Stage IB Squamous Cell Carcinoma Research Articles

Are positive margins associated with worse survival for patients with FIGO stage IB squamous cell carcinoma of the vulva? (471)

Are positive margins associated with worse survival for patients with FIGO stage IB squamous cell carcinoma of the vulva? (471)

Facility level volume of surgical lymph node assessment for patients with vulvar cancer: A multi-institutional database analysis (368)

<b>Objectives:</b> To investigate surgical lymph node assessment (LND) facility level volume for patients with vulvar cancer using a large hospital-based database and evaluate the potential impact on perioperative and survival outcomes. <b>Methods:</b> The National Cancer Database was accessed, and patients who were diagnosed between 2004 and 2016 with a pathologically confirmed invasive vulvar malignancy, who received all treatment at the reporting facility and underwent surgical lymph node assessment (LND) (including lymph node sampling, dissection, or sentinel lymph node biopsy) were identified. Annual LND volume was calculated for facilities that reported at least 12 cases. High-volume facilities were defined as those performing at least ten LND annually. The impact of facility volume on perioperative and survival outcomes was examined in a cohort of patients with apparent stage IB squamous cell carcinoma, and available data on lymph node status from the pathology report. Clinical-pathologic and demographic characteristics of patients managed in low and high-volume facilities were compared with the Chi-square test while overall survival (OS) was compared with the log-rank test. A Cox model was constructed to control for a priori selected confounders. <b>Results:</b> A total of 376 facilities performed at least 12 cases of LND in vulva cancer patients between 2004 and 2016. The median annual facility volume was 2.9 cases; 10^th and 90^th percentiles were 1.81 and 6.41 cases, respectively. Only eight facilities performed at least ten vulvar cancer LND cases annually. The analysis cohort included 10821 patients with apparent stage IB SCC who met the inclusion criteria; 990 (9.1%) were managed at high-volume centers. There was no difference between patients managed in low and high-volume facilities in terms of patient age, insurance status, and presence of comorbid conditions. Rate of lymph node metastases (22.4% vs 24%, p=0.24) and 90-day mortality (1.5% vs 1.4%, p=0.66) were comparable between low and high-volume facilities. The rate of prolonged hospital stay (defined as >3 days) was higher in low-volume facilities (26.2% vs 21.2%, p<0.001); however, the rate of unplanned re-admission 30 days from discharge was lower (5.2% vs 7.8%, p<0.001). There was no difference in OS between low and high-volume facilities (median OS: 106.9 and 108.9 months, respectively, p=0.21). However, patients who had negative lymph nodes who were managed at highvolume facilities had better OS (p=0.024); 5-year OS rates were 80% and 75%, respectively. After controlling for patient age, race, insurance status, presence of comorbid conditions, history of another tumor, tumor size, and status of lymph nodes, there was no difference in OS between low and high-volume centers (HR: 0.93; 95% CI: 0.83, 1.04). <b>Conclusions:</b> The majority of institutions in the United States perform very few LND for vulvar cancer. Although facility volumes do not appear to affect OS, lymph node assessments appear to be more accurate at high-volume centers.

Safety and efficacy study of laparoscopic or robotic radical surgery using an endoscopic stapler for inhibiting tumour spillage of cervical malignant neoplasms evaluating survival (SOLUTION): a multi-centre, open-label, single-arm, phase II trial protocol

BackgroundThe Laparoscopic Approach to Cervical Cancer trial and Surveillance, Epidemiology, and End Results program database study demonstrated that minimally invasive radical hysterectomy was inferior to abdominal radical hysterectomy in terms of disease recurrence and survival. Among risk factors related to poor prognosis after minimally invasive surgery (MIS), tumour spillage during intracorporeal colpotomy became a significant issue. Thus, we designed this trial to evaluate the efficacy and safety of minimally invasive radical hysterectomy using an endoscopic stapler for early-stage cervical cancer.MethodsThis trial is a prospective, multi-centre, open-label, single-arm, non-inferiority phase II study. The nine organisations will participate in this trial after the approval of the institutional review board. Major eligibility criteria include women aged 20 years or older with cervical cancer stage IB1 squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma according to the revised 2009 FIGO staging system who will undergo type B2 or C hysterectomy by MIS. The primary endpoint is the 4.5-year disease-free survival (DFS) rate between abdominal radical hysterectomy and MIS using an endoscopic stapler. For calculating the sample size, we hypothesised that the 4.5-year DFS rate after MIS using an endoscopic stapler is assumed to be the same after abdominal radical hysterectomy at 90.9%, and the non-inferiority margin was 7.2%. When we consider a three-year accrual and 4.5-year follow-up, at least 13 events must happen, requiring a total of 111 patients assuming a statistical power of 80% and the one-tailed test of 5% significance. A total of 124 patients is needed, considering a drop-out rate of 10%.DiscussionWe expect intracorporeal colpotomy using an endoscopic stapler may prevent tumour spillage during MIS for stage IB1 cervical cancer, showing a comparable prognosis with abdominal radical surgery.Trial registrationClinicalTrials.gov; NCT04370496; registration date, May 2020.

