Aharon Dick

Distinguishing mature from immature ovarian teratoma in the pre-operative setting

To identify clinical, sonographic and laboratory findings that might distinguish mature from immature ovarian teratoma in a pre-operative setting. A retrospective case-control study performed in a tertiary medical center between 1995 and 2023. The study group comprised of 22 women who were surgically diagnosed with immature ovarian teratoma. A control group of 44 women with a mature ovarian teratoma was created, matched two-to-one according to age and year of surgery. Women in the study group were younger (mean 17.7 (8.7) vs 23.2 (7.7), p = 0.01) and more commonly were symptomatic (abdominal pain 95.5 % vs. 61.4 %, p  10 cm (OR 10.6, CI [2.7-40.9]) and ascites (OR 12.9 CI [1.1-151.6]) were independent factors associated with immature ovarian teratoma. Tumor size > 10 CM and presence of ascites might aid in the pre-operative differentiation between mature and immature ovarian teratomas, possibly contributing to surgical approach planning.

Sonographic features of ovarian malignancies in children and young adults – A case control study

To investigate whether ovarian cancer in children and young adults, display the same accepted sonographic features that raise suspicious of ovarian malignancy among adults, and whether sonographic features predict clinical behavior. A matched case-control study. The study group comprised all youngsters < 25 years of age diagnosed with ovarian cancer in a tertiary university hospital between the years 1995-2023. A control group with benign ovarian masses was matched according to age and year of diagnosis in a 2:1 ratio. Clinical data, sonographic features and disease outcomes were compared. The study group included 30 youngsters, 24 (80 %) of them had germ cell tumors, 4 (13.3 %) sex-cord tumors and two (6.7 %) were epithelial tumors. The control group included 60 youngsters, of them 27 (45 %) with mature teratomas, 25 (41.6 %) serous cystadenomas and 8 (13.4 %) with other benign ovarian tumors. In a univariate analysis, Palpation of mass (43.3 % vs. 15 %, p < 0.01), vomiting (33.3 % vs. 13.3 %, p = 0.02) and elevated tumor markers (79.3 % vs.21.6 %, p < 0.01) were more common in the study group. Malignant masses were larger (mean of maximal diameter 159 mm vs. 88 mm, p < 0.01), were more likely to contain a solid component (60 % vs. 21.7 %, P < 0.01), to have ascites (33.3 % vs. 3.3 %, P < 0.01) and to have a high color content on Doppler examination (50 % vs. 11.7 %, p < 0.01). These features remained significant also in a multivariable analysis. Disease recurrence was not associated with any sonographic parameters. sonographic features suspicious for ovarian mass malignancy among adult women are valid also among the young population. However, none of these features are associated with a worse clinical course.

Sentinel lymph node mapping in endometrial cancer: A comparison of main national and international guidelines

AbstractObjectivesTo compare national and international guidelines regarding sentinel lymph node (SLN) mapping in endometrial cancer.MethodsA descriptive comparative study of the National Comprehensive Cancer Network (NCCN), the Society of Gynecologic Oncology (SGO), the European Society of Gynecological Oncology (ESGO), the British Gynecological Cancer Society (BGCS), and the Japan Society of Gynecologic Oncology (JSGO) guidelines.ResultsThere is a broad consensus that SLN mapping is an appropriate alternative to pelvic lymphadenectomy for uterine‐confined endometrioid endometrial cancer (five of five guidelines). It is broadly accepted that a full lymphadenectomy should be performed in case of failed SLN mapping (four of five guidelines), and that mapping with the fluorescent dye indocyanine green is superior to other methods (four of five guidelines). It is agreed that the cervix is the preferable site for dye injection (four of five guidelines), and pathology ultrastaging is advocated by most guidelines (three of five guidelines). Regarding high‐risk patients (i.e., high‐grade histology and non‐endometroid carcinomas), some guidelines accept (three of five), but others currently do not advocate (one of five guidelines), SLN mapping as a sole method for lymph node evaluation. There is no consensus regarding para‐aortic lymph node evaluation in pelvic SLN‐positive patients.ConclusionGuidelines for SLN mapping are comparable with regards to surgical technique, ultrastaging, and management in case of failed mapping. Nevertheless, some variations exist regarding the management of high‐grade histology and positive pelvic lymph nodes.

Comparison of Two-Position and Four-Position Cervical Injection Techniques for Sentinel Lymph Node Mapping in Endometrial Cancer Using Methylene Blue

This clinical trial evaluates lymph node mapping in newly diagnosed endometrial cancer patients undergoing surgery. The standard technique uses a 2-point methylene blue cervical injection. The study aims to determine if increasing injection points improves mapping success.