Radical vulvectomy with a bilateral pudendal flap in the treatment of a vulvar cancer relapse.

One of the main risk factors for relapse in vulvar cancer after lymph-node metastases is free surgical margins. In the case of a relapse, radical vulvectomy with perineal reconstruction is the first choice. Perineal reconstruction is usually indicated in relapse and unusual for a first surgery, except extensive damage 1, 2, 3, 4, 5.

Sentinel lymph node mapping in patients with stage I endometrial carcinoma: a focus on bilateral mapping identification by comparing radiotracer Tc99m with blue dye versus indocyanine green fluorescent dye.

PURPOSE: The aim of this study was to compare technetium radiocolloid (Tc99m) + blue dye (BD) versus Indocyanine green (ICG) fluorescent dye in terms of the overall detection rate and bilateral sentinel lymph node (SLN) mapping in patients with endometrial carcinoma. METHODS: Patients from five European centers with apparently confined clinical stage I endometrial cancer were reviewed. A comparison was made between women who received SLN mapping with pelvic and/or aortic lymphadenectomy (LND), and women who underwent SLN algorithm (SA), was also performed between the two groups. RESULTS: Three hundred and forty-two (342) women were involved (147 in the Tc99m + BD group and 195 in the ICG group). The overall detection rate of SLN biopsy was 97.3% (143/147) for women in the Tc99m + BD group and 96.9% (189/195) for women in the ICG group (p = 0.547). The bilateral mapping rate for ICG was 84.1%-significantly higher with respect to the 73.5% obtained with Tc99m + BD (p = 0.007). No differences in overall sensitivity (OS) and overall false negative rate (FNR) were seen between LND and SA (p value = 0.311), whereas the negative predictive value (NPV) was in favor of SA group (p value = 0.030). CONCLUSIONS: In this study, fluorescent mapping using ICG resulted equivalent to the standard combined radiocolloid and BD, but real-time SLN mapping achieves a higher bilateral detection rate. The added value that this fast emerging technology promises to give certainly warrants future studies to further consolidate the advantages there are over the standard technique.

Potential implications on female fertility and reproductive lifespan in BRCA germline mutation women.

PURPOSE: Women who carry a mutation in the BRCA1 or BRCA2 genes not only have an increased lifetime risk of developing breast and ovarian cancer, but also a complicated reproductive future. Based on the hypothesis that BRCA germline mutations (BRCAm) are associated with accelerated follicular loss and early menopause, the aim of this paper is to discuss and review the most outstanding recently published articles about BRCA gene and fertility. METHOD: A literature research in PubMed was conducted, using the keywords "anti-Müllerian hormone", "BRCA1/2 gene", "female fertility", "ovarian reserve" and "premature ovarian failure", selecting outstanding articles published since 2010. RESULTS: BRCA genes, mainly BRCA1, play a role in the maintenance of double-stranded DNA breaks and telomere length, a factor associated with reproductive lifespan and early depletion of ovarian reserve. BRCAm women have a decreased ovarian reserve and worse response in fertility preservation. In the case of being given chemotherapy or tamoxifen, that would increase the apoptosis of follicular reserve. Low Anti-Müllerian hormone serum concentrations have not been shown to affect natural fecundability and fertility in BRCAm women below 30 s, but it does in women above that threshold. Surgical risk reduction salpingo-oophorectomy implies another important limitation in reproductive possibilities. Removal of the fallopian tubes with delayed oophorectomy could be a reasonable strategy in high-risk premenopausal women in the context of a clinical trial. CONCLUSIONS: BRCAm women should not delay pregnancy, especially if they are BRCA1, older than 35 years or with previous gonadotoxic treatments. Future prospective studies on infertility outcomes in this population are needed.

From Conventional Radiotracer Tc-99(m) with Blue Dye to Indocyanine Green Fluorescence: A Comparison of Methods Towards Optimization of Sentinel Lymph Node Mapping in Early Stage Cervical Cancer for a Laparoscopic Approach.

BACKGROUND: The credibility of sentinel lymph node (SLN) mapping is becoming increasingly more established in cervical cancer. We aimed to assess the sensitivity of SLN biopsy in terms of detection rate and bilateral mapping in women with cervical cancer by comparing technetium-99 radiocolloid (Tc-99(m)) and blue dye (BD) versus fluorescence mapping with indocyanine green (ICG). METHODS: Data of patients with cervical cancer stage 1A2 to 1B1 from 5 European institutions were retrospectively reviewed. All centers used a laparoscopic approach with the same intracervical dye injection. Detection rate and bilateral mapping of ICG were compared, respectively, with results obtained by standard Tc-99(m) with BD. RESULTS: Overall, 76 (53 %) of 144 of women underwent preoperative SLN mapping with radiotracer and intraoperative BD, whereas 68 of (47 %) 144 patients underwent mapping using intraoperative ICG. The detection rate of SLN mapping was 96 % and 100 % for Tc-99(m) with BD and ICG, respectively. Bilateral mapping was achieved in 98.5 % for ICG and 76.3 % for Tc-99(m) with BD; this difference was statistically significant (p < 0.0001). CONCLUSIONS: The fluorescence SLN mapping with ICG achieved a significantly higher detection rate and bilateral mapping compared to standard radiocolloid and BD technique in women with early stage cervical cancer. Nodal staging with an intracervical injection of ICG is accurate, safe, and reproducible in patients with cervical cancer. Before replacing lymphadenectomy completely, the additional value of fluorescence SLN mapping on both perioperative morbidity and survival should be explored and confirmed by ongoing controlled trials.