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The article presents analysis on the results of 171 second-look laparotomy (SLL) and equate survival of patients having advanced ovarian cancer. The study reveals that the survival rate in patients having recurrence after negative SLL was importantly lower equated to patients with microscopic disease. It shows that probable explanation for encouraging prognosis in the group having microscopic disease was early medication of chemotherapy after SLL.

Mannan-binding lectin (MBL) is an important factor of innate immunity contributing to the clearance of microorganisms. Recently, an antitumourigenic role of MBL has been suggested. We investigated mbl2 genotypes, MBL concentrations, and MBL-MASP-2 complex activity in patients with ovarian cancer. The expression of both mbl2 and masp-2 genes were investigated in ovarian tissue sections. Additionally, samples from patients with other malignant and benign tumours of the reproductive tract were tested. A significantly higher incidence of MBL deficiency/insufficiency-associated genotypes was found among patients with malignant disease compared to age-matched controls. Unexpectedly, no differences in median MBL level or MBL-MASP-2 complex activity were found between the groups. This was partly a reflection of higher MBL concentrations and MBL-MASP-2 activity in cancer patients compared with healthy women carrying corresponding genotypes. MBL-specific mRNA expression was detected in several normal and malignant ovarian tissues, as well as in ovarian epithelial cell lines. Intracellular staining with MBL-specific antibodies demonstrated the presence of MBL in ovarian cell lines, and in normal as well as malignant ovarian tissue sections. In contrast, MASP-2-specific mRNA expression was detected only in the ovary tissues of patients with malignant disease. No significant changes in MBL concentration during 3 months of chemotherapy were noticed. MBL was detected in ascites and in the fluid of benign ovarian cysts. Our findings may reflect anti-tumourigenic activity of MBL protein which might suggest potential therapeutic application. However, it cannot be excluded that mbl-2 mutant alleles may be in linkage disequilibrium with an unidentified tumour susceptibility gene(s). [ABSTRACT FROM AUTHOR]

Abstract: Aim: To assess the relationship between carrier molecule size and time elapsing between marker injection and sentinel node(s) biopsy in patients with breast cancer. Material: The study performed on 122 women, in whom the sentinel node(s) was identified according to the procedure described below. In Group I (n =72 patients), SN identification was done with radioisotope marker of 400–3000nm molecule size (tin colloid). In Group II (n =50 patients) radioisotope marker of <100nm molecule size (colloidal albumin) was used. Methods: All the patients of both groups received the markers with a single-point, intradermal, periareolar injection. Four hours after the injection (Group I – surgery in the next day) or immediately before the surgery (in this same day) (Group II), stationary lymphoscintigraphy was performed. Results: Mean numbers of sentinel nodes identified with the radioisotope method in Groups I and II were 1.22 and 1.48, respectively. The difference was statistically significant (p <0.01). Conclusions: There is a relationship between the radioisotope marker molecule size and the injection-to-intra-operative evaluation time. Administration of small molecule size radioisotope marker several hours prior to the planned surgery appears to be the optimum procedure in this method of SN identification in patients with breast cancer. [Copyright &y& Elsevier]

BACKGROUND: Elevated serum cancer antigen 125 (CA-125) is observed in some cervical cancers (CCs). Is the correlation of CA-125 with the presence of nodal events useful in predicting early metastasis to the lymph nodes?

An abstract of the research paper "The ultrasound-measured tumor-free distance ( uTDF) is a valuable predictor of lymph node status in endometrial cancer" by M. Liro and colleagues, presented at the 24th World Congress on Ultrasound in Obstetrics and Gynecology, is presented.

