Sophie Derchain

Implementation of a new histological grading system in ovarian mucinous carcinomas and its association with the risk of recurrence: a retrospective cohort study

ABSTRACT BACKGROUND: This retrospective cohort study evaluated the prognostic significance of the GrowthBased Grade (GBG) system compared to International Federation of Gynecology and Obstetrics (FIGO) grading in ovarian mucinous carcinoma (OMC). Although FIGO grading is commonly used, its prognostic value remains controversial. The GBG system, which classifies tumors as low-grade (G1) or high-grade (G2) based on the proportion of infiltrative growth, has emerged as a potential prognostic tool. OBJECTIVES: To assess the prognostic significance of GBG and compare it with FIGO grading in OMC. DESIGN AND SETTING: This retrospective cohort study included 37 women with OMC treated at a single institution between 2009 and 2022. METHODS: GBG was determined by a histopathological review of hematoxylin and eosin-stained slides. Clinical and demographic data, including FIGO stage, CA125 levels, surgical procedures, and follow-up information, were collected. Kaplan-Meier analysis and Cox regression were used to assess the associations between GBG grading, FIGO stage, and survival outcomes. RESULTS: GBG 2 tumors were significantly associated with elevated CA125 levels, advanced FIGO stage (III), and bilaterality. Multivariate analysis showed that GBG 2 conferred a 5.4-fold higher risk of recurrence compared with GBG 1. While FIGO stage III was predictive of overall survival, FIGO grading was not associated with recurrence risk. CONCLUSION: This study suggests a potential prognostic value of the GBG system in mucinous ovarian carcinoma. GBG 2 tumors showed a higher risk of recurrence than GBG 1 tumors, whereas FIGO grading showed no such association. These findings align with previous reports and should be interpreted in the context of additional studies to clarify the system’s clinical relevance.

Vaginal stenosis in women with cervical or endometrial cancer after pelvic radiotherapy: a cross-sectional study of vaginal measurements, risk for sexual dysfunction and quality of life

Radiotherapy (RT) for cervical (CC) and endometrial cancer (EC) is known to lead to vaginal stenosis (VS), but the comparison between vaginal anatomical measurements and the risk of sexual dysfunction presents a wide variety of results among the literature. Thus, we sought to assess the prevalence of VS, vaginal measurements, sexual dysfunction and QOL in women with CC and EC submitted to pelvic RT with or without previous surgery. Cross-sectional study that included 61 women with CC and 69 with EC. VS was classified by the Common Terminology Criteria for Adverse Effects version 5.0 (CTCAE v5.0), sexual function by the validated Female Sexual Function Index (FSFI) and QOL by the validated World Health Organization questionnaire (WHOQOL-BREF). Acrylic cylinders were used for vaginal measurements. Uni-/multivariate analyses to address factors associated with VC in both groups were performed. The prevalence of VS was 79% and 67% within patients with CC and EC, respectively. Vagina length was decreased in both groups without statistical difference (7.2 ± 1.7 vs. 6.6 ± 1.8;p = 0.072). Vaginal diameter was significantly higher (p = 0.047) in women with EC (25.4 ± 6.3) than in those with CC (23.1 ± 5.7). Sexual dysfunction was highly prevalent for both CC and EC (88% vs. 91%; p = 0.598). There was no difference in all WHOQOL-BREF domains between women with CC and EC. VS is highly prevalent in CC and EC patients, with vaginal length decreased in both groups but with a higher vaginal diameter in those with EC. Nevertheless, sexual dysfunction is highly prevalent in both groups.

The top hat procedure does not impact the management of women treated by LEEP in cervical cancer screening

To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative. The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.

Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers

Abstract Objective To evaluate the role of clinical features and preoperative measurement of cancer antigen 125 (CA125), human epididymis protein (HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. Methods One hundred and nineteen consecutive women with germ cell, sex cord-stromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Results Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Conclusion Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Diagnostic Value of the Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Thrombocytosis in the Preoperative Investigation of Ovarian Masses

