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To present our experience with ultrasound-guided minimally invasive bioptic techniques in gynecologic oncology.Original paper.Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague.Minimally invasive ultrasound-guided biopsy may be done in patients with primary inoperable disease, suspicious recurrence of gynecological or non-gynecological malignancy or in case of diagnostic uncertainty of pelvic tumor origin.Ultrasound-guided minimally invasive bio-psy represents an accessible and relatively simple method useful in many indications, not only in gynecologic oncology.

To analyze our experience with transperitoneal laparoscopic dissection of lymphatic nodes in women with gynecologic malignancies.Retrospective clinical study.Center of gynecologic endoscopy and minimally invasive surgery; Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty in Prague.Analysis of data from our laparoscopic procedures in the years 2006-2011. The following procedures have been included: systematic pelvic lymphadenectomy (PLN), paraaortic lymphadenectomy (PALN), pelvic sentinel node excision, focused dissection of bulky lymphatic nodes from pelvis or paraaortic area.We performed 177 primarily laparoscopic procedures pointed at dissection of pelvic and/or paraaortic lymph-nodes. The mean operating time and the mean number of lymph-nodes was 82 minutes and 26.5 nodes in patients with PLN, and 75 minutes and 12.5 nodes in patients with PALN. The overall rate of laparo-conversions was 4.5%; the incidence of major complications was 6.8% and of serious bleeding 5.6%. Laparoscopic lymphadenectomy could not be performed or completed in 2.3% of cases. Complications were more frequently associated with PALN than with PLN.Laparoscopic approach to PLN and PALN is feasible in vast majority of patients. It provides adequate earnings of the lymphatic nodes, tolerable operative time, and relatively low complication rate. The highly experienced operation team for especially high infrarenal PALN is necessary.

To present our experience with ultrasound-guided minimally invasive interventions in gynecologic oncology.Original paper.Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague - First Faculty of Medicine and General Faculty Hospital, Prague.We provide minimally invasive punction interventions under ultrasound guidance using either abdominal or vaginal probe in three indication groups - diagnostics (tru-cut biopsy), therapy (punction drainage of lymphocyst) and palliation (insertion of permanent peritoneal catheter).Ultrasound-guided minimally invasive interventions represent a group of accessible and relatively simple methods useful in many indications, not only in gynecologic oncology. Adoption of these methods allows to broadening the spectrum of interventions offered and decreasing patient's stress.

To present up-to-date knowledge concerning risk-reducing surgery in carriers of susceptibility mutations among hereditary breast/ovarian cancer syndrome and Lynch syndrome.Review.Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague - First Faculty of Medicine and General Faculty Hospital, Prague.After having reviewed the now-a-days literature and summarized our experience we present here an overview of risk-reducing strategies in gynecology and a proposal of guidelines to risk-reducing salpingo-oophorectomy and hysterectomy.Risk-reducing salpingo-oophorectomy or hysterectomy is the most effective strategy for gynecological cancer prevention in susceptibility gene mutation carriers so far. This type of surgery, however, requires specific indication work-up and techniques different from those standardly used.

To present up-to-date knowledge concerning field of hereditary susceptibility to endometrial cancer as a part of hereditary non-polyposis colorectal cancer (Lynch syndrome).Review.Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine and General Faculty Hospital, Prague.After having gone over the now-a-days literature and summarized our experience with management of high risk women of Lynch syndrome families we present up-to-date overview of this field problematics.Although endometrial cancer arising due to germ-line susceptibility account for a small part of these malignancies only, they represent disease with clearly defined and detectable serious risk factor. Management approach for these women is now defined and allows for early detection or lowering the risk. Educated gynecologist, as a field specialist, has good chance to identify women at risk and manage them in an appropriate way.