Purpose: We found a need for balancing the application of clinical guidelines and tailored approaches to follow-up of cervical cancer (CC) patients in the lymph node micrometastatic (MICs) setting. This review aimed to determine the current knowledge of management of MIC-positive CC cases., Methodology: We addressed prognostic and risk of recurrence monitoring impacts associated with MIC+ cases. The electronic databases for literature and relevant articles were analysed., Results: Fifteen studies, (4882 patients), were included in our systematic review. While the results show that MICs significantly worsen prognosis in early CC. A tertiary prevention algorithm for low volume lymph node disease may stratify follow-up according to the burden of nodal disease and provide data that helps improve follow-up performance., Conclusion: MICs worsen prognosis and should be managed as suggested by the algorithm. However, this algorithm must be externally validated. The clinical impact of isolated tumor cells (ITC) remains unclear., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The mRNA splicing is regulated on multiple levels, resulting in the proper distribution of genes' transcripts in each cell and maintaining cell homeostasis. At the same time, the expression of alternative transcripts can change in response to underlying genetic variants, often missed during routine diagnostics., Aim: The main aim of this study was to define the frequency of aberrant splicing in BRCA1 and BRCA2 genes in blood RNA extracted from ovarian cancer patients who were previously found negative for the presence of pathogenic alterations in the 25 most commonly analysed ovarian cancer genes, including BRCA1 and BRCA2., Material and Methods: Frequency and spectrum of splicing alterations in BRCA1 and BRCA2 genes were analysed in blood RNA from 101 ovarian cancer patients and healthy controls (80 healthy women) using PCR followed by gel electrophoresis and Sanger sequencing. The expression of splicing events was examined using RT-qPCR., Results: We did not identify any novel, potentially pathogenic splicing alterations. Nevertheless, we detected six naturally occurring transcripts, named BRCA1ΔE9-10, BRCA1ΔE11, BRCA1ΔE11q, and BRCA2ΔE3, BRCA2ΔE12 and BRCA2ΔE17-18 of which three (BRCA1ΔE11q, BRCA1ΔE11 and BRCA2ΔE3) were significantly higher expressed in the ovarian cancer cohort than in healthy controls (p ≤ 0.0001)., Conclusions: This observation indicates that the upregulation of selected naturally occurring transcripts can be stimulated by non-genetic mechanisms and be a potential systemic response to disease progression and/or treatment. However, this hypothesis requires further examination., Competing Interests: Declaration of Competing Interest The author(s) declare that they have no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The low attendance rate for cancer screening tests in Poland is a major healthcare concern that requires specific analysis and the development of implementation recommendations for prevention, and both actions are likely to benefit culturally similar countries. Four female cancers account for approximately 20% of all cancer cases-breast cancer, cervical cancer, endometrial cancer, and ovarian cancer-suggesting that gynecologists have a significant preventative role. Of the four, breast cancer and cervical cancer are among the 10 most common malignant neoplasms globally, regardless of gender, occur only in women and are known to have effective screening measures. Our research aims to create a screening model that combines cervical cancer and breast cancer to maximize health outcomes for women at risk of both cancers. In the study protocol, we have created a model that maximizes benefits for patients with minimal additional costs to the health care system. To achieve the set goal, instead of regular clinical breast exams as recommended by the gynecological societies, we proposed an ultrasound examination, during which palpation may also be performed (in the absence of elastography). We present a scheme for such a protocol that takes into consideration all types of prevention in both cancers, and that emphasizes breast ultrasound as the most frequently missing element. Our study includes a discussion of the strengths and weaknesses of our strategy, and the crucial need for infrastructure and education for the successful implementation of the program. We conclude that our model merits consideration and discussion among health-care decision makers, as the screening changes we propose have significant potential benefits for the female population.

Complicated or unusual cases appear in clinical practice. It's important to know how to react when we face clinical difficulty. The more unusual the case, the longer or more demanding the decision-making process is. In this case we present a patient with a gigantic ovarian tumor whose diagnosis was overturned, and the choice of the surgical procedure changed, which makes this case a very educative example of why we should consult our patients, whenever we may encounter doubts or difficulties in a therapeutic process.

Objectives: Hemoptysis in pregnancy is a very rare finding causing diagnostic and therapeutic difficulties. The case report of hemoptysis by a 29 years old patient in the 31st week of pregnancy is presented and discussed along with the diagnostic process and treatment provided.Upon pharyngeal cancer occurrence in a pregnant patient a multidisciplinary medical team performed appropriate treatment along with delivery of a healthy newborn at term. Patients and fetal conditions and outcomes were analyzed and compared to available literature in this newly created literature review., Material and Methods: After MEDLINE database analysis using formula "hemoptysis" AND "pregnancy" more than 125 results were found published during the period 2002-2022. Almost 30 papers about hemoptysis were found and included for full analysis., Conclusions: The literature review offers a detailed description of previously reported incidents of hemoptysis in pregnancy to gain understanding of the etiology, differential diagnosis, available treatment and predicted future outcomes for both patient and fetus.

Background: ALK receptor tyrosine kinase (ALK) aberrations have an established role in pathogenesis of many neoplasms, but their clinical significance in high grade serous ovarian carcinoma (HGSOC) is unclear., Objective: To analyse the frequency of ALK overexpression, molecular abnormalities of ALK, and their impact on the progression-free survival (PFS) and overall survival (OS) in HGSOC., Methods: Protein expression was examined by immunohistochemistry (IHC) using three different clones of anti-ALK antibody. The presence of translocations was analysed using fluorescent in situ hybridization. Next-generation sequencing was used for studying the copy number variation, as well as point mutation and translocations involving other commonly rearranged genes., Results: ALK overexpression was demonstrated in up to 52% of tumours, whereas ALK copy gains in 8.2%, with no clear impact on survival. ALK point mutations were identified in 13 tumours (8.9%), with 3 belonging to the class IV showing significantly better OS. A trend suggesting better PFS was also noticed in these cases. Additionally, three gene fusions were found: ERBB2-GRB7, PRKCA-BRCA1 and SND1-BRAF, none of which has been previously described in HGSOC., Conclusions: HGSOC harbouring activating ALK mutations might be associated with a better survival, while ALK overexpression and ALK amplification does not impact the prognosis.