Benefit of adjuvant chemotherapy for patients with stage IB non-small cell lung cancer: a systematic review and meta-analysis.

BackgroundAdjuvant chemotherapy (ACT) is routinely the recommended treatment for patients with advanced non-small cell lung cancer (NSCLC) but remains a controversial option in stage IB patients. We therefore pooled the current evidence to determine the prognostic impact of ACT in stage IB NSCLC patients in the context of the eighth tumor, node, metastasis (TNM) staging system.MethodsFive electronic databases were searched for eligible studies up to December 2020 without language restrictions. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS). Search results were filtered by a set of eligibility criteria and analyzed in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The risk of bias was assessed independently using a modified set. Stata 16.0 was used for general data analysis and meta-analysis, and subgroup analyses were performed to investigate the source of interstudy heterogeneity.ResultsIn all, 12 eligible studies were identified and 15,678 patients included. Our results demonstrated that ACT was associated with improved OS [n=11; hazard ratio (HR) =0.65; 95% confidence interval (CI): 0.60–0.70; P<0.001; I2=33.4%, P=0.131] and DFS (n=9; HR =0.73; 95% CI: 0.63–0.83; P<0.001; I2=66.7%, P=0.002) in stage IB NSCLC patients. Subgroup analysis by histology indicated that administration of ACT conferred more favorable survival to both stage IB squamous cell carcinoma (n=1; HR =0.56; 95% CI: 0.28–0.84; P<0.001) and adenocarcinoma (n=6; HR =0.59; 95% CI: 0.47–0.71; P<0.001; I2=31.0%, P=0.203). Meanwhile, both platinum-based ACT (n=7; HR =0.62; 95% CI: 0.51–0.74; P<0.001; I2=44.8%, P=0.093) and other regimens (n=2; HR =0.66; 95% CI: 0.61–0.72; P<0.001; I2=0.7%, P=0.316) could benefit patients with stage IB disease.DiscussionACT might provide survival benefits to patients with stage IB NSCLC irrespective of histology or regimens. Patient selection and time trend biases were inevitable due to the limitation of retrospective studies. More prospective studies should be initiated to investigate the optimal ACT regimens in different histologic types in stage IB NSCLC patients.

P84.20 VATS Right Upper Lobectomy for Advanced Non-Small Cell Lung Cancer After ALK-Tyrosine Kinase Inhibitor Administration.

Surgical resection is not generally indicated, but systemic chemotherapy or several molecular-targeted agents are selected as main treatments for advanced lung cancer. But as for the molecular-targeted agents, most patients eventually experience tumor progression due to acquired resistance. The role of residual or recurrent tumor resection after the treatment is unclear. A 65 year-old man was referred to our hospital due to abnormal radiographic image. Chest CT revealed a 50mm solid mass in the right upper lobe. The tumor involved hilar lymph node and extended to the junction of upper lobar bronchus. MRI revealed a 20mm brain metastasis in the left parietal lobe. He was initially diagnosed with cT2bN1M1b StageIVA EGFR(-) adenocarcinoma by transbronchial lung biopsy. Then, brain metastasis was removed surgically. He was finally diagnosed with ALK-rearranged adenocarcinoma from tissue of brain metastasis. Alectinib (600mg/day) was started as the first-line therapy. After 14 months of alectinib therapy, chest CT revealed remarkable reduction of the tumor and other two new lesions in the right upper lobe. One was a 10mm nodule close to the scar of primary tumor, which had not found at chest CT from three months ago. The other was a 15mm nodule apart from the scar, which existed before the alectinib treatment and had got larger gradually. PET-CT revealed the high fluorodeoxyglucose (FDG) uptake of only two new lesions. We performed complete VATS right upper lobectomy and mediastinal lymph node dissection for treatment and diagnosis. Histopathlogical diagnoses: No residual viable cell was found in the primary lesion. The lesion close to the scar of the primary lesion was adenocarcinoma (ALK-rearranged), which was thought to be a recurrent lesion because of resemblance to brain metastasis in pathological tissue. The lesion apart from the main lesion was pT1bN0M0 StageIB squamous cell carcinoma, which was thought to be primary lung cancer. Alectinib was continued after the operation, and chest CT shows no sign of recurrence so far. We experienced a VATS right upper lobectomy for advanced non-small cell lung cancer after ALK-tyrosine kinase inhibitor administration.

