Cervical Stage Research Articles

Clinical impact of dose volume adaptation and dose escalation in MRI-guided high-dose-rate brachytherapy including the use of combined intracavitary/interstitial techniques for patients with poor response cervical cancer FIGO stage IIB or IIIB

Clinical impact of dose volume adaptation and dose escalation in MRI-guided high-dose-rate brachytherapy including the use of combined intracavitary/interstitial techniques for patients with poor response cervical cancer FIGO stage IIB or IIIB

Tumoren des weiblichen Beckens

Cervical, endometrial and ovarian carcinomas are the main malignant neoplasms of the female pelvis. For CT, a thin-slice venous phase with good bowel contrast is used. For MRI, an anti-peristaltic agent is necessary. Thin-slice T2- weighted TSE images with a high in-plane spatial resolution are particularly suitable for imaging the uterine wall; a parenteral contrast medium is absolutely necessary to demonstrate endometrial and ovarian carcinoma. In the guidelines, MRI is recommended only for cervical cancer FIGO 1b and higher stages; nevertheless, CT and MRI play an important role in preoperative diagnosis of these tumors. Lymph node staging is performed during surgery where possible. In patients with endometrial carcinoma, preoperative staging focuses on the infiltration depth in the myometrium. Preoperative diagnosis of ovarian cancer centers on any tumor spread in the abdomen, and diagnostic imaging methods are designed to provide the surgeon with information about compartments of a possible peritoneal carcinosis that are difficult to see. In patients with incidental findings of ovarian masses, CT and MRI can detect evidence of malignancy, although an exact differential diagnosis is not usually possible in this very heterogeneous group of ovarian tumors.

Assessing skeletal maturity by using blood spot insulin-like growth factor I (IGF-I) testing

Accurate determination of skeletal maturity and remaining growth is crucial to many orthodontic, orthognathic, and dental-implant timing decisions. Cervical vertebral stages and hand-wrist radiographs are currently used to identify peak mandibular bone growth. These are highly subjective techniques that not only involve radiographic exposure but also lack the ability to determine the intensity of the growth spurt and the end of growth. Insulin-like growth factor I (IGF-I) is a circulating growth hormone-dependent factor whose level correlates with sexual maturity; it is used to diagnose growth hormone deficiency and excess. We hypothesized that IGF-I levels would also correlate with cervical skeletal maturity and would be highest at the cervical stages that correspond to the greatest amount of facial growth. We measured mean blood spot IGF-I levels in a cross-sectional study of 83 patients (44 female, 39 male) on recall to begin orthodontic treatment, in active treatment, or in posttreatment follow-up. Mean blood spot IGF-I levels were significantly higher in the late pubertal stages than in the prepubertal, early pubertal, and postpubertal stages. Linear correlation showed that IGF-I levels had a significant positive correlation with cervical skeletal maturity from the prepubertal to the late pubertal stages, and a significant negative correlation from the late pubertal to the postpubertal stages. In the postpubertal stage, IGF-I levels had a negative linear correlation with increasing time since the onset of puberty and with chronological age. Blood spot IGF-I could be used as a skeletal maturity indicator and might be useful in detecting residual mandibular growth in young adults.

Cervical Vertebral and Dental Maturity are Correlated in Turkish Subjects

Article Title and Bibliographic Information Cervical vertebral and dental maturity in Turkish subjects Basaran G, Ozer T, Hamamci N. Am J Orthod Dentofacial Orthop 2007;131(4):447.e13-20 Level of Evidence 2 Purpose/Question The purpose of this study was to investigate the relationships between the stages of calcification of teeth and the cervical vertebral maturity stages in Turkish subjects. Source of Funding Not reported. Type of Study/Design A retrospective cross-sectional study.

