Gedgaudaitė, Miglė

Remiantis Pasaulio sveikatos organizacijos (PSO) ir Tarptautinio vėžio stebėsenos agentūros (GLOBOCAN) duomenimis, gimdos kaklelio vėžys užima ketvirtą vietą tarp moterų onkoginekologinių susirgimų [1]. Maždaug 3 proc atvejų yra diagnozuojama nėštumo metu [2]. Nėščiosioms dažniausiai diagnozuojami krūties onkologiniai susirgimai, tačiau gimdos kaklelio vėžys yra antra pagal dažnumą onkologinė ir dažniausiai diagnozuojama onkoginekologinė liga, jos atvejų skaičius siekia 0,1-12 susirgimų 10 000 nėštumų [3, 4]. Mokslinių tyrimų duomenimis, maždaug 2-7 proc. nėščiųjų nustatoma pokyčių atlikus gimdos kaklelio citologinį tyrimą (CT) ir šis dažnumas iš esmės yra toks pat atitinkamo amžiaus nesilaukiančių moterų grupėse [5]. Histologiškai patvirtintų pokyčių dažnumas tarp nėščiųjų siekia 1,3-2,7 atvejo 1000 nėštumų [3, 4, 6].

Introduction/Background: The aim of this retrospective study was to compare progression free survival (PFS) and overall survival (OS) in patients with advanced ovarian cancer (OC) treated at the single tertiary centre. Methodology: The patients treated for advanced OC (FIGO stages IIIA – IVB) during the period of 2020 – 2022 were included. Based on the radiological evaluation patients underwent primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy followed by interval cytoreductive surgery (ICS). PFS and OS analysis was performed 24 months after completion of treatment. Results: Out of the 134 patients, 82 underwent PCS and 52 - ICS. There were no significant differences between the groups concerning the age (60.7 (SD 11.4) vs. 61.9 (SD 9.1), p=0.52) and ECOG status (ECOG of 0-1 in both groups was 91.5% and 92.5% (p=0.86), respectively). Complete (< 5mm residuals) cytoreduction was achieved in 45/82 (54.9%) PCS patients and 30/52 (57.7%) ICS patients (p=0.75). 90 (71.4%) recurrences and 43 (32.1%) deaths were registered. The patients in PCS group had significantly better median PFS (17 vs. 12 months) and mean OS (20 vs. 18 months) (HR 1.86 95% CI 1.02 to 3.39, p=0.04; HR 1.53 95% CI 1.01 to 2.32, p=0.047). The subgroup analysis showed significantly better PFS and OS in complete PCS subgroup (18 and 22 months, respectively), compared to the other three subgroups of incomplete PCS and complete and incomplete ICS (PFS HR 2.82 (95% CI 1.59 to 4.99 (p<0.001)), 2.06 (95% CI 1.14 to 3.71 (p=0.02)) and 3.31 (95% CI 1.74 to 6.31 (p<0.001); OS HR 3.56 (95% CI 1.38 to 9.18 (p=0.01)), 2.98 (95% CI 1.10 to 8.07 (p=0.03)) and 5.35 (95% CI 1.98 to 14.49 (p<0.001), respectively). Conclusion: Patients in PCS group showed significantly better PFS and OS compared to those in ICS group. The PCS patients with complete surgery had the best PFS and OS.

Introduction/Background Vulvar cancer is a rare oncological pathology affecting mainly older women in higher income countries and is associated with relatively good prognosis, especially, if diagnosed in early stages. However, the recurrence rate is quite high, and it is associated with poor prognosis. The aim of this study was to evaluate the factors associated with vulvar cancer recurrence. Methodology Retrospective analysis of 107 patients, treated for the primary vulvar cancer in the Lithuanian University of Health Sciences Hospital, Kaunas Clinics during the period of 2017 – 2023, was performed. Demographical data of patients was collected concerning age, stage of the disease, tumour’s morphological parameters, treatment options, disease free survival and type of the recurrence. Statistical analysis was performed using SPSS statistical package (Version 29.0.2). Results 21/107 (19.6%) patients were diagnosed with vulvar cancer recurrence at the median time of 15 (2 – 42) months after the treatment. 9/21 (42.9%) of patients had local recurrent disease, and 12 (57.1%) patients were diagnosed with recurrence in inguinal lymph-nodes (ILN). The disease-free survival was shorter for patients with ILN recurrence than with local recurrence (mean 16.7 (SD 13.2) vs. 19.2 (SD 13.3) months, p=0.333, respectively). The recurrent disease was diagnosed more often for patients with bigger tumours (mean 35.1mm (SD 22.1) vs. 31.7mm (SD 15.6), p=0.046); present lympho-vascular space invasion (9 (42.9%) vs. 13 (18.8%), p=0.025), deeper tumour invasion (median of 5 (1-21) mm vs. 4 (0-20) mm, p=0.248), smaller tumour free margin (median of 4 (1-12) mm vs. 5 (1-15)mm, p=0.224) and positive inguinal lymph-nodes (8 (38.1%) vs. 17 (24.6%), p=0.228). Conclusion The vulvar cancer recurrence rate was 19.6%. Significant factors associated with vulvar cancer recurrence were larger tumour size and present lympho-vascular space invasion.

