Evaluation of the Impact of Letrozole in Combination with the GnRH Antagonist Ovarian Stimulation Protocol in Patients Expected to Have a Poor Ovarian Response (POSEIDON Groups 3 and 4).

Background and Objectives: The objective of this study was to evaluate the impact of adjuvant letrozole administration during ovarian stimulation using the gonadotropin-releasing hormone (GnRH) antagonist protocol on treatment outcomes in women categorized into POSEIDON groups 3 and 4. Materials and Methods: This retrospective cohort study analyzed data from patients classified into POSEIDON groups 3 and 4 who underwent fresh embryo transfer subsequent to intracytoplasmic sperm injection following a GnRH antagonist stimulation protocol between January 2017 and December 2021. Patients were divided into two groups: the GnRH-LZ group, who received letrozole at a dosage of 5 mg/day for five consecutive days, and the GnRH-ant group, who did not receive adjuvant letrozole. The primary outcome measure of the study was a comparative analysis of live birth rates between the two groups. Results: A total of 449 patients were deemed suitable for final analysis and were allocated into two groups: 281 patients in the GnRH-ant group and 168 patients in the GnRH-LZ group. Live birth rates were found to be comparable in both groups (11% vs. 9%, p = 0.497). Letrozole administration significantly reduced the total amount of gonadotropins required (2606.2 ± 1284.5 vs. 3097.8 ± 1073.3, p < 0.001), the duration of ovarian stimulation (11.2 ± 3.9 vs. 10.2 ± 3, p = 0.005), and the serum peak estradiol concentration (901.4 ± 599.6 vs. 463.8 ± 312.3, p < 0.001). Conclusions: Adjuvant letrozole administration did not demonstrate a significant impact on live birth rates among women categorized into POSEIDON groups 3 and 4. However, this approach may offer potential cost reductions by diminishing the necessity for exogenous gonadotropins and shortening the duration of ovarian stimulation.

Neoadjuvant chemotherapy in patients with stage IVB uterine serous carcinoma: a Turkish multicentric study.

The aim of this study was to evaluate the prognostic factors for and determine the effect of neoadjuvant chemotherapy (NACT) on oncologic outcome in stage IVB pure serous endometrial carcinoma patients who received taxane and platinum. Forty-two patients with 2009 International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma were enrolled from six gynecologic oncology centers and a study group was created. The study group had a 2-year disease-free survival (DFS) of 32% and 2-year disease-specific survival (DSS) of 73%. On univariate analysis; lymphadenectomy (not performed vs. performed), paraaortic lymph node metastasis (positive vs. negative) and number of metastatic lymph node count (≤5 vs. >5) were found to have statistical significance for DFS (p < 0.001, p = 0.026 and p = 0.044, respectively). Adnexal metastasis (positive vs. negative) and type of cytoreductive surgery (maximal vs. optimal and suboptimal) had statistical significance for DSS (p = 0.041 and p = 0.015, respectively). Receiving NACT did not affect DFS and DSS in stage IVB uterine serous carcinoma patients. As our sample size was small, precise conclusions could not be made for suggesting the use of NACT in advanced stage uterine serous carcinoma. For more accurate results, more randomized controlled studies are needed in this patient group.IMPACT STATEMENTWhat is already known on this subject? Endometrial carcinoma is the most common type of gynecologic tract malignancies and usually it is diagnosed at early stages. Although the favorable prognosis, uterine serous carcinoma (USC), one of the rarest subtypes, has a poorer prognosis when compared to other histological subtypes. USC has a propensity to spread beyond pelvis. Due to this aggressive behavior, surgical intervention could not be feasible in advanced stage disease.What do the results of this study add? Our study evaluated the prognostic factors that affect survival in advanced stage USC patients. Also we investigated that neoadjuvant chemotherapy (NACT) could improve oncologic outcomes. Performing lymphadenectomy, presence of paraaortic lymph node and adnexal metastasis, number of metastatic lymph nodes and type of cytoreductive surgery improved survival in advanced stage USC patients. However, NACT did not have a statistical significance as a predictor for disease-specific survival (DSS) and disease-free survival (DFS).What are the implications of these findings for clinical practice and/or further research? Maximal surgical effort should be performed in advanced stage USC according to our results. On the other hand, NACT had no impact on DSS and DFS rates. For this reason, we could not be able to suggest the routine use of NACT in advanced stage USC. But more randomized controlled trials are warranted for confirmation of our results.