Robotic Radical Trachelectomy with an Abdominally Placed Vaginal Cerclage

Study Objective To demonstrate a robotic radical trachelectomy where-in a vaginal purse-string suture was placed abdominally in order to contain the cervical tumor. Design A case report. Setting A tertiary referral center. Patients or Participants A 32-year-old gravida 0 presented with stage IB1 squamous cell carcinoma of the cervix. Pelvic MRI demonstrated a tumor the size of 1.5cm where the upper margin of the lesion was >2 cm from the uterine isthmus. PET/CT was without evidence of metastatic disease. Interventions The patient desired future fertility and opted for a robotic radical trachelectomy. The patient was placed in dorsal lithotomy position. No intrauterine manipulator was placed. ICG dye was injected onto cervix for delineation of pelvic sentinel lymph nodes. Bilateral pararectal, paravesical, and obturator spaces were developed after which bilateral pelvic sentinel lymph nodes were removed with negative frozen results. The uterine arteries were skeletonized and separated from their ureteral attachments. The rectovaginal and vesicovaginal spaces were developed. The bilateral paracervix were transected off. 2-0 prolene suture was utilized to place a purse-string suture onto upper vagina. The colpotomy was then performed circumferentially and cervix was amputated about 1 cm below the uterine isthmus. Trachelectomy specimen margins were negative. The upper vagina was then reconstructed to the lower uterine segment. A pediatric foley was placed into the lower uterine segment to minimize the risk of cervical stenosis. Measurements and Main Results Robotic radical trachelectomy was performed without any complications, where-in a uterine manipulator was avoided and a purse-string suture was placed onto upper vagina to minimize tumor manipulation and prevent spillage into peritoneal cavity, respectively. Conclusion We believe that if MIS surgeons adhere to basic oncologic surgical principles, we will be able to provide our patients with proven MIS benefits without compromising oncological safety.

Uterine Artery–sparing Minimally Invasive Radical Trachelectomy: A Case Report and Review of the Literature

Radical trachelectomy is considered in patients with early-stage cervical cancer who desire future fertility. This article is accompanied by a video that provides step-by-step demonstration of a uterine artery-sparing robotic-assisted radical trachelectomy in a patient with stage IB1 squamous cell carcinoma of the cervix, a 2-cm mass, and a desire for future fertility. We also conducted a review of the literature examining the use of uterine artery-sparing techniques among minimally invasive radical trachelectomies. Using PubMed, Google Scholar, and Ovid search tools, 28 total publications were reviewed, of which 16 were eligible for use in our comparison. With the addition of our case report, a total of 154 cases sparing the uterine artery and 40 cases sacrificing the uterine artery were examined, including both conventional laparoscopic and robotic-assisted approaches. Data describing patient demographics as well as surgical, oncologic, and fertility outcomes were collected. The mean age was 30 years for the spared group and 32 years for the sacrificed group. At least 42% of the women in the spared and 53% of the uterine artery-sacrificed group were nulliparous. The majority of cases in both the spared and sacrificed groups represented squamous cell histology (71% for spared and 51% for sacrificed) followed by adenocarcinoma (24% vs 43%). The majority of the patients in both groups had stage IB1 disease (79% for spared vs 65% for sacrificed). The operative times among the 2 groups were similar, with a mean time of 314 minutes (range, 170-420 minutes) in the spared group and 283 minutes (range, 172-345 minutes) in the sacrificed group. The mean estimated blood loss was 173 mL (range, 23-300 mL) in the spared group and 77 mL (range, 50-250 mL) in the sacrificed group. The recurrence rates for the uterine artery-sparing and -sacrificing groups were equal at 2.6% after a mean follow-up of 42 months and 26 months, respectively. The methods of reporting fertility outcomes were varied among the different publications, with 41 patients achieving pregnancy in the spared group and 2 patients achieving pregnancy in the sacrificed group. Among patients who were not trying to conceive or had not conceived, 15 patients in the spared group and 6 patients in the sacrificed group were reported to have normal menses. The successful preservation of uterine arteries supports the maintenance of uterine arterial blood flow and is used by many gynecologic surgeons performing minimally invasive radical trachelectomy, with promising oncologic and obstetric outcomes.

