Development and Validation of an Algorithm to Identify Endometrial Adenocarcinoma in US Administrative Claims Data.

BACKGROUND: Endometrial adenocarcinoma is the most prevalent type of endometrial cancer. Diagnostic codes to identify endometrial adenocarcinoma in administrative databases, however, have not been validated. OBJECTIVE: To develop and validate an algorithm for identifying the occurrence of endometrial adenocarcinoma in a health insurance claims database. METHODS: To identify potential cases among women in the HealthCore Integrated Research Database (HIRD), published literature and medical consultation were used to develop an algorithm. The algorithm criteria were at least one inpatient diagnosis or at least two outpatient diagnoses of uterine cancer (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 182.xx) between 1 January 2010 and 31 August 2014. Among women fulfilling these criteria, we obtained medical records and two clinical experts reviewed and adjudicated case status to determine a diagnosis. We then estimated the positive predictive value (PPV) of the algorithm. RESULTS: The PPV estimate was 90.8% (95% CI 86.9-93.6), based on 330 potential cases of endometrial adenocarcinoma. Women who fulfilled the algorithm but who, after review of medical records, were found not to have endometrial adenocarcinoma, had diagnoses such as uterine sarcoma, rhabdomyosarcoma of the uterus, endometrial stromal sarcoma, ovarian cancer, fallopian tube cancer, endometrial hyperplasia, leiomyosarcoma, or colon cancer. CONCLUSIONS: An algorithm comprising one inpatient or two outpatient ICD-9-CM diagnosis codes for endometrial adenocarcinoma had a high PPV. The results indicate that claims databases can be used to reliably identify cases of endometrial adenocarcinoma in studies seeking a high PPV.

Preoperative serum CA-125 levels in patients with surgical stage I invasive ovarian adenocarcinoma.

Preoperative serum CA-125 levels were elevated in only three of 13 patients (23%) with a pelvic mass who were found to have surgical stage I invasive ovarian adenocarcinoma. This low incidence is surprising, since elevated levels have been found in greater than 80% of patients with advanced ovarian cancer. This suggests serious limitations for using serum CA-125 levels as a screening test for ovarian cancer.

Carbon dioxide laser vaporization of diaphragmatic metastases for cytoreduction of ovarian epithelial cancer.

Three patients with International Federation of Gynecology and Obstetrics state IIIC ovarian adenocarcinoma underwent CO2 laser vaporization of large-volume (5-6 cm) and miliary right hemidiaphragmatic metastases at the conclusion of standard debulking surgery to effect optimal cytoreduction. Destruction of diaphragmatic metastases was accomplished rapidly with no added morbidity or blood loss. The hand-held CO2 laser is a useful modality for removal of isolated large- and small-volume diaphragmatic disease, particularly if only the peritoneum is involved, and avoids the morbidity that may accompany entry into the pleural space.

Pseudomyxoma peritonei: possible prevention of mucinous ascites by peritoneal lavage.

Combined use of intraperitoneal lavage with dextrose 5% and water and an aggressive surgical approach has thus far successfully prevented reaccumulation of pseudomyxoma peritonei originating from bilateral ovarian mucinous cystadenoma associated with multiple peritoneal implants. Three and a half years after treatment the patient remains without clinical or ultrasonographic evidence of recurrence.

Does preoperative serum squamous cell carcinoma antigen level predict occult extracervical disease in patients with stage Ib invasive squamous cell carcinoma of the cervix?

Preoperative serum squamous cell carcinoma antigen levels were obtained from 65 patients with International Federation of Gynecology and Obstetrics stage Ib invasive squamous cervical cancer before planned radical hysterectomy to determine whether elevated squamous cell carcinoma antigen levels (greater than 2.5 ng/mL) predicted occult extracervical extension of disease. Although the specificity of a normal level was good (0.91), the sensitivity of an elevated level was only 0.68. Not all patients with nodal metastases had elevated serum squamous cell carcinoma antigen levels; in particular, no patient with occult para-aortic nodal disease had elevated serum squamous cell carcinoma antigen.

Ureteral injuries in an obstetrics and gynecology training program: etiology and management.

Between July 1980 and September 1987, 3185 major gynecologic operations were performed in our residency program. Ureteral injury occurred in 17 cases, 14 of which (0.4%) were accidental. In 16 cases, the injury was noted intraoperatively and repaired primarily; one injury was repaired after identification on the fourth postoperative day. Large pelvic masses, which limited exposure, and tumor invasion of the parametrium contributed to ureteral injury. Preoperative intravenous pyelogram or computed tomography did not prevent ureteral damage. Sixteen ureteroneocystostomies were performed with good result. One ureteroureterostomy leaked, but healed over a percutaneous stent without problems. All patients subsequently had normal renal function.

