Glandular Extension Research Articles

Análisis de factores predictores de lesión residual dependientes de la paciente después de conización cervical

Introduction: in the care of women with precursor lesions of cervical cancer, preventing possible progression to invasive cancer without over-treating the high chances of regression is extremely important. Over time, different treatments and protocols have been tested in order to obtain the best results in the control of this condition with conservative techniques. Objective: to identify predictors of residual disease depending on the intrinsic characteristics of the patients with conization, due to high-grade epithelial lesions or with microinvasion. Methods: A prospective descriptive study was conducted to determine the relationship between the diagnosis of residual disease and clinical- epidemiological variables dependent on the patient, in 1090 patients with high-grade cervical epithelial lesions who were treated at the "Héroes del Baire" General Teaching Hospital on the Isle of Youth (Cuba) during the period 2014-2019. Result: a linear trend of the association of age and residual disease was observed, as well as an association with glandular disease, histological severity and infection by oncogenic serotypes of the human papillomavirus. HPV infection (OR=11.3), history of previous lesion (OR=9.8), persistence of viral infection (OR=4.9) and glandular involvement (OR=3.1) were the factors that showed the greatest association with residual disease. Conclusion: the severity and size of the lesion, the glandular extension and the persistent infection by the human papilloma virus were the predictive factors that contribute to the existence of residual lesion.

Minimally invasive versus abdominal hysterectomy for endometrial carcinoma with glandular or stromal invasion of cervix

<h3>Objectives:</h3> To evaluate the feasibility of laparoscopic approach in endometrial cancer that extends to the cervix in the form of glandular extension and/or stromal invasion and compare with laparotomy. <h3>Methods:</h3> A retrospective, single-center cohort study was conducted using data between January 1, 2002 and December 31, 2017 at an urban tertiary academic medical center. We identified patients who were diagnosed with endometrial cancer FIGO stage I with endocervical glandular extension and FIGO stage II on final pathology. Operative and oncologic outcomes were compared between the patients who underwent minimally-invasive surgery (MIS) and those who underwent laparotomy. <h3>Results:</h3> Eighty-five patients with endometrial cancer were reviewed for the study. Among these patients, 25 patients underwent hysterectomy and surgical staging via MIS. There was no conversion from MIS to laparotomy. In the MIS group, shorter hospital stay (4.4 ± 2.3 days for MIS group vs. 7.1 ± 4.7 days for laparotomy group; <i>p</i>-value = 0.002) and less blood loss during the operations (200 mL vs. 400 mL, <i>p</i>-value < 0.001) were observed compared with the laparotomy group. In terms of pathological findings, there was no statistical difference in FIGO stage (IB and II), the rate of endometrioid histology, grade, tumor size, depth of myometrial invasion and lymph-vascular space invasion (LVSI) between the MIS and laparotomy groups. For the treatment, types of hysterectomy (Type 1 vs. 2 vs. 3) and the rate of adjuvant radiotherapy or chemotherapy were similar in both groups. In univariate analyses, no difference in disease-free and overall survival was observed between the two groups and these findings were reproduced in multivariate analysis. <h3>Conclusions:</h3> Among the women with endometrial cancer that involved the cervix without evidence of extrauterine disease, surgical treatment via MIS compared with laparotomy showed no difference in overall survival but better perioperative outcomes. These findings support the use of MIS for these patient group.

Minimally-Invasive Versus Abdominal Hysterectomy for Endometrial Carcinoma With Glandular or Stromal Invasion of Cervix.