Radiomics analysis of uterine tumors in 18F-fluorodeoxyglucose positron emission tomography for prediction of lymph node metastases in endometrial carcinoma.

BACKGROUND: In this single-center study, we aimed to analyze texture features of primary uterine lesions on 18F-FDG PET/CT to predict lymph node metastases. METHODS: Totally, 157 (mean age: 62 ± 10.2 years) patients were included in the analysis. Histopathological examination results were considered as the standard reference for nodal involvement. On 18F-FDG PET/CT images, only the primary tumor was segmented. SUVmax, SUVmean, SUVpeak, MTV, and TLG of primary uterine lesions were calculated for analyses. For texture analysis first, second, and higher-order texture features were calculated. RESULTS: Mean diameter of primary uterine lesions was calculated as 35± 18.1 mm. Lymph node metastases were detected in 19% of patients in histopathological examination of surgical materials. While 26 patients had pelvic lymph node metastases, 19 patients had additional paraaortic lymph node metastases. On radiomics analysis for 20 features, a significant difference was found between patients with and without lymph node metastasis. With using data mining methods GLZLM ZLNU, EntropyGLCM, Entropyhisto, GLRLM LRHGE, GLZLM HGZE, GLZLM SZHGE, GLRLM HGRE, GLRLM SRHGE were found significant radiomics features to predict lymph node metastasis with a diagnostic accuracy of 0.8. DISCUSSION: The radiomics analysis of intratumoral heterogeneity is a promising method for improving triage of the patients for lymph node dissection in endometrial carcinoma.

Ocular vascular changes during pregnancy: an optical coherence tomography angiography study.

BACKGROUND: Pregnancy is a period presenting with many physiological adaptation mechanisms. One of the structures in which these mechanisms are observed is ocular tissues. The cornea, lacrimal and meibomian glands, and chorioretinal complex are all among the structures affected by changes during pregnancy. In this study we aimed to evaluate the macular and optic disc vessel density (VD) changes by Optical Coherence Tomography Angiography (OCTA) imaging in pregnancy. METHODS: A total of 248 eyes from 124 pregnant women and 80 eyes from 40 healthy control women were involved. Vessel densities of macula were evaluated for superficial capillary plexus (SCP) and deep capillary plexus (DCP) in whole macula, foveal, parafoveal and perifoveal region. Peripapillary and whole optic disc VDs were also evaluated. Vessel densities of macula and optic disc were compared between control individuals and pregnant women. Vessel densities in different trimesters were also evaluated. RESULTS: Modest but significant differences in VDs of whole macula of SCP and DCP were observed in pregnancy group. Additionally, perifoveal and parafoveal region of SCP, whole disc and radial peripapillary capillary VD were significantly higher in pregnancy group. There was no correlation between VD ratios of macula and optic disc and pregnancy weeks and trimesters. CONCLUSIONS: This is the first study focusing on the OCTA parameters in pregnant individuals. These findings suggest that physiological changes during pregnancy are not limited to the cornea, eyelids and the choroid but also to the retinal and optic disc vasculature.

Prognostic factors for disease-free and overall survival of patients with uterine carcinosarcoma.

