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Background/aim: The trend in today's surgical gynecological oncology is to provide equal oncological safety with less radical surgery. The SHAPE trial demonstrated the non-inferiority of a simple hysterectomy compared to a radical hysterectomy in low-risk cervical cancer. As a result, the accuracy of preoperative diagnostics has become increasingly important to avoid both under- and overtreatment. The aim of the study was to investigate the accuracy of MRI-based T-stage., Patients and Methods: Forty-five patients who were surgically treated for an initial diagnosis of a primary cervical carcinoma at the University Hospital Cologne in the Department of Gynecology and Obstetrics between 2015 and 2021 were included in the study. All patients underwent MRI prior to their surgical treatment., Results: In 44.4% of cases, the pathological tumor size in the surgical specimen was consistent with the preoperative tumor size determined by MRI. In 28.9% of the cases, MRI overestimated the final pathologic T-stage while in 26.7% of cases, MRI underestimated it. Furthermore, we were able to show that overall survival was significantly poorer (p<0.05) in patients whose preoperative MRI had underestimated the final T-stage in our study cohort., Conclusion: Preoperative MRI diagnostics alone are not reliable enough for accurate T-stage estimation. Multimodal diagnostic approaches are essential for accurate preoperative staging. Prospective trials are needed to evaluate preoperative staging strategies to optimize sizing accuracy., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: This study investigated the clinical impact of resection of pelvic sentinel lymph nodes (PSLNs) in squamous cell vulvar cancer (SCVC)., Patients and Methods: Sixty-two groins of 33 patients with SCVC who underwent sentinel lymph node (SLN) resection between 2010 and 2021 at the University Hospital of Cologne, Germany, were analyzed in this retrospective cohort study. The frequency of additionally resectable PSLNs, histological findings, and count rates were analyzed and compared to the findings for inguinal sentinel lymph nodes (ISLNs)., Results: In all patients and in 61 (98%) of the 62 radiolabeled groins, at least one SLN could be resected. Five (8%) of the 62 groins had histologically confirmed lymph node metastases (4/33 patients, 12%). Twenty (33%) of the 62 groins underwent additional PSLN resection. Resection of these PSLNs was feasible without causing an additional burden for the patients. None of the PSLNs showed signs of tumor infiltration. Information on the extent of radioactivity for ISLNs and simultaneously for PSLNs, expressed as count rate of intraoperative measurement with the gamma probe, was available for 20 (32%) groins. In three (15%) of these cases, the highest count rate in a SLN was found in a PSLN and not in an ISLN., Conclusion: Resection of PSLNs is feasible and can be performed without short-term complications. In patients with early SCVC, resection of PSLNs is not necessary, even in those with early infiltration of inguinal lymph nodes. The intraoperative count rate of SLN is not relevant for the decision to perform resection., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: To date, magnetic resonance imaging (MRI) remains the gold standard for diagnosing breast implant rupture. As MRI is an expensive procedure with limited availability, the improvement of sonographic assessment is desirable. A potentially useful tool in this regard is elastography. To evaluate the diagnostic benefits of strain elastography and shear wave elastography under standardized conditions we developed an animal model., Materials and Methods: An animal model was created by preparing an implant site in a chicken breast, imitating tissue layers covering a breast implant after mastectomy. Different broken and intact implants were inserted. Thereby, measurements were performed using strain elastography and shear wave elastography. For strain elastography, the resulting images were investigated on repeated patterns. The data generated by shear wave elastography were analyzed for significant differences between the ruptured and intact implants., Results: The animal model using chicken breast generated realistic images and measurements comparable to those of a human breast. Hence, ruptured and intact implants could be compared under standardized conditions. Statistical analysis showed no significant difference between intact and ruptured implants with respect to the data generated by shear wave elastography. Qualitative analysis using strain wave elastography showed different patterns between intact and ruptured implants in the animal model. Intact implants showed a characteristic sonographic image of three layers in certain levels., Conclusion: Shear wave elastography does not seem to produce reliable data for the evaluation of breast implants, whereas