The purpose of the study was to evaluate the feasibility of laparoscopic approach versus laparotomy in endometrial cancer that extends to the cervix in the form of glandular extension and/or stromal invasion. A retrospective, single-center cohort study was conducted using data between 1995 and 2017 at an urban tertiary academic medical center. We identified patients who were diagnosed with endometrial cancer whose tumor involved the uterine cervix on final pathology. Operative and oncologic outcomes were compared between the patients who underwent minimally-invasive surgery (MIS) versus those who underwent laparotomy. A total of 282 patients with endometrial cancer were reviewed for the study. Among these patients, 76 patients underwent hysterectomy and surgical staging via MIS. There was no conversion from MIS to laparotomy. In the MIS group, shorter hospital stay (4.4 ± 2.3 days for MIS group vs. 7.1 ± 4.7 days for laparotomy group; p-value = 0.002) and less blood loss during the operations (228 mL vs. 478 mL, p-value < 0.001) were observed compared to the laparotomy group. The multivariate Cox regression analysis revealed that age at diagnosis, FIGO stage, histology grades, tumor size, lymph-vascular space invasion were independent prognostic markers for poor oncologic outcomes but the types of surgical approach (MIS vs. laparotomy) were not associated with it. The means by which colpotomy was performed (either intracorporeal or transvaginal) among the MIS group also did not affect patient survivals. Among the women with endometrial cancer that involved the uterine cervix, surgical treatment via MIS compared to laparotomy showed no difference in survival outcomes but better perioperative results. These findings support the use of MIS for these patient group.

Submandibular gland cancers: prognostic factors and survival analysis.

The aim of this study is to evaluate prognosis and prognostic factors affecting oncological outcome. Records of the subjects managed for a submandibular gland cancer (SGC) between January 1997 and June 2014 were retrospectively reviewed. Survival outcomes were analyzed. All subjects had a minimum follow up of 5years or until death. Of 24 subjects (13male, 11 female), 16 (64.6%) were adenoid cystic carcinoma (ACC). Eight patients had clinically positive neck nodes and 2 of the 16 clinically negative necks were also positive histologically. None of the subjects had distant metastases at presentation. The Kaplan-Meier 5-year estimated locoregional control (LRC), distant metastasis free survival (DMFS), disease free survival (DFS) and overall survival (OS) were 62.5%, 83.3%, 58.3% and 66.7%, respectively. American Joint Committee on Cancer (AJCC) overall stage and extra glandular extension (EGE) proved to be significant predictors of LRC. Only smoking was found to be a significant factor related with lower DMFS and only EGE significantly lowered DFS. Positive nodal stage and positive surgical margin were proved to be significant predictors of OS. Surgery alone is effective in subjects with early stage, noninvasive and low-grade cancers. Despite aggressive treatment, locoregional recurrence was common in subjects who were at advanced stage.

The detection of DNA methylation of tumour suppressor genes in cervical high-grade squamous intraepithelial lesion: A prospective cytological-histological correlation study of 70 cases.

DNA methylation has been suggested as one of the epigenetic changes promoting carcinogenesis. The aim of this study was to prospectively evaluate the methylation status of CADM 1, MAL and hsa-miR-124 genes in high-grade squamous intraepithelial lesion (HSIL) liquid-based cytology (LBC) samples with a histological correlation. Seventy histologically confirmed cases of HSIL paired with prior screening LBC diagnosis of HSIL within a 3-month interval were selected. Histologically, the lesions were reviewed and assessed including: (a) number of blocks harbouring dysplastic squamous epithelium; (b) number of blocks containing glandular extension of dysplastic epithelium; and (c) the depth of glandular extension (which was assessed semi-quantitatively as graded 1-3). Human papillomavirus (HPV) subtyping was performed from residual LBC materials using the LINEAR ARRAY HPV Genotyping Test and in-house polymerase chain reaction targeting the HPV E1 gene. The detection of methylation silencing of tumour suppressor genes CADM1, MAL and hsa-miR-124 was performed by multiplex methylation-specific real-time polymerase chain reaction. A positive methylation status was detected in 41 cases (58.6%). The number of blocks with HSIL varied from one to 13. Glandular extension was seen in 44 cases with the number of blocks involved ranging from one to 10. The depth of HSIL glandular extension varied. The DNA methylation test allows HSIL lesions to be divided into two distinct groups of methylated HSIL in significantly older patients and unmethylated HSIL in younger patients. This study was not able to prove that methylation status in cervical HSIL correlates with the size of the lesion (measured by the number of blocks involved) or with HSIL propensity for endocervical glandular extension, nor with HPV type or multi-infection.

