Healthcare

Editorial

5 pages, 228 KiB

Open AccessEditorial

Advances on Prevention and Screening of Gynecologic Tumors: Are We Stepping Forward?

by Andrea Giannini, Giorgio Bogani, Enrico Vizza, Vito Chiantera, Antonio Simone Laganà, Ludovico Muzii, Maria Giovanna Salerno, Donatella Caserta and Ottavia D’Oria

Healthcare 2022, 10(9), 1605; https://doi.org/10.3390/healthcare10091605 - 24 Aug 2022

Cited by 45 | Viewed by 3099

Abstract

According to 2020 comprehensive global cancer statistics published by the International Agency for Research on Cancer, gynecologic malignancies accounted overall for 16 [...] Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

Research

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12 pages, 262 KiB

Open AccessArticle

Evaluation of Borderline Ovarian Tumor Recurrence Rate after Surgery with or without Fertility-Sparing Approach: Results of a Retrospective Analysis

by Basilio Pecorino, Antonio Simone Laganà, Liliana Mereu, Martina Ferrara, Grazia Carrara, Andrea Etrusco, Mariano Catello Di Donna, Vito Chiantera, Giuseppe Cucinella, Fabio Barra, Péter Török and Paolo Scollo

Healthcare 2023, 11(13), 1922; https://doi.org/10.3390/healthcare11131922 - 3 Jul 2023

Cited by 12 | Viewed by 2672

Abstract

Borderline ovarian tumors (BOTs) comprise 15–20% of primary ovarian neoplasms and represent an independent disease entity among epithelial ovarian cancers. The present study (Clinical Trial ID: NCT05791838) aimed to report a retrospective analysis of the management and outcomes of 86 consecutive BOTs patients, [...] Read more.

Borderline ovarian tumors (BOTs) comprise 15–20% of primary ovarian neoplasms and represent an independent disease entity among epithelial ovarian cancers. The present study (Clinical Trial ID: NCT05791838) aimed to report a retrospective analysis of the management and outcomes of 86 consecutive BOTs patients, 54 of which were at a reproductive age. All patients with BOTs undergoing surgical treatment from January 2010 to December 2017 were included. Data were retrospectively reviewed. High levels of Ca-125 were observed in 25.6% of the FIGO stage I patients and 58.3% of the advanced disease patients. Fertility-sparing surgery and comprehensive surgical staging were performed in 36.7% and 49.3% of the patients, respectively. Laparotomy was the most frequent surgical approach (65.1%). The most common diagnosis at frozen sections was serous BOT (50.6%). Serous BOTs have significantly smaller tumor diameters than mucinous BOTs (p < 0.0001). The mean postoperative follow-up was 29.8 months (range 6–87 months). Three patients experienced a recurrence, with an overall recurrence rate of 3.5% (10% considering only the patients who underwent fertility-sparing treatment). BOTs have low recurrence rates, with excellent prognosis. Surgery with proper staging is the main treatment. Conservative surgery is a valid option for women with reproductive potential. Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

12 pages, 2577 KiB

Open AccessArticle

Diagnostic Performances of Ultrasound-Based Models for Predicting Malignancy in Patients with Adnexal Masses

by Clarissa L. Velayo, Kareen N. Reforma, Renee Vina G. Sicam, Michele H. Diwa, Alvin Duke R. Sy and Ourlad Alzeus G. Tantengco

Healthcare 2023, 11(1), 8; https://doi.org/10.3390/healthcare11010008 - 20 Dec 2022

Cited by 4 | Viewed by 2462

Abstract

This study compared the diagnostic performance of different ultrasound-based models in discriminating between benign and malignant ovarian masses in a Filipino population. This was a prospective cohort study in women with findings of an ovarian mass on ultrasound. All included patients underwent a [...] Read more.