Definite chemoradiotherapy is a competent treatment option in FIGO stage IB2 cervical cancer compared with radical surgery +/- neoadjuvant chemotherapy.

To compare the treatment outcomes of different treatment modalities for International Federation of Gynecology and Obstetrics (FIGO) stage IB2 cervical cancer. From January 2002 to July 2016, 91 patients with FIGO stage IB2 squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma of the cervix were enrolled. All of them received one of the following treatment modalities, including intensity-modulated radiotherapy (IMRT) with concurrent platinum-based chemotherapy (CCRT group, n=27), radical surgery with or without adjuvant treatment (RH group, n=25), or neoadjuvant chemotherapy followed by radical surgery with or without adjuvant treatment (NACT group, n=39). Overall survival (OS), disease free survival (DFS), loco-regional failure-free survival (LRFFS) and distant metastasis-free survival (DMFS) were compared among the three different groups. The median follow up durations were 63.3 months for the CCRT group, 83.5 months for the NACT group, and 89.8 months for the RH group, respectively. The 5-year OS, DFS, LRFFS and DMFS for CCRT group vs. NACT group vs. RH group were 80.1% vs. 94.1% vs. 93.8% (p=0.197), 79.5% vs. 79.3% vs. 91.0% (p=0.401), 88.1% vs. 81.8% vs. 95.8% (p=0.253), and 83.3% vs. 88.8% vs. 95.2% (p=0.422). No significant prognostic factor was found in OS. Age>48 was significant in predicting poor DFS and DMFS. The non-squamous cell carcinoma was a significant predictor of poor DFS, LRFFS and DMFS. CCRT is a feasible therapeutic option with acceptable acute and chronic treatment-related toxicities for patients who cannot tolerate radical surgery or neoadjuvant chemotherapy.

Contemporary recurrence and survival outcomes for stage IB squamous cell carcinoma of the vulva: Time to raise the bar

Contemporary recurrence and survival outcomes for stage IB squamous cell carcinoma of the vulva: Time to raise the bar

The prognostic significance of histology and treatment modality in stage IB1 squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma of the uterine cervix: SEER study 2004–2008

Objective: To determine the significance of histology and treatment modality on overall survival and cause-specific survival in stage IB1 cervical...

Is There a Difference in Cause-Specific Survival and Overall Survival in 1B1 Squamous Cell Carcinoma and Adenocarcinoma of the Uterine Cervix?: SEER Database 2004-2008

To determine the significance of histology and treatment modality on overall survival (OS) and cause-specific survival (CSS) in stage IB1 cervical carcinoma. Cases of stage IB1 squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the uterine cervix managed with either radical hysterectomy (RAH), local tumor destruction (including methods such as cryotherapy, laser ablation, excisional biopsy, or trachelectomy, etc.) followed by radiation therapy (RT) which may include external beam radiation therapy (EBRT) and/or brachytherapy (BT), or simple total hysterectomy with RT which may include EBRT and/or BT were abstracted from the SEER database (2004-2008). The primary endpoints of this study were OS and CSS. Statistical methods included Kaplan-Meier and Cox regression analyses. 5-year OS for SCC and AC were 82.9% and 87.2%, respectively (p = 0.06). 5-year CSS for SCC and AC were 92.8% and 90.6%, respectively (p = 0.20). On multivariate Cox regression analysis, patients with AC were not more likely to die of cervical cancer than patients with SC (HR = 1.072, p = 0.821). 5-year OS for patient with IB1 disease was 88.3%, 76.9%, and 84.9% for RAH, local surgery with RT, and TAH with RT, respectively (p = 0.002). 5-year CSS for patients with IB1 disease was 96.6%, 86.1%, and 96.9% for RAH, local surgery with RT, and TAH with RT, respectively (p<0.0001). On multivariate Cox regression analysis, patients who received RAH had improved CSS compared to patients who received local surgery with RT. (HR 4.272, p<0.0001); patients who received RAH did not have improved CSS compared to patients who received TAH with RT (HR 1.007, p = 0.987). No significant difference in OS or CSS between patients with stage IB1 SCC or AC of the cervix was identified. In IB1 patients, management with RAH was associated with improved OS compared to management with local surgery and RT or management with TAH and RT. In IB1 patients, management with RAH or TAH and RT was significantly associated with improved CSS compared to management with local surgery and RT. Radiation is not a preferred method to compensate for inadequate surgery.