Myometrial invasion (MI) is a parameter currently used in transvaginal ultrasound (TVS) in endometrial cancer (EC) to determine local staging; however, without molecular diagnostics, it is insufficient for the selection of high-risk cases, i.e., those with a high risk of lymph node metastases (LNM). The study’s objective was to answer the question of which TVS markers, or their combination, reflecting the molecular changes in EC, can improve the prediction of LNM. Methods: The TVS examination was performed on 116 consecutive EC patients included in this prospective study. The results from the final histopathology were a reference standard. Univariate and multivariate logistic models of analyzed TVS biomarkers (tumor [T] size, T area [AREA], T volume [SPE-VOL], MI, T-free distance to serosa [TFD], endo-myometrial irregularity, [EMIR], cervical stromal involvement, CSI) were evaluated to assess the relative accuracy of the possible LNM predictors., Spline functions were applied to avoid a potential bias in assuming linear relations between LNM and continuous predictors. Calculations were made in R using libraries splines, glmulti, and pROC. Results: LNM was found in 20 out of the 116 (17%) patients. In univariate analysis, only uMI, EMIR, uCSI and uTFD were significant predictors of LNM. The accuracy was 0.707 (AUC 0.684, 95% CI 0.568−0.801) for uMI (p < 0.01), 0.672 (AUC 0.664, 95% CI 0.547−0.781) for EMIR (p < 0.01), 0.776 (AUC 0.647, 95% CI 0.529−0.765) for uCSI (p < 0.01), and 0.638 (AUC 0.683, 95% CI 0.563−0.803) for uTFD (p < 0.05). The cut-off value for uTFD was 5.2 mm. However, AREA and VOL revealed a significant relationship by nonlinear analysis as well. Among all possible multivariate models, the one comprising interactions of splines of uTFD with uMI and splines of SPE-VOL with uCSI showed the most usefulness. Accuracy was 0.802 (AUC 0.791, 95% CI 0.673−0.91) Conclusions: A combination of uTFD for patients with uMI > 50%, and SPE-VOL for patients with uCSI, allows for the most accurate prediction of LNM in EC, rather than uMI alone.

Several ovarian cancer susceptibility genes have been discovered, but more are likely to exist. In this study, we aimed to analyze knowledge-based selected genes, that is, BARD1, PRDM9, RCC1, and RECQL, in which pathogenic germline variants have been reported in patients with breast and/or ovarian cancer. As deep sequencing of DNA samples remains costly, targeted next-generation sequencing of DNA pools was utilized to screen the exons of BARD1, PRDM9, RCC1, and RECQL in approximately 400 Polish ovarian cancer cases. A total of 25 pools of 16 samples (including several duplicated samples with known variants) were sequenced on the NovaSeq6000 and analyzed with SureCall (Agilent) application. The set of variants was filtrated to exclude spurious variants, and, subsequently, the identified rare genetic variants were validated using Sanger sequencing. No pathogenic mutation was found within the analyzed cohort of patients with ovarian cancer. Validation genotyping of filtered rare silent and missense variants revealed that the majority of them were true alterations, especially those with a higher mutation quality value. The high concordance (R2 = 0.95) of population allele frequency for 44 common SNPs in the European control population (gnomAD) and our experiment confirmed the reliability of pooled sequencing. Mutations in BARD1, PRDM9, RCC1, and RECQL do not contribute substantially to the risk of ovarian cancer. Pooled DNA sequencing is a cost-effective and reliable method for the initial screening of candidate genes; however, it still requires validation of identified rare variants., Prevention Relevance: BARD1, PRDM9, RCC1, and RECQL are not high/moderate-risk ovarian cancer susceptibility genes. Pooled sequencing is a reliable and cost-effective method to detect rare variants in candidate genes., (©2021 American Association for Cancer Research.)

