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American Journal of Obstetrics and... Oct 2021A sentinel lymph node biopsy is widely accepted as the standard of care for surgical staging in low-grade endometrial cancer, but its value in high-grade endometrial... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A sentinel lymph node biopsy is widely accepted as the standard of care for surgical staging in low-grade endometrial cancer, but its value in high-grade endometrial cancer remains controversial. The aim of this systematic review and meta-analysis was to evaluate the performance characteristics of sentinel lymph node biopsy in patients with endometrial cancer with high-grade histology (registered in the International Prospective Register of Systematic Reviews with identifying number CRD42020160280).
DATA SOURCES
We systematically searched the MEDLINE, Epub Ahead of Print, MEDLINE In-Process & Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Embase databases all through the OvidSP platform. The search was performed between January 1, 2000, and January 26, 2021. ClinicalTrials.gov was searched to identify ongoing registered clinical trials.
STUDY ELIGIBILITY CRITERIA
We included prospective cohort studies in which sentinel lymph node biopsy were evaluated in clinical stage I patients with high-grade endometrial cancer (grade 3 endometrioid, serous, clear cell, carcinosarcoma, mixed, undifferentiated or dedifferentiated, and high-grade not otherwise specified) with a cervical injection of indocyanine green for sentinel lymph node detection and at least a bilateral pelvic lymphadenectomy as a reference standard. If the data were not reported specifically for patients with high-grade histology, the authors were contacted for aggregate data.
METHODS
We pooled the detection rates and measures of diagnostic accuracy using a generalized linear mixed-effects model with a logit and assessed the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.
RESULTS
We identified 16 eligible studies of which the authors for 9 of the studies provided data on 429 patients with high-grade endometrial cancer specifically. The study-level median age was 66 years (range, 44-82.5 years) and the study-level median body mass index was 28.6 kg/m (range, 19.4-43.7 kg/m). The pooled detection rates were 91% per patient (95% confidence interval, 85%-95%; I=59%) and 64% bilaterally (95% confidence interval, 53%-73%; I=69%). The overall node positivity rate was 26% (95% confidence interval, 19%-34%; I=44%). Of the 87 patients with positive node results, a sentinel lymph node biopsy correctly identified 80, yielding a pooled sensitivity of 92% per patient (95% confidence interval, 84%-96%; I=0%), a false negative rate of 8% (95% confidence interval, 4%-16%; I=0%), and a negative predictive value of 97% (95% confidence interval, 95%-99%; I=0%).
CONCLUSION
Sentinel lymph node biopsy accurately detect lymph node metastases in patients with high-grade endometrial cancer with a false negative rate comparable with that observed in low-grade endometrial cancer, melanoma, vulvar cancer, and breast cancer. These findings suggest that sentinel lymph node biopsy can replace complete lymphadenectomies as the standard of care for surgical staging in patients with high-grade endometrial cancer.
Topics: Adenocarcinoma, Clear Cell; Carcinoma, Endometrioid; Carcinosarcoma; Coloring Agents; Endometrial Neoplasms; Female; Humans; Indocyanine Green; Lymph Node Excision; Neoplasm Grading; Neoplasms, Cystic, Mucinous, and Serous; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 34058168
DOI: 10.1016/j.ajog.2021.05.034 -
Journal of the American Academy of... Mar 2022
Meta-Analysis
Topics: Female; Humans; Lasers; Lichen Sclerosus et Atrophicus; Vulvar Diseases; Vulvar Lichen Sclerosus; Vulvar Neoplasms
PubMed: 33684499
DOI: 10.1016/j.jaad.2021.02.081 -
Clinical & Translational Oncology :... Aug 2021The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar...
OBJECTIVE
The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar carcinoma.
EVIDENCE ACQUISITION
A systematic research using PubMed, Scopus and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Only full-text English-language articles related to IRT for treatment of primary or recurrent VC were identified and reviewed. Conference paper, survey, letter, editorial, book chapter and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered.
EVIDENCE SYNTHESIS
Primary disease: the median 5-year LC was 43.5% (range 19-68%); the median 5-year DFS was 44.5% (range 44-81%); the median 5-year OS was 50.5% (range 27-85%). Recurrent disease: the median 5-year DFS was 64% (range 56-72%) and the median 5-year OS was 45% (range 33%-57%). Acute ≥ grade 2 toxicity was reported in three patients (1.6%). The severe late toxicity rates (grade 3-4) ranged from 0% to 14.3% (median 7.7%).
