Woo Dae Kang

Enhancing the accuracy of preoperative and intraoperative evaluation of malignant ovarian germ cell tumors with a focus on fertility preservation in young women

Abstract Objective To analyze and improve the accuracy of preoperative assessment and intraoperative frozen‐section analysis (FSA) for malignant ovarian germ cell tumors (MOGCTs), especially in the context of fertility preservation. Methods A retrospective review of 48 women aged under 40 years, diagnosed with MOGCTs, and treated at Chonnam National University Hospital between July and December 2022 was conducted. The results of preoperative magnetic resonance imaging (MRI), measurement of serum tumor markers (α‐fetoprotein [AFP], β‐human chorionic gonadotropin, lactate dehydrogenase [LDH], cancer antigen [CA] 125, CA 19–9, CA 72–4, carcinoembryonic antigen), and intraoperative FSA were compared with the final pathology diagnosis. Results MRI demonstrated a sensitivity of 95.5%, whereas FSA showed a sensitivity of 72.9% for all MOGCTs. Sensitivities varied according to the subtype, but were consistently higher in MRI (100% for dysgerminoma, 88.9% for immature teratoma, 100% for endodermal sinus tumor, 100% for others). However, there were differences in FSA according to subtype (100% for dysgerminoma, 50.0% for immature teratoma, 100% for endodermal sinus tumor, 25.0% for others). Serum tumor markers also provided diagnostic insights, particularly LDH for dysgerminoma (82.4%) and AFP for immature teratoma (75.0%) and endodermal sinus tumor (100%). Conclusion Preoperative MRI and serum tumor marker measurement may be effective in guiding fertility‐sparing surgical decisions. MRI could outperform FSA in terms of accuracy, especially for immature teratoma.

Human papillomavirus genotyping for predicting disease progression in women with biopsy-negative or cervical intraepithelial neoplasia grade 1 of low-grade intraepithelial lesion cytology

Our study used human papillomavirus (HPV) genotyping to assess the disease occurrence probability in women with a low-grade squamous intraepithelial lesion (LSIL) without histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This study investigated CIN2+ incidence in 1986 women from January 2005 to August 2016, including 1123 with LSIL who were histology-proven negative and 863 with LSIL who were histology-proven CIN1. Baseline high-risk HPV (HR-HPV) status was determined using the hybrid capture II assay (HC2), and HR-HPV genotype was determined using the HPV DNA chip test (HDC). Among 1986 women, the HC2 yielded positive results in 1529 (77.0%), while the HDC identified 1624 (81.8%). Thus, the overall HDC and HC2 agreement was 93.2%. Overall, 169 (8.5%) patients developed CIN2+. The 5-year cumulative CIN2+ incidence rates for HPV-16, HPV-18, HPV-31, and HPV-33 were 11.8%, 9.9%, 16.3%, and 16.1%, respectively. Multivariate analysis revealed that HPV-16 (HR 1.637, 95% CI 1.064 to 2.520, p=0.025), HPV-31 (HR 1.845, 95% CI 1.051 to 3.238, p=0.033), and HPV-33 (HR 2.272, 95% CI 1.235 to 4.183, p=0.008) were significantly associated with CIN2+ development. Among women with LSIL, those who test positive for HPV-16, HPV-31, or HPV-33 may require more rigorous follow-up because of a higher CIN2+ risk.