Endometrial cancer is the most common gynaecological malignancy in high-income countries. Systemic pelvic lymphadenectomy is an important part of the surgical staging, however, it is associated with a number of complications and is lacking the therapeutical benefit. Sentinel lymph node (SLN) biopsy with indocyanine green (ICG) dye mapping was introduced as the alternative method of surgical lymph node staging in endometrial cancer patients. Still, many questions arise with the introduction of new surgical procedures into the clinical practice. The aim of this study was to evaluate the feasibility of the indocyanine green mapped sentinel lymph node biopsy in endometrial cancer patients with following objectives: 1. To evaluate the overall and bilateral detection rates of ICG mapped SLN in endometrial cancer patients undergoing laparoscopic surgery. 2. To identify the factors that might have influence on the successful bilateral SLN mapping. 3. To evaluate the sensitivity and negative predictive value of the ICG mapped SLN biopsy. 4. To evaluate the impact of SLN ultrastaging on the accuracy of SLN biopsy 5. To assess the learning curve of SLN mapping with ICG in endoscopic surgery for endometrial cancer patients.

Tikslas. Įvertinti veiksnius, kurie gali turėti įtakos abipusei indociano žaliuoju (ICŽ) žymėtų sarginių limfmazgių (SL) vizualizacijai endometriumo vėžio atvejais. Tyrimo metodai. Perspektyvusis stebėsenos tyrimas atliktas Lietuvos sveikatos mokslų universiteto Kauno klinikų Akušerijos ir ginekologijos klinikoje. Į tyrimų įtraukta 200 pacienčių, histologiškai patvirtinus endometriumo vėžio diagnozę. SL žymėjimui buvo naudojamas IC2 dažas, jį suleidžiant į gimdos kaklelį prieš operacijų. Pacientės po operacijos suskirstytos į dvi grupes - sėkmingos ir nesėkmingos abipusės SL vizualizacijos. Statistinei analizei surinkti pacienčių, operacijos ir naviko klinikiniai duomenys, kurie palyginti tarp grupių. Rezultatai. Sėkmingai abipus SL rasti 143(71,5 proc.) pacientėms, 37 (18,5 proc.) - vienoje dubens pusėje. SL neidentifikuoti 20 (10,0 proc.) atvejų. Tiriant veiksnius atskirai, abipus dubenyje SL dažniau rasti jaunesnio amžiaus (63,0 ir 65,0 metų, p = 0,038) pacientėms, turinčioms mažesnį KMI (29,4 ir 31,1, p = 0,015). Nesėkminga SL vizualizacija dažniau buvo nustačius gilių naviko invazijų į miometriumą (39,2 proc. ir 56,1 proc., p = 0,029) bei pašalinus sąaugas dubenyje (13,3 proc. ir 28,1 proc., p = 0,013). Sėkmingas abipusis SL aptikimas reikšmingai gerėjo, didėjant atliktų procedūrų skaičiui. Taikant logistinės regresijos metodą, nustatyta, jog vienintelis statistiškai reikšmingas veiksnys, turintis įtakos SL aptikimui, buvo atliktų procedūrų skaičius - abipusis SL identifikavimas pagerėjo 1,117 karto, atlikus 10 papildomų procedūrų. Išvados. Chirurgo patirtis, susijusi su atliekamomis SL biopsijomis, bei atliktų procedūrų skaičius - vienintelis reikšmingas veiksnys, susijęs su abipusiu sėkmingu SL aptikimu.