Melphalan, 5-fluorouracil, and medroxyprogesterone acetate in metastatic endometrial carcinoma.

Fifty consecutive patients with recurrent and metastatic endometrial carcinoma were treated with melphalan, 5-fluorouracil, and medroxyprogesterone acetate with or without tamoxifen as first-line chemotherapy. The objective response rate was 48%, with 20% complete responses. The estimated median progression-free survival time was only five months (0.5 to 65 months) with estimated two- and five-year progression-free survival rates of 16 and 13%, respectively. The estimated median progression-free survival time was 24 months for complete responders; the progression-free survival times were significantly longer than the survival times (median = four months) for all other patients (P = .0002). Whether or not the addition of cytotoxic chemotherapy to progesterone hormonal therapy for metastatic endometrial carcinoma lengthens survival time is still open to question.

Topical podofilox for the treatment of condylomata acuminata in women.

The purpose of this study was to determine the efficacy and safety of 0.5% podofilox solution (Condylox) for the treatment of genital warts in women. Thirty-seven women with anogenital warts applied the solution to the surface of these warts twice daily for 3 days, followed by 4 drug-free days. A minimum of two and a maximum of four treatment cycles were given. The subjects were evaluated weekly for the first 4 weeks and again at 6 and 10 weeks. At the end of 10 weeks, the mean number of warts per patient was reduced from 6.27 to 1.1, and half of the patients were completely cleared of warts. Only eight of 37 subjects (21.6%) developed new warts during the study period. Approximately 15% of patients reported "severe" local reactions to the treatment after the first treatment cycle, but this was reduced to only 5% by the last treatment cycle. During the same period, the patients reporting no side effects increased from 44 to 86%. The only woman who discontinued the study did so because of dizziness and epigastric discomfort, probably unrelated to drug use. Thus, 0.5% podofilox solution appears to be an effective treatment for condylomata acuminata, with acceptable side effects that are local and temporary.

Umbilical metastases from a stage IB cervical cancer after laparoscopy: a case report.

The first reported case of laparoscopy site metastases from an unsuspected stage IB cervical cancer diagnosed during laparoscopy for endometriosis is presented. Implications of this clinical situation are discussed.

Is there a role for CT scanning to monitor therapy of optimally debulked patients with advanced ovarian epithelial cancer?

Sixty patients with optimally debulked stage III ovarian epithelial cancer had abdomino-pelvic CT scan preoperatively and after three and six courses of cis-platin-based chemotherapy just prior to second-look surgery. Pelvic examination was performed and serum CA-125 drawn preoperatively, prior to each course of chemotherapy and prior to second-look surgery. All pelvic examinations and operative procedures were done by the author. Eight additional patients who were optimally debulked but whose disease progressed on first-line therapy were monitored in a similar fashion. None of 60 patients who underwent second-look surgery had evidence of disease on CT scan after three or six courses of chemotherapy, regardless of size of residual disease. Routine use of CT scanning to monitor therapy following optimal debulking is of little value and may be safely omitted.

Invasive adenocarcinoma of the ovary diagnosed after cardiac transplantation. A case report.

After cardiac transplantation, a woman was maintained on cyclosporine A and prednisone and shortly thereafter was diagnosed as having stage IV ovarian cancer. This is the first such reported case. Comprehensive preoperative gynecologic evaluation and diligent postoperative surveillance of such patients are recommended.

Same-day Dilapan insertion before second-trimester dilatation and evacuation for a fetal anomaly or death.

OBJECTIVE: To evaluate the efficacy of same-day Dilapan insertion prior to nonelective second-trimester dilatation and evacuation. STUDY DESIGN: Eighty women had Dilapan inserted six to eight hours prior to surgery. Degree of cervical dilatation was assessed after Dilapan was removed. RESULTS: Seventy-eight of 80 women had adequate cervical dilatation from a single, same-day Dilapan insertion. There were no major complications. CONCLUSION: Same-day Dilapan insertion prior to planned second-trimester dilatation and evacuation is safe and effective.

Cervical and vaginal pathology in women with vulvar condylomata.