Background: Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have implications for LLL assessment standardisation., Methods: In the prospective international multicentre trial SENTIX, a group of 150 patients with stage IA1-IB2 cervical cancer treated by uterine surgery with bilateral sentinel lymph node biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery., Results: Patient LVC substantially fluctuated in both positive and negative directions, which were comparable in frequency up to ±14% change. Thirty-eight patients experienced persistent LVC increase >10% classified as LLL, with nine months median time to onset. Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits. No significant correlation between LVC >10% and a patient-reported swelling was observed., Conclusions: Given that we observed comparable fluctuations of the the lower-limb volumes after surgical treatment of cervical cancer in both positive and negative direction up to ±14%, the diagnostic threshold for LLL diagnosis based on LVC should be increased to >15% LVC. The distinction of transient oedema from persistent LLL requires repeated measurements. Also, as one-third of LLL cases are diagnosed >1-year post-surgery, a sufficient follow-up duration needs to be ensured. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment., Trial Registration: ClinicalTrials.gov: NCT02494063., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction and Hypothesis: The aim of this study was to develop a Polish language version of the short form of the Pelvic Floor Impact Questionnaire 7 (PFIQ-7) and to validate it in a sample of Polish-speaking women with pelvic floor disorders (PFDs)., Methods: The PFIQ-7 was initially translated in a stepwise fashion as guided by the International Urogynecological Association (IUGA) Translation Protocol. First, two bilingual physicians in Poland and the USA performed a forward translation of the PFIQ-7. Next, a community review process was undertaken consisting of one-on-one cognitive interviews with 20 patients. The translated questionnaire was then back translated into English. The final Polish version of the PFIQ-7 was subsequently administered to Polish-speaking patients presenting with PFDs at university-based urogynecology clinics in Poland and the USA along with a Polish version of the Pelvic Floor Distress Inventory (PFDI-20). Internal consistency and criterion validity were assessed., Results: A total of 225 women with PFDs enrolled in this multicenter study. Complete data from 185 women in Poland and 40 primarily Polish-speaking women in the USA were analyzed. Participants had a mean age of 60.1 ± 11.1 years and mean body mass index (BMI) 27.9 ± 4.9. The Poland and United States cohorts did not vary significantly in age, BMI, or education level. PFIQ-7 internal consistency as measured by Cronbach's alpha was good (0.93). Criterion validity was adequate between responses on the PFIQ-7 and PFDI-20 prolapse, colorectal, and urinary subscales (0.62-0.69, p < 0.05)., Conclusions: The Polish version of the PFIQ-7 is a reliable tool for evaluating pelvic floor symptoms in Polish-speaking women with PFDs., (© 2020. The International Urogynecological Association.)

Background: Ultrasonography's usefulness in endometrial cancer (EC) diagnosis consists in its roles in staging and prediction of metastasis. Ultrasound-measured tumor-free distance from the tumor to the uterine serosa (uTFD) is a promising marker for these diagnostic and prognostic variables. The aim of the study was to determine the usefulness of this biomarker in locoregional staging, and thus in the prediction of lymph node metastasis (LNM)., Methods: We conducted a single-institutional, prospective study on 116 consecutive patients with EC who underwent 2D transvaginal ultrasound examination. The uTFD marker was compared with the depth of ultrasound-measured myometrial invasion (uMI). Univariable and multivariable logit models were evaluated to assess the predictive power of the uTFD and uMI in regard to LNM. The reference standard was a final histopathology result. Survival was assessed by the Kaplan-Meier method., Results: LNM was found in 17% of the patients (20/116). In the univariable analysis, uMI and uTFD were significant predictors of LNM. The accuracy was 70.7%, and the NPV was 92.68% (OR 4.746, 95% CI 1.710-13.174) for uMI ( p = 0.002), and they were 63.8% and 89.02% (OR 0.842, 95% CI 0.736-0.963), respectively, for uTFD ( p = 0.01). The cutoff value for uTFD in the prediction of LNM was 5.2 mm. The association between absence of LNM and biomarker values of uMI < 1/2 and uTFD ≥ 5.2 mm was greater than that between the presence of metastases and uMI > 1/2 and uTFD values <5.2 mm. In the multivariable analysis, the accuracy of the uMI-uTFD model was 74%, and its NPV was 90.24% ( p = non-significant). Neither uMI nor uTFD were surrogates for overall and recurrence-free survivals in endometrial cancer., Conclusions: Both uMI and uTFD, either alone or in combination, were valuable tools for gaining additional preoperative information on expected lymph node status. Negative lymph nodes status was better described by ultrasound biomarkers than a positive status. It was easier to use the uTFD rather than the uMI measurement as a biomarker of EC invasion, and the former still maintained a similar predictive value for lymph node metastases to the latter at diagnosis.

Objectives: Sentinel lymph node detection (SLND) has not yet displaced lymphadenectomy, but it is a desired supplementary technique in cervical cancer surgery. The aim of our study was to identify the sources of SLND failure while performing the procedure by injecting blue dye (BD) into the cervix in cases of early-stage cervical cancer (ECC)., Material and Methods: We analyzed 27 consecutive ECC patients (FIGO IA2-IB1) who underwent hysterectomy with SLND and systematic lymphadenectomy between October 2011 and June 2014. The main inclusion criterion was at least unilateral SLND by BD. Predictors of either unilateral or bilateral staining were identified using multinomial logit models and a decision tree., Results: Overall, bilateral staining was achieved in nine patients (33%). Among the factors analyzed, BMI > 23.5 kg/m2 was the only factor negatively affecting the quality of SLND using BD (p < 0.02) in the univariable multinomial logit model. All patients with BMI < 23.5 kg/m2 and depth of invasion ≥ 15 mm had unilateral mapping., Conclusions: Both obese and overweight patients are unlikely to achieve optimal SLN staining with BD alone. Although some possible reasons are discussed, we believe that further studies are needed to clarify the specific limitations of other dyes currently in use.