Mirror-Image Lymph Node in FDG PET/CT and SPECT/CT for Sentinel Node Detection

We report a case of a patient with presumed stage IB1 squamous cell carcinoma of the cervix in which FDG PET/CT scan revealed 1 hypermetabolic left iliac node suggestive to be malignant. Lymphoscintigraphy and SPECT/CT studies previous to sentinel node (SLN) biopsy revealed unilateral drainage in the right pelvis. Intraoperative pathological assessment of the SLN showed no tumoral involvement, and the hypermetabolic node revealed macrometastasis. Tumor node invasion can lead to a lymphatic blockage and become false-negative for SLN technique. Although FDG PET/CT has lower sensitivity than surgical staging, this case shows its value as a preoperative imaging technique.

Radical Abdominal Trachelectomy for IB1 Cervical Cancer at 17 Weeks of Gestation: A Case Report and Literature Review.

Background. With regard to the therapy for early invasive cervical carcinoma during pregnancy, radical trachelectomy is also a treatment of choice, along with its advantages and disadvantages. Case Report. A 28-year-old woman, para 1-0-0-1, was diagnosed with FIGO stage IB1 squamous cell carcinoma of the cervix at 12 weeks of gestation. The patient underwent radical abdominal trachelectomy with pelvic lymphadenectomy at 17 weeks of gestation. Her pregnancy was successfully maintained after the surgery. The patient underwent a planned cesarean section at 38 weeks of gestation. A healthy baby girl weighing 2970 g was born with an Apgar score of 8/9. The mother and child in overall good health were discharged. Ten months after the delivery, there was no clinical evidence of recurrence. Conclusions. We believe that it is appropriate to perform radical abdominal trachelectomy in the early second trimester with preserving uterine arteries, although it is a technically challenging approach. It may be possible that radical abdominal trachelectomy during pregnancy can help women avoid the triple losses of a desired pregnancy, fertility, and motherhood.

“Kegel ball” induced vaginal cuff dehiscence following radical abdominal hysterectomy: Laparoscopically-assisted transvaginal retrieval

The patient was a healthy 27year-old female who underwent uncomplicated exploratory laparotomy with Piver/Rutledge class III radical abdominal hysterectomy and pelvic lymphadenectomy for FIGO Stage IB1 squamous cell carcinoma of the cervix. Pathology revealed a 3cm moderately differentiated squamous cell carcinoma invading 8/13mm cervical thickness. There was no lympho-vascular space invasion and 24 pelvic lymph nodes were negative for metastasis. No adjuvant therapy was administered and the patient had an uncomplicated post-operative course.

Neoadjuvant Chemotherapy with Paclitaxel Plus Platinum Followed by Radical Surgery in Early Cervical Cancer During Pregnancy: Three Case Reports

To date, only seven women with Stage Ib1 to IIb cervical cancer during pregnancy treated with neoadjuvant chemotherapy followed by radical surgery have been reported. We describe three cases of pregnant women with Stage Ib1 to IIa cervical cancer who were treated with paclitaxel plus platinum neoadjuvant chemotherapy followed by radical surgery. The first patient had a Stage Ib1 small cell neuroendocrine carcinoma of the cervix, the second had a Stage IIa, 8 cm squamous cell carcinoma of the cervix and the third had a Stage Ib2 squamous cell carcinoma and positive lymph nodes. The three patients and their newborns were followed up. All patients had a partial or complete response to neoadjuvant chemotherapy. Two of these patients developed recurrences and one died due to progressive disease at 49 months. All neonates were healthy and had no abnormalities. In conclusion, neoadjuvant chemotherapy with paclitaxel and platinum followed by radical surgery may be an option for pregnant women with invasive cervical cancer.