To analyze up-to-data knowledge in the field of molecular characterization of epithelial ovarian borderline tumors with respect to clinical management and prognosis.Review.Oncogynecological Center, Department of Obstetrics and Gynecology, Charles University in Prague, First Faculty of Medicine, and General Faculty Hospital, Prague.Based on literature search and own experimental data in the field of molecular biology of ovarian cancer and borderline tumors of ovary, we summarize up-to-date knowledge of molecular differences and specific features of BTO with respect to implementation of these knowledge into the clinical management.We suppose that spectrum of genomic changes (i.e. genetic and epigenetic) causing tumor transformation is limited and these changes take place in stem or progenitor cell. Analysis of genomic changes can help to define certain subtypes of BTO and, correlated to clinical characteristics, to identify subtypes with different biological behavior. Such molecular typing of BTO allows to individualize treatment.

The goal of this study was to compare the accuracy of magnetic resonance imaging (MRI)--a standard method--and transrectal ultrasound (TRUS) in the staging and determination of significant prognostic parameters in early-stage cervical cancer. The following prognostic parameters were evaluated: identification of residual tumor in the cervix after cone-biopsy, tumor volume, and early parametrial infiltration.Prospective study.Oncogynecological Center, Department of Obstetrics and Gynecology, General Faculty Hospital of Charles University, Prague.Patients referred to Oncogynecological Center from January 2004 to February 2006, in whom early-stage cervical cancer (T1a1-T2a) was diagnosed by clinical examination, were prospectivelly enrolled in the study. Only those patients who were examined by both MRI and TRUS with following surgical treatment were included. Imaging results were compared with pathology findings.Data from 95 patients were evaluated. The accuracy of tumor detection in 95 patients was 93.7% for TRUS and 83.2% for MRI (Por = 0.006). In small tumors (or = 1 cm3), the accuracy of tumor detection by TRUS was 90.5% and 81.1% by MRI (Por = 0.049). The accuracy of parametrial infiltration detection by TRUS and MRI was 98.9% and 94.7%, respectively (Por = 0.219). The accuracy was not influenced by body mass index values.Our results show TRUS achieving comparable or even higher accuracy than the more commonly used MRI in staging of early-stage cervical cancer.

Carriers of hereditary mutations in cancer susceptibility genes represent a limited but high-risk population characterized by a high probability of cancer development, frequently with its manifestation in early age and with a 50% chance of pathogenic allele inheritance by offspring. In case of monogenic disorders, preimplantation genetic diagnosis (PGD) could be used for characterization of the DNA region affected by pathogenic mutation in the early stages of an embryo created by in vitro fertilization (IVF). Therefore, the transfer of unaffected embryos could be performed based on the results of PGD genotyping, enabling the development of offspring not carrying the pathogenic alteration.Here we present the consensus of the collaborative group of the Society for Medical Genetics, the Czech Society for Oncology and other professionals for use of PGD in the Czech Republic for carriers of mutations in cancer susceptibility genes. We address the conditions, prerequisites, and limits of practical application of this method. We also point out specific issues of ovarian hyperstimulation in carriers of mutations in BRCA1, BRCA2, and p53, anticipating the increased risk of hormonally dependent breast and ovarian cancers development.We assume that a narrow but non-negligible subgroup of cancer susceptibility gene mutation carriers may benefit from PGD.They are mainly individuals deciding to undergo IVF and PGD recruited from mutation carriers with extreme concerns about transmitting the mutation to their children. The PGD in these individuals should be managed by a closely cooperating multidisciplinary team of professionals responsible for indication of PGD, giving complete information regarding the IVF and PGD procedures including their limits, evaluating individual risks and performing instrumental and laboratory procedures with respect to up-to-date good laboratory and clinical practice.

To characterize molecular pattern differences (LOH and expression) between DCIS and invasive breast cancer.Original paper.Oncogynecologic center, Clinic of Obstetrics and gynecology, First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, Prague.We analyzed LOH in 3 genes (BRCA1, BRCA2 and p53) and expression of 2 genes (VEGF and Bcl-2) in fresh frozen tissue samples of DCIS and invasive breast cancer. Each sample was evaluated by pathologist before sampling and analysis.Molecular pattern analysis was performed in three types of tissue: healthy breast gland (65 samples), DCIS (25 samples) and invasive breast cancer (42 samples). LOH in BRCA1 was detected in 22.3% of invasive cancer samples and in 13.4% of DCIS; BRCA2 LOH in 32.1% of invasive cancer samples and in 14.1% of DCIS; p53 LOH in 35.6% of invasive cancer samples and in 33.2% of DCIS. VEGF was overexpressed in 15.3% of invasive cancer samples and in 8.3% of DCIS. Overexpression of Bcl-2 was detected in 13.2% of invasive breast cancer samples and in 7.1% of DCIS.We confirmed that substantial part of DCIS has molecular pattern similar to invasive cancer. These molecular changes could serve as potential markers of DCIS progression to invasive cancer or they could identify subgroup of DCIS with latent invasion.