BACKGROUND: Uterine carcinosarcoma (UCS) is a relatively rare and very aggressive tumor. The predictors of survival for patients with UCS have not been determined clearly yet. The aim of the present study was to investigate the possible predictors of disease-free survival (DFS) and overall survival (OS) for patients with UCS. METHODS AND MATERIALS: All patients with UCS who were treated surgically at a university-based Gynecology Oncology Clinic between January 2008 and December 2014 were recruited into this retrospective cohort study. Data regarding clinical, pathologic and treatment information were obtained retrospectively from hospital records. The Kaplan-Meier method was used to calculate DFS and OS, and Cox regression analysis was performed to define the effects of risk factors on survival. RESULTS: A total of 88 UCS patients with a median age of 64.5 years were included in the study. Forty-seven (53.4%) patients were diagnosed with stage III disease and seven (7.9%) with stage IV disease. The median follow-up time was 16 months. Among all patients, 60 (68.1%) underwent lymphadenectomy. Optimal cytoreductive surgery was achieved in 67 (76.1%) patients. Stepwise variable selection Cox regression analysis showed that lymph node metastasis was associated with poor DFS (hazard ratio 6.524; 95% CI 2.625-16.211; P < 0.001) and OS (hazard ratio 6.993; 95% CI 2.631-18.587; P < 0.001). Subgroup analysis in both early and advanced-stage diseases revealed no significant impact of risk factors on survival. CONCLUSIONS: Lymph node metastasis is the most significant prognostic factor associated with poor DFS and OS in UCS patients.

Nomogram with potential clinical use to predict lymph node metastasis in endometrial cancer patients diagnosed incidentally by postoperative pathological assessment.

PURPOSE: To determine the clinical and pathological risk factors for lymph node metastasis (LNM) in patients with endometrial cancer and to create a nomogram to predict LNM in patients without surgical staging. METHODS: All patients with endometrial adenocarcinoma who were treated surgically at a university based gynecologic oncology clinic between January 2011 and December 2014 were recruited. Women with endometrial adenocarcinoma who were surgically staged including lymphadenectomy were included in the study. Data regarding clinical and pathological risk factors were recorded. The histopathologic slides from the staging surgeries were re-evaluated microscopically by a gynecologic pathologist for all parameters along with lymphovascular space invasion (LVSI). RESULTS: A total of 279 patients with endometrial cancer were analyzed. Among those, 31 (11.1%) had lymph node metastasis. According to the univariate analyses, elevated CA 125 (>35 U/mL), LVSI, myometrial invasion ≥50%, grade 3 disease, non-endometrioid type, and cervical stromal involvement were significantly associated with LNM. The multivariate logistic regression analysis showed that LVSI, non-endometrioid type, elevated CA 125, and cervical stromal involvement increased the risk of LNM. However, myometrial invasion and grade did not significantly affect the risk of LNM. A nomogram to predict LNM was constructed using these factors (concordance index 0.92). CONCLUSIONS: LVSI is the most important predictor for LNM. The present nomogram can be useful to decide if adjuvant therapy is required for patients who undergo simple hysterectomy for a benign etiology and incidentally diagnosed with endometrial cancer by pathological evaluation.

Effect of Bilateral Erector Spinae Plane Block on Postoperative Analgesia in Cesarean Section Under Spinal Anaesthesia: A Prospective Randomized Controlled Trial.

Objective: Acute pain after cesarean section (CS) can affect the quality of life of patients. This study aimed to assess the impact of bilateral erector spinae plane block (ESPB) under spinal anaesthesia on postoperative pain, analgesic usage, and patient satisfaction in elective CS. Methods: A total of 116 ASA II females aged 18-45 years who had elective CS were included in this prospective randomized study. Adjusted for the patient's height and weight, 0.5% bupivacaine and 12.5 µg fentanyl were administered for spinal anaesthesia. In the ESPB group, ultrasonography-guided ESPB with 10 mL 0.5% bupivacaine+10 mL saline was applied bilaterally at the T12 vertebrae level at the end of the surgery. Postoperative analgesia was planned with diclofenac and paracetamol. Patients' satisfaction, analgesic usage, rest, movement, cough, and low back pain were evaluated using a visual analogue scale (VAS) at postoperative hours 2, 4, 6, 12, and 24. The extent of the sensory block level of ESPB was evaluated after the spinal anaesthesia had worn off. Results: The analysis included 49 patients in the ESPB group and 50 in the control group with comparable demographics. Rest, movement, and cough VAS scores were substantially lower at the 2nd, 4th, 6th, and 12th h in the ESPB group, and satisfaction was better. Total analgesic consumption and the need for rescue analgesics were higher in the control group. VAS scores and ESPB spread levels are negatively correlated. Conclusion: As a safe component of multimodal analgesia following CS, bilateral ESPB can be effectively performed.