Eruption of the maxillary canines in relation to skeletal maturity

Our aim in this study was to assess the relationship between the eruption of the permanent maxillary canines and skeletal maturity in subjects with different skeletal relationships in the sagittal and vertical planes. A sample of 152 subjects (63 boys, 89 girls) with erupting permanent maxillary canines was analyzed. On the lateral cephalograms, the stage of cervical vertebral maturation was assessed. Then the subjects were divided into prepeak (before the pubertal growth spurt, cervical stage [CS]1 and CS2), peak (during the pubertal growth spurt, CS3 and CS4), and postpeak (after the pubertal growth spurt, CS5 and CS6) groups. Skeletal relationships in the sagittal and vertical planes were evaluated, and relationships to timing of canine eruption were tested statistically. The prepeak group comprised 86 subjects, the peak group 66 subjects, and the postpeak group 0 subjects. The differences in prevalence rates between either the prepeak or peak groups and the postpeak group were statistically significant (P < 0.001). The prevalence rate for hyperdivergent subjects showing eruption of the permanent maxillary canine in the prepeak group (37.2%) was significantly higher than in the reference orthodontic population (21%). The eruption of the permanent maxillary canine can occur at any stage in skeletal maturation before the end the pubertal growth spurt (CS1-CS4), with hyperdivergent subjects more frequently having prepubertal canine eruption.

Human papillomavirus type-distribution in the cervix of Chinese women: a meta-analysis

The aim of the study was to determine human papillomavirus (HPV) type-distribution in the cervix of Chinese women, and to estimate the potential future impact of HPV prophylactic vaccines for cervical cancer prevention in China. A total of 32 studies using polymerase chain reaction for HPV detection were included in the meta-analysis, including 2844 invasive cervical cancer (ICC), 820 high-grade squamous intraepithelial lesions (HSIL), 432 low-grade squamous intraepithelial lesions (LSIL) and 2902 women with normal cytology/histology. The overall and type-specific HPV prevalence of 18 HPV types (HPV 6, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 70, 73 and 82 of different cervical stages) were estimated. Overall HPV prevalence was 83.7%, 66.2%, 61.3% and 11.2% in ICC, HSIL, LSIL and normal, respectively. HPV 16 was the predominant type in all cervical stages. Estimated HPV 16/18 positive fractions in ICC, HSIL, LSIL and normal were 69.7%, 45.5%, 32.23% and 4.6%, respectively. HPV-16/18 vaccine has the 69.7% potential prevention in ICC. HPV 58 and 52 were the priority HPV types in Chinese women.

A case of massive serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy for cervical adenocarcinoma stage IB2

Ascites following radical hysterectomy with retroperitoneal lymphadenectomy for invasive cervical cancer has been reported previously. Most of these reports described chylous ascites. The chylous ascitic fluid is milky; further, chylous ascites leads to nutritional problems. Authors present the case of a patient who developed serous ascites following radical hysterectomy with bilateral pelvic lymphadenectomy. The amount of ascites was approximately 18,000 ml over 52 days. The patient had no nutritional problems or complications. Although the etiology could not be determined, Authors surmise that the ascites may have been due to massive drainage from injured lymphatic channels below the cisterna chyli. Authors could not found any literatures which described massive serous ascites following surgery in gynecologic malignancy and reports this case with review of literatures.

Évidement cervical systématique dans les cancers épidermoïdes de la cavité orale

Objectives To evaluate the neck control after prior surgical management of patients with squamous cell carcinoma of the oral cavity and to quantify the ratio of patients among whom neck dissection did not have a real therapeutic value. To discuss the usefulness of the sentinel node biopsy in this group of patients. Method Retrospective analysis of patients with epidermoid carcinoma of the oral cavity who had systematically a neck dissection. Results Thirty-nine files of patients have been processed. We found 45% patients classified pN0 (among whom about one half where classified pT4). With a mean follow-up of 19 months, we did not find any cervical lymph node relapse. Five patients died (13.5%) without any cervical disease. Conclusion The systematic cervical lymph node dissection remains the most effective means to obtain the neck control of squamous cell cancers of the oral cavity. It however was applied without therapeutic value for 45% of the patients of this series. The validation of the sentinel node concept as a method of cervical staging should make it possible to avoid this surgical procedure in more than one third of the cases.

Diagnostic performance study on the relationship between the exfoliation of the deciduous second molars and the pubertal growth spurt

The aim of this study was to evaluate the possible relationship between the exfoliation of the deciduous second molars (Es) and the onset of the pubertal growth spurt assessed with the cervical vertebral maturation method. The ability to identify the onset of the pubertal growth spurt (cervical stage 3, CS3) was evaluated in a sample of 123 patients with exfoliation of the Es (exfoliation group) with respect to a control group of 250 subjects in the late mixed dentition selected with random criteria. Tests of diagnostic performance were applied. The comparison of the prevalence rates of CS3 in the exfoliation group vs the control group was not statistically significant. The positive likelihood ratio was smaller than 1, thus indicating lack of diagnostic power of the exfoliation of the deciduous second molars with regard to CS3. No significant relationship was found between the moment of exfoliation of the Es and the onset of the pubertal growth spurt.

