Hande Nur Öncü

A novel technique for transdiaphragmatic latero-pericardial cardiophrenic lymph node excision using the minimally invasive surgical access procedure in patient with advanced stage ovarian cancer

This study reports the first case of transdiaphragmatic lateropericardial cardiophrenic lymph node excision using the GelPOINT™ mini access platform in a patient with advanced-stage ovarian cancer. A 69-year-old woman with high-grade serous epithelial ovarian cancer. Cardiophrenic lymph node dissection is vital in advanced ovarian cancer surgery, as enlarged nodes are linked to poor prognosis. No clear guidelines exist for operating on patients with enlarged cardiophrenic lymph nodes [1,2]. These nodes are categorized by location relative to the heart: anterior, median (lateropericardial), and posterior [3]. Cardiophrenic lymph node resection can be performed using transdiaphragmatic, transxiphoid, or transthoracic approaches with video-assisted thoracoscopic surgery [4]. In cases with suspicious nodes on imaging, removing them is essential for optimal cytoreduction and accurate staging. In this case, preoperative computed tomography revealed suspicious cardiophrenic lymph nodes measuring 16×13 mm and 10×8 mm, located near the xiphoid process and lateral pericardium. A 30 mm diaphragm incision was made 60 mm from the xiphoid process. An Alexis O-wound retractor was used, and the GelPOINT™ mini platform was introduced with three ports, including one for the camera. A 30-degree optic scope was used to excise the node with LigaSure. When we needed smoke management, we used an aspirator. With this method, we were able to access distally located cardiophrenic lymph nodes with a small incision. Transdiaphragmatic excision of the cardiophrenic lymph node using the mini access platform can be performed effectively with a smaller incision, demonstrating the feasibility and safety of this minimally invasive technique in managing such cases.

Uterine Mapping for Lymph Node Metastasis in Endometrial Cancer: A Multicenter Retrospective Cohort Study

ABSTRACT Aim To evaluate the association between uterine tumor localization and lymph node metastasis (LNM) in endometrial cancer through pathological uterine mapping. Methods This multicenter retrospective cohort study included 427 patients with endometrial carcinoma who underwent total hysterectomy, bilateral salpingo‐oophorectomy, and systematic lymphadenectomy. Tumor localization was classified based on a six‐site pathological mapping model: isolated lower uterine segment (LUS), LUS + corpus, corpus‐only, corpus+fundus, fundus‐only, and total uterine cavity. LNM patterns and pathological features were compared across sites. Logistic regression was used to determine independent predictors of LNM. Results The highest LNM rates were observed in tumors involving the LUS + corpus (37.0%) and total uterine cavity (32.4%), whereas the lowest rate was seen in corpus‐only tumors (10.2%) ( p  < 0.001). Tumors in high‐risk sites featured significantly higher rates of deep myometrial invasion, substantial LVSI, and high‐grade histology. In multivariate analysis, substantial LVSI (OR: 9.2, p  < 0.001), any LUS involvement (OR: 2.6, p  = 0.001), aggressive histology (OR: 2.1, p  = 0.017), and BMI (OR: 1.08, p  = 0.025) independently predicted LNM. Conclusions Pathological uterine mapping reveals that LUS involvement is an independent risk factor for lymphatic dissemination in endometrial cancer. Tumor site classification may enhance preoperative risk stratification and guide individualized surgical strategies.

The relationship between lymph node metastasis and immunohistochemical molecular subtypes in endometrial cancer: A cohort study of 339 patients

Abstract Aim This study evaluated the association between immunohistochemically (IHC) molecular subtypes and lymph node metastasis (LNM) in endometrial cancer. Methods The study included 339 patients diagnosed with endometrial cancer (EC) confined to the uterus and treated with pelvic ± para‐aortic lymph node dissection (LND), who were included in the study. Patients were divided into two groups: LNM‐negative (Group 1, n  = 289) and LNM‐positive (Group 2, n  = 50). All patients underwent IHC‐based molecular subtype analysis. Demographic, clinical, and histopathological characteristics were evaluated. Results The median age was 62 years (34–79) in Group 1 and 64 years (48–79) in Group 2 ( p  = 0.022). Body mass index (BMI) and parity were similar between the groups ( p  > 0.05). LNM was detected in 14.7% of patients (50/339). Among Group 1, 64.4% (186/289) had a non‐specific molecular profile (NSMP), 20.1% (58/289) had mismatch repair deficiency (MMRd), and 15.5% (45/289) had the p53 abnormal (p53abn) subtype. In contrast, in Group 2, 44% (22/50) were NSMP, 24% (12/50) were MMRd, and 32% (16/50) were p53abn ( p  = 0.008). A statistically significant association was observed between LNM and the p53abn subtype. LNM was present in 26% (16/61) of patients with the p53abn subtype, compared to 17% (12/70) in the MMRd group and 11% (22/208) in the NSMP group. Conclusion While our study identified an association between the p53abn subtype and lymph node metastasis, this finding alone does not support using p53 status in isolation to determine lymphatic staging; instead, it should be considered a complementary marker alongside established clinicopathologic factors.