This study compared the diagnostic performance of different ultrasound-based models in discriminating between benign and malignant ovarian masses in a Filipino population. This was a prospective cohort study in women with findings of an ovarian mass on ultrasound. All included patients underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation using the different International Ovarian Tumor Analysis (IOTA) Group’s risk models. Serum CA-125 and a second-generation multivariate index assay (MIA2G) were also determined for all patients. The ovarian imaging and biomarker results were correlated with the histological findings. A total of 260 patients with completed ultrasound, CA-125, MIA2G, and histopathologic results was included in the study. The presence of papillae with blood flow and irregular cyst walls during the ultrasound were significantly associated with a 20-fold (OR: 20.13, CI: 8.69–46.67, p < 0.01) and 10-fold (OR: 10.11, CI: 5.30–19.28, p < 0.01) increase in the likelihood of a malignant lesion, respectively. All individual sonologic procedures performed well in discerning malignant and benign ovarian lesions. IOTA-LR1 showed the highest accuracy (82.6%, 95% CI: 77.5–87%) for identifying ovarian cancer. IOTA-ADNEX showed the highest sensitivity (93.3%, 95% CI: 87.2–97.1%) while IOTA-LR2 exhibited the highest specificity (84.4%, 95% CI: 77.3–90%). Among the different serial test combinations, IOTA-LR1 with MIA2G and IOTA-LR2 with MIA2G showed the highest diagnostic accuracy (AUROC = 0.82). This study showed that all individual ultrasound-based models performed well in discerning malignant and benign ovarian lesions, with IOTA-LR1 exhibiting the highest accuracy. Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

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6 pages, 229 KiB

Open AccessCommunication

Radiomics and Molecular Classification in Endometrial Cancer (The ROME Study): A Step Forward to a Simplified Precision Medicine

by Giorgio Bogani, Valentina Chiappa, Salvatore Lopez, Christian Salvatore, Matteo Interlenghi, Ottavia D’Oria, Andrea Giannini, Umberto Leone Roberti Maggiore, Giulia Chiarello, Simona Palladino, Ludovica Spano’ Bascio, Isabella Castiglioni and Francesco Raspagliesi

Healthcare 2022, 10(12), 2464; https://doi.org/10.3390/healthcare10122464 - 7 Dec 2022

Cited by 52 | Viewed by 2790

Abstract

Molecular/genomic profiling is the most accurate method to assess prognosis of endometrial cancer patients. Radiomic profiling allows for the extraction of mineable high-dimensional data from clinical radiological images, thus providing noteworthy information regarding tumor tissues. Interestingly, the adoption of radiomics shows important results [...] Read more.

Molecular/genomic profiling is the most accurate method to assess prognosis of endometrial cancer patients. Radiomic profiling allows for the extraction of mineable high-dimensional data from clinical radiological images, thus providing noteworthy information regarding tumor tissues. Interestingly, the adoption of radiomics shows important results for screening, diagnosis and prognosis, across various radiological systems and oncologic specialties. The central hypothesis of the prospective trial is that combining radiomic features with molecular features might allow for the identification of various classes of risks for endometrial cancer, e.g., predicting unfavorable molecular/genomic profiling. The rationale for the proposed research is that once validated, radiomics applied to ultrasonographic images would be an effective, innovative and inexpensive method for tailoring operative and postoperative treatment modalities in endometrial cancer. Patients with newly diagnosed endometrial cancer will have ultrasonographic evaluation and radiomic analysis of the ultrasonographic images. We will correlate radiomic features with molecular/genomic profiling to classify prognosis. Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

Review

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16 pages, 693 KiB

Open AccessReview

The Role of Micronutrients in Human Papillomavirus Infection, Cervical Dysplasia, and Neoplasm

by Filippo Alberto Ferrari, Francesca Magni, Mariachiara Bosco, Giulia Biancotto, Pier Carlo Zorzato, Antonio Simone Laganà, Vito Chiantera, Ricciarda Raffaelli, Massimo Franchi, Stefano Uccella and Simone Garzon

Healthcare 2023, 11(11), 1652; https://doi.org/10.3390/healthcare11111652 - 5 Jun 2023

Cited by 8 | Viewed by 5891

Abstract

There is evidence that diet and nutrition are modifiable risk factors for several cancers. In recent years, attention paid to micronutrients in gynecology has increased, especially regarding Human papillomavirus (HPV) infection. We performed a review of the literature up until December 2022, aiming [...] Read more.