Current developments in artificial intelligence from obstetrics and gynecology to urogynecology.

In today's medical practice clinicians need to struggle with a huge amount of data to improve the outcomes of the patients. Sometimes one clinician needs to deal with thousands of ultrasound images or hundred papers of laboratory results. To overcome this shortage, computers get in help of human beings and they are educated under the term "artificial intelligence." We were using artificial intelligence in our daily lives (i.e., Google, Netflix, etc.), but applications in medicine are relatively new. In obstetrics and gynecology, artificial intelligence models mostly use ultrasound images for diagnostic purposes but nowadays researchers started to use other medical recordings like non-stress tests or urodynamics study results to develop artificial intelligence applications. Urogynecology is a developing subspecialty of obstetrics and gynecology, and articles about artificial intelligence in urogynecology are limited but in this review, we aimed to increase clinicians' knowledge about this new approach.

Do the Ultrasonographic Measures of Midurethral Sling Location Relate With Surgical Outcomes?

IMPORTANCE: The proper placement of a midurethral sling (MUS) is the key factor for a successful surgical outcome. OBJECTIVE: This study aimed to evaluate the relationship of perineal ultrasonographic measures of the tape location with subjective and objective outcomes after MUS surgery at midterm follow-up of women. METHODS: The tape percentile (TP; total urethral length/bladder neck tape distance×100) and urethra tape distance (UTD; the shortest distance from the longitudinal smooth muscle complex of the urethra to the midpoint of the tape) were correlated with midterm surgical success. Patient satisfaction measured with the visual analog scale (VAS) was considered as the primary outcome. The presence of stress urinary incontinence on direct questioning, the Urinary Distress Inventory 6 (UDI-6) scores, findings of the cough stress test, free uroflowmetry, postvoid residual volume, and single-cycle voiding ambulatory urodynamic monitoring (AUM) were the other outcomes. RESULTS: Seventy-eight women were evaluated at a mean follow-up of 4.4 ±3.3 years. Women who were highly satisfied (VAS ≥ 8) had a significantly higher TP (64.7% vs 50.8%, P < 0.001) and lower UTD (3.6 vs 4.5 mm, P = 0.018). Irritative, stress, and obstructive scores at UDI-6 increased as the tape was located closer to the bladder neck (P < 0.001, P < 0.001 and P = 0.044, respectively), and stress symptoms decreased with a tape closer to the urethra (P < 0.001). Women with detrusor overactivity at AUM were found to have a lower TP (P < 0.001). CONCLUSION: The perineal ultrasonographic evaluation of tape location with UTD and TP seems to be well correlated with the women's midterm MUS surgical outcomes.

Evaluation of chronotype and sleep quality in infertile population and comparison with fertile population: a cross-sectional study.