CONCLUSION
IRT as part of primary treatment for primary and/or recurrent vulvar cancer is associated with promising clinical outcomes.
Topics: Adult; Aged; Aged, 80 and over; Brachytherapy; Disease-Free Survival; Female; Humans; Middle Aged; Multicenter Studies as Topic; Neoplasm Recurrence, Local; Retrospective Studies; Time Factors; Vulvar Neoplasms
PubMed: 33650029
DOI: 10.1007/s12094-021-02557-1 -
Reproductive Sciences (Thousand Oaks,... Sep 2021Long non-coding RNAs (lncRNAs) are emerging regulators of cellular pathways, especially in cancer development. Among the lncRNAs, nuclear paraspeckle assembly transcript...
Long non-coding RNAs (lncRNAs) are emerging regulators of cellular pathways, especially in cancer development. Among the lncRNAs, nuclear paraspeckle assembly transcript 1 (NEAT1) forms a scaffold for a nuclear body; the paraspeckle and aberrant expression of NEAT1 have been reported in breast and gynecologic cancers (ovarian, cervical, endometrial, and vulvar). Abundantly expressed NEAT1 in breast and gynecologic cancers generally contribute to tumor development by sponging its corresponding tumor-suppressive microRNAs or interacting with various regulatory proteins. The distinct expression of NEAT1 and its contribution to tumorigenic pathways make it a promising therapeutic target in breast and gynecologic cancers. Herein, we summarize the functions and molecular mechanisms of NEAT1 in human breast, ovarian, cervical, endometrial, and vulvar cancers. Furthermore, we emphasize its critical role in the formation of paraspeckle development and its functions. Conclusively, NEAT1 is a considerable biomarker with a bright prospect and can be therapeutically targeted to manage breast and gynecologic cancers.
Topics: Animals; Biomarkers, Tumor; Breast Neoplasms; Clinical Decision-Making; Female; Gene Expression Regulation, Neoplastic; Genital Neoplasms, Female; Humans; Ovarian Neoplasms; Precision Medicine; Predictive Value of Tests; Prognosis; RNA, Long Noncoding; Signal Transduction; Uterine Neoplasms; Vulvar Neoplasms
PubMed: 33569749
DOI: 10.1007/s43032-021-00481-x -
Gynecologic Oncology May 2021Sentinel lymph node biopsy (SLN) helps define lymph node status, a major prognostic factor in vulvar cancer. The aim of the current systematic review was to assess the...
INTRODUCTION
Sentinel lymph node biopsy (SLN) helps define lymph node status, a major prognostic factor in vulvar cancer. The aim of the current systematic review was to assess the use of indocyanine green (ICG) coupled with near-infrared (NIR) fluorescence imaging in SLN mapping in vulvar cancer in terms of technique used, feasibility and accuracy.
DATA SOURCES
We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. MeSH terms for SLN, ICG and vulvar cancer were combined and restricted to the English language. The final search was performed on May 28, 2020. The primary outcome was to determine if the use of ICG alone in detecting SLN in women with vulvar cancer is as accurate as the gold standard dual labeling technique.
RESULTS
Of the 34 studies initially identified, 13 were included for analysis. The SLN detection rate with ICG and NIR fluorescence ranged from 89.7 to 100%. No studies demonstrated the superiority of other detection techniques compared to ICG and NIR imaging. Lower SLN detection rates were found in studies with the most metastatic lymph nodes. No consensus was reached concerning the optimal use of ICG in terms of: injection timing or site; concentrations or volume of ICG; or use of human serum albumin or hybrid tracer. No adverse events were reported.
CONCLUSION
ICG for SLN mapping appears to be safe in women with vulvar cancer with a detection rate similar to the current techniques. A large prospective randomized controlled study with optimization of the technique is necessary to homogenize current practice and determine the true value of ICG in vulvar cancer.
PROSPERO ID
CRD42020178261.
Topics: Carcinoma; Female; Fluorescent Dyes; Humans; Image-Guided Biopsy; Indocyanine Green; Optical Imaging; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Spectroscopy, Near-Infrared; Vulvar Neoplasms
PubMed: 33551201
DOI: 10.1016/j.ygyno.2021.01.031 -
Clinical Nuclear Medicine Feb 2021The aims of this study were to determine the role of 18F-FDG PET/CT in vulvar cancer patients and to extract summary estimates of its diagnostic performance for... (Meta-Analysis)
Meta-Analysis
AIM
The aims of this study were to determine the role of 18F-FDG PET/CT in vulvar cancer patients and to extract summary estimates of its diagnostic performance for preoperative lymph node staging.
