Cristina Taliento

Correlation between ultrasound and gross pathology examination of malignant ovarian tumors: a pictorial review for pattern recognition

Circulating tumor DNA in the diagnosis of ovarian cancer: a systematic review

Ovarian cancer remains a leading cause of gynecologic cancer mortality worldwide, largely due to late-stage diagnosis and limited early detection tools. Circulating tumor DNA (ctDNA) has emerged as a promising non-invasive biomarker with the potential to improve diagnostic accuracy through detection of tumor-specific genetic and epigenetic alterations. This systematic review aimed to evaluate the diagnostic accuracy of ctDNA in detecting ovarian cancer compared to healthy controls or benign conditions. A comprehensive literature search was conducted across PubMed, Web of Science, and EBSCO databases through April 2024, including studies that assessed sensitivity, specificity of ctDNA assays in plasma or serum samples. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. PROSPERO registration number: CRD42024590089. Nineteen studies met inclusion criteria, employing a variety of molecular techniques including polymerase chain reaction-based methylation assays (73.7%) and sequencing methods (whole genome sequencing/next-generation sequencing) (21%), targeting single genes or multi-gene panels. Diagnostic accuracy of ctDNA varied, with sensitivity (40.6%-94.7%) and specificity (56%-100%) ranging broadly, but often outperforming CA125, particularly in early-stage. Concordance between ctDNA and tumor tissue ranged from moderate (r = 0.428) to strong (r = 0.771). Although heterogeneity across studies precluded meta-analysis, narrative synthesis suggests that ctDNA may offer an improved early detection capability over CA125, through methylation and copy number variation analyses. Further controlled prospective studies are needed to validate the clinical utility of ctDNA as a complementary tool in ovarian cancer detection.

Predictive Factors for Failed Sentinel Lymph Node Mapping in Endometrial Cancer: A Retrospective Multicenter Study

ABSTRACT Background and Objectives This study aims to evaluate the predictive factors associated with failed sentinel lymph node (SLN) mapping in a large, retrospective cohort of patients with early‐stage endometrial cancer (EC). Methods We retrospectively evaluated a series of EC patients who underwent laparoscopic SLN mapping with intracervical indocyanine green (ICG) injection in five referred oncological centers from January 2019 to March 2024. We compared the clinical and pathological features of bilateral and failed SLN mapping, which was defined as either unilateral mapping or no SLN mapping. Logistic regression was used to identify predictors of failure. Results Among 623 analyzed patients, 437 (70.14%) had a successful bilateral procedure. On univariate analysis, age ( p  = 0.03), non‐endometrioid histology ( p  = 0.02) and previous vaginal delivery ( p  = 0.015) were significant associated with failed SLN mapping. On multivariable analysis, only increasing age (OR 1.03; 95% CI, 1.01–1.04, p  = 0.03) and non‐endometrioid histology (OR 1.81; 95% CI, 1.01–3.19) were independently associated with unsuccessful procedure. No significant differences were observed for BMI, enlarged lymph nodes, intraoperative lysis of adhesion, LVSI, grade 3, and FIGO stage. Conclusions Increasing age and non‐endometrioid histology are independent predictors of bilateral SLN mapping failure in EC patients undergoing SLN mapping with cervical ICG injection.

Influence of uterine manipulator on oncological outcome in minimally invasive surgery of endometrial cancer: A systematic review and meta-analysis

The endoscopic approach for early-stage endometrial cancer (EC) treatment is considered gold standard. Some authors expressed their concern regarding uterine manipulator (UM) as a risk factor for tumor spillage and dissemination allowing peritoneal or lympho-vascular spaces invasion (LVSI). This meta-analysis aimed to evaluate the effect of UM on the presence of LVSI, recurrence rate and presence of atypical or malignant peritoneal cytology in patients with endometrial cancer. We searched electronic databases including PubMed, MEDLINE, Embase, Scopus, EBSCO, Google Scholar, and ClinicalTrials.gov. The pooled results were used to evaluate the association between the use of UM and oncological outcomes. This systematic review was reported according to PRISMA statement 2020. Statistical meta-analysis was performed using Review Manager software. This systematic review included 18 studies (3 prospective studies, 13 retrospective studies, and 2 RCT). The pooled results showed no significant difference (RR: 0.86, 95% CI, 0.69 to 1.08) in the incidence of LVSI between manipulated hysterectomy and total abdominal hysterectomy (TAH) and between UM group and non-UM group in minimally invasive surgery (RR: 1.18, 95% CI, 0.76 to 1.85), no significant difference in the rate of recurrence (RR: 1.11, 95% CI, 0.71 to 1.74), in the incidence of positive peritoneal cytology between manipulated and non-manipulated hysterectomies in minimally invasive surgery (RR: 1.89, 95% CI, 0.74 to 4.83) and before and after the use of uterine manipulator (RR: 1.21, 95% CI, 0.68 to 2.16). We found a positive association between malignant cytology and hysterectomies in which a uterine manipulator had been used in a sub-group analysis where LH/LAVH were compared to TAH. (RR = 2.26, 95% CI, 1.08-4.71. P = 0.03). This meta-analysis supports that the use of uterine manipulator for minimally invasive treatment of endometrial cancer does not increase the rate of recurrence and LVSI. Therefore, the opportunity of any other studies on its use in endometrial cancer women should be questioned.