All women referred to the Department of Obstetrics and Gynecology, School of Medicine, State University of New York at Stony Brook, for evaluation of vulvar condylomata were reviewed to identify concurrent cervical and vaginal pathology. Over the five-year period 1981-1985, referrals to our colposcopy clinic for vulvar condylomata increased from 7.8% to 29.2%. All patients underwent a thorough history, physical examination and colposcopic evaluation of the cervix, vulva and vagina. Of the patients with vulvar condylomata, 68% had biopsy-proven cervical and vaginal pathology. While 50% of patients with cervical disease had human papillomavirus infection alone, the other 50% had concurrent cervical intraepithelial neoplasia (CIN) or CIN only. Proper evaluation of patients with vulvar condylomata must include colposcopy of the cervix and vagina.

Radical abdominal versus laparoscopic hysterectomy for stage IB cervical cancer: what's the point?

OBJECTIVE: To evaluate surgical morbidity and length of stay for type III radical abdominal hysterectomy performed in the private practice setting, and to compare these results with currently available data on laparoscopic radical hysterectomy. METHODS AND MATERIALS: One hundred seventy-five consecutive type III radical abdominal hysterectomies performed by the author in a uniform fashion over a ten-year period for patients with stage IB cervical cancer were evaluated. All surgeries were performed in private community hospitals in New Jersey. RESULTS: Type III radical abdominal hysterectomy performed in the private setting using the author's protocol resulted in lower surgical morbidity, equivalent hospital stay and resumption of normal activities, and much shorter operating times than laparoscopic radical hysterectomy. CONCLUSION: Laparoscopic radical hysterectomy provides no surgical or financial advantage over radical abdominal hysterectomy when the latter is performed in the private practice setting; results from laparoscopic surgery are inferior with respect to morbidity.

CUSA resection of massive recurrent vulvar carcinoma.

The CUSA was employed to resect a massive recurrent vulvar carcinoma involving prior rotational flaps, urethra and rectovaginal septum.

Peritoneal cytology in patients with stage IB cervical cancer undergoing radical hysterectomy: limited value.

Peritoneal cytology, obtained at the start of planned radical hysterectomy in 200 consecutive patients with Stage IB cervical cancer, none of whom had intra-abdominal extension of disease, was positive in only one patient; this patient received no adjuvant treatment and remains disease-free at 48 months. Routine peritoneal cytology during radical hysterectomy adds little information for patient management and may be safely omitted.

Radical abdominal hysterectomy using the ENDO-GIA stapler: report of 150 cases and literature review.

Over a seven-year period from 1990-1997 150 consecutive patients underwent Type III radical abdominal hysterectomy using the ENDO-GIA stapler on the cardinal and uterosacral ligaments. Compared to prior patients operated on with standard suturing methods, the stapler patients had shorter operating times, lower blood loss and infection rates, and shorter hospital stays without any increase in recurrence rate. The equipment failure rate was 3%. Although not all improvements in surgical and post-operative morbidity are likely due to use of the ENDO-GIA stapler, the use of the stapler clearly lowered operating times, blood loss, surgical morbidity, hospital stay with no adverse effect on patient survival.

Late recurrence of a uterine clear cell adenocarcinoma confined to an endometrial polyp: case report.

A patient with an endometrial clear cell adenocarcinoma confined to a polyp developed recurrent disease in the abdomen and pelvis four years following hysterectomy. Treatment issues related to this uncommon clinical situation are discussed.

Ovarian epithelial carcinoma metastatic to the choroid of the eye: prolonged survival with radiation and taxol chemotherapy.

A 64-year-old was diagnosed with a stage 1aII clear cell adenocarcinoma of the ovary in 1986. Initial chemotherapy was with Cisplatinum, Cytoxan, and Adriamycin. A pelvic recurrence developed in 1991 which failed to respond to Carboplatin therapy, and progression of disease with retroperitoneal nodal and choroidal metastases was noted in 1992. Debulking of retroperitoneal disease along with radiotherapy and seventeen cycles of Taxol chemotherapy resulted in a sustained clinical remission for three years until December 1995 when a right pelvic recurrence was noted. The patient underwent resection of disease again and was restarted on Taxol which was continued for six cycles until increasing serum CA-125 and recurrent pelvic disease were noted.

Routine retroperitoneal drainage is not required for uncomplicated pelvic lymphadenectomy for uterine cancer.

Four hundred consecutive patients with endometrial carcinoma clinically confined to the corpus and cervix underwent extrafascial hysterectomy and pelvic lymphadenectomy by the author over an eight-year period of time. No patient had retroperitoneal drains, and only one patient (0.25%) developed a pelvic lymphocyst. Routine retroperitoneal drainage may be safely omitted in patients with uterine carcinoma undergoing hysterectomy and staging pelvic lymphadenctomy.