Aims: To assess responsiveness of sexual function questionnaires: Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) and Female Sexual Function Index (FSFI) in women with pelvic floor disorders (PFD)., Methods: The study included 261 subjects who completed PISQ-IR and FSFI at baseline and after treatment (median: 8 months). Standardized response mean (SRM) and effect size (ES) were calculated for sexually active (SA) and not-SA (NSA) women. Patient Global Impression of Improvement (PGI-I) was applied to assess treatment outcomes., Results: A total of 184 women reported "very much better"/"much better" on the PGI-I scale posttreatment and were enrolled for further study. After treatment, 21.7% of the NSA women resumed sexual activity, 13.9% of the initially SA-abstained, and no change was reported for 152 (82.6%) subjects (87-SA and 65-NSA). Significant improvement in PISQ-IR SA domains was observed, with mild responsiveness for Arousal/Orgasm (SRM = 0.34, ES = 0.29, p = .003) and good responsiveness for Condition Specific, Global Quality and Summary Score (SRM = 0.51, ES = 0.50; SRM = 0.54, ES = 0.47; SRM = 0.75, ES = 0.63, p < .001). The Condition Impact domain demonstrated excellent responsiveness (SRM = 1.13, ES = 1.17, p < .001). In NSA, PISQ-IR had good responsiveness in Condition Impact (SRM = -0.76, ES = -0.59, p < .001), and mild in Condition Specific (SRM = -0.30, ES = -0.28, p < .03) domains. In FSFI, posttreatment sexual function in SA was improved in Desire, Arousal, Orgasm, Satisfaction, Pain domains and Total score, proving mild responsiveness (SRM, 0.24-0.48; p < .04). In NSA, FSFI proved nonresponsive., Conclusion: PISQ-IR and FSFI are responsive tools, useful to investigate the effects of treatment on sexual function in SA (both questionnaires) and NSA (only PISQ-IR) women with PFD., (© 2020 Wiley Periodicals LLC.)

Current oncological developments are based on improved understanding of genetics, and especially the discovery of genes whose alterations affect cell functions with consequences for the whole body. Our work is focused on the one of these genes, BRCA1-associated RING domain protein 1 (BARD1), and its oncogenic role in breast cancer. Most importantly, the study points to new avenues in the treatment and prevention of the most frequent female cancer based on BARD1 research. The BARD1 and BRCA1 (BReast CAncer type 1) proteins have similar structures and functions, and they combine to form the new molecule BARD1-BRCA1 heterodimer. The BARD1-BRCA1 complex is involved in genetic stabilization at the cellular level. It allows to mark abnormal DNA fragments by attaching ubiquitin to them. In addition, it blocks (by ubiquitination of RNA polymerase II) the transcription of damaged DNA. Ubiquitination, as well as stabilizing chromatin, or regulating the number of centrosomes, confirms the protective cooperation of BARD1 and BRCA1 in the stabilization of the genome. The overexpression of the oncogenic isoforms BARD1β and BARD1δ permit cancer development. The introduction of routine tests, for instance, to identify the presence of the BARD1β isoform, would make it possible to detect patients at high risk of developing cancer. On the other hand, introducing BARD1δ isoform blocking therapy, which would reduce estrogen sensitivity, may be a new line of cancer therapy with potential to modulate responses to existing treatments. It is possible that the BARD 1 gene offers new hope for improving breast cancer therapy.