PURPOSE: Infertility is a stressful condition for couples and can affect patients' circadian rhythm and sleep quality. The goal of this study is to assess differences in chronotype and sleep quality between infertile and fertile people. METHODS: A cross-sectional study was conducted. The infertile patient population consisted study group. Primiparous patients without any known gynecological disease who presented for routine cervical cancer screening follow-up were included in the control group. The Turkish version of the Morningness-Eveningness Questionnaire (MEQ) and Pittsburg Sleep Quality Index (PSQI) scores were evaluated between groups. RESULTS: A total of 227 patients were assessed. There were 110 patients in the study (infertile) group and 117 patients in the control (fertile) group. The evening chronotype proportion (23.6 vs. 0.9%, p < 0.001) was higher in the infertile group. The median of MEQ score was significantly higher in the fertile patients (50, IQR = 43 - 55 vs. 56, IQR = 51 - 59; p < 0.001), and the median of PSQI score was significantly higher in the infertile patients (5, IQR = 4 - 6, vs. 4, IQR = 3 - 5; p < 0.001). CONCLUSIONS: In this study, we found significantly worse sleep quality, and more evening chronotype in the patients with infertility.

The association of coital incontinence with clinical factors and single voiding cycle ambulatory urodynamic monitoring findings in women.

Introduction: Coital incontinence (CI) is a frequent problem in women with urinary incontinence (UI) with significant impact on female sexuality and quality of life. The underlying mechanism is controversial; it has been known that CI is associated with both stress urinary incontinence (SUI) and detrusor overactivity (DO). However, recently it has been reported that CI is mainly related with SUI and urethral incompetence, but not with DO. Ambulatory urodynamic monitoring (AUM) has been shown to be a sensitive tool for the detection of DO. The aim of this study was to investigate the clinical risk factors for CI and the association of CI with urodynamic diagnoses at single voiding cycle AUM. Methods: Records of sexually active women with urinary incontinence attending the urogynaecology unit of a university hospital, who completed the PISQ-12 were reviewed retrospectively (n = 1,005). Patients were grouped using the 6th question; patients answering "never" to this question were considered as continent during coitus (n = 591) and patients reporting any urinary leakage at coitus were considered to have CI (n = 414). Demographics, clinical examination findings, incontinence severity measured by the Sandvik Incontinence Severity Index, scores of Turkish validated questionnaires (PFDI-20, IIQ-7, OAB-V8, and PISQ-12) and single voiding cycle AUM findings were compared, and univariate and multivariate logistic regression analyses were performed. Results: Among all sexually active women with UI, 41.2% had CI; UI was more severe, symptom bother was higher, related quality of life (p < 0.001) and sexual function were worse (≤0.018) in these women. Younger age (OR 0.967, p < 0.001), history of vaginal delivery (OR 2.127, p = 0.019), smoking (OR 1.490, p = 0.041), postural UI (OR 2.012, p = 0.001), positive cough stress test (OR 2.193, p < 0.001), and positive SEST (OR 1.756, p = 0.01) were found as independent clinical factors associated with CI. Urodynamic SUI (OR 2.168, p = 0.001) and MUI (OR 1.874, p = 0.002) were found as significant and independent urodynamic diagnoses associated with CI, whereas no association was found with DO or UUI. Conclusion: Both clinical and AUM findings supported that CI is a more severe form of UI that it is mainly related with SUI and urethral incompetence, but not with UUI or DO.

The Role of the Supine Empty Stress Test in the Evaluation of Women with Stress Urinary Incontinence: A Retrospective Cohort Study.

The International Continence Society recommends the supine empty stress test (SEST) as an accessory test in the evaluation of women with urinary incontinence, especially for the presence of intrinsic sphincter deficiency (ISD). The aim of this study was to investigate the relationship between the SEST and clinical findings in women diagnosed with stress urinary incontinence with single voiding cycle ambulatory urodynamics (AUM). AUM tracings of patients with lower urinary tract symptoms (LUTS = Lower urinary tract symptoms) (n = 513) were retrospectively reviewed, and 364 charts with urodynamic SUI were analyzed. Demographics, examination findings, scores of the Sandvik Incontinence Severity Index and validated questionnaires, and AUM findings were compared between SEST-positive and -negative groups. Additionally, the diagnostic accuracy of the SEST in the diagnosis of low abdominal leak point pressure (ALPP ≤ 60 cm H2O) in women with pure urodynamic SUI was calculated. The SEST was positive in 41.8% (n = 152) of the cohort. Women with a positive SEST had higher scores on the Sandvik severity index (9.2 ± 3.6 vs. 7.5 ± 3.8, p = 0.003) and lower ALPP (79.6 ± 29.3 vs. 98.4 ± 31.3, p < 0.001). The negative predictive value of the SEST for ISD was found to be 92.4%. Thus, the SEST seems to be an objective clinical test reflecting urinary incontinence severity while excluding the presence of ISD.