Influence of lymph vascular space invasion on prognosis of patients with early-stage cervical squamous cell carcinoma

In the past decade, no remarkable improvement has been made in the 5-year survival of cervical cancer patients. This study was to explore the influence of lymph vascular space invasion (LVSI) on the prognosis of patients with early-stage cervical squamous cell carcinoma. A total of 111 eligible patients with FIGO stage IB and IIA cervical squamous cell carcinoma underwent radical hysterectomy and pelvic lymphadenectomy at Sun Yat-sen University Cancer Center between January 1995 and December 2002. The histopathological slides of the 111 patients were reviewed by a senior gynecological pathologist. LVSI, invasion depth, tumor differentiation and lymph node metastasis were evaluated. LVSI was present in 62 patients. The univariate analysis showed that the risk factors of overall survival (OS) included positive LVSI (P = 0.019) and lymph node metastasis (P = 0.002), while the risk factors of progression-free survival (PFS) included LVSI (P = 0.029), lymph node metastasis (P = 0.002), SccAg value (P = 0.018), invasion depth (P = 0.022) and positive surgical margin (P = 0.002). The multivariate analysis showed that lymph node metastasis was the independent prognostic factor of OS (P = 0.015), while lymph node metastasis and positive surgical margin were the independent factors of PFS (P = 0.006, P = 0.006). LVSI was correlated with lymph node metastasis (P = 0.011). Whether LVSI is an independent prognostic factor of early-stage cervical squamous cell carcinoma cannot be determined currently while LVSI is a risk factor of metastasis and relapse.

Expression and prognostic relevance of CD44v6 in stage I non-small cell lung carcinoma

Expression of CD44 and its variants has been shown to be relevant to tumor progression in various human malignancies. We evaluated the expression of CD44v6 in the primary lesions of stage I non-small cell lung cancer (NSCLC) and correlated the expression level to its prognosis. The expression of CD44v6, measured by immunohistochemistry, was assessed in the tumor specimens from 190 patients with stage I NSCLC. Each slide was assigned a score: the average of the score of tumor cells staining multiplied by the score of staining intensity. And depending on the cut-off score based on receiver operating characteristic (ROC) curve analysis, the CD44v6 expression was categorized into high- and low-level groups, which were then correlated directly with the clinical outcomes. The high expression of CD44v6 was detected more frequently in the squamous cell carcinoma (38 of 71 patients, 53.5%) than in the other types of carcinoma (p < 0.05). The Kaplan-Meier survival curves showed that high level expression of CD44v6 indicated a better post-operative survival (p = 0.006), especially for stage IB disease (p = 0.049) and squamous cell carcinoma (p = 0.029). The multivariate analysis also confirmed that the expression of CD44v6 was an independent prognostic indicator (p = 0.011). CD44v6 might be correlated with histogenesis of NSCLC, and its decreased expression may be an adverse prognostic indicator for the patients with stage I NSCLC, especially for those with stage IB diseases. Patients of this subgroup might need adjuvant therapy additionally.

Histopathological and immunohistochemical (cytokeratins AE1/AE3) study of the parametrium of patients with early stage cervical cancer