There is evidence that diet and nutrition are modifiable risk factors for several cancers. In recent years, attention paid to micronutrients in gynecology has increased, especially regarding Human papillomavirus (HPV) infection. We performed a review of the literature up until December 2022, aiming to clarify the effects of micronutrients, minerals, and vitamins on the history of HPV infection and the development of cervical cancer. We included studies having as their primary objective the evaluation of dietary supplements, in particular calcium; zinc; iron; selenium; carotenoids; and vitamins A, B12, C, D, E, and K. Different oligo-elements and micronutrients demonstrated a potential protective role against cervical cancer by intervening in different stages of the natural history of HPV infection, development of cervical dysplasia, and invasive disease. Healthcare providers should be aware of and incorporate the literature evidence in counseling, although the low quality of evidence provided by available studies recommends further well-designed investigations to give clear indications for clinical practice. Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

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12 pages, 290 KiB

Open AccessReview

Role of Genomic and Molecular Biology in the Modulation of the Treatment of Endometrial Cancer: Narrative Review and Perspectives

by Ilaria Cuccu, Ottavia D’Oria, Ludovica Sgamba, Emanuele De Angelis, Tullio Golia D’Augè, Camilla Turetta, Camilla Di Dio, Maria Scudo, Giorgio Bogani, Violante Di Donato, Innocenza Palaia, Giorgia Perniola, Federica Tomao, Ludovico Muzii and Andrea Giannini

Healthcare 2023, 11(4), 571; https://doi.org/10.3390/healthcare11040571 - 15 Feb 2023

Cited by 54 | Viewed by 5038

Abstract

Endometrial cancer (EC) is one of the most common gynecological malignancies in Western countries. Traditionally, loco-reginal dissemination and histological characteristics are the main prognostic factors. Nowadays, molecular and genomic profiling showed exciting results in terms of prognostication. According to the data provided by [...] Read more.

Endometrial cancer (EC) is one of the most common gynecological malignancies in Western countries. Traditionally, loco-reginal dissemination and histological characteristics are the main prognostic factors. Nowadays, molecular and genomic profiling showed exciting results in terms of prognostication. According to the data provided by The Cancer Genome Atlas and other studies, molecular and genomic profiling might be useful in identifying patients al low, intermediate, and high risk of recurrence. However, data regarding the therapeutic value are scant. Several prospective studies are ongoing to identify the most appropriate adjuvant strategy in EC patients, especially for those with positive nodes and low volume disease. The molecular classification has offered the possibility to improve the risk stratification and management of EC. The aim of this review is to focus on the evolution of molecular classification in EC and its impact on the research approach and on clinical management. Molecular and genomic profiling might be useful to tailor the most appropriate adjuvant strategies in apparent early-stage EC. Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

9 pages, 884 KiB

Open AccessReview

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation

by Radmila Sparić, Mladen Andjić, Ottavia D’Oria, Ivana Babović, Zagorka Milovanović, Gaetano Panese, Martina Licchelli, Đina Tomašević, Andrea Morciano and Andrea Tinelli

Healthcare 2022, 10(10), 2087; https://doi.org/10.3390/healthcare10102087 - 19 Oct 2022

Cited by 2 | Viewed by 3285

Abstract

The authors reviewed uterine fibroid (UF) morcellation and its potential consequences, notably a hypothetical spread and dissemination of occult uterine leiomyosarcoma (LMS) tissue, evaluating the effect of laparoscopic versus open myomectomies with and without morcellation on patients’ outcomes, as well as related medical-legal [...] Read more.