PATIENTS AND METHODS
PubMed/Medline and Embase databases were searched to identify studies evaluating 18F-FDG PET/CT in vulvar cancer patients. The assessment of methodological quality of the included articles was performed. Per-patient and per-groin pooled estimates, with 95% confidence intervals (CIs), of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) were calculated.
RESULTS
Ten articles were included in the systematic review, 7 among which evaluated the diagnostic performance of preoperative 18F-FDG PET/CT for lymph node staging. Qualitative per-patient analysis (72 patients from 4 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.70 (95% CI, 0.44-0.95), 0.90 (95% CI, 0.76-1.04), 0.86 (95% CI, 0.66-1.06), 0.77 (95% CI, 0.56-0.97), and 10.49 (95% CI, 1.68-65.50), respectively. Qualitative per-groin analysis (245 groins from 5 studies) resulted in estimated pooled sensitivity, specificity, PPV, NPV, and DOR of 0.76 (95% CI, 0.57-0.94), 0.88 (95% CI, 0.82-0.94), 0.70 (95% CI, 0.55-0.85), 0.92 (95% CI, 0.86-0.97), and 19.43 (95% CI, 6.40-58.95), respectively.
CONCLUSIONS
Despite limited literature data, this systematic review and meta-analysis revealed that a negative preoperative PET/CT scan may exclude groin metastases in at least early-stage vulvar cancer patients currently unfit for sentinel node biopsy and select those eligible for a less invasive surgical treatment. A positive PET/CT result should otherwise be interpreted with caution. Larger prospective studies are needed to confirm these results and to evaluate the diagnostic value of standardized semiquantitative analysis compared with the qualitative one.
Topics: Female; Fluorodeoxyglucose F18; Humans; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Vulvar Neoplasms
PubMed: 33234921
DOI: 10.1097/RLU.0000000000003411 -
Gynecologic Oncology Nov 2020To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) for oligometastatic gynecologic malignancies.
OBJECTIVE
To assess the efficacy and safety of stereotactic body radiation therapy (SBRT) for oligometastatic gynecologic malignancies.
METHOD
A comprehensive search of the PubMed, Medline, and EMBASE databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. "Oligometastatic" was defined as a limited number of uncontrolled/untreated metastatic lesions (typically ≤ 5), including regional nodal metastases. Primary outcomes were response rate (complete response or partial response), local control of oligometastatic lesions, and toxicity.
RESULTS
Of 716 screened records, 17 studies (13 full length articles, 4 conference abstracts) were selected and analyzed as 16 unique studies. A total of 667 patients were treated with ~1071 metastatic lesions identified. Primary sites included ovarian (57.6%), cervical (27.1%), uterine (11.1%), vaginal (0.4%), vulvar (0.3%), and other/unspecified (3.4%). Most patients (65.4%) presented with a single metastatic lesion. Metastatic lesion sites included the abdomen (44.2%), pelvis (18.8%), thorax (15.5%), neck (4.6%), central nervous system (4.3%), bone (1.6%), and other/unspecified (11%). Of the lesions, 64% were nodal. Response rate (among 8 studies) ranged from 49% to 97%, with 7/8 studies reporting > 75% response rate. Local control ranged from 71% to 100%, with 14/16 studies reporting ≥ 80% local control. No grade ≥ 3 toxicities were observed in 9/16 (56%) studies. Median progression-free survival (PFS) (among 10 studies) ranged from 3.3 months to 21.7 months. Disease progression most commonly occurred outside of the SBRT radiation field (79% to 100% of failures).
CONCLUSIONS
SBRT for oligometastatic gynecologic malignancies is associated with favorable response and local control rates but a high rate of out-of-field progression and heterogeneous PFS. Additional study into rational combinations of SBRT and systemic therapy appears warranted to further improve patient outcomes.
Topics: Aged; Female; Genital Neoplasms, Female; Humans; Middle Aged; Neoplasm Metastasis; Progression-Free Survival; Radiosurgery; Retrospective Studies
PubMed: 32917412
DOI: 10.1016/j.ygyno.2020.08.010 -
Journal of Gynecology Obstetrics and... Jan 2021Paget's disease of the vulva is a rare form of extramammary Paget's disease mainly affecting postmenopausal women. Its pathophysiology remains largely unknown. Up to...