qualitative analysis using strain elastography might be a useful tool to improve diagnostic accuracy., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: The aim of this study was to evaluate the difference in clinical outcomes in patients with histologically confirmed cervical cancer of the uterus treated with either laparoscopy or laparotomy with curative intent between 2011 and 2017 at the Department of Gynecology and Obstetrics of University Hospital Cologne., Materials and Methods: This retrospective analysis included all patients who received surgical treatment with curative intent between January 2011 and December 2017 for stages IA1 to IIB cervical carcinoma. Patients receiving primary or secondary surgery after neoadjuvant chemotherapy were also included., Results: In total, 75 patients were included, of whom 34 patients underwent minimally invasive surgery and 41 underwent open surgery. Neoadjuvant chemotherapy was performed in 10 patients in the minimally-invasive group and in 14 patients in the laparotomy group. Statistically, no significant difference in overall survival (OS) was observed in both groups. Disease-free survival showed a significant difference in favor of the minimally invasive group., Conclusion: Minimally invasive surgical therapy for cervical cancer improves disease-free-survival. Prospective trials are needed to further confirm these results., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: The aim of the present study was to analyze metastasized breast cancer (BC) patients with regard to the discordance of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). We especially aimed to analyze the association between the change of tumor biology and previous treatment or metastatic sites., Patients and Methods: Patients with metastasized BC who were treated at the Department of Gynecology/Breast Center of the University Hospital of Cologne were analyzed., Results: Loss of HER2 occurred more frequently in lymph node metastases that were not in the axillary region (p=0.026). Letrozole showed a significant correlation with loss of ER and/or PR (p=0.041). Improved overall survival and post-metastasis survival were noticed with a gain of HER2 (p=0.044 and p=0.009, respectively) and concordant positive ER and PR status (p=0.002 and p=0.001, respectively)., Conclusion: The discordance of receptors and the dependence of BC on therapies as well as metastatic sites stresses the necessity of early sample taking to offer patients suitable therapy options., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Clinical data concerning synthetic meshes in comparison to acellular dermal matrices (ADMs) in breast reconstruction are limited. Also, direct comparisons between titanium-coated polypropylene mesh and partially absorbable polypropylene mesh have not yet been reported., Materials and Methods: This analysis represents a retrospective, single-surgeon, multi-center study of 320 cases using either TiLoop Bra/TiMesh® (n=192) or Seragyn® (n=128) in breast reconstruction. Results were compared with ADM-based reconstructions (Epiflex® and SurgiMend®)., Results: Major complication rates (i.e. revision surgery) occurred in 3.9% (Seragyn®) and 8.3% (TiLoop Bra/TiMesh®) of all cases. Minor complications occurred in 18% (Seragyn®) and 8.9% (TiLoop Bra/TiMesh®). Subgroup analysis showed red breast syndrome to occur more often in the Seragyn group (3.9% Seragyn® vs. 0.5% TiLoop Bra/TiMesh®, p<0.05)., Conclusion: TiLoop Bra/TiMesh® and Seragyn® do not differ significantly in complication rates. There was no difference in performance when compared to ADMs., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Estimating distant recurrence risk in women with estrogen receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer is still challenging. Oncotype DX® is a gene expression-based test predicting the likelihood of recurrent disease. This study analyzed the difference in oncological decision making with and without the knowledge of gene-expression tests based on oncological work experience., Materials and Methods: This was a retrospective analysis including n=113 patients diagnosed with hormone receptor-positive, HER2-negative breast cancer between 2011 and 2015 at the Municipal Breast Cancer Center Cologne, Germany. All 113 patients underwent evaluation by OncotypeDX®. An oncological Tumor Board with knowledge of these results served as baseline (control group). This baseline was compared to the treatment decision for adjuvant chemotherapy reached by oncologists with different experience levels (less than 5 years, between 5 and 15 years and more than 15 years) who were not provided the OncotypeDX® results., Results: Inexperience led to a significant increase in recommendations for chemotherapy, with those made by the Tumor Board being least frequent (41.6% vs. <5 years=55.6%, 5-15 years=50.4%, and >15 years=42.5%; p<0.05). An exploratory subgroup analysis