The authors reviewed uterine fibroid (UF) morcellation and its potential consequences, notably a hypothetical spread and dissemination of occult uterine leiomyosarcoma (LMS) tissue, evaluating the effect of laparoscopic versus open myomectomies with and without morcellation on patients’ outcomes, as well as related medical-legal issues. MEDLINE and PubMed search was performed for the years 1990–2021, using a combination of keywords on this topic. Relevant articles were identified and included in this narrative review. There is an individual risk, for all patients, for LMS diagnosis after myomectomy. However, the risk for occult LMS diagnosis during a laparoscopic myomectomy is generally reduced when the guidelines of scientific societies are followed, with an overall benefit from the laparoscopic approach with morcellation in appropriate cases. Gynecological societies do not ban morcellation and laparoscopic hysterectomy/myomectomy per se, but recommend their use on the basis of the patients’ clinical characteristics. It is suggested for gynecologists to provide detailed information to patients when obtaining an informed consent for open or laparoscopic hysterectomy/myomectomy. A detailed preoperative assessment of patients and the risk benefit ratio of laparoscopic morcellation of uterine mass could overcome the “a priori” banning of the morcellation technique. Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

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Other

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9 pages, 391 KiB

Open AccessBrief Report

Prevalence of Precancerous Cervical Lesions among Nonvaccinated Kazakhstani Women: The National Tertiary Care Hospital Screening Data (2018)

by Balkenzhe Imankulova, Aisha Babi, Torgyn Issa, Zhanar Zhumakanova, Ljubov Knaub, Aidana Yerzhankyzy and Gulzhanat Aimagambetova

Healthcare 2023, 11(2), 235; https://doi.org/10.3390/healthcare11020235 - 12 Jan 2023

Cited by 3 | Viewed by 2115

Abstract

Objective: At the present time, cervical cancer remains the fourth most prevalent cancer among women worldwide. Most cervical cancer cases are attributed to high-risk human papillomavirus (HPV) infection. Because the natural history of cervical cancer takes decades, the disease could be prevented if [...] Read more.

Objective: At the present time, cervical cancer remains the fourth most prevalent cancer among women worldwide. Most cervical cancer cases are attributed to high-risk human papillomavirus (HPV) infection. Because the natural history of cervical cancer takes decades, the disease could be prevented if premalignant conditions are identified and appropriately managed. The aim of this study is to identify the prevalence of precancerous lesions among non-vaccinated women attending the national tertiary care hospital in Kazakhstan. Methods: This was a retrospective study of the cervical cancer screening database (2018) from the national tertiary care hospital in Kazakhstan. Records of 6682 patients, who had cervical cytology tests by Papanicolaou (Pap test), were analyzed. Out of the revised cases, 249 patients had abnormal cervical cytology reports. The Pap test was performed using liquid-based cytology (LBC). The data were analyzed using the statistical software STATA 16. A p-value of less than 0.05 was considered statistically significant. Results: In this retrospective analysis of 6682 patients’ records, we found 3.73% (249 patients) out of all Pap tests performed in 2018 were abnormal. The prevalence of high-grade squamous intraepithelial lesion (HSIL) was high at 19.28%, and the proportion of atypical squamous cells of undetermined significance (ASCUS) and atypical squamous cells (ASCs-H) was 18.47%, while low-grade squamous intraepithelial lesion (LSIL) were identified in 62.25% of the cases. Almost 25% of the women included in the study had concurrent lower and upper genital tract infections. Conclusion: Although the overall rate of abnormal Pap test results was not high, the study shows the elevated prevalence of HSIL. It calls the attention of local policymakers and gynecology specialists and requires immediate actions to improve the prophylactic measures to decrease morbidity and mortality from cervical cancer in Kazakhstan. Full article

(This article belongs to the Special Issue Gynecological Cancer Diagnosis and Prevention)

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