Diverse glandular pathologies coexist with high‐grade squamous intraepithelial lesion in cyto‐histological review of atypical glandular cells on ThinPrep specimens

To identify in cytology, high-grade squamous intraepithelial lesions with endocervical glandular extension in cases previously diagnosed as atypical glandular cells (AGC), analyse possible reasons for the diagnostic pitfall and document the frequency of glandular pathology coexisting with high-grade cervical intraepithelial lesion in histology. Thirty-nine ThinPrep cervical smear (Pap) tests reported as AGC of undetermined significance and showing high-grade lesions on histology [cervical intraepithelial neoplasia (CIN) 2 or 3, endometrial or extrauterine adenocarcinoma] were reviewed retrospectively to identify the cases of high-grade squamous intraepithelial lesion with endocervical glandular extension, using the Bethesda 2001 system. Cyto-histological correlation was performed. A high frequency of diverse glandular pathologies coexisted with high-grade cervical intraepithelial lesions on histology. This included endocervical glandular extension in 63%, benign glandular pathology in 33% and pre-neoplastic or malignant glandular pathology (endocervical glandular dysplasia, adenocarcinoma in situ and metastatic breast carcinoma) in 17% cases. On cytology, the sensitivity was 40%, specificity was 80% and positive predictive value was 86% for endocervical gland extension in high-grade squamous intraepithelial lesions. Special efforts to recognize endocervical glandular extension in high-grade squamous intraepithelial lesions and glandular neoplasia coexisting with squamous intraepithelial lesions from the heterogeneous category of AGC can contribute to increasing the diagnostic accuracy. The identification of endocervical glandular extension on cervical cytology would alert the gynaecologist to perform a thorough assessment of the endocervix during colposcopy. This could also help to decide on the need to perform deeper conization rather than loop electrosurgical excision procedure to ensure negative margins when colposcopic biopsy shows CIN 2 or 3.

Morphological Ultrasound Microimaging of Thyroid in Living Mice

The objective of the study was to explore high-frequency ultrasound (HFUS) for noninvasive microimaging of thyroid in living mice. Thyroid examination was performed by HFUS in 10 normal C57BL/6 mice, eight mice treated by propylthiouracil, and 22 Tg-TRK-T1 transgenic mice. The dimension of the gland and the presence of nodules were evaluated. Nodules were classified as malignant (hypoechogenicity, poorly defined margins, internal microcalcification, irregular shapes, and extra glandular extension) or not, and the findings were compared with histological data. Thyroid images were successfully obtained in all the animals analyzed. Normal thyroid reached a volume of 4.92 microl (range 2.11-4.92 microl). Mice with propylthiouracil-induced goiter showed diffuse thyroid enlargement (median volume 6.67 microl, range 4.09-8.82 microl). In 19 of 22 Tg-TRK-T1 mice (86%), HFUS identified a nodular process (the smallest detected nodule had a diameter of 0.46 mm). Eleven nodules were classified as malignant and eight as benign. Compared with histological analysis, HFUS showed a sensitivity of 100% in the detection of thyroid nodules and a specificity of 60% (two of the nodules identified by HFUS were not confirmed at the histology). The specificity and sensitivity of HFUS in predicting the malignancy of the thyroid nodules were 83 and 91%, respectively. Thus, HFUS is an accurate imaging modality that can potentially replace more invasive techniques, and, therefore, it represents a significant advancement in phenotypic assessment of mouse models of thyroid cancer.

Human Papillomavirus Test After Conization in Predicting Residual Disease in Subsequent Hysterectomy Specimens

To estimate the effectiveness of the human papillomavirus (HPV) test performed after conization in predicting residual disease in patients who subsequently underwent hysterectomy. A total of 115 patients who underwent hysterectomy after conization caused by cervical intraepithelial neoplasia grade 3 (CIN 3) and microinvasive cervical cancer (IA1 cancer) were included in this prospective study. All patients underwent HPV testing with a liquid hybridization assay immediately before hysterectomy. Differences in sensitivity, specificity, and accuracy between resection margin and the HPV test in predicting residual disease in subsequent hysterectomy samples were estimated using the McNemar exact test. Univariable analysis showed that age, parity, menopausal status, glandular extension, and severity of disease were not predictive for residual disease, but positive resection margin and positive HPV tests were significant factors for predicting residual disease. These factors were also significant in a multivariable analysis (positive resection margin 45.5%, odds ratio [OR] 3.09, 95% confidence interval [CI] 1.19-8.03, P=.021; positive HPV test 57.6%, OR 11.05, 95% CI 4.01-30.49, P<.001). With resection margin, the sensitivity, specificity, and accuracy in predicting residual disease were 75%, 53%, and 61%, respectively, whereas, with the HPV test, these values were 85%, 67%, and 73%, respectively (P=.454, .080, and .044, respectively). Of patients with positive resection margins, 79% of HPV-negative patients had no residual disease. Of patients with negative resection margins, no HPV-negative patient had residual disease. The HPV test after conization was significantly more accurate than resection margin for predicting residual disease. The predictive value of resection margin for predicting residual disease was much improved when used in combination with the HPV test. Use of the HPV test is recommended for identifying patients for subsequent hysterectomy after conization for CIN 3 and IA1 cancer. III.

