Objectives
Accurate assessment of disease extent is required to select the best primary treatment for advanced epithelial ovarian cancer patients. Estimation of tumour burden is challenging and it is ...usually performed by means of a surgical procedure. Imaging techniques and tumour markers can help to estimate tumour burden non-invasively. 2-
18
FFDG PET/CT allows the evaluation of the whole-body disease. This study aimed to correlate HE4 and CA125 serum concentrations with tumour burden evaluated by volumetric 2-
18
FFDG PET/CT parameters in advanced high-grade epithelial ovarian cancer.
Methods
We included 66 patients who underwent 2-
18
FFDG PET/CT and serum tumour markers determination before primary treatment. Volumes of interest were delimited in every pathological uptake. Whole-body metabolic tumour volume (wb_MTV) and total lesion glycolysis (wb_TLG) were calculated summing up every VOI’s MTV value. SUVmax thresholds were set at 40% (MTV40 and TLG40) and 50% (MTV50 and TLG50). In addition, four VOI subgroups were defined: peritoneal carcinomatosis, retroperitoneal nodes, supradiaphragmatic nodes, and distant metastases. MTV and TLG were calculated for each group by adding up the corresponding MTV values. TLG was calculated likewise.
Results
wb_MTV and wb_TLG were found to be significantly correlated with serum CA125 and HE4 concentrations. The strongest correlation was observed between HE4 and wb_MTV40 (
r
= 0.62,
p
< 0.001). Pearson’s correlation coefficients between peritoneal carcinomatosis MTV40 and tumour markers were 0.61 (
p
< 0.0001) and 0.29 (
p
= 0.02) for HE4 and CA125 respectively. None of these tumour markers showed a positive correlation with tumour load outside the abdominal cavity assessed by volumetric parameters.
Conclusion
HE4 performs better than CA125 to predict metabolic tumour burden in high-grade epithelial ovarian cancer before primary treatment. 2-18FFDG PET/CT volumetric parameters arise as feasible tools for the objective assessment of tumour load and its anatomical distribution. These results support the usefulness of HE4 and PET/CT to improve the stratification of these patients in clinical practice.
Key Points
• In patients with high-grade advanced ovarian epithelial carcinoma, both CA125 and HE4 correlate to whole-body tumour burden assessed by PET/CT before primary treatment.
• HE4 estimates peritoneal disease much better than CA125.
• PET/CT volumetric parameters arise as feasible tools for the objective assessment of tumour load and its anatomical distribution.
Sistematic pelvic and para-aortic lymphadenectomy is part of the staging surgery for early-stage epithelial ovarian cancer, with no therapeutic value. The Mapping Sentinel Lymph Nodes In Early-Stage ...Ovarian Cancer (MELISA) trial prospectively assessed the SLN detection rate and the diagnostic accuracy of the SLN mapping technique in patients with early-stage epithelial ovarian cancer.
This prospective, single-arm study included patients diagnosed with early-stage epithelial ovarian cancer (FIGO stages I and II), via either primary surgery or re-staging surgery. SLN mapping was performed by injecting 0.2 mL of 37-mBq
Tc-nanocoloid albumin and 2 mL of 2.5 mg/mL indocyanine green into the infundibulopelvic and utero-ovarian ligaments. After removal of SLNs, a complete systematic pelvic and para-aortic lymphadenectomy was performed. SLN Ultrastaging analysis was applied. The primary outcome was the overall SLN detection rate, either with one or both tracers. Secondary outcomes were the diagnostic accuracy of detecting lymph node metastases and factors that may influence SLN detection.
Thirty patients were included. SLNs were identified in 27 patients (90%). Detection rates in primary and re-staging surgery were 89% and 92%, respectively. Para-aortic drainage was the predominant lymphatic spread, observed in 26 of 27 patients. Ultrastaging pathologic reports listed 1 SLN with macrometastasis, 1 with micrometastasis, and 5 with isolated tumor cells; the sensitivity of SLN mapping was 100%, with a false-negative rate of 0%. Univariate analysis showed a nonsignificant higher proportion of patients with uterine fibroids, adenomyosis, and endometriosis (100%, 67%, 67%, respectively) in patients in whom SLNs were not detected.
SLN mapping has a high detection rate (90%) and is an accurate technique for detecting lymph node involvement in early-stage epithelial ovarian cancer. SLN mapping is a potential alternative to systematic lymphadenectomy to reduce associated morbidity, but further research is needed to evaluate the impact of SLN mapping on oncologic outcomes and its cost-effectiveness.