Objective This study was undertaken in order to evaluate histopathological and immunohistochemical (cytokeratins AE1/AE3) characteristics of parametrial invasion in patients with early stage cervical cancer. Study design Thirty patients with stage IB squamous cell carcinoma (SCC) of the cervix submitted to radical hysterectomy from November 2001 to September 2002 were prospectively studied. Histopathological studies were undertaken using tissue samples ( n = 60) taken from the parametrium, whose surgical margins were inked and the entire parametrial tissue was fixed in 10% buffered formalin and embedded in paraffin for further analysis using hematoxylin–eosin (H&E) staining. Specific patterns of parametrial involvement (continuous invasion, parametrial lymphatic vascular space invasion (LVSI) and/or parametrial lymph nodes’ (PMLN) metastasis) were recorded. Parametrial samples, in which the histological examination showed no tumor involvement, were immunohistochemically assessed through monoclonal antibodies for cytokeratins AE1/AE3. Clinicopathological characteristics of the patients were also recorded. Results Patient’s mean age was 49 ± 10 years (27–73 years). Histopathological analysis (H&E) showed parametrium involvement in 12 patients (40%) of whom 11 (92%) presented parametrial LVSI, 9 (75%) continuous invasion and 4 (33%) PMLN metastasis. Micrometastasis was detected in 3/18 (17%) of the patients with histologically negative parametrium by H&E evaluation. Parametrial involvement detected by H&E was associated with tumor recurrence ( p = 0.009) and survival ( p = 0.025). This association was not correlated with the presence of parametrial micrometastasis ( p = 1.00 and 1.00, respectively). Conclusions The process of parametrial spreading in patients with SCC of the cervix may develop several histopathological patterns, which are associated with clinicopathological features and prognosis. Our findings highlight the importance to ink the parametria, which is the only way to define the pattern of tumor spreading. The clinical significance of micrometastasis, detected in patients with histologically negative parametrium by H&E, remains to be clear.

Low podoplanin expression of tumor cells predicts poor prognosis in pathological stage IB squamous cell carcinoma of the lung, tissue microarray analysis of 136 patients using 24 antibodies

The aim of this study was to identify clinicopathological and biological prognostic markers for patients who had undergone complete resection of pathological stage IB squamous cell carcinoma (SqCC) of the lung. A total of 136 consecutive stage IB SqCC patients fulfilled eligibility criteria, and their clinicopathological factors were evaluated. Tissue microarrays were also constracted, and immunohistochemical staining with 24 antibodies was performed. Correlations between clinicopathological factors, antibody immunohistochemical reactions, the patients’ overall survival (OS) and relapse-free survival (RFS) were evaluated. The univariate analysis showed that 70-year-old and over elderly group had a shorter OS time and RFS time than the younger group ( p = 0.0086 and p = 0.0091, respectively). The univariate analysis for immunohistochemical staining showed that the podoplanin-negative group had a shorter OS time and RFS time than the podoplanin-positive group ( p = 0.0106 and p = 0.0308, respectively). Multivariate analysis revealed a significant correlation between both the 70-year-old and over elderly group and the podoplanin-negative group and poor outcome (OS, p = 0.007 and p = 0.008, respectively; RFS, p = 0.008 and p = 0.024, respectively). The results showed that patient age and a novel biological prognostic marker, podoplanin, are useful for predicting a poor outcome of patients after complete resection of stage IB SqCC of the lung.

The use of LigaSure for preservation of a previous coronary artery bypass graft by using the left internal thoracic artery in a left upper lobectomy

We report an interesting clinical case concerning the use of an electrothermal bipolar tissue-sealing system (LigaSure, Valleylab, Inc, Boulder, Colo) 1 in a particularly challenging technical situation, such as the resection of the left upper pulmonary lobe in a patient with a previous coronary artery bypass graft (CABG) with the left internal thoracic artery (LITA). Clinical Summary In a 63-year-old man, an opacity localized in the left upper pulmonary lobe was incidentally discovered on chest radiographic analysis. He had undergone CABG 8 years before with the LITA on the left anterior descending coronary artery. Clinical and laboratory evaluation showed no abnormalities. Spirometric results were normal. Computed tomographic analysis demonstrated a peripheral mass in the left upper lobe, and there was no significant mediastinal adenopathy. Bronchoscopy did not demonstrate abnormalities of the left upper bronchus, and percutaneous needle biopsy showed a non‐small cell lung cancer (NSCLC). A standard posterolateral thoracotomy incision was performed through the fifth intercostal space. A 6-cm tumor was found in the left upper lobe (Figure 1). The dissection of the lobe from the pericardium was possible, but dense adhesions were identified between the LITA and the apex of the upper lobe. The challenge was to do an upper lobectomy while avoiding injury to the LITA. Therefore the part of parenchyma adjacent to the LITA was separated from the upper lobe by using LigaSure system (Figure 2). After this maneuver, we performed an anatomic upper lobectomy, leaving a small strip of parenchyma adjacent to the LITA; we tested the arterial graft manually, and a good pulsation was found. Anatomopathologic studies showed a 6‐cm stage IB squamous cell carcinoma, according to TNM classification. 2 The patient’s postoperative course was unremarkable, and he was discharged on the seventh postoperative day.