Impact of pelvic floor distress on non-invasive urodynamic findings in women.

OBJECTIVE (S): To compare non-invasive urodynamic findings in women with and without pelvic floor distress and to investigate the patient characteristics affecting maximum flow rates. STUDY DESIGN: This is a retrospective study including data derived from a prospective cohort study evaluating free uroflowmetry findings in asymptomatic and symptomatic women with urinary dysfunction attending the gynecology outpatient clinic for routine annual control, infertility, abnormal uterine bleeding and pelvic floor dysfunction. Data regarding baseline characteristics, questionnaires, urogynecologic examination findings and free uroflowmetry results were retrieved. Women were grouped according to the Turkish validated Pelvic Floor Distress Inventory (PFDI-20); women who scored 0 or 1 points for each item ("no" or "not at all") were considered as asymptomatic in terms of pelvic floor dysfunction, and women who scored 2 or more points to any item were accepted as symptomatic. Baseline characteristics, clinical examination findings and free uroflowmetry data were compared among the groups using Student's-t or Mann-Whitney U tests, Chi-square test or Fisher's exact tests, where appropriate. Correlations and their significance, and patient characteristics affecting Qmax were investigated using the Pearson test. A multiple linear regression model was used to identify independent factors affecting Qmax. RESULTS: The study population (n = 186) comprised asymptomatic (n = 70, 37.6%) and symptomatic (n = 116, 62.4%) women according to the scores of the PFDI-20. Corrected Qmax, TQmax, Tvv and PVR were found significantly lower in asymptomatic women (p ≤ 0.001). In asymptomatic women, PVR was <100 mL in 98.5%, and <50 mL in 80%. In multivariate linear regression analysis parity, obstructive subscale score of the UDI-6, previous mid-urethral sling surgery and hysterectomy were found to affect Qmax negatively, whereas VV was found to affect Qmax positively. CONCLUSION(S): Although significantly different, overlapping wide ranges of non-invasive urodynamic findings have been observed in women with and without pelvic floor distress in the present study population. Maximum urinary flow rates were significantly affected by patient characteristics such as parity, obstructive symptoms, prior incontinence surgery and hysterectomy. There is need for further larger studies considering all possible factors that may affect voiding.

Evaluation of readability levels of online patient education materials for female pelvic floor disorders.

Most women hesitate to seek help from healthcare providers as they find it difficult to share complaints of involuntary leakage or vaginal prolapse. Hence, they often refer to the websites of national and/or international bodies' patient education materials (PEMs), which are considered the most reliable sources. The crucial factor that determines their usefulness is their readability level, which makes them "easy" or "difficult" to read, and is recommended, not to exceed the sixth grade level. In this study, we aimed to assess the readability levels of Turkish translated PEMs from the websites of the International Urogynecological Association and the European Association of Urology and the PEMs originally written in Turkish from the website of the Society of Urological Surgery in Turkey. All the PEMs (n = 52) were analyzed by online calculators using the Atesman formula, Flesch-Kincaid grade level, and Gunning Fog index. The readability parameters, number of sentences, words, letters, syllables, and readability intervals of these methods were compared among the groups using the Kruskal-Wallis test, or ANOVA test, with post hoc comparisons where appropriate. The readability level of all PEMs is at least at an "averagely difficult" interval, according to both assessment methods. No significant differences were found among the PEM groups in terms of readability parameters and assessment methods (P > .05). Whether original or translated, international or national societies' PEMs' readability scores were above the recommended level of sixth grade. Thus, the development of PEMs needs to be revised accordingly by relevant authorities.

