Evaluation of myometrial invasion in endometrial cancer: comparison of diffusion-weighted magnetic resonance and intraoperative frozen sections.

OBJECTIVE: To compare the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DWI) and frozen-section analysis in assessing myometrial invasion in endometrial cancer to guide surgery. METHODS: In this prospective study, 51 women with diagnosed endometrial cancer were examined using magnetic resonance imaging (MRI) and subsequently underwent hysterectomy with intraoperative frozen-section assessment. The MRI protocol included T2-weighted images (T2WI), a dynamic T1-weighted post-gadolinium series, and DWI sequences acquired with b values of 0, 150, and 800 s/mm(2). Apparent diffusion coefficient (ADC) maps were obtained in all the studies. Deep myometrial invasion was defined as involvement of ≥50% of the thickness of the myometrium. The final postoperative pathological evaluation was considered as the reference standard. RESULTS: The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of DWI for detecting deep invasion of the myometrium were 90.2%, 77.8%, 97%, 93.3%, and 88.9%, respectively. For the intraoperative frozen section, these figures were 90.2%, 73.7%, 100%, 100%, and 86.5%. The precision for both tests was the same using McNemar's test (p = 1). CONCLUSION: In assessing the depth of myometrial invasion, ADC maps show the same accuracy as intraoperative histological studies in endometrial cancers. They also allow for a more precise assessment than conventional MRI sequences. Frozen-section analysis can be avoided if the preoperative MRI study includes DWI sequences and ADC maps.

Efficacy of a canarypox-vectored recombinant vaccine expressing the hemagglutinin gene of equine influenza H3N8 virus in the protection of ponies from viral challenge.

OBJECTIVE: To determine onset and duration of immunity provided by a 2- or 3-dose series of a new canarypox-vectored recombinant vaccine for equine influenza virus (rCP-EIV vaccine) expressing the hemagglutinin genes of influenza H3N8 virus strains A/eq/Kentucky/94 and A/eq/Newmarket/2/93 in ponies. ANIMALS: Forty-nine 1- to 3-year-old male Welsh Mountain Ponies that were seronegative for equine influenza virus. PROCEDURES: Vaccinated and control ponies were challenged with aerosolized influenza virus A/eq/Sussex/89 (H3N8), representative of the Eurasian lineage of circulating influenza viruses. In trial 1, control ponies and ponies that received rCP-EIV vaccine were challenged 2 weeks after completion of the 2-dose primary vaccination program. In trial 2, ponies were challenged 5 months after 2 doses of rCP-EIV vaccine or 1 year after the first boosting dose of rCP-EIV vaccine, administered 5 months after completion of the primary vaccination program. After challenge, ponies were observed daily for clinical signs of influenza and nasal swab specimens were taken to monitor virus excretion. RESULTS: The challenge reliably produced severe clinical signs consistent with influenza infection in the control ponies, and virus was shed for up to 7 days. The vaccination protocol provided clinical and virologic protection to vaccinates at 2 weeks and 5 months after completion of the primary vaccination program and at 12 months after the first booster. CONCLUSION AND CLINICAL RELEVANCE: The rCP-EIV vaccine provided protection of ponies to viral challenge. Of particular importance was the protection at 5 months after the second dose, indicating that this vaccine closes an immunity gap between the second and third vaccination.