Value of Second Pass in Loop Electrosurgical Excisional Procedure

The aim of this study was to compare the rate of incomplete resection and treatment outcome of the second-pass technique with those of single-pass technique in loop electrosurgical excisional procedure (LEEP). From 1997 to 2002, 683 women were diagnosed as squamous dysplasia via LEEP in our institution. Age, parity, LEEP technique, grade of lesion, glandular extension, margin status, residual tumor and recurrence were obtained by reviewing medical records. Positive margin was defined as mild dysplasia or higher grade lesions at resection margin of the LEEP specimen. In women who underwent hysterectomy, residual tumor was defined as mild dysplasia or higher grade lesions in hysterectomy specimen. In women who did not underwent hysterectomy, Pap smear more than atypical squamous cells of undetermined significance or biopsy result more than mild dysplasia within two years after LEEP were regarded as cytologic or histologic recurrences, respectively. Treatment failure of LEEP was defined as residual tumor or histologic recurrence. The second-pass technique significantly reduced the endocervical margin positivity (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63). However, the second-pass technique did not reduce the treatment failure (OR, 0.62; 95% CI, 0.29-1.32). In conclusion, the second-pass technique markedly reduced the endocervical margin positivity, but did not reduce the treatment failure rate of LEEP.

The association of pre-conization high-risk HPV load and the persistence of HPV infection and persistence/recurrence of cervical intraepithelial neoplasia after conization

Objective. The aim of this study was to evaluate whether the pre-conization high-risk human papilloma virus (HR-HPV) load is predictive for the persistence of HR-HPV infection and the persistence/recurrence of cervical intraepithelial neoplasia (CIN) after conization of the cervix. Materials and methods. A retrospective review was performed on 236 women who underwent conization due to CIN at the Center for Uterine Cancer, National Cancer Center, Korea, between March 2001 and March 2006. The samples for pre-conization HR-HPV test were obtained at least within 3 weeks before conization. All patients underwent HR-HPV testing and cytology between 3 and 6 months after conization, and subsequent follow-up of 3- to 6-month interval was performed thereafter. The persistence of HR-HPV infection and persistence/recurrence of histologic abnormality after conization were analyzed by age, parity, menopausal status, method of conization, glandular extension, margin status, severity of CIN, and pre-cone HR-HPV load in univariate and multivariate analysis. Results. In univariate analysis, high pre-cone HR-HPV load was the only risk factor for the persistence of HR-HPV infection after conization (persistent HR-HPV infection; 19.8% [23/116] of patients with an HR-HPV load ≥ 100 RLU/PC vs. 10.0% [12/120] of patients with a load < 100 RLU/PC, P = 0.034). Multivariate analysis showed that an HR-HPV load ≥ 100 RLU/PC was a risk factor for persistence/recurrence of histological abnormalities after conization ( P = 0.040, OR = 5.748, 95% CI = 1.082–30.526). Conclusion. Patients with a pre-conization HR-HPV load ≥ 100 RLU/PC had a higher rate of persistent HR-HPV infection and a higher rate of persistent/recurrent histological abnormalities after conization for CIN compared to patients with a load < 100 RLU/PC.