Abstract Objective To evaluate the diagnostic accuracy of cancer antigen 125 (CA125) and complete blood count (CBC) parameters, such as the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), and thrombocytosis in patients with ovarian masses. Methods The present is a retrospective study conducted at a single tertiary hospital from January 2010 to November 2016. We included consecutive women referred due to suspicious adnexal masses. The CBC and CA125 were measured in the serum of 528 women with ovarian masses before surgery or biopsy. We evaluated the diagnostic performance of the NLR, PLR, platelets (PLTs), CA125, and the associations between them. We tested the clinical utility of the CBC parameters and CA125 in the discrimination of ovarian masses through decision curve analysis (DCA). Results The best balance between sensitivity and specificity was obtained by the associations of CA125 or PLTs ≥ 350/nL, with 70.14% and 71.66%, CA125 or PLTs ≥ 400/nL, with 67.30% and 81.79%, CA125 or PLR, with 76.3% and 64.87%, and CA125 or NLR, with 71.09% and 73.89% respectively. In the DCA, no isolated CBC parameter presented a higher clinical utility than CA125 alone. Conclusion We showed that no CBC parameter was superior to CA125 in the prediction of the malignancy of ovarian tumors in the preoperative scenario.

Improving the performance of IOTA simple rules: sonographic assessment of adnexal masses with resource-effective use of a magnetic resonance scoring (ADNEX MR scoring system)

To compare the International Ovarian Tumor Analysis (IOTA) simple rules, simple rules risk ultrasound models, alone or in combination with magnetic resonance (MR) score to predict malignancy in women with adnexal masses. 171 women with adnexal masses were included from February 2014 to February 2016. 120 women had histopathological diagnosis obtained from surgery or percutaneous biopsy. The other 51 women were submitted to surveillance with ultrasound (US) for at least 1 year. Patients were examined with US and MR. US reports were rendered using IOTA systems. We compared five diagnostic approaches, aimed at diagnosing women with malignant tumors among those with adnexal masses: We calculated the performance and net benefits (decision curve analysis) for five distinct diagnostic approaches: (1) US simple rules (SR), (2) simple rules risk score (SRRisk), (3) US SR followed by subjective assessment (SA) of indeterminate cases, (4) SR followed by MR score for the indeterminate cases, and (5) MR score for all women. The MR score for all patients was the approach that yielded the best-standardized net benefit regardless of the risk threshold. However, referring women with indeterminate masses on SR to MR score yielded the second-best net benefit. Although this study leaves no doubt about the superiority of MR score over US-based methods for the discrimination of malignant tumors in women with adnexal masses, restricting the use of MR score only to women with indeterminate masses on US SR is a safe, appropriate way to triage women with adnexal masses.

Influence of Gender and Undergraduate Course on the Knowledge about HPV and HPV Vaccine, and Vaccination Rate among Students of a Public University

Abstract Objective To evaluate the knowledge related to human papillomavirus (HPV) infection and the rate of HPV vaccination among undergraduate freshmen and senior students of medicine, pharmacy, speech therapy, nursing and physical education in a Brazilian university. Methods A questionnaire concerning sociodemographic aspects, sexual background, and knowledge about HPV and its vaccine was filled out by 492 students. Three months later, a second questionnaire, concerning the new rate of vaccination, was applied to 233 students. Results Among the 290 women who answered the first questionnaire, 47% of the freshmen and 13% of the seniors stated they were not sexually active, as well as 11% of the 202 freshman and senior male students. Although the knowledge about HPV was higher among women, they reported a lower use of condoms. More than 83% of the women and 66% of the men knew that HPV can cause cervical cancer, but less than 30% of the students knew that HPV can cause vulvar, anal, penile and oropharyngeal cancer. Less than half of the students knew that HPV causes genital, anal and oropharyngeal warts. Comparing the students, the seniors had more knowledge of the fact that HPV is sexually transmitted, and that HPV infection can be asymptomatic. The rate of vaccination was of 26% for women, and of 8% for men, and it increased to 52% and 27% respectively among the 233 students evaluated in the second questionnaire. Conclusion As almost half of freshman women declared being sexually inactive, the investment in public health information programs and easier access to the HPV vaccine seem to be a useful strategy for undergraduate students.

Cervical Cancer Screening with HPV Testing: Updates on the Recommendation

AbstractThe present update is a reassessment of the 2018 ‘Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil’ (Zeferino et al.)9, according to the changes observed in new international guidelines and knowledge updates. The most relevant and recent guidelines were assessed. Questions regarding the clinical practice were formulated, and the answers considered the perspective of the public and private sectors of the Brazilian health system. The review addressed risk-based strategies regarding age to start and stop screening, the use of cytology and colposcopy to support management decisions, treatment, follow-up strategies, and screening in specific groups, including vaccinated women. The update aims to improve the prevention of cervical cancer and to reduce overtreatment and the misuse of HPV testing.

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.