Laparoscopy versus open surgery for the surgical management of tubo-ovarian abscess (TOA). Is there a beneficial impact of early endoscopic intervention in terms of fertility rates?

OBJECTIVES: To compare success rates and complications in women undergoing laparoscopic versus open surgical management of tubo-ovarian abscess. We further examined whether early laparoscopic intervention has any impact on pregnancy rates in a subgroup of infertile patients following frozen-thawed embryo transfer. MATERIAL AND METHODS: Hospital records of 48 patients diagnosed with TOA between January 2015 and December 2020, who underwent surgical intervention or received only medical treatment were analyzed. All patients were hospitalized, and parenteral antibiotics were commenced on admission initially. Laparoscopic or open surgery was performed within 48 hours course of intravenous antibiotherapy (early intervention) or later according to the clinical findings and antibiotherapy response. RESULTS: Of 48 patients with TOA, 18 (37.5%) underwent laparoscopic and 30 (62.5%) underwent open surgical intervention. The median postoperative hospital stay was shorter (4.5 days vs 7.5 days, respectively; p = 0.035), and postoperative opioid analgesic requirement was lesser in the laparoscopy group compared to open surgery group (22% vs 53%, respectively; p = 0.034). Intra- and post-operative complication rates were similar between the groups. Of these 48 patients, seven were diagnosed to have TOA following oocyte retrieval, and four of these conceived with frozen thawed embryo transfer all of whom underwent laparoscopic surgery within 48 hours of diagnosis. CONCLUSIONS: Minimal invasive surgery should be preferred even in the presence of severely adhesive and inflammatory TOA in order to improve postoperative outcomes. Moreover, early laparoscopic intervention may be considered in infertile patients with an aim to optimize pregnancy rates in a subsequent frozen-thawed embryo transfer.

Morcellation in gynecology: short review and suggestions from Turkish Society of Minimally Invasive Gynecologic Oncology

Morcellation allows the removal of a large uterus and fibroids through small incisions with minimally invasive surgery. It helps to prevent the complications associated with large incisions in both hysterectomy and myomectomy operations. Currently, there is much debate regarding the use of power morcellation in laparoscopic hysterectomy and myomectomy, mainly due to the risk of peritoneal dissemination of undiagnosed uterine sarcomas. Unfortunately, there is no valid pre-operative diagnostic method that can differentiate sarcomas from myomas, and the currently available scientific literature regarding morcellation is insufficient. As the Turkish Society of Minimally Invasive Gynecological Oncology, we present our consensus opinion and suggestions for the preoperative evaluation and morcellation of fibroids, in line with the recent literature.

Anorexigenic peptide (leptin, obestatin, nesfatin-1) levels and their impact on assisted reproductive technology treatment outcomes in patients with polycystic ovary syndrome.

OBJECTIVE: In this study we aimed to assess anorexigenic peptide levels in patients with or without polycystic ovary syndrome (PCOS) and their effects on assisted reproductive treatment (ART) outcomes. METHODS: A prospective case-control study was conducted in a tertiary care university-based ART clinic. Eighty-three patients were included in the study. The PCOS group included 41 patients, and the non-PCOS group included 42 controls. The 2003 Rotterdam criteria were used for PCOS patient selection. The ART indications in the non-PCOS group were tubal factor or unexplained infertility. Venous blood samples were taken on the third day of the menstrual cycle to determine the serum anorexigenic peptide levels. The enzyme-linked immunosorbent assay method was used for laboratory analyses. RESULTS: In the PCOS group, serum obestatin levels were significantly lower than in the control group, but serum anorexigenic peptide levels were similar in PCOS patients with or without clinical pregnancy. Ovarian hyperstimulation syndrome (OHSS) was diagnosed only in PCOS patients, and the obestatin levels of OHSS patients were significantly lower than those of other PCOS patients. CONCLUSION: Baseline anorexigenic peptide levels did not affect the clinical pregnancy rate in ART cycles. Obestatin may play a role in the pathophysiology of OHSS. This possibility should be confirmed in further research.

