Rossana Veronica Mendonza Lopez

Analysis of Sentinel Lymph Node Adoption Compared to Systematic Lymphadenectomy in Staging Early Endometrial Cancer at a Tertiary Center: An Ambispective Study

ABSTRACTObjectiveThe purpose of this study was to assess the impact of changing endometrial carcinoma staging from systematic lymph node dissection to the sentinel lymph node approach.MethodsThis is an ambispective study including patients with endometrial carcinoma (EC) limited to the uterus (FIGO 2018 IA/IB). From December 2015 to October 2021, a group of patients underwent systematic staging with lymph node dissection (LND). From December 2021 to April 2024, another group of patients underwent surgical staging with the sentinel lymph node‐indocyanine green (SLN) algorithm and pathology ultrastaging analisys. The groups were matched (1 LND: 1 SLN) based on age, body mass index (BMI), tumor type, tumor size, and myometrial invasion. The primary endpoints were lymph node involvement, length of surgery, and complications. Complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.ResultsTwo hundred fifty‐seven patients were surgically treated during the study period (156 in the LND cohort, 101 in the SLN cohort). Propensity score matching revealed two equivalent groups containing 84 patients each. The rate of positive lymph nodes was similar between the LND group (3.6%) and the SLN group (8.3%) (OR: 2.46, 95% CI: 0.61–9.84; p = 0.205). The length of surgery was significantly lower in the SLN group (152.2 ± 51.9 min) compared to the LND group (304 ± 77.8 min) (p < 0.001). Intraoperative blood loss greater than 100 mL was significantly lower in the SLN group (9.5%) compared to the LND group (29.8%) (p < 0.001). CTCAE grades requiring intervention (grades 3, 4, and 5) were higher in the LND group (14.3%) compared to the SLN group (4.8%) (p = 0.049).ConclusionThe transition from LND to SLN approach was similar compared to systematic lymphadenectomy, allowing the reduction of surgical length, blood loss and severity of complications without compromising surgical complications and lymph node positivity.

Role of systematic pelvic and para‐aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy cycles for high‐grade serous ovarian carcinoma

AbstractIntroductionWe analyzed the role of systematic pelvic and para‐aortic lymphadenectomy in delayed debulking surgery after six neoadjuvant chemotherapy (NACT) cycles for advanced high‐grade serous ovarian carcinoma.Materials and MethodsWe retrospectively reviewed patients with advanced ovarian carcinoma who underwent NACT with carboplatin‐paclitaxel between 2008 and 2016. Patients were included only if they had FIGO IIIC‐IVB high‐grade serous carcinoma with clinically negative lymph nodes after six NACT cycles (carboplatin‐paclitaxel) and underwent complete or near complete cytoreduction. Patients with partial lymphadenectomy or bulky nodes were excluded. Patients who underwent systematic pelvic and aortic lymphadenectomy and those who did not undergo lymph node dissection were compared. Progression‐free and overall survivals were analyzed using the Kaplan–Meier method.ResultsTotally, 132 patients with FIGO IIIC‐IVB epithelial ovarian carcinoma were surgically treated after NACT. Sixty patients were included (39 and 21 in the lymphadenectomy and nonlymphadenectomy group, respectively); 40% had suspicious lymph nodes before NACT. Patient characteristics, blood transfusion numbers, and complication incidence were similar between the groups. In the lymphadenectomy group, 12 patients (30.8%) had histologically positive lymph nodes and the surgical time was longer (229 vs. 164 min). The median overall survival in the lymphadenectomy and nonlymphadenectomy groups, respectively, was 56.7 (95% CI 43.4–70.1) and 61.2 (21.4–101.0) months (p = 0.934); the corresponding disease‐free survival was 8.1 (6.2–10.1) and 8.3 (5.1–11.6) months (p = 0.878). Six patients exclusively presented with lymph node recurrence.ConclusionsSystematic lymphadenectomy after six NACT cycles may have no influence on survival.

Barriers and attitudes toward cervical cancer screening among eligible women

This study examined barriers and attitudes toward cervical cancer screening among eligible women in São Paulo, Brazil, and their associations with sociodemographic factors, screening behaviors, and knowledge. A survey was conducted with 384 women aged 25-64 attending primary healthcare units, selected through multistage random sampling across 50 primary health units from 17 regional health departments of São Paulo. Participants rated barriers and attitudes using 5-point Likert items, which were later condensed in a 3-point scale for analysis. Non-parametric tests assessed associations with sociodemographic factors, screening practices, and knowledge levels. The sample was predominantly low-income (40% in the lowest income bracket; 82% without private health insurance), with 87% reporting a Pap smear within the past five years. Key personal and structural barriers included fear of bad news (41%), test results delays (30%), long wait times (30%), and shame (29%). Significant associations were found between lower income and reporting delays in test results (p = 0,020) and long wait times (p = 0,012), as well as between lower education and experiencing delays (p = 0,030) and shame (p = 0,007). Positive attitudes toward screening exceeded 95% overall and were stronger among women who understood the Pap smear's role in early detection (p = 0,026) and improving survival (p = 0,006). While screening participation was high, persistent socioeconomic disparities in access and personal barriers require targeted interventions. Strengthening primary healthcare systems with patient-centered approaches could improve screening adherence and reduce inequities.

Gastrin-releasing peptide receptor: a promising new biomarker to identify cervical precursor lesions and cancer

This study aimed to verify the relation between gastrin-releasing peptide receptor (GRPR), oncogenic Human Papillomavirus (HPV) and cervical lesions severity. GRPR mRNA levels were evaluated in cervical cancer-derived cell lines and in primary keratinocytes expressing HPV16 oncogenes by RT-PCR. GRPR protein expression was assessed by immunohistochemistry in organotypic cell cultures derived from keratinocytes transduced with HPV16 oncogenes and in 208 cervical samples, including 59 non-neoplastic tissue, 28 cervical intraepithelial neoplasia grade 3 (CIN3), 44 squamous cell carcinomas (SCC) and 77 adenocarcinomas (ADC). Generic primers (GP5+/GP6+) were used to identify HPV infection in tissue samples. Experiments involving cell lines were analyzed through non-parametric tests (Kruskal Wallis), and Fisher's Exact Test for human tissues samples. All statistical tests were considered significant at p <0.05. Immunohistochemical evaluation was conducted independently and blindly by two observers (AD- LO). Any discordant findings were resolved through discussion to reach a consensus score. GRPR mRNA levels were not increased in cells expressing HPV16 or HPV18 oncogenes. However, at the protein level, GRPR was upregulated in organotypic cell cultures containing HPV oncogenes. Besides, it was identified an association between GRPR expression and cervical lesion severity (p < 0.0001). The detection rate of high-risk HPV DNA was directly correlated with cervical disease. Nonetheless, HPV infection was not directly associated with GRPR in cervical samples. GRPR expression is highly predictive of cervical lesion severity, irrespective of HPV infection and might contribute to improving patient's therapeutic management as well as being used a marker of disease progression.