The significance of proto-oncogene HGF/SF receptor c-Met mRNA expression in nasopharyngeal carcinoma

To explore the expression of c-Met mRNA in nasopharyngeal carcinomas (NPC) and its relation with clinical biological behavior. In situ hybridisation was used to detect mRNA expression of c-Met in 15 cases of non-tumor nasopharyngeal (NP), 55 cases of NPC. The positive rates of c-Met mRNA in NP and NPC cells were 13.3% (2/15) and 61.8% (34/55) respectively. The expression of c-Met mRNA was significantly correlated with lymph node metastasis, local invasion (skull base erosion), and clinical stage. In cases with cervical lymph node metastasis, local invasion, and clinical stage III and IV (UICC), the positive rates of expression of c-Met mRNA were significantly higher than that in those without the conditions mentioned above (P 0.05). The abnormal expression of c-Met gene was well correlated with the biological behavior of metastasis and invasion. To detection the expression of c-Met mRNA could serve as an important index to estimate the prognosis of NPC. C-Met may be a new diagnostic/therapeutic target of NPC.

Use of Amaranthus leucocarpus Lectin to Differentiate Cervical Dysplasia (CIN)

Alterations in O‐glycosylation of proteins in cell surfaces can originate disorder in cellular function, as well as in cell transformation and tumoral differentiation. In this work, we investigate changes in O‐glycosylation in cervical intraepithelial dysplasia (CIN) at different stages of differentiation (CIN I, CIN II, and CIN III) using lectins specific for O‐glycosidically linked glycans. Twenty cases with CIN I, CIN II, and CIN III dysplasias each, and 20 normal cases were studied by lectin histochemistry and evaluated under optical microscopy. The lectins from Glycine max and Griffonia simplicifolia showed no differences in their recognition pattern among the different CIN stages and normal tissue. Dolichos Biflorus lectin recognized CIN I dysplasia. Lectin from Amaranthus leucocarpus showed increased reactivity in the presence of CIN II dysplasia, compared with CIN I and CIN III. These results suggest that subtle modifications in the O‐glycosylation pattern could be considered in diagnosis or prognosis of cervical precancerous stages.

Effect of concurrent chemoradiotherapy with cisplatin and 5-fluorouracil for FIGO stage IIB of the uterine cervix

Objective : To determine effect of concurrent chemoradiotherapy (CCRT) in treatment of FIGO stage IIB cervical cancer the uterus and of consolidation chemotherapy using same chemotherpeutic regimens. Methods : The study population consisted of total number of 41 patients diagnosed as having cervical cancer FIGO stage IIB between January 1999 and December 2003 and treated with CCRT. We were divided into 2 groups according to number of cycles of chemotherapy received [e.g., ≤3 (n=19, cases) cycles versus >3 (n=22, controls) cycles]. Both groups had received the chemotherapeutic regimens which consist of cisplatin 60㎎/㎡ followed by five consecutive daily infusions of 5-fluorouracil (5-FU) 1,000㎎/㎡ every 3 weeks. Results : 5 years survival rate and 3 years progression free survival are 80.1% and 60.6% in 45 months median follow up duration (range 6-81 months). The median duration of follow up for case and control is 42 months (range 6-81 months) and 52.5 months (range 11-74 months) respectively (p=0.89). Both progression free survival rate (p=0.77) and survival rate (p=0.39) of the groups were revealed to be without statistical significance. Conclusion : This study shows similar results to compare with previous CCRT reports and that CCRT is primary treatment of cervical cancer IIB. We may not improve remarkably survival with many chemotherapy cycles. But because of small population and retrospective study, further study of a large number of patients, prospective and long term follow up will be necessary to test the efficacy of the consolidation chemotherapy.

