Comprehensive Review of Serous Tumors of Tubo-Ovarian Origin: Clinical Behavior, Pathological Correlation, Current Molecular Updates, and Imaging Manifestations.

Ovarian cancer is the eighth most common women's cancer worldwide, with the highest mortality rate of any gynecologic malignancy. On a global scale, the World Health Organization (WHO) reports that ovarian cancer has approximately 225,000 new cases every year with approximately 145,000 deaths. According to the National Institute of Health, Surveillance Epidemiology and End Results program (SEER) database, 5-year survival for women with ovarian cancer in the United States is 49.1%. High-grade serous ovarian carcinoma typically presents at an advanced stage and accounts for the majority of these cancer deaths. Given their prevalence and the lack of a reliable method for screening, early and reliable diagnosis of serous cancers is of paramount importance. Early differentiation of borderline, low and high-grade lesions can assist in surgical planning and support challenging intraoperative diagnoses. The objective of this article is to provide a review of the pathogenesis, diagnosis, and treatment of serous ovarian tumors, with a specific focus on the imaging characteristics that help to preoperatively differentiate borderline, low-grade, and high-grade serous ovarian lesions.

Improving Colposcopy Education Through Images: A Preliminary Assessment of an Image-Based Mobile App for Colposcopic Education.

OBJECTIVES: Colposcopy is an indispensable part of cervical cancer screening. However, in most training programs, there is little by way of a formalized curriculum. We created an image-based teaching tool and hypothesized that this tool, in a mobile app format, would increase resident comfort with colposcopic practice and quantitatively increase their ability to correlate colposcopic images with impressions. MATERIALS AND METHODS: This was a pilot study conducted among ObGyn residents during March 2021. Thirty-eight residents participated and were randomized to either an app user or an independent study control group. Both groups were surveyed before and after their assigned training and completed a postintervention standardized cognitive examination. The primary end points were subjective improvements in comfort with colposcopy. The secondary end point was performance on a standardized image quiz. RESULTS: Of the 46 targeted residents, 38 participated and 26 completed all elements of the study. On the image examination, app users performed slightly better when compared with the independent study group (mean score, 14.9/25 [SD = 2.15] vs 14.0/25 [SD = 3.27], p = .39). App users also were more likely to be confident in providing an overall colposcopic impression (73% vs 30%, p = .111). One hundred percent of the participants in the app user group said that they would recommend the tool to other residents and residency programs. CONCLUSIONS: Image-based teaching tools, such as the ICE-TI app, are valued by learners and can be a useful adjunct to standardized colposcopy curricula. In addition, making use of a mobile platform facilitated convenience learning.

CA-125 monitoring in gynecologic cancer patients with COVID-19: A case series.

CA-125 has long been utilized as a surveillance biomarker for gynecologic malignancies but can be elevated in other conditions, including infection. A study of tumor markers in non-cancer patients saw a rise in CA-125 values during severe COVID-19 infections. Given the potential confounding effect this could have on surveillance and treatment planning, we sought to describe the impact of COVID-19 on CA-125 trends in a gynecologic oncology patient population. We conducted a retrospective chart review of patients treated at a UPMC hospital during the COVID-19 pandemic from March of 2020 through September of 2021. Patients were included for analysis if they had confirmed uterine or ovarian malignancies, a COVID-19 infection and more than one CA-125 value drawn within one year of their COVID-19 diagnosis. The CA-125 values were plotted against the timeline of their COVID-19 infections to assess for trends in CA-125 during and after infection. There were 17 patients who met the above criteria. Of these 17 patients, three had a rise in their CA-125 trend at the time of their COVID-19 diagnosis. Another three had newly elevated CA-125 values, without a prior documented baseline level, at the time of their infection. In all six of these patients, their CA-125 elevations could be attributed to malignancy. The remaining 11 patients showed stable or decreasing CA-125 values coinciding with their COVID-19 infection. This case series illustrates that while CA-125 values may increase during an acute COVID-19 infection, cancer remains the most likely cause of a CA-125 increase. Clinical suspicion should remain high for a possible change in cancer status.

Surgical management of female genital mutilation-related morbidity: A scoping review.

BACKGROUND: Over 200 million women and girls worldwide have suffered from the partial to total removal of external female genitalia for nonmedical purposes, referred to as female genital mutilation (FGM). Survivors of FGM may develop debilitating physical and psychological long-term sequelae. This is the first study to examine the scope of the extant surgical literature on the management of FGM-related morbidity. METHODS: A systematic scoping review of five major research citation databases was conducted. RESULTS: A total of 190 articles from 29 countries met the inclusion criteria. The majority (76%) were primary source articles and from obstetrics and gynecology literature (71%). Reported interventions for FGM-related morbidity were defibulation, cyst excision, clitoral and vulvar reconstruction, urological reconstruction, peripartum procedures, labial adhesion release, and reinfibulation. CONCLUSIONS: Surgery for FGM complications spans multiple specialties, which suggests multidisciplinary collaboration benefit. Plastic and reconstructive surgeons have a clear role in the multidisciplinary care team for these patients. This scoping review identified a paucity of high-quality evidence with respect to functional quality of life outcomes and long-term follow-up.