Paget's disease of the vulva is a rare form of extramammary Paget's disease mainly affecting postmenopausal women. Its pathophysiology remains largely unknown. Up to fairly recently, the only treatment for this disease was surgery, often mutilating the vulva, with significant psychosexual repercussions without the assurance of complete therapeutic efficacy. New therapeutic approaches -topical treatments, radiotherapy or chemotherapy- have emerged in recent years but lack consensual guidelines. We present a literature review of the recent results published in this field.
Topics: Administration, Topical; Antineoplastic Agents; Diagnosis, Differential; Female; Humans; Imiquimod; Lasers, Gas; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Paget Disease, Extramammary; Photochemotherapy; Prognosis; Radiotherapy Dosage; Vulvar Neoplasms
PubMed: 32828871
DOI: 10.1016/j.jogoh.2020.101896 -
Minerva Ginecologica Dec 2020The aim of this study was to update clinical practice applications and technical procedures regarding sentinel lymph node (SLN) biopsy in vulvar cancer considering...
The aim of this study was to update clinical practice applications and technical procedures regarding sentinel lymph node (SLN) biopsy in vulvar cancer considering European experts' opinions from this field. Systematic data search performed using PubMed/medline database up to May 20, 2020. Focus was only for English language publications of original studies on SLN biopsy in vulvar cancer. Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer. In early-stage vulvar cancer patients with a negative sentinel node the groin recurrence rate is low, survival is excellent, and treatment-related morbidity is minimal. We advise that sentinel node dissection, performed by a quality-controlled multidisciplinary team, should be part of the standard treatment in selected patients with early-stage vulvar cancer.
Topics: Carcinoma, Squamous Cell; Female; Humans; Lymph Nodes; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Vulvar Neoplasms
PubMed: 32677774
DOI: 10.23736/S0026-4784.20.04601-8 -
The interplay of HIV and human papillomavirus-related cancers in sub-Saharan Africa: scoping review.Systematic Reviews Apr 2020People living with HIV (PLHIV) are at a high risk of developing HPV-related cancers. HPV-related malignancies occur frequently and/or are high among PLHIV, with cervical... (Review)
Review
BACKGROUND
People living with HIV (PLHIV) are at a high risk of developing HPV-related cancers. HPV-related malignancies occur frequently and/or are high among PLHIV, with cervical cancer as a designated AIDS-defining condition. We aimed to explore the evidence on the interplay of HIV and HPV-related cancers in sub-Saharan Africa (SSA).
METHODS
The scoping review was guided by Arksey and O'Malley's framework. We searched for literature from the following databases: PubMed; World Health Organization (WHO) Library; Science Direct; Google Scholar and EBSCOhost (Academic search complete, Health Source: Nursing/Academic Edition, CINAHL). Studies reporting on evidence HIV and HPV-related cancers interplay in SSA were eligible for inclusion in this review. The Mixed Methods Appraisal Tool (MMAT) tool was used to assess the risk of bias of the included studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used for reporting the search results. Thematic analysis used to reveal the emerging themes from the included studies.
RESULTS
A total of 74 potentially eligible articles were screened. Of these, nine (7 reviews, 1 transversal case controls, and 1 quantitative study) were eligible for data extraction. The studies reported about a total of 16,351 participants in different settings. The nine included studies showed evidence of cervical cancer among HIV-infected women and distribution of HPV infection and cervical abnormalities among HIV-positive individuals. In the four studies generalizing about HIV and anal cancer, only one reported about HPV. Two studies generally reported about HIV and head and neck cancers and one reported about interaction of HIV with vaginal cancer, vulvar cancer, and penile cancer, respectively.
CONCLUSION
HIV positivity is associated with increased prevalence of HPV infection on different anatomic sites, which will result in increased burden of HPV-related cancers among PLHIV. Furthermore, primary studies with robust study designs aimed at investigating the risk developing HPV-related cancers among PLHIV are recommended. Systematic review registration: PROSPERO CRD42017062403.
Topics: Africa South of the Sahara; Alphapapillomavirus; Female; HIV Infections; Humans; Neoplasms; Papillomaviridae; Papillomavirus Infections
PubMed: 32321580
DOI: 10.1186/s13643-020-01354-1