Background: SENTIX (ENGOT-CX2/CEEGOG-CX1) is an international, multicentre, prospective observational trial evaluating sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. We report the final preplanned analysis of the secondary end-points: SLN mapping and outcomes of intraoperative SLN pathology., Methods: Forty-seven sites (18 countries) with experience of SLN biopsy participated in SENTIX. We preregistered patients with stage IA1/lymphovascular space invasion-positive to IB2 (4 cm or smaller or 2 cm or smaller for fertility-sparing treatment) cervical cancer without suspicious lymph nodes on imaging before surgery. SLN frozen section assessment and pathological ultrastaging were mandatory. Patients were registered postoperatively if SLN were bilaterally detected in the pelvis, and frozen sections were negative., Trial Registration: ClinicalTrials.gov (NCT02494063)., Results: We analysed data for 395 preregistered patients. Bilateral detection was achieved in 91% (355/395), and it was unaffected by tumour size, tumour stage or body mass index, but it was lower in older patients, in patients who underwent open surgery, and in sites with fewer cases. No SLN were found outside the seven anatomical pelvic regions. Most SLN and positive SLN were localised below the common iliac artery bifurcation. Single positive SLN above the iliac bifurcation were found in 2% of cases. Frozen sections failed to detect 54% of positive lymph nodes (pN1), including 28% of cases with macrometastases and 90% with micrometastases., Interpretation: SLN biopsy can achieve high bilateral SLN detection in patients with tumours of 4 cm or smaller. At experienced centres, all SLN were found in the pelvis, and most were located below the iliac vessel bifurcation. SLN frozen section assessment is an unreliable tool for intraoperative triage because it only detects about half of N1 cases., Competing Interests: Conflict of interest statement The authors declare no conflict of interest., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versus-host disease (cGVHD) of the anogenital zone (cGVHDgyn), and secondary neoplasms. Aiming to assess a real-life scale of problems associated with HCT, we performed a detailed analysis of a consecutive series of females after allo-HCT who were referred for a routine gynecological evaluation. The study includes 38 females after allo-HCT in whom gynecological examination with cervical smear and USG were performed, followed by colposcopy according to NCCN guidelines. NIH scoring system was used to classify a grade of cGVHDgyn. The incidence of cGVHD was 71% whereas GVHDgyn was 29%, including 5 patients with score 3 at the time of diagnosis. The other manifestations (frequently noted) included the skin, mucosa, eyes, and liver. Menopause was diagnosed in 93% females, and in 81% of them, POI criteria were fulfilled. Ovarian function resumed in 2 cases. The rate of abnormal cytology was 26%: 4 ASCUS, 1 AGUS, 1 LSIL, 3 HSIL/ASC-H, and one cytological suspicion of cervical cancer. GVHDgyn was documented in 10 patients, and 6 of them had abnormal cervical cytology. Early topical estrogen therapy led to a significant reduction in vaginal dryness (p < 0.05), dyspareunia (p < 0.05), and less frequent cGVHDgyn (p < 0.05). GVHDgyn develops in about 30% of long-term allo-HCT survivors. Topical estrogens and hormonal replacement therapy alleviate symptoms and prevent the occurrence of severe consequences of menopause.

Surgical interventions in patients with peritoneal metastases combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and systemic treatment are becoming more common and, when applied to selected patient groups, they reach 5-year survival rates of 32-52%. Good clinical outcomes require experienced and well-equipped healthcare centers, experienced surgical team and adequate patient qualification process. As a result of the discussion on the need for evaluation of quality of care and treatment outcomes and at the request of the Peritoneal Cancer Section of the Polish Society of Surgical Oncology, accreditation standards have been developed and the Accreditation Committee has been established for healthcare centers providing cytoreductive surgery and HIPEC for the management of primary and secondary peritoneal cancers.

The quality of pathological assessment is crucial for the safety of patients with cervical cancer if pelvic lymph node dissection is to be replaced by sentinel lymph node (SLN) biopsy. Central pathology review of SLN pathological ultrastaging was conducted in the prospective SENTIX/European Network of Gynaecological Oncological Trial (ENGOT)-CX2 study. All specimens from at least two patients per site were submitted for the central review. For cases with major or critical deviations, the sites were requested to submit all samples from all additional patients for second-round assessment. From the group of 300 patients, samples from 83 cases from 37 sites were reviewed in the first round. Minor, major, critical, and no deviations were identified in 28%, 19%, 14%, and 39% of cases, respectively. Samples from 26 patients were submitted for the second-round review, with only two major deviations found. In conclusion, a high rate of major or critical deviations was identified in the first round of the central pathology review (28% of samples). This reflects a substantial heterogeneity in current practice, despite trial protocol requirements. The importance of the central review conducted prospectively at the early phase of the trial is demonstrated by a substantial improvement of SLN ultrastaging quality in the second-round review., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

The aim of this cross-sectional study was to determine the cutoff scores for sexual dysfunction in disease-specific Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA Revised (PISQ-IR) for women with pelvic floor disorders (PFD). Medical history and urogynecological data of 521 women with PFD were collected. The subjects provided information about their sexual activity and completed Female Sexual Function Index (FSFI) and PISQ-IR questionnaires. Sexually active (SA) women were further analyzed and categorized using their FSFI scores: <26.55-sexual dysfunction, >26.55-no sexual dysfunction. Receiver operating characteristics (ROC) curve tested how well PISQ-IR allowed to discriminate between patients with and without sexual disorders. Area under curve (AUC) was calculated to measure the PISQ-IR Summary Score efficiency in the prediction. The cutoff values which minimalize (1-specifity) and maximize sensitivity were selected. In the analyzed cohort, 250 (48%) women were SA and a total of 226 SA were recruited for the study: 143 (63.3%) with <26.55 FSFI and 83 (36.7%) with >26.55 FSFI (response rate: 90.4%). Using ROC curve analysis, PISQ-IR Summary Score of 2.68 was determined to be the optimal cutoff for distinguishing between dysfunctional and nondysfunctional women (AUC = 0.85), allowing to diagnose sexual dysfunction in SA women with PFD, with 90% sensitivity and 71% specificity.