Comparison of two intraoperative examination methods for the diagnosis of sentinel lymph node metastasis in clinically early stage endometrial cancer: A Turkish Gynecologic Oncology Group Study (TRSGO-SLN-003).

OBJECTIVE: This study evaluated diagnostic accuracy of intraoperative sentinel lymph node (SLN) frozen section examination and scrape cytology as a possible solution for management of SLN positive patients. STUDY DESIGN: Clinically early-stage endometrial cancer patients who underwent SLN algorithm and intraoperative SLN examination were analyzed. Findings were compared with final pathology results and diagnostic accuracy of frozen section and scrape cytology were evaluated. RESULTS: Of the 208 eligible patients, 100 patients (48 %) had frozen section examination and 108 (52 %) had scrape cytology of the SLN. Intraoperative examination and final pathology were negative for metastasis in 187/208 (90 %) cases. The rest 21 cases had metastatic SLNs according to final pathology. 12 of 21 (57 %) metastases were classified as macrometastasis. Intraoperative examination of SLNs correctly identified 13 cases (true positive) and missed 8 cases (false negative). Five of 8 false negative cases had micrometastasis or isolated tumor cells. Considering identification of macrometastasis, sensitivity and negative predictive value were 85.71 % and 98.94 %, respectively, for the frozen section and 60.00 % and 98.15 %, respectively, for the scrape cytology. CONCLUSION: Frozen section examination of SLN has higher sensitivity in detecting macrometastasis compared to scrape cytology and it could help the surgeon in decision for further lymphadenectomy intraoperatively.

Complementary role of 18F-FDG PET/CT for sentinel lymph node algorithm in endometrial cancer with high-risk factors for lymphatic metastasis.

OBJECTIVE: National Comprehensive Cancer Network (NCCN) sentinel lymph node (SLN) algorithm includes 'mandatory steps' for evaluating pelvic lymph nodes, but assessment of paraaortic area is left to surgeon's discretion. In this study, we aimed to investigate the complementary role of preoperative F-FDG PET/computed tomography (CT) scan in detecting pelvic and especially paraaortic lymphatic metastasis in endometrial cancer patients with high-risk factor(s) according to Mayo Clinic Criteria and underwent SLN algorithm. METHODS: Patients who underwent preoperative F-FDG PET/CT scan, intraoperative SLN algorithm followed by systematic lymphadenectomy (LND) and had at least one high-risk criterion for lymphatic metastasis were included in this study. F-FDG PET/CT and SLN algorithm were compared with final histopathological results of systematic LND. RESULTS: Thirty-eight patients were eligible for the study. Lymphatic metastasis was seen in 10 patients (26.3%). Four cases had paraaortic lymphatic metastases which were together with pelvic (n:2) or isolated (n:2) metastases. SLN algorithm was able to detect all pelvic lymph node metastases. However, isolated paraaortic metastases were diagnosed only by F-FDG PET/CT. In 76 hemipelvises, sensitivity and negative predictive value of SLN algorithm for diagnosis of pelvic nodal metastasis were 100%, while sensitivity, specificity, positive predictive value and negative predictive value of F-FDG PET/CT were 45.4, 95.3, 62.5 and 91.1%, respectively. CONCLUSIONS: Although SLN algorithm has an excellent diagnostic value for pelvic nodal metastasis, paraaortic metastasis might be underdiagnosed. F-FDG PET/CT may be a feasible tool to exclude paraaortic lymphatic metastasis in high-risk patients for lymphatic metastasis who will undergo SLN algorithm.