Information about new possibilities of early diagnostics in mammary lesions.Review.Gynecology-Obstetrics Clinic, 1st Medical Faculty and General Teaching Hospital, Prague.Most malignant tumors of the breast originate from ductal epithelium. A direct examination of the ductal system, could significantly improve diagnostics of breast cancer as well as its preinvasive stages (DCIS) and to influence mortality. The concept of ductal approaches includes several techniques and ductal lavage and duscoscopy.Ductal approaches represent an attractive area for minimal load upon the patients. Specificity and sensitivity of these methods have some limits, which will be subject to change in relation to understanding of carcinogenesis and in a close relation to the knowledge of biomarkers, genomics and proteomics. Ductoscopy appears to be the ideal method for the future due to possibilities of direct visualization of epithelium in combination with biopsy and ductal lavage. It other advantages include minimal invasiveness, minimal risk and the origin of possible complications for the patient.

Review of diagnostical and therapeutical methods in glandular premalignant lesions of the uterine cervix.Review article.Department of Obstetrics and Gyneacology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague.The incidence of invasive adenocarcinomas of the uterine cervix is increasing. Incidence ratio between adenocarcinomas and spinocellular carcinomas is approximately 1:5; however ratio of premalignant lesions reaches only about 1:80. Glandular premalignant disease is usually found in the specimen taken for squamous disease. The coincidence of both types of premalignant lesions, so called "mixed lesion", is revealed in about 46-72%. PAP-smear of AGC-NOS/-NEO or adenocarcinoma in situ (AIS) in combination with typical colposcopic appearance raise a suspicion of glandular lesion. Direct biopsy must be always performed to get definite diagnosis. Optimum biopsy technique requires cylindrical excision. A woman can be carefully followed if desires pregnancy and specimen margins are negative. Hysterectomy is indicated if reproductive plans are completed.Diagnosis of glandular premalignat lesion of the uterine cervix is more complicated in comparison to spinocellular one, however it is getting more significant due to increasing incidence. Colposcopy and cytology are less reliable. Any suspicion on glandular premalignat leasion requires more active approach and radical procedure (hysterectomy) if possible.

This article reviews the topic of hereditary ovarian cancer, describes persons at risk of hereditary disposition to cancer and gives instructions for genetic counselling and molecular analysis, including contacts to specialized centres in the Czech Republic.Review.Institute of Biochemistry and Experimental Oncology, Charles University in Prague.Hereditary ovarian cancer occurs in three autosomal dominant syndromes: appropriate hereditary ovarian cancer (HOC), hereditary breast and ovarian cancer (HBOC) and hereditary non-poliposis colorectal cancer (HNPCC). Physician in practice or specialist at the clinic should focus interest on patients form families with frequent occurrence of breast and/or ovarian cancer, patients with early onset disease or tumour duplicity (breast and ovarian cancer). Hereditary disposition to ovarian (and breast) cancer could be assessed by molecular genetic analysis of two main susceptibility genes BRCA1 and BRCA2, or other genes in families with diverse tumours. Molecular genetic analysis should be in any cases indicated by experienced clinical genetic. In the Czech Republic, the consensus of genetic and clinical care of risk patients was published and specialized centres for families with hereditary predisposition were settled in Prague and Brno.Persons with hereditary susceptibility to cancer constitute noted group where painstaking dispensarisation and preventive care may prevent malignancy or detect it in the early stage.