Aims: To compare quality of life (QoL) in women with urinary incontinence (UI) using continence pads during the day versus all day and night; to identify risk factors for a 24-hour pad use; to calculate quality-adjusted life years (QALY)., Methods: A cross-sectional study in 331 women with lower urinary tract symptoms referred to urogynaecologic examination was conducted. Main outcome measures were the scores of King's Health Questionnaire (KHQ), clinical data, and KHQ-derived utility values., Results: A total of 270 women with UI were recruited: 176 (57.3%) using continence pads only during the day (group I) and 94 (30.6%) for 24 hours (group II). The groups did not differ in terms of age, menopause, parity, type of UI, stage of POP-Q, and percentage of sexually active subjects. Group II had significantly higher body mass index (BMI) and lower education than group I (P < 0.05). QoL was significantly deteriorated in group II in KHQ Global score and in all domains except one (General Health). Risk factors for 24 hours pad use were as follows: BMI ≥ 30 vs BMI 25-30 (OR = 2.02 (1.09-3.73), P = 0.037), higher scores in KHQ Severity measures (OR = 1.03 (1.02-1.04), P < 0.001), KHQ Global score (OR = 1.03 (1.02-1.05), P < 0.001) and primary compared to secondary (OR = 0.4 (0.19-0.84)) or higher education (OR = 0.41 (0.18-0.94), P < 0.05). Annual QALY was significantly lower in group II (0.9288 ± 0.03 vs 0.9432 ± 0.03, P < 0.001)., Conclusion: One-third of women with UI used continence pads for 24 hours. Among these patients QoL and QALY were found lower compared to women using continence pads only during the day. KHQ Severity measures domain was an independent predictor for a 24-hour usage of continence pads., (© 2018 John Wiley & Sons Ltd.)

Background: Ficolin-3 is a pattern-recognition molecule with the ability to activate the lectin pathway of complement. It is found in lung, liver and blood, but its physiological role is unclear. We have investigated interaction of recombinant ficolin-3 with malignant cells and tissues., Material and Methods: Cells of various lines of human origin as well as ovarian tissue sections have been studied with the use of flow cytometry and immunohistochemistry., Results: Recombinant (but not serum-derived) ficolin-3 was found to bind strongly to the ovarian cancer cell lines, SKOV-3, OVCAR-3 and ES-2, at concentrations of 2.5 μg/ml and above. Moreover, His-tagged recombinant ficolin-3 (10 μg/ml) preferentially stained ovarian tissue sections from patients with malignant tumours compared with those from patients without. Binding to cell lines was inhibited by EDTA and specific carbohydrate ligands, indicating involvement of the fibrinogen-like domain. Binding was enhanced under mildly acidic conditions and at physiological pH after pre-incubation of cells with mildly acidic buffer., Conclusion: Basing on data concerning recombinant protein, it may be suggested that ficolin-3 is involved in immune response in ovarian cancer. However, unidentified serum factor(s) seem(s) to protect cancer cells from recognition by natural or rficolin-3., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Cervical uterine cancer is the second most frequent female cancer worldwide and a substantial burden for low-income societies and the patients themselves. Understanding the molecular mechanisms of metastasis permits the development of therapies that limit tumor progression, as well as providing health and social benefits. Pathomorphology is still the basis of research and a reference standard for molecular analysis. The aim of our study was to research and critically evaluate clinical trials that use new oncological approaches for node-positive cervical cancer to gain an insight into the molecular mechanisms of tumor metastasis., Inclusion Criteria: node-positive disease at baseline; at least a first phase clinical study comprising adult female patients; novel clinical approach (e.g., radiotherapy, immunotherapy, targeted therapy, vaccines, radiosurgery); histologic measurement of treatment efficacy (preferably lymph node ultrastaging); and publications in English language only., Information Sources: US Clinical trials registry, EU Clinical trials register, ISRCTN registry, and Ovid, EBSCO and Cochrane Collaboration databases. Access dates: from January 2010 to April 2018., Exclusions: Abstracts that did not meet the inclusion criteria or with unreliable data. We collected complete data (e.g., the entire publication associated with included abstracts, heterogeneity examination of individual studies, and validity measurement of the statistical methods used). Results were analyzed in relation to the most recent understanding of the pathogenesis of cervical cancer metastasis. We proposed a possible direction for drug treatment of epithelial tumors based on the mechanisms of metastasis.