O.390 Efficacy of lymphoscintigraphic sentinel node detection for cervical staging of patient with squamous cell carcinoma

Sentinel lymph node (SLN) biopsy is an alternative to axillary node dissection for staging breast cancer treatment. In this article, we investigated nodal drainage patterns and tumor location using lymphoscintigraphy to predict the axillary sentinel lymph node status. We enrolled 88 patients with clinically suspicious or biopsy-proven breast cancer from March 2001 to October 2002. The average age of subjects was 48 ± 4 years and the clinical stage was T1-2N0Mx. Tc-99m sulfur colloid was used in a hybrid combination of subdermal and perilesional injections around the selected corners of the tumor or biopsy site. Sentinel lymphoscintigraphy was performed 16-20 hours before surgery. Sentinel nodes were marked on the skin. An intraoperative gamma probe was used to confirm the sentinel lymph node location before biopsy. Most primary tumors were in the outer upper quadrant (52.3%), followed by the inner upper quadrant (17.0%), outer inferior quadrant (12.5%), central areolar area (11.4%), and inner inferior quadrant (6.8%). The nodal drainage patterns on 2-hour lymphoscintigraphy were as follows: axillary alone (76.1%), internal mammary nodes alone (1.1%), both axillary and internal mammary nodes (11.4%), and no drainage (11.4%). Internal mammary lymphatic drainage is related to tumor location in the inner quadrants of the breast. About 11.4% of all patients had poorly identified SLNs on lymphoscintigraphy within a 2-hour period, but there was improvement in the overall detection rate up to 95% by intraoperative gamma probe the next day. Preoperative lymphoscintigraphic mapping has value in providing individual lymphatic drainage patterns and tumor location that are important in the interpretation of the results of SLN biopsy during surgery.

Urine cytology as a screening test for bladder infiltration in cervical cancer

Ultrasound is currently used as a screening test for bladder infiltration in patients with advanced-stage cervical cancer at our institution. Cystoscopy is reserved for patients with abnormal bladder ultrasound findings. This study was undertaken to reevaluate this policy and to compare the results of different screening tests. The study was carried out in Pretoria academic complex. All newly diagnosed cervical carcinoma patients stage II and above were included in this study. The standard staging investigations were done on all patients. In addition, urine midstream and catheter specimens were sent for cytology. Cystoscopy and biopsy were performed on all patients. Two hundred twenty-eight patients were enrolled into this study. At cystoscopy, 47 patients had bladder mucosa suspicious of malignant infiltration, of which 17 had bladder mucosa infiltration diagnosed on histology. Urine catheter cytology has a sensitivity of 94% and specificity of 82% for bladder mucosa infiltration. The predictive value of a positive test is 31% and for a negative test is 99%. Catheter urine cytology is a very useful screening test for bladder infiltration in patients with cervical cancer. Cystoscopy should be reserved for patients with abnormal urine cytology in resource-poor settings with a large burden of disease.

The Cervical Vertebral Maturation (CVM) Method for the Assessment of Optimal Treatment Timing in Dentofacial Orthopedics

The present study introduces a further modified version of the Cervical Vertebral Maturation (CVM) method for the detection of the peak in mandibular growth, based on the analysis of the second through fourth cervical vertebrae in a single cephalogram. The morphology of the bodies of the second (C2 –odontoid process), third (C3), and fourth (C4) cervical vertebrae were analyzed in 6 consecutive cephalometric observations (T₁ through T₆) of 30 orthodontically untreated subjects. Observations for each subject consisted of two consecutive cephalograms comprising the interval of maximum mandibular growth (as assessed by means of the maximum increment in total mandibular length, Condylion –Gnathion: Co-Gn), together with two earlier consecutive cephalograms and two later consecutive cephalograms. The analysis consisted of both visual and cephalometric appraisals of morphological characteristics of the three cervical vertebrae. The construction of this new modified version of the CVM method was based on the results of both ANOVA for repeated measures with post hoc Scheffé's test (<i>P</i> < 0.05) and discriminant analysis. The new clinically improved CVM method is comprised of six maturational stages (cervical stage 1 through cervical stage 6, ie, CS1 through CS6). CS1 and CS2 are prepeak stages; the peak in mandibular growth occurs between CS3 and CS4. CS6 is recorded at least 2 years after the peak. The use of the CVM method enables the clinician to identify optimal timing for the treatment of a series of dentoskeletal disharmonies in all three planes of space.