Background/Aim: Ovarian cancer is one of the leading causes of cancer-related deaths in women around the world. Patients with ovarian cancer are especially prone to thrombotic events that can lead to deteriorating wellbeing and poorer overall outcomes. The aim of the study was to evaluate how the hemoglobin level, leukocyte and thrombocyte count, and cancer antigen 125 (CA-125) level can help predict future risks for thrombotic events in patients with ovarian cancer. Patients and Methods: A comparative analysis was combined with a retrospective study of newly diagnosed patients with ovarian cancer from 2017 till 2021 (n=342). From The Hospital of Lithuanian University of Health Sciences Kauno Clinic archive, we gathered information about whether the patient had a low level of hemoglobin (<100 g/l), high leukocyte (>11×109/l) and thrombocyte (>350×109/l) counts, and what the CA-125 level was before cancer treatment. We observed whether the patient had any thrombotic events during that time (n=66) and compared laboratory results with patients who had no complications. Results: We found there was a significant risk for thromboembolism in patients with ovarian cancer that had a low hemoglobin level [odds ratio (OR)=2.742, 95% confidence interval (CI)=1.408-5.339, p<0.002], high leukocyte count (OR=4.587, 95% CI=2.192-9.598, p<0.001), high thrombocyte count (OR=4.963, 95% CI=2.777-8.867, p<0.001) in comparison with patients with no thrombotic complications. A CA-125 level higher than 522 U/ml was associated with higher risk for thrombosis (OR=5.200, 95% CI=2.751-9.830, p<0.001). Conclusion: Full blood count and CA-125 determination might help assess the risk of future possible thrombotic complications before a cancer treatment plan is made. By evaluating risk, anticoagulant therapy can be administered earlier and prolonged depending on the course of treatment.

Objectives: To evaluate surgeons' learning curves for laparoscopic sentinel lymph node biopsy in endometrial cancer. Methods: A prospective observational study was performed at the Oncogynecology Center, Lithuanian University of Health Sciences Hospital, from March 2018 to October 2022. Participating surgeons had no previous experience of laparoscopic sentinel lymph node biopsy with indocyanine green tracer. Cumulative sum analysis was used to create learning curves for the performance of eight surgeons, based on a specific result over a time period. Two different cumulative sum plots were made for each surgeon: successful bilateral sentinel lymph node mapping and removal of sentinel lymph node specimens containing actual lymphatic tissue. Results: 190 patients were included. The overall rate of sentinel lymph node mapping was 89.5%: successful bilateral mapping was achieved in 134 (70.5%) patients, while in 36 (19%) patients sentinel lymph nodes were mapped unilaterally. The bilateral detection rate significantly improved in later study periods (from 59.3% in the first year to 85.0% in the last year; p=0.03). Analysis of the performance of the surgeons for bilateral sentinel lymph node mapping showed that the cumulative sum plot crossed the H0 limit line after 13 consecutive successful bilateral sentinel lymph node biopsies, indicating an acceptable level of competence to achieve the bilateral detection rate of at least 75%. This was accomplished by only one surgeon after 30 surgeries. Analysis of the performance of the surgeons for identification and removal of specimens containing histologically confirmed lymphatic tissue showed that the cumulative sum plots crossed the H0 limit line after six consecutive successful sentinel lymph node removals. This was accomplished by most of the surgeons (5 of 8).Conclusion: At least 30 procedures of indocyanine green traced laparoscopic sentinel lymph node biopsy were needed to reach an acceptable level of competence for a bilateral sentinel lymph node detection rate of at least 75%.Trial registration number: ACTRN12619000979156.