Introduction and Hypothesis: The aim of this study was to develop a Polish language version of the short form of the Pelvic Floor Distress Inventory (PFDI-20) and to validate it in a sample of Polish-speaking women with pelvic floor disorders (PFDs)., Methods: The PFDI-20 was initially translated in a stepwise fashion as guided by the International Urogynecological Association (IUGA) Translation Protocol. After initial forward translation from English to Polish, a community review process consisting of cognitive interviews and confirmation via back translation was performed. The final Polish version of the PFDI-20 was administered to Polish-speaking patients presenting with PFDs at university-based urogynecology clinics in Poland and the United States, along with a Polish version of the King's Health Questionnaire (KHQ). Internal consistency and criterion validity were assessed. Test-retest reliability was assessed in 100 patients after 2 weeks., Results: A total of 254 women with PFDs enrolled in this multicenter study. Complete data from 44 Polish-speaking women in the United States and 200 women in Poland were analyzed. Participants had a mean age of 60.3 ± 11.2 years and mean body mass index (BMI) 27.6 ± 4.7. Internal consistency as measured by Cronbach's alpha was good (0.89). Criterion validity was adequate between responses on the KHQ and PFDI-20 with Pearson correlations in particular domains (0.27-0.50, P < 0.05). Excellent test-retest reliability was demonstrated by intraclass correlation using a two-way mixed-effects model with absolute agreement (0.87)., Conclusions: The Polish version of the PFDI is a reliable tool for evaluating pelvic floor symptoms in Polish-speaking women with PFDs.

Constitutional loss-of-function pathogenic variants in the tumor suppressor genes BRCA1 and BRCA2 are widely associated with an elevated risk of ovarian cancer (OC). As only ~15% of OC individuals carry the BRCA1/2 pathogenic variants, the identification of other potential OC-susceptibility genes is of great clinical importance. Here, we established the prevalence and spectrum of the germline pathogenic variants in the BRCA1/2 and 23 other cancer-related genes in a large Polish population of 333 unselected OC cases. Approximately 21% of cases (71/333) carried the BRCA1/2 pathogenic or likely pathogenic variants, with c.5266dup (p.Gln1756Profs*74) and c.3700&#95;3704del (p.Val1234Glnfs*8) being the most prevalent. Additionally, ~6% of women (20/333) were carriers of the pathogenic or likely pathogenic variants in other cancer-related genes, with NBN and CHEK2 reported as the most frequently mutated, accounting for 1.8% (6/333) and 1.2% (4/333) of cases, respectively. We also found ten pathogenic or likely pathogenic variants in other genes: 1/333 in APC , 1/333 in ATM , 2/333 in BLM , 1/333 in BRIP1 , 1/333 in MRE11A , 2/333 in PALB2 , 1/333 in RAD50, and 1/333 in RAD51C , accounting for 50% of all detected variants in moderate- and low-penetrant genes. Our findings confirmed the presence of the additional OC-associated genes in the Polish population that may improve the personalized risk assessment of these individuals.

Aims: To assess female sexual function (SF) in different grades of urodynamic stress urinary incontinence (SUI), with/without pelvic organ prolapse (POP); to investigate associations between clinical data and pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ) scores., Methods: A cross-sectional study was conducted in sexually active women (130 with SUI and 126 controls). Stamey score and POP quantification (POP-Q) were used. Urogynecological examinations were performed; all participants completed PISQ. Multivariable linear regression was used to identify negative SF predictors., Results: SF was lower in the study group (P < 0.001), in moderate (P < 0.001), and severe SUI (P  < 0.02) versus controls, in each particular domain and total PISQ-score (total score: 83.8 ± 14.8, 80.8 ± 14.5, 84.5 ± 11.1 vs 95.7 ± 10.3, respectively). Women with mild SUI had better SF in physical and partner-related domains compared to moderate SUI (33.6 ± 6.1 vs 30.7 ± 6.4, P < 0.02; 18.8 ± 2.9 vs 17.3 ± 3.3, P = 0.02, respectively). Age correlated with PISQ-scores in behavioral/emotive (r = -0.24, P = 0.006), and partner-related domains (r = -0.28, P = 0.002), and total PISQ-score (r = -0.2, P = 0.02); menopausal status with partner-related domain (r = -0.32, P = 0.000) and total PISQ-score (r = -0.19, P = 0.029); menopause duration with physical domain (r = 0.17, P = 0.045); SUI stage only with PISQ scores in physical domain (r = -0.22, P = 0.014). No correlations were found between BMI, parity, number of vaginal deliveries, POP-Q stages, with PISQ results. Age in the SUI group and controls (β = -0.18, P < 0.05) and BMI in controls (β = -0.26, P < 0.01) were independent predictors of impaired SF., Conclusions: Different SF predictors were found in SUI women and controls. Impaired SF was confirmed in SUI women compared to controls, with more severe SUI corresponding to lower SF., (© 2017 Wiley Periodicals, Inc.)