Reproductive, obstetrical and oncological outcomes of fertility-sparing treatment for cervical cancer according to the FIGO 2018 staging system: A systematic review

We assessed reproductive, obstetrical, and oncological outcomes in patients who underwent fertility-sparing treatment by including studies that adhere to the FIGO 2018 staging system. Data on recurrence, mortality, pregnancy rate, live birth rate, and preterm delivery rate were collected. In patients with stages IA1, IA2, and IB1, the recurrence rate was 4.7 % and the death rate was 0.6 %. For patients with stage IB2, the recurrence rate was 12.1 % and the death rate was 3.2 %. Pregnancy rates for conization/simple trachelectomy and radical trachelectomy were 61.7 % and 50 %, respectively. A higher live birth rate (84.4 % vs 58.6 %), and lower preterm birth rate (18.3 % vs 33.3 %) were observed in patients undergoing conization compared to radical trachelectomy. We found a recurrence rate of 4.7 % in patients with stage less than or equal to IB1 and 12.1 % in those with stage IB2. A higher rate of preterm delivery was observed in patients who underwent radical trachelectomy.

Circulating tumor DNA as a biomarker for predicting progression-free survival and overall survival in patients with epithelial ovarian cancer: a systematic review and meta-analysis

Circulating tumor DNA (ctDNA) is emerging as a potential prognostic biomarker in multiple tumor types. However, despite the many studies available on small series of patients with ovarian cancer, a recent systematic review and meta-analysis is lacking. The objective of this study was to determine the association of ctDNA with progression-free-survival and overall survival in patients with epithelial ovarian cancer. An electronic search was conducted using PubMed (MEDLINE), Embase, CENTRAL (Cochrane Library), and CINAHL-Complete from January 2000 to September 15, 2023. To be included in the analysis the studies had to meet the following pre-specified inclusion criteria: (1) evaluable ctDNA; (2) progression-free-survival and overall survival reported as hazard ratio (HR); and (3) the patient population had epithelial ovarian cancer at the time of ctDNA detection. We evaluated the association of ctDNA with progression-free survival and overall survival. Secondary outcomes focused on sub-group analysis of genomic alterations and international Federation of Gynecology and Obstetrics (FIGO) stage. A total of 26 studies reporting on 1696 patients with epithelial ovarian cancer were included. The overall concordance rate between plasma-based and tissue-based analyses was approximately 62%. We found that a high level of ctDNA in epithelial ovarian cancer was associated with worse progression-free survival (HR 5.31, 95% CI 2.14 to 13.17, p<0.001) and overall survival (HR 2.98, 95% CI 1.86 to 4.76, p<0.0001). The sub-group analysis showed a greater than threefold increase in the risk of relapse in patients with positive HOXA9 meth-ctDNA (HR 3.84, 95% CI 1.57 to 9.41, p=0.003). ctDNA was significantly associated with worse progression-free survival and overall survival in patients with epithelial ovarian cancer. Further prospective studies are needed. CRD42023469390.

Simple hysterectomy versus radical hysterectomy in early-stage cervical cancer: A systematic review and meta-analysis

This systematic review (SR) and meta-analysis aims to compare the surgery-related results and oncological outcomes between SH and RH in patients with early-stage cervical cancer. We systematically searched databases including PubMed, Embase and Cochrane to collect studies that compared oncological and surgery-related outcomes between SH and RH groups in patients with stage IA2 and IB1 cervical cancer. A random-effect model calculated the weighted average difference of each primary outcome via Review Manager V.5.4. Seven studies comprising 6977 patients were included into our study. For oncological outcomes, we found no statistical difference in recurrence rate [OR = 0.88; 95% CI (0.50, 1.57); P = 0.68] and Overall Survival (OS) [OR = 1.23; 95% CI (0.69, 2.19), P = 0.48]. No difference was detected in the prevalence of positive LVSI and lymph nodes metastasis between the two groups. Concerning surgery-related outcomes, the comprehensive effects revealed that the bladder injury [OR = 0.28; 95% CI (0.08, 0.94), P = 0.04] and bladder disfunction [OR = 0.10; 95% CI (0.02, 0.53), P = 0.007] of the RH group were higher compared to the SH group. This meta-analysis suggested there are no significant differences in terms of both recurrence rate and overall survival among patients with stage IA2-IB1 cervical cancer undergoing SH or RH, while the SH group has better surgery-related outcomes. These data confirm the need to narrow the indication for RH in early-stage cervical cancer.