Discrepancies between author- and industry-reported disclosures of financial relationships at an annual gynecologic oncology research meeting.

OBJECTIVE: Trillions of dollars pass to physicians from industry-related businesses annually, leading to many opportunities for financial conflicts of interest. The Open Payments Database (OPD) was created to ensure transparency. We describe the industry relationships as reported in the OPD for presenters at the 2019 Society of Gynecologic Oncology (SGO) Annual Meeting and evaluate concordance between author disclosures of their financial interests and information provided by the OPD. METHODS: This is an observational, cross-sectional study. Disclosure data were collected from authors with oral and featured abstract presentations in the 2019 SGO annual conference. These disclosures were compared to data available for each author in the 2018 OPD, which included the amount and nature of industry payments. RESULTS: We examined the disclosures of 301 authors who met inclusion criteria. Of 161 authors who had disclosure statements on their presentations,147 reported "no disclosures," and 14 disclosed industry relationships. The remaining 140 did not list any disclosure information. Sixty percent (184/301) of authors had industry relationships in the 2018 OPD, including 173 of 287 (60.3%) of authors who either reported no disclosures or did not have disclosure data available in their presentations. These transactions totaled over 43 million USD from 122 different companies, with most payments (46%) categorized as "Research or Associated Research." Accurate disclosure reporting was associated with receiving higher payments or research payments, and being a presenting author. CONCLUSIONS: Most authors at the SGO annual conference did not correctly disclose their industry relationships when compared with their entries in the OPD.

Good news on the active management of pregnant cancer patients.

Cancer occurs in approximately 1/1000 to 1/2000 pregnancies and presents complex medical and ethical dilemmas for patients and providers. The most common cancers diagnosed in the gestational period include breast, cervical, melanoma, and lymphomas. The majority of existing evidence regarding the treatment of cancer during pregnancy is derived from experiences with breast cancer. Other cancers often pose unique challenges given the location of the tumors and their traditional mode of treatment with pelvic surgery and radiation. Additionally, many emerging therapies for cancer target mechanisms that are necessary for fetal development, such as angiogenesis, and are contraindicated in pregnant women. Although limitations on the treatment of cancer during pregnancy currently exist, increasing evidence shows that many surgical and systemic therapies can be effective for a mother's oncologic outcomes without significant detriment to the developing fetus. Traditional perspectives of cancer during gestation may sway providers to encourage pregnancy termination, delays in therapy, or early delivery. However, recent studies and reviews discourage such practices. Although every cancer diagnosis in pregnancy requires an individualized approach and should use the multidisciplinary perspectives of maternal-fetal medicine specialists as well as medical and surgical oncologists, providers should feel empowered to safely employ systemic, surgical, and even reserved cases of radiation therapies for their pregnant patients with cancer. The aim of this review is to highlight some of the recent advances in cancer therapies for common cancer subtypes and encourage providers to use this growing body of evidence to employ treatments with curative intent while continuing to evaluate the long-term effects of these therapies on mothers and their children.

Patient Counseling and Preferences for Elective Repeat Cesarean Delivery.

Objective We sought to identify factors influencing a woman's decision to have an elective repeat cesarean delivery (ERCD) versus vaginal birth after cesarean (VBAC). Methods and Materials A prospective study at two academic medical centers of women with one prior cesarean, and no contraindication to a trial of labor, delivered by ERCD from October 2013 to June 2014. Participants completed anonymous surveys during their delivery hospitalization. Counseling was considered adequate if women reported being counseled, recalled being quoted a VBAC success probability, and this probability was within 20% of that derived from an established VBAC success prediction model. Participants were also asked why they chose ERCD. Results Of 68 participants, only 8 (11.8%) had adequate counseling. Of those with inadequate counseling, 21.7% did not recall being counseled, 63.3% were not quoted a chance of success, and 60.0% had more than a 20% discrepancy between their recalled and predicted success rates. Eighteen women were calculated to have more than 70% chance of successful VBAC. Of these, 16 (88.9%) were not adequately counseled. Conclusion Most women were inadequately counseled about delivery options. The most important factors influencing the choice of ERCD over VBAC were patient preferences, risk for fetal injury, and perceived physician preference.