 66.7%, and NPV was 56.1%. The accuracy rate was 57.5%, and the false negative rate was 38.3%. Due to its high specificity, the performance of a preoperative PET-CT scan could contribute to the de-escalation and reduction of lymphadenectomy in the surgical management of advanced EOC in a significant number of patients free of lymph node metastases.

Accuracy of peritoneal carcinomatosis extent diagnosis by initial FDG PET CT in epithelial ovarian cancer: A multicentre study of the FRANCOGYN research group.

INTRODUCTION: Peritoneal carcinomatosis extent in ovarian cancer is difficult to evaluate by imaging techniques even though it determines the surgical complexity and survival. The aim of this study was to estimate the accuracy of 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-PET CT (Positron-emission tomography coupled with Computerised Tomography) performed before any treatment, in the diagnosis of the extent of peritoneal carcinomatosis. We compared these results to per-operative observations/ histology samples obtained during surgery (laparotomy/ laparoscopy). MATERIAL AND METHODS: All women managed for an epithelial ovarian cancer between 1st January 2000 and 30th June 2016 were included if they had a FDG PET CT, before initiation of any treatment (neoadjuvant chemotherapy or frontline cytoreductive surgery). The extent of disease on histology samples from cytoreductive surgery/observations during exploratory laparoscopy were compared with the PET CT results. RESULTS: Over the study period, 980 women were managed for epithelial ovarian cancer, among them 90 (9.2 %) had a PET CT before any treatment. The diagnostic reliability of an ovarian lesion was 67.8 %, a colon lesion was 61.25 %, a small intestine lesion was 50.6 %, an epiploic lesion was 41.7 %, a pelvic ganglionic invasion was 62.9 % and a paraortic lymph node invasion was 61.5 %. PET CT was less effective than a standard CT examination. CONCLUSION: PET CT is not the most effective imaging examination to estimate the extent of peritoneal carcinomatosis during the initial management of an epithelial ovarian cancer.

Isolated lymph node recurrence in epithelial ovarian cancer: Recurrence with better prognosis?

INTRODUCTION: The aim of this study was to compare overall survival (OS) between women with isolated lymph node recurrence (ILNR) and those with isolated peritoneal localization of recurrence (ICR), in patients managed for epithelial ovarian cancer. METHODS: Data from 1508 patients with ovarian cancer were collected retrospectively from1 January 2000 to 31 December 2016, from the FRANCOGYN database, pooling data from 11 centres specialized in ovary treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analyses were performed to define prognostic factors of overall survival. Patients included had a first recurrence defined as ILNR or ICR during their follow up. RESULTS: 79 patients (5.2 %) presented with ILNR, and 247 (16.4 %) patients had isolated carcinomatosis recurrence. Complete lymphadenectomy was performed more frequently in the ILNR group vs. the ICR group (67.1 % vs. 53.4 %, p = 0.004) and the number of pelvic lymph nodes involved was higher (2.4 vs. 1.1, p = 0.008). The number of involved pelvic LN was an independent predictor of ILNR (OR = 1.231, 95 % CI [1.074-1.412], p = 0.0024). The 3-year and 5-year OS rates in the ILNR group were 85.2 % and 53.7 % respectively, compared to 68.1 % and 46.8 % in patients with ICR. There was no significant difference in terms of OS after initial diagnosis (p = 0.18). 3- year and 5-year OS rates after diagnosis of recurrence were 62.6 % and 15.6 % in the ILNR group, and 44 % and 15.7 % in patients with ICR (p = 0.21). CONCLUSION: ILNR does not seem to be associated with a better prognosis in terms of OS.

Evolution of characteristics of women with endometrial cancer during a 40 years study period.

OBJECTIVES: The aim of our work was to investigate changes in presentation and endometrial cancer (EC) types frequencies thorough a 40 years study period. PATIENTS AND METHODS: The patient group consisted of consecutive women undergoing surgery for endometrial cancer in our institution between 1975, and 2014. Clinical data included age, BMI (Kg/m2), histological data from surgical staging and survival data. RESULTS: 842 patients with the final diagnosis of endometrial cancer were enrolled. BMI was overweight rising through study decades. Age of diagnosis was also in constant augmentation since 1975. Type II EC proportion was 9.2% in the seventies and 27.9% after 2000. Overall survival was stable over time. Women with BMI < 18 kg/m2 had lower overall survival when compared to women with other BMI categories (p < 0.0001). DISCUSSION AND CONCLUSION: An analysis on a larger population of underweight women with EC is needed to identify specific factors. A trend to develop more type II EC can partly explain these results. We identified a clear trend of augmentation of type II EC, known to have a poor prognosis while necessitating specific surgical management. Histologic analysis standardisation, surgical strategy and amelioration of adjuvant treatments permitted to maintain a stable overall survival for the whole population despite this augmentation.