Flávia Fazzio Barbin

Multiscale Optical Imaging Fusion for Cervical Precancer Diagnosis: Integrating Widefield Colposcopy and High-Resolution Endomicroscopy

Early detection and treatment of cervical precancers can prevent disease progression. However, in low-resource communities with a high incidence of cervical cancer, high equipment costs and a shortage of specialists hinder preventative strategies. This manuscript presents a low-cost multiscale in vivo optical imaging system coupled with a computer-aided diagnostic system that could enable accurate, real-time diagnosis of high-grade cervical precancers. The system combines portable colposcopy and high-resolution endomicroscopy (HRME) to acquire spatially registered widefield and microscopy videos. A multiscale imaging fusion network (MSFN) was developed to identify cervical intraepithelial neoplasia grade 2 or more severe (CIN 2+). The MSFN automatically identifies and segments the ectocervix and lesions from colposcopy images, extracts nuclear morphology features from HRME videos, and integrates the colposcopy and HRME information. With a threshold value set to achieve sensitivity equal to clinical impression (0.98 [p = 1.0]), the MSFN achieved a significantly higher specificity than clinical impression (0.75 vs. 0.43, p = 0.000006). Our findings show that multiscale optical imaging of the cervix allows the highly sensitive and specific detection of high-grade precancers. The multiscale imaging system and MSFN could facilitate the accurate, real-time diagnosis of cervical precancers in low-resource settings.

Is infracolic omentectomy necessary for presumed early-stage Borderline Ovarian Tumors (BOTs)? A retrospective cohort study and meta-analysis

While omentectomy is included in the guidelines for the surgical management of Borderline Ovarian Tumors (BOTs), it is unclear whether removal of a normal-appearing omentum confers a therapeutic advantage. The retrospective cohort study of patients with BOTs evalua0 ted the role of routine omentectomy and was followed by a meta-analysis to enhance the robustness of the findings. Data were obtained from patients treated at three Brazilian reference centers between January 2009 and October 2023. Progression-Free Survival (PFS), risk of death, and recurrence were compared between patients who underwent omentectomy and those who did not. A total of 218 patients with BOTs were assessed: omentectomy was performed in 161 (73.8 %) and not performed in 57 (26.1 %). OS at 60 months was 95.5 % in the omentectomy group and 94.6 % in the non-omentectomy group (HR = 0.97 [95 % CI 0.20‒4.68]; p = 0.96). PFS was 97.2 % and 89.3 %, respectively (HR = 0.42; 95 % CI 0.10‒1.76; p = 0.23). Twelve studies comprising 2996 women with BOT, were included in the systematic review to evaluate the outcomes with and without omentectomy. Relative Risk (RR) of recurrence was 0.94 (95 % CI 0.67‒1.31; p = 0.7) for the non-omentectomy group compared with the omentectomy group. No statistically significant difference was observed, with an RR of 1.98 (95 % CI 0.24‒16.43; p = 0.53) for risk of death and an HR of 1.02 (95 % CI 0.25‒4.15; p = 0.98) for PFS. The retrospective cohort study and meta-analysis showed a low incidence of metastatic disease in the omentum. No effect of omentectomy on OS, PFS, and recurrence in patients with BOT.