Risk factors predicting residual disease in subsequent hysterectomy following conization for cervical intraepithelial neoplasia (CIN) III and microinvasive cervical cancer

Objective. To determine factors predicting post-cone residual disease in cervical intraepithelial neoplasia (CIN) III and microinvasive cervical cancer. Methods. Of 337 patients who underwent conization due to CIN III and microinvasive cervical cancer between November 2001 and March 2006, 77 underwent hysterectomy within 6 months of conization. We analyzed their demographic features, pathologic parameters and pre-cone high-risk human papilloma virus (HR-HPV) load measured by Digene Hybrid Capture II. Results. In univariate analysis, age ≥ 50 years ( P = 0.048, relative risk [RR] = 2.74, 95% confidence interval [CI] = 1.0–7.4), positive resection margin ( P = 0.004, RR = 4.35, 95% CI = 1.5–12.3), and pre-cone HR-HPV load ≥ 300 relative light units (RLU)/positive control (PC) ( P = 0.009, RR = 3.41, 95% CI = 1.3–8.7) were significant factors associated with residual disease. While postmenopausal status showed borderline significance ( P = 0.065, RR = 2.65, 95% CI = 0.9–7.5), parity ≥ 3, severity of disease (CIN III vs. microinvasive cancer), conization method (large loop excision of transformation zone vs. cold knife conization), and glandular extension were not significant. In multivariate analysis only positive margin ( P = 0.023, RR = 3.56, 95% CI = 1.2–10.7) and pre-cone HR-HPV load ≥ 300 RLU/PC ( P = 0.034, RR = 2.96, 95% CI = 1.1–8.1) were significant factors associated with residual disease. Conclusion. Positive margin and pre-cone HR-HPV load ≥ 300 RLU/PC were the only significant factors predicting post-cone residual disease in multivariate analysis. Appropriate application of these predictive factors may avoid post-cone hysterectomy.

The Natural History of Carcinoma In Situ Involving Bronchial Resection Margins

Microscopic residual disease in the bronchial resection margins after surgical resection of lung cancer is rare, and its clinical significance remains unsettled. We studied the natural history of patients with carcinoma in situ (CIS) at their bronchial resection margins to focus on the issue of stump recurrence. Eleven individuals who had undergone radical surgery for N0M0 lung tumors were found to have CIS at the bronchial resection margins. All of the resection specimens were reviewed with respect to the pattern of CIS extension and reclassified as follows: superficial CIS, involving surface epithelium only (CIS-S), CIS extending into the submucosal gland ducts but not deeper (CIS-D), and CIS extending into submucosal gland acini (CIS-A). Patients were followed using autofluorescence bronchoscopy and high-resolution computer tomography. Clinical parameters and the local extent of CIS at histology review were correlated with outcome. Median follow-up was 35 months (range, 15 to 89). Histology review showed two CIS-S cases, six CIS-D cases, and three CIS-A cases. All of the patients with CIS-A developed stump recurrences in contrast with those with only CIS-S. Three patients with CIS-D have developed metachronous primaries in the contralateral lung, whereas the stump region remained free of tumor. The presence of CIS in the bronchial resection margin after resection of lung cancers is associated with stump recurrences. Although absolute numbers are too small for firm conclusions, our data suggest that those with deep glandular extension of CIS bear the highest risk of early recurrence. However, the development of new primaries away from the stump region and the possible development of distant disease are equally relevant considerations with respect to the choice of additional therapy.

Carcinoembryonic antigen in intraepithelial neoplasia of the uterine cervix

Carcinoembryonic antigen (CEA) was elevated (>2.5 ng. per milliliter) in 29 of 100 patients with cervical intraepithelial neoplasia (CIN). CEA concentration was related to the amount of intraepithelial neoplasia and to the presence of glandular extension. Lymphoplasmacytic infiltration of tumor cells was unrelated to CEA levels. CEA values returned to normal within 8 weeks following surgery in 77 per cent of patients. A persistently elevated (>5.0 ng. per milliliter) plasma CEA value following conization was associated with residual CIN in the cervix. These results suggest that sequential CEA determinations may be of value in the follow-up of those cervical cancer patients who initially have high plasma antigen levels.