Effectiveness of Lymphoscintigraphic Sentinel Node Detection for Cervical Staging of Patients With Squamous Cell Carcinoma of the Head and Neck

To evaluate the feasibility and staging ability of the sentinel node (SN) technique for patients with squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks. This prospective study compares the histopathologic status of the SN with that of the remaining neck dissection tissues. Thirty previously untreated patients with T1 to T4 squamous cell carcinoma of the oral cavity or oropharynx and clinically negative necks (N0) were included in the study. Injection of 99m Tic-radiolabeled sulfur colloid around the primary tumor and lymphoscintigraphy were performed the day before surgery. Intraoperatively, the SN(s) was localized with a gamma probe and removed during neck dissection. The tumor was resected at the same time. For 1 patient, lymphoscintigraphy revealed no SN. SN were identified in 29 patients/37 necks. In 29 necks, there were no positive SN. In 5 patients, the SN was the only histopathologically positive node. In 1 patient, SN and other nodes in the remaining neck tissue were positive. There was 1 false negative case; the first case of the study, indicating the need for a learning curve for the technique. This prospective study shows that the SN is useful for the staging of N0 necks. The SN technique has the potential to decrease the need for neck dissections, which are usually performed in clinically negative necks, thus reducing both associated morbidity for patients and cost.

Topical vidarabine or 5-fluorouracil treatment against persistent HPV in genital (pre)cancerous lesions

In the present study, effectiveness of topical vidarabine or subsequent 5-fluorouracil (5-FU) administration was examined against persistent genital human papillomavirus (HPV) infection after local surgery. Thirty patients underwent local eradication treatment of uterine cervical intra-epithelial neoplasia (CIN) and stage Ia1 uterine cervical cancers. HPV typing was performed by PCR-RFLP analysis. HPV infection was detected pre-operatively in 29 of 30 patients. Of these, HPV was still present in the 20 patients within two months after the therapy. Topical administration of vidarabine or subsequent 5-FU once a week for four weeks was performed to the post-operative persistent HPV-positive cases. HPV infection was abolished in 1 of 10 (10%) with topical vidarabine, and in 2 of 4 vidarabine-resistant cases (50%) with topical 5-FU. Topical vidarabine or 5-FU treatment is beneficial for HPV-positive cases after local surgical excision.

Widespread elevated expression of the human papilloma virus (HPV)-activating cellular transcription factor Brn-3a in the cervix of women with CIN3 (cervical intraepithelial neoplasia stage 3)

Widespread elevated expression of the human papilloma virus (HPV)-activating cellular transcription factor Brn-3a in the cervix of women with CIN3 (cervical intraepithelial neoplasia stage 3)

Widespread elevated expression of the human papilloma virus (HPV)-activating cellular transcription factor Brn-3a in the cervix of women with CIN3 (cervical intraepithelial neoplasia stage 3)

Widespread elevated expression of the human papilloma virus (HPV)-activating cellular transcription factor Brn-3a in the cervix of women with CIN3 (cervical intraepithelial neoplasia stage 3)

Tumour Size in Cancer of the Cervix

In a randomized trial comprising 204 patients with operable cervical carcinomas stages I and II, two low-dose rates in gynaecological brachytherapy were compared. Treatment consisted of Cs-137 uterovaginal application followed by surgery (either immediate or delayed). The results for the two dose rates have been published previously. The present paper concerns the correlation between outcome and tumour size. Tumour size was carefully estimated in two ways: by clinical examination under general anaesthesia and by measurements on the customized vaginal mould used for the brachytherapy. Ninety-one patients (45%) were classified as stage I, and 113 were classified as stage II proximal. The mean tumour size was 39 mm (range 15-64 mm). Cox's multivariate analysis indicated that the factors with a poor prognostic value were for survival: node involvement (N+) (p<0.001), large tumour size (T+) (p<0.001) and involvement of the endocervix (E+) (p<0.01); for event-free survival: N+ (p<0.001), T+ (p<0.001); for local control; N+ (p=0.0001); for metastasis and regional relapse: N+ (p<0.001) and T+ (p<0.001). Stage was not a prognostic factor over the present range in either univariate or multivariate analysis. In this series tumour size is a powerful independent prognostic factor. It is therefore suggested that for the classification of cervical cancer and the indications for surgical staging and adjuvant treatment, tumour size should be taken into account.