Diagnostic accuracy and economic impact of three work-up strategies identifying risk groups in endometrial cancer, fully incorporating sentinel lymph node algorithm.

BACKGROUND: According to the European Society for Medical Oncology/ European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology (ESMO/ESGO/ESTRO) Consensus Conference, the role of preoperative risk groups (RGs) in endometrial cancer (EC) is to direct surgical nodal staging. We compared diagnostic accuracy and economic impact of three work-up strategies to identify RGs. METHODS: A retrospective multicentre study including patients with early-stage EC. The three different work-up strategies were as follows:-Mondovì Hospital: transvaginal ultrasonography, pelvic magnetic resonance imaging (MRI); frozen section examination of the uterus in case of imaging discordance. High-risk patients underwent abdominal computed tomography.-Gemelli Hospital: transvaginal ultrasonography, MRI, One-Step Nucleic Acid Amplification (OSNA) of sentinel lymph node (SLN); frozen section examination of the uterus in case of imaging discordance.-Negrar Hospital: positron emission tomography (PET), frozen section examination of the uterus and of SLN. For statistical purposes patients were assigned, preoperatively and postoperatively, to two groups: group A (high-risk) and group B (not high-risk). RESULTS: Three hundred eighty-five patients were included (93 Mondovì, 215 Gemelli, 77 Negrar). Endometrial biopsy errors led to 47.3% misclassifications. Test accuracy of Mondovì, Gemelli and Negrar strategies was 0.83 (95%CI 0.734-0.901), 0.95 (95%CI 0.909-0.975) and 0.94 (95%CI 0.866-0.985), respectively. Preoperative work-up mean cost per patient in group A was €514.5 at Mondovì, €868.5 at Gemelli, and €1212.8 at Negrar hospital (p-value < 0.001), while in group B was €378.8 at Mondovì, €941.2 at Gemelli, and €1848.4 at Negrar hospital (p-value < 0.001). CONCLUSIONS: In our study, work-up strategies with more relevant economic impact showed a better diagnostic accuracy. Upcoming guidelines should specify recommendations about the gold standard work-up strategy, including the role of SLN.

Sperm cell toxicity test using sea urchin Paracentrotus lividus lamarck (Echinodermata: Echinoidea): sensitivity and discriminatory ability toward anionic and nonionic surfactants.

A reliable sperm cell toxicity test procedure has been developed for the Mediterranean sea urchin Paracentrotus lividus. The sensitivity and discriminatory ability of the test were investigated with regard to surfactants and their biotransformation products. Aromatic and aliphatic surfactants of anionic (linear alkylbenzene sulfonates [LAS]) and nonionic (alcohol polyethoxylates [AE] and nonylphenol polyethoxylates [NPE]) types and their aerobic biodegradation products, i.e., sulfophenylcarboxylates (SPC), polyethylene glycols (PEG), carboxylated polyethylene glycols (PEGC), carboxylated AE (AEC), and nonylphenol (NP), were examined in order to elucidate the influence of their molecular structure on toxicity. Experimental results reveal that the sperm cell test showed good discriminatory ability among all tested compounds, median effective concentration (EC50) values differing by about four orders of magnitude. The toxicity of anionic surfactants depends on the length of the alkyl chain and that of nonionic surfactants is due to their length and branching. Much lower toxicity was shown by aerobic biodegradation products in comparison with that of their parent compounds, with the exception of NP. The obtained EC50s were comparable with available literature data and constitute new toxicity data regarding surfactants for sea urchins.