showed the Tumor Board was significantly less likely to recommend chemotherapy for patients with Ki67 >14%, pN1 and postmenopausal status than were oncologists with up to 15 years experience, with a strong trend for those with tumor size larger than pT2., Conclusion: With a maximum reduction of 14.2% for those with the lowest level of oncological experience, the likelihood of recommending chemotherapy was found to decrease with increasing oncological work experience. A subgroup analysis showed that differences in decision making were most likely in patients with a Ki67 >14%, tumor sizes larger than pT2, pN1 and postmenopausal patients. It is the opinion of this study group that gene-expression testing is especially pertinent for these subgroups., (Copyright© 2019, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Breast cancer is a heterogenous and complex disease. A rare site of metastatic breast cancer disease is the neck. Data about supraclavicular metastases in patients with metastatic breast cancer are still lacking. Hence, our study aimed to analyze histological subtypes of supraclavicular metastases compared to the primary site., Materials and Methods: This was a retrospective hospital-based cohort study of patients with breast cancer who developed supraclavicular metastases. Diagnosis of supraclavicular metastases was confirmed by biopsy or diagnostic lymph node extirpation. Histological subtypes were analyzed and Kaplan-Meier estimates were calculated for overall survival., Results: A total of 20 patients were included in the analysis. The majority of the patients (12/20) had hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative supraclavicular metastases, disease in 3/20 patients was HR-positive/HER2-positive, HR-negative/HER2-positive in 1/20 patients and basal-like in 4/20 patients. Total discordance rates for estrogen receptor, progesterone receptor and HER2 between primary and metastatic tumors were 20.0%, 36.8% and 29.4%, respectively. The 5-year overall survival was 80%, whereas the 5-year survival after the onset of neck metastasis was 45%., Conclusion: As a rare site of metastatic breast cancer, supraclavicular metastases are associated with a worse median overall survival from their onset. The high rate of discordance of histological subtype stresses the necessity for biopsies in patients with supraclavicular metastasis., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: The Ki-67 index is chiefly important for distinguishing between luminal A and luminal B human epidermal growth factor receptor 2 (HER2neu)-negative breast cancer subtypes. However, its ability to predict response to chemotherapy is uncertain., Patients and Methods: Patients treated for primary breast cancer at the University Hospital of Cologne were identified. Immunohistochemistry for Ki-67 detection was performed according to standard protocols. Kaplan-Meier survival curves were calculated and compared using the log-rank test., Results: Patients with low Ki-67 index had a significantly better disease-free-survival (DFS) than patients with high Ki-67 index (hazard ratio=2.85; 95% confidence interval=1.45-5.59; p=0.002). A significant influence on DFS was demonstrated (hazard ratio(HR)=1.02; confidence interval(CI)=1.00-1.04; p=0.048) within the subgroup of hormone receptor-positive and HER2neu-negative patients, but not within the subgroup of those with luminal B/HER2neu-negative tumors (DFS: p=0.801; overall-survival: p=0.379)., Conclusion: The Ki-67 index has a prognostic impact on DFS in patients with hormone receptor-positive and HER2neu-negative tumors. The strict cut-off value was not suitable for distinguishing between high- and low-risk patients and their response to adjuvant chemotherapy., (Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Estrogen receptor-alpha is usually expressed in normal cervical tissue, but its presence is decreased or absent in invasive cervical cancer indicating that its expression is lost during development of invasive cervical cancer. The aim of the present study was to investigate ESR1 promoter methylation in cervical cancer and correlate methylation status with clinico-pathological parameters., Materials and Methods: Fifty patients treated for cervical cancer were included in the study. Isolation and bisulfite treatment of genomic DNA from cervical cancer tissue was performed by commercially-available kits. Methylated ESR1 promoter sequences were detected by quantitative real-time methylation-specific PCR., Results: Methylation status did not present differences regarding age at-diagnosis, FIGO stage, grade, BMI and overall survival for all patients, but within the subgroup of non-keratinizing squamous cell cancer methylation status correlated with grading (p=0.047)., Conclusion: Methylation of the ESR1 promoter does not seem to be of any prognostic relevance, but is associated with higher tumor grading of cervical cancer patients.