A novel model to estimate lymph node metastasis in endometrial cancer patients.

OBJECTIVES:: To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy. METHODS:: A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis. RESULTS:: Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration >50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value >21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%. CONCLUSION:: Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.

A novel model to estimate lymph node metastasis in endometrial cancer patients

OBJECTIVES: To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy. METHODS: A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis. RESULTS: Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration >50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value >21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%. CONCLUSION: Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.

Surgical treatment of endometrial cancer in developing countries: reasons to consider systematic two-step surgical treatment.

OBJECTIVE: The aim of this study was to determine the lymph node status in a large cohort of women with endometrial cancer from the public health system who were referred to an oncology reference center in Brazil to identify candidates for the omission of lymphadenectomy based on clinicopathological parameters. METHODS: We retrospectively analyzed a cohort of 310 women with endometrial cancer (255 endometrioid, 40 serous, and 15 clear cell tumors) treated between 2009 and 2014. We evaluated the histological type, grade (low vs. high), tumor size (cm), depth of myometrial invasion (≤50%, >50%) and lymphovascular space invasion to determine which factors were correlated with the presence of lymph node metastasis. RESULTS: The factors related to lymph node involvement were tumor size (p=0.03), myometrial invasion (p<0.01), tumor grade (p<0.01), and lymphovascular space invasion (p<0.01). The histological type was not associated with the nodal status (p=0.52). Only twelve of 176 patients (6.8%) had low-grade endometrioid carcinoma, tumor size ≤2 cm and <50% myometrial infiltration. CONCLUSIONS: The omission of lymphadenectomy based on the histological type, grade, tumor size and depth of myometrial invasion is not likely to have a large impact on the surgical treatment of endometrial cancer in our population because most patients present with large and advanced tumors. New strategies are proposed that prioritize hysterectomy performed in a general hospital as soon as possible after diagnosis, followed by an evaluation of the need for lymph node dissection at a reference center.

Câncer de mama associado à gravidez: revisão de literatura / Pregnancy-associated breast cancer: a literature review

O Câncer de mama associado à gravidez inclui todos os casos diagnosticados durante a gestação e nos 12 meses subseqüentes ao parto. Sua incidência entre 0,02 e 3,8 por cento das gestações resulta na freqüência de um caso em 3.000 a 10.000 partos. A evolução clínica, diante de parâmetros epidemiológicos equivalentes, parece semelhante à dos casos não relacionados com a gravidez. O estado pré-menopausal, a presença de linfonodos comprometidos, tumores de alto grau com baixa expressão de receptores hormonais e cerbB2 positivo, associados ao retardo no diagnóstico ou tratamento, contribuem para prejudicar o prognóstico. A identificação de fatores de risco, o exame físico minucioso no primeiro trimestre e a ultrasonografia de mama, são os recursos essenciais para agilizar o diagnóstico do câncer de mama associado à gravidez. A ultra-sonografia colabora para a triagem das pacientes com alto risco, otimizando a punção aspirativa com agulha fina, a core-biopsy ou a mamotomia, permitindo obter material adequado ao estudo citológico ou exame anatomopatológico. A mamografia possui baixa sensibilidade e especificidade durante a gravidez. O tratamento mantém analogia com o preconizado para as pacientes não grávidas, retardando-se a quimioterapia até o segundo trimestre e adiando-se a radioterapia para o pós-parto

Prevalência da papilomatose vestibular e infecção pel HPV na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / The prevalence of vestibular papillomatosis and HPV infection analyzed in the division of gynecology of Hospital das Clínicas, São Paulo, University Medical School, São Paulo

Objetivos: determinar a prevalência da papilomatose labial em pacientes assintomáaticas na Clínica Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Método: foram avaliadas 100 mulheres, todas fizeram citologia oncológica da face interna dos pequenos lábios, cervical e vulvoscopia quando o teste do acético ou lugol eram positivos...