ANATOMIC DISTRIBUTION AND GRADING OF CARCINOMA IN SITU OF THE CERVIX

One hundred cervical cone biopsies and the subsequent hysterectomized uteri were studied. In each case the diagnosis of carcinoma in situ (CIS) was established on the cone biopsy. The lesions were classified by 4 criteria: the degree of cellular atypia, linear, circumferential and glandular extension. The patient's age and the presence or absence of residual tumor in the hysterectomy specimen were recorded. In about half of the cases the lesions were fairly well differentiated and were located at the squamocolumnar area without extension beyond 2 cervical quadrants and the superficial endocervical glands. The other half presented highly anaplastic and extensive in situ carcinomas. These patients were older and all 17 cases of residual tumor in this series occurred in this group. The most important factors in determining the presence of residual tumor are the degree of linear and circumferential extension. The grading of CIS on cone biopsy according to this method may effect a re-evaluation of the indications for hysterectomy in which the cone biopsy itself may constitute final therapy.

Anatomic distribution and grading of carcinoma in situ of the cervix.

One hundred cervical cone biopsies and the subsequent hysterectomized uteri were studied. In each case the diagnosis of carcinoma in situ (CIS) was established on the cone biopsy. The lesions were classified by 4 criteria: the degree of cellular atypia, linear, circumferential and glandular extension. The patient's age and the presence or absence of residual tumor in the hysterectomy specimen were recorded. In about half of the cases the lesions were fairly well differentiated and were located at the squamocolumnar area without extension beyond 2 cervical quadrants and the superficial endocervical glands. The other half presented highly anaplastic and extensive in situ carcinomas. These patients were older and all 17 cases of residual tumor in this series occurred in this group. The most important factors in determining the presence of residual tumor are the degree of linear and circumferential extension. The grading of CIS on cone biopsy according to this method may effect a re-evaluation of the indications for hysterectomy in which the cone biopsy itself may constitute final therapy.

Re-evaluation of four-quadrant punch biopsies of the cervix

Two hundred forty-four cases of punch biopsies of the cervix, with a diagnosis of preinvasive, questionably invasive, or minimally invasive squamous cell carcinoma of the cervix were tabulated. These patients had been treated by hysterectomy (213) or therapeutic conization (31). Of 196 lesions originally diagnosed as preinvasive, 3 (1.5 per cent) were found, after treatment, to be seriously invasive. One (3.4 per cent) of 29 questionably invasive, and 2 (10.5 per cent) of 19 minimally invasive, were also found to be seriously invasive.These cases were re-examined, and the diagnoses re-evaluated. Of 163 preinvasive lesions on biopsy, 1 (0.6 per cent) was seriously invasive in the treatment specimen; 1 (4.0 per cent) of 25 questionably invasive, and 1 (9.1 per cent) of 11 minimally invasive turned out to be seriously invasive. A total of 3 (1.5 per cent) of 199 cases were thus seriously invasive. One case was found to be lymphatic extension in the biopsy, and to be markedly invasive in the treatment specimen. The remaining 44 of the originally tabulated cases were excluded, either because of a remaining inadequate number of slides or a biopsy diagnosis now considered less than preinvasive carcinoma.The significance of biopsy adequacy, number of quadrants involved, and the presence of glandular extension, have been discussed.We believe four-quadrant punch biopsies of the uterine cervix, when properly obtained and studied, are adequate in the diagnosis of preinvasive squamous cell carcinoma of the cervix. A diagnostic cone is necessary in patients with a punch biopsy diagnosis of questionably or minimally invasive squamous cell carcinoma before definitive therapy is undertaken.

THE TREATMENT BY RADON OF THE GLANDULAR EXTENSION FROM A MALIGNANT CERVIX

Medical Journal of AustraliaVolume 2, Issue 8 p. 253-253 Original Article THE TREATMENT BY RADON OF THE GLANDULAR EXTENSION FROM A MALIGNANT CERVIX† L. S. Kidd M.D. (Melbourne), F.R.A.C.S., L. S. Kidd M.D. (Melbourne), F.R.A.C.S. MelbourneSearch for more papers by this author L. S. Kidd M.D. (Melbourne), F.R.A.C.S., L. S. Kidd M.D. (Melbourne), F.R.A.C.S. MelbourneSearch for more papers by this author First published: 01 August 1933 https://doi.org/10.5694/j.1326-5377.1933.tb55935.x †Read at the Fourth Australian Cancer Conference, Canberra, March, 1933. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue8August 1933Pages 253-253 RelatedInformation