Evaluate technique, indications and limits of surgical procedure in the treatment of cervical cancer diagnosed from uterus specimen from simple hysterectomy.Retrospective observational study, review of literature.Department of Obstetrics and Gynecology, 1st Medical Faculty and General Faculty Hospital, Charles University, Prague, Czech Republic.Women following radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy were enrolled to the study. In all patients unexpected invasive cervical cancer was found from the uterus specimen after simple hysterectomy.Together 10 patients were enrolled to the study. CIN was the indication for primary hysterectomy in all but two patients. There were two operative complications, cystostomy in both cases, treated properly during surgery. In the specimen from radical procedure residual tumor in parametria was found in 2 cases, and metastasis to pelvic nodes in 4 cases. There was no postoperative complication. Adjuvant radiotherapy was recommended in 4 patients due to positive lymph nodes, in one case due to residual tumor in parametria, and in one case for both reasons.Radical parametrectomy with upper vaginectomy and pelvic lymphadenectomy should be considered as an alternative solution in patients following simple hysterectomy with unexpected finding of invasive cervical cancer. Morbidity of the procedure is higher in comparison to standard radical hysterectomy, however majority of complications are easy to repair. The most significant criteria for patient's selection for surgical approach is a depth of invasion to cervical stroma. In our group radical procedure obviated the need for radiotherapy in half of the patients.

Part of breast and ovarian cancer cases develops on the hereditary predisposition, i.e. mutation in one of predisposing genes. Although this proportion is relatively small, 5-10% of all breast and ovarian carcinomas, it represents a group with clearly defined etiologic factor. Predictive analysis of unaffected family members allows to identify individuals at high risk of cancer and to include them into the programme of primary and secondary cancer prevention. Following article presents basic review of the hereditary predisposition to breast and ovarian cancer focusing especially on BRCA1 and BRCA2 genes, which are responsible for almost three-quarters of those hereditary tumours.

The objective of the work was to evaluate the incidence and type of postoperative complications after radical exenteration of the axilla in conjunction with an implemented surgical operation.Retrospective clinical study.Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital Prague, Apolinárská 18, Prague.The authors made a retrospective analysis of postoperative complications in 116 selected patients, who underwent partial breast surgery or ablation of the breast with dissection of the axilla at the Gynaecological and Obstetric Clinic, First Medical Faculty Charles University and General Faculty Hospital in Prague in 1994-2000 on account of breast cancer stage I and II according to FIGO. The group comprised patients where radiotherapy or chemotherapy of the axilla was not used. The patients were at least 12 months after operation without signs of locoregional relapse of the disease and in the dissected axillary tissue at least 10 lymph nodes were found. The operations were implemented by nine different surgeons. Early (infection, seroma, haematoma) as well as late (oedema, paraesthesia, stiffness, pain, weakness of the upper extremity) complications were also evaluated. The authors compared the incidence of complaints in relation to age, the number of dissected nodes and extent of the breast surgery. The statistical significance of the phenomena was evaluated by Fisher's exact test.At least one complication was recorded in 65% of the patients. In early complications (haematoma, infection, seroma) neither the correlation with the patient's age nor with the number of removed nodes was significant. There was a statistically significant relationship (P0.05) between the incidence of infection and the extent of the breast surgery which probably was associated with the wound area. As to late complications (oedema, paraesthesia, stiffness, pain and weakness of the upper extremity) a significant relationship was found with lower painfulness in patients above 55 years (P0.05) and lower sensation of weakness and paraesthesias in patients with partial breast operations (P0.05). The more frequent complaints of younger patients were probably due to their greater everyday physical activity as compared with older women. The higher number of subjective complications in patients after ablation of the breast is explained not only by the size of the wound area but also by psychosocial reasons.Dissection of the axilla is part of standard surgical treatment of breast cancer. The surgical operation without radio- or chemotherapy is associated in 65% cases with long-term morbidity of the patients. With regard to the shift of diagnosis of breast cancer to earlier stages it is important to seek a less invasive staging method which will reduce the patient's morbidity. The sentinel node biopsy method seems perspective.