The Effect of Uterine Manipulator on Peritoneal Cytology Positivity in Endometrial Cancer: A Prospective Observational Study

ABSTRACTAimThere are studies suggesting that the use of a uterine manipulator during minimally invasive surgery (MIS) may lead to tumor spread in endometrial cancer patients, and there is no clear consensus on the safety of uterine manipulator use. The aim of this study was to investigate the effect of uterine manipulator use on peritoneal cytology (PC) results obtained before and after hysterectomy in endometrial cancer patients.MethodsA single‐center, prospective observational study was conducted, including 108 patients who were diagnosed with endometrial cancer and underwent surgical intervention. The patients were divided into three groups: Group 1 (n = 36), total abdominal hysterectomy (TAH); Group 2 (n = 41) laparoscopic hysterectomy with intrauterine manipulator (TLH with IUM); and Group 3 (n = 31) laparoscopic hysterectomy without IUM (TLH without IUM). PC samples were taken before and after the hysterectomy, and cytology results were compared among the groups.ResultsOf the 108 patients included in the study, 33.3% (36/108) were in Group 1, 38% (41/108) were in Group 2, and 28.7% (31/108) were in Group 3. The clinical and demographic data among the groups were similar (p > 0.05). PC was positive in six of the 108 patients. In the TLH with IUM group, one patient with a negative cytology sample before the manipulation showed a positive result after the hysterectomy.ConclusionsAlthough statistical significance was not reached, utilizing an IUM to manage endometrial cancer with MIS may enhance cytology positivity. This finding requires further validation through larger prospective studies.

Impact of molecular and histopathological findings on FIGO 2009 stage I endometrial cancer: Transition to FIGO 2023 staging system

Abstract Aim This study aims to investigate the impact of integrating molecular and histopathological findings into the revised International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system on patients initially diagnosed with stage I endometrial cancer (EC) according to the FIGO 2009 criteria. Methods A cohort of 197 EC patients, initially classified as stage I under FIGO 2009, underwent restaging based on the updated FIGO 2023 criteria. The patients' molecular and histopathological characteristics were documented, and their impact on upstaging was analyzed. Results Molecular profiling was conducted for 81.2% (160/197) of the patients, revealing that 55.3% (109/197) were classified as non‐specific molecular profile, 14.7% (29/197) as mismatch repair deficiency, 11.2% (22/197) as p53 abnormality (p53abn), and 18.8% (37/197) as unknown. Upstaging was identified in 26.9% (43/160) of the 160 patients with known molecular profiles. Among the upstaged patients, 51.2% experienced upstaging due to p53 abnormality, 20.9% due to substantial lymphovascular space invasion (LVSI), 20.9% due to aggressive histological types, and 6.9% due to high grade. Conclusions The introduction of the molecular profile into the revised FIGO 2023 staging system for stage I EC has led to notable changes in the staging of approximately one‐fifth of patients. While p53 abnormalities have emerged as the most influential factor contributing to the upstaging, LVSI and aggressive histological types also represent significant contributing factors.

The impact of human papillomavirus 16/18 positivity on cyberchondria levels in women undergoing colposcopy

SUMMARY OBJECTIVE: The negative consequences of the widespread use of the Internet for health-related information have recently become a topic of research. Recently, the impact of internet information-seeking on anxiety has been defined as cyberchondria, and a standardized scoring system has been developed to document it. However, the significance of this scoring system in gynecologic oncology has not yet been established. Therefore, the aim of this study was to evaluate the impact of human papillomavirus 16/18 positivity on the level of cyberchondria in women with human papillomavirus positivity undergoing colposcopy. METHODS: The study included 333 women with human papillomavirus 16/18 and other high-risk human papillomavirus positivity who underwent colposcopy in the gynecologic oncology clinic. Participants were divided into two groups: human papillomavirus 16/18 positive (Group 1, n=201) and other high-risk human papillomavirus positive (Group 2, n=132). Both groups were administered the short form of the Cyberchondria Severity Scale (CSS-12). Demographic and clinical findings and cyberchondria scores were compared between the groups. RESULTS: The median ages of the study groups were 36 (26–59) and 40 (25–63) years, respectively (p=0.004). Both groups had similar body mass index, parity, menopausal status, and educational levels (p>0.05). When comparing the four subscales and the total score, the excessiveness (11 [3–15] vs. 9 [3–15], p<0.001, respectively) and the total CSS-12 score (31 [12–55] vs. 28 [12–49], p=0.002, respectively) were statistically significantly different between the two groups. CONCLUSIONS: In women with human papillomavirus 16/18 positivity undergoing colposcopy, cyberchondria levels were found to be significantly higher. Specifically, excessive information-seeking behavior significantly contributed to this elevated level of cyberchondria.