Background: The malformations of female genital system are usually associated with abnormal Mullerian duct embryological development. A didelphys uterus, commonly called a “double uterus”; is the consequence of Mullerian duct fusion failure that has a broad spectrum of clinical manifestations. We report a case of a teenage girl presenting with lower abdominal pain after the menarche leading to the diagnosis of rare congenital condition. Case report: A 14-year-old girl presented with severe lower abdomen pain, nausea, and vomiting. Her symptoms have started at a menarche (since 13 years-old) and tend to get worse during irregular menstrual cycles. On the ultrasound examination (US) the uterus was normal in size and structure, pushed to the right side of the pelvis by a unilocular cystic mass 81x80x106 mm with thick irregular walls filled with ground-glass content. Another unilocular cystic formation 64x34x35 mm with incomplete septum and low-echogenicity content was seen above the mass. The latter formation was supposedly the left hydrosalpinx and the bigger mass was differentiated between adnexal pathologies considering the congenital malformation of the uterus (the hematometracolpos and obstructed left hemivagina were suspected). The magnetic resonance imaging confirmed the congenital uterine anomaly: the didelphic uterus with left hematometra due to the blind left upper vagina and left hydrosalpinx was diagnosed. The structure of both ovaries was normal. The patient was admitted for surgical treatment. While the blind vagina ended up near the normally structured right cervix with no contact to the right vagina, it was decided to do the laparoscopic hysterectomy of the left uterus. During the surgery, the left salpingectomy was performed after removal of adhesions. The normal left ovary was left intact. The surgery was continued removing the blood-filled left uterus and cervix, leaving a part of vaginal tissue adherent to the posterior part of the right cervix in the pouch of Douglas. The postoperative period was uneventful. 3 months after the surgery patients has normal menstrual cycles, and the US scan showed normally sized right uterus with bilateral ovaries, with no pelvic masses. Conclusion: With this case report, we wanted to emphasize the challenges of differential diagnosis of pelvic mases in the female adolescents after the menarche. While the benign adnexal pathology is diagnosed in most of the cases, the uncommon congenital uterine anomalies should be taken into consideration.

Introduction/Background The aim of this study was to analyze the surgeons’ learning process for indocyanine green (ICG) mapped sentinel lymph-node biopsy (SLB) in endometrial cancer (EC) patients. Methodology Prospective study was conducted in a centre with no previous experience on ICG mapped SLB. 190 EC patients underwent laparoscopic hysterectomy with SLB (and additional lymphonodectomy in intermediate and high-risk groups). All surgeries were performed by 8 oncogynaecologists.The tabular cumulative sum (CUSUM) charts with sequential probability ratio test (SPRT) limits were plotted for each surgeon to evaluate the bilateral SL identification (target rate 75%) and removal of SLs containing lymphatic tissue (target rate 90%). Results At least one SL per hemipelvis was mapped in 89.5% (170/190) of the patients. Bilateral mapping rate was 70.5% (134/190).The cumulative successful bilateral mapping rate tends to improve with the experience gained performing the SLB (Spearman’s rho 0.728; p <0.001).The CUSUM plot for bilateral SL mapping showed that the primary SPRT limit was crossed only by one surgeon after 13 consecutive, successfully bilaterally mapped SLB. The result was achieved after 30 SLB procedures.305 SL samples were mapped and removed. After final histological evaluation in 10.5% (32/305) no lymphatic tissue was found. The overall rate of lymphatic-tissue containing SL samples was 89.5%.The CUSUM plotted for removal of SLs containing lymphatic tissue showed that SPRT limit was crossed by 5 surgeons after 6 consecutives lymphatic tissue containing SL specimens. Other two surgeons crossed the SPRT limit after the removal of 11 and 20 SL specimens, while one surgeon reached the limit after removing 71 SL specimens. Conclusion The CUSUM plots indicates that bilateral mapping of SL in endometrial cancer patients was achieved after 30 SLB procedures performed. However, the successful identification and removal of lymphatic tissue containing SL specimens was achieved after 6 consecutives procedures.

Abstract Objectives Sentinel lymph-node biopsy (SLB) with indocyanine green (ICG) could be an alternative for the systematic pelvic lymphadenectomy (LND) to stage lymph-nodes in endometrial cancer (EC). The success of SLB depends on the bilateral identification of sentinel lymph-nodes (SLs) in the pelvis. The aim of this study was to evaluate factors that may impact successful bilateral SL mapping. Methods Prospective study was performed in Lithuanian University of Health Sciences Hospital. 180 patients with histologically confirmed EC were included into the study. SLs were mapped with intracervical ICG injection. Results Bilateral SL mapping rate was 69.4%. The factors associated with mapping failure were as follows: older age (63.0 vs. 65.0, p=0.021), higher BMI (29.4 vs. 30.9, p=0.026), decreased lymphatic flow (16.0% vs. 29.1%, p=0.043), deep myometrial invasion (37.6% vs. 56.4%, p=0.019) and adhesiolysis performed during surgery (10.4% vs. 27.3%, p=0.004). After binary logistic regression analysis, the only independent factor associated with the bilateral SL mapping failure was the adhesiolysis during surgery (OR 2.888; 95% CI 1.81 – 7.063, p=0.020). Conclusions The removal of adhesions in the pelvis was the only independent factor associated with the lower rates of successful bilateral SL mapping.