(1) OBJECTIVE: To assess the performance of CA125, HE4, ROMA index and CPH-I index to preoperatively identify epithelial ovarian cancer (EOC) or metastatic cancer in the ovary (MCO). (2) METHODS: ...single center retrospective study, including women with a diagnosis of adnexal mass. We obtained the AUC, sensitivity, specificity and predictive values were of HE4, CA125, ROMA and CPH-I for the diagnosis of EOC and MCO. Subgroup analysis for women harboring adnexal masses with inconclusive diagnosis of malignancy by ultrasound features and Stage I EOC was performed. (3) RESULTS: 1071 patients were included, 852 (79.6%) presented benign/borderline tumors and 219 (20.4%) presented EOC/MCO. AUC for HE4 was higher than for CA125 (0.91 vs. 0.87). No differences were seen between AUC of ROMA and CPH-I, but they were both higher than HE4 AUC. None of the tumor markers alone achieved a sensitivity of 90%; HE4 was highly specific (93.5%). ROMA showed a sensitivity and specificity of 91.1% and 84.6% respectively, while CPH-I showed a sensitivity of 91.1% with 79.2% specificity. For patients with inconclusive diagnosis of malignancy by ultrasound features and with Stage I EOC, ROMA showed the best diagnostic performance (4) CONCLUSIONS: ROMA and CPH-I perform better than tumor markers alone to identify patients harboring EOC or MCO. They can be helpful to assess the risk of malignancy of adnexal masses, especially in cases where ultrasonographic diagnosis is challenging (stage I EOC, inconclusive diagnosis of malignancy by ultrasound features).
Microbial invasion of the amniotic cavity (MIAC) is only identified by amniocentesis, an invasive procedure that limits its clinical translation. Here, we aimed to evaluate whether the vaginal ...metabolome discriminates the presence/absence of MIAC in women with preterm labor (PTL) and intact membranes. We conducted a case-control study in women with symptoms of PTL below 34 weeks who underwent amniocentesis to discard MIAC. MIAC was defined as amniotic fluid positive for microorganisms identified by specific culture media. The cohort included 16 women with MIAC and 16 control (no MIAC). Both groups were matched for age and gestational age at admission. Vaginal fluid samples were collected shortly after amniocentesis. Metabolic profiles were analyzed by nuclear magnetic resonance (NMR) spectroscopy and compared using multivariate and univariate statistical analyses to identify significant differences between the two groups. The vaginal metabolomics profile of MIAC showed higher concentrations of hypoxanthine, proline, choline and acetylcholine and decreased concentrations of phenylalanine, glutamine, isoleucine, leucine and glycerophosphocholine. In conclusion, metabolic changes in the NMR-based vaginal metabolic profile are able to discriminate the presence/absence of MIAC in women with PTL and intact membranes. These metabolic changes might be indicative of enhanced glycolysis triggered by hypoxia conditions as a consequence of bacterial infection, thus explaining the utilization of alternative energy sources in an attempt to replenish glucose.
Recent evidence indicates that some minimally invasive surgery approaches, such as laparoscopic and robotic-assisted radical hysterectomy, offer lower survival rates to patients with early-stage ...cervical cancer than open radical hysterectomy. We evaluated the oncological results of a different minimally invasive surgery approach, that of laparoscopically assisted radical vaginal hysterectomy (LARVH) in this setting.
From January 2001 to December 2018, patients with early-stage cervical cancer were treated by LARVH. Colpotomy and initial closure of the vagina were performed following the Schauta operation, avoiding manipulation of the tumor. Laparoscopic sentinel lymph node (SLN) biopsy was performed in all cases. Women treated between 2001 and 2011 also underwent pelvic lymphadenectomy.
There were 115 patients included. Intraoperative complications occurred in nine patients (7.8%). After a median follow-up of 87.8 months (range 1-216), seven women (6%) presented recurrence. Four women died (mortality rate 3.4%). The 3- and 4.5-year disease-free survival rates were 96.7% and 93.5%, respectively, and the overall survival was 97.8% and 94.8%, respectively.
LARVH offers excellent disease-free and overall survival in women with early-stage cervical cancer and can be considered as an adequate minimally invasive surgery alternative to open radical hysterectomy.
Introduction
The aim of this study was to compare oncological outcomes and morbidity in patients with early‐stage vulvar cancer with negative sentinel lymph node (SLN) biopsy vs negative ...inguinofemoral lymphadenectomy (IFL).
Material and methods
Study with retrospectively collected data in patients with squamous cell vulvar carcinomas ≤ 4 cm without suspected inguinofemoral lymph node metastases. Only patients with negative nodes after histopathology procedure were followed. Patients who underwent only SLN were compared with patients who underwent IFL ± SLN to compare recurrences, survival rates and morbidity.
Results
Ninety‐three patients were eligible for follow up: 42 with negative SLN and 51 with negative IFL ± SLN. The median follow‐up period was 60.4 months (range 6.7‐160.7). The rate of isolated first groin recurrence was 4.8% in patients with negative SLN and 2.0% in patients with negative IFL ± SLN (P = 0.587) and the rates of first isolated local recurrence were 28.6% and 31.4%, respectively (P = 0.823). Only 1 patient (2.4%) in the group of negative SLN had distant recurrence. The disease‐specific survival rate at 5 years was 83.3% in the negative SLN group and 92.2% in the negative IFL ± SLN group (P = 0.214). We observed a higher rate of wound breakdown and infection after IFL than SLN biopsy (17.6% vs 10.6%; P = 0.020) and lymphedema (33.3% vs 0%; P < 0.001).
Conclusions
We report in the same population of patients with early‐stage vulvar cancer that SLN biopsy does not have significantly higher rates of groin recurrences or lower survival rates compared with IFL. Moreover, the SLN procedure has less morbidity, which should encourage gynecologists to abandon IFL.
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•Trioza erytreae is vector of Huanglongbing, the main global citrus threat.•For T. erytreae biological control, the role of each potential predator is key.•The designed T. ...erytreae-specific primers detected the target pest in predator guts.•The 70% of the analysed generalist predators were fed on T. erytreae.•A wide range of predators ingested T. erytreae, showing 20 to 100% PCR detection.
Trioza erytreae is one of the vectors of Huanglongbing (HLB), the main global citrus groves threat. Since its recent detection in the north-western Iberian Peninsula (Spain and Portugal), its contention and eradication have been a priority to prevent its spread. For the biological control of T. erytreae, it is important to understand the role that each potential natural enemy could have. With the aim to determine which predators have incorporated T. erytreae into their diet, a PCR-based method has been developed for the specific detection of T. erytreae in their gut contents. For this, a pair of specific primers was designed from the mitochondrial cytochrome c oxidase subunit I (COI) region. Specificity of this pair of primers was studied and feeding trials with two predator species were conducted to determine the decay rates of T. erytreae within their gut. None of the non-target species was amplified, showing the high specificity of these T. erytreae primers. Feeding trials showed 4.8 h and 4.5 h half-life time detections of T. erytreae ingested by Chrysoperla carnea and Cryptolaemus montrouzieri, respectively. Finally, field-collected generalist predators of T. erytreae-infested citrus trees from the Canary Islands and Galicia (Spain), were analysed by conventional PCR for the presence of T. erytreae in their guts. Results showed that a wide range of predator taxa ingested the target prey, like the families Coccinellidae, Anthocoridae, Chrysopidae, Hemerobiidae, Forficulidae, Miridae, Syrphidae, Formicidae, Erythraeidae and the order Araneae, with detection percentages ranging from 20 to 100%. These results confirm that most of the analysed generalist predators found in citrus trees could be potential candidates for the biological control of T. erytreae in future biological control programs of this HLB vector.
Development of conservation biological control programs requires the identification of sources that contribute to predator colonization of crops. Macrolophus pygmaeus (Rambur) (Hemiptera: Miridae) is ...an efficient polyphagous predator used in biological control programs in vegetable crops in Europe. We have developed a marking method based on spraying with a solution of the brine shrimp Artemia spp. (Anostraca: Artemiidae) cysts, followed by a PCR detection of Artemia DNA to monitor M. pygmaeus dispersal from banker plants to tomato crops. Experiments conducted in climatic chambers show that the topical application of this marking solution on M. pygmaeus does not significantly reduce adult longevity and that it is detected up to 6 d after the application. When this Artemia solution was applied on Calendula officinalis L. banker plants harboring M. pygmaeus and maintained outdoors, Artemia DNA was still detected on 62% of the insects after 6 d. The conducted field applications in commercial greenhouses have confirmed the usefulness of this method to monitor M. pygmaeus dispersal from banker plants to a newly planted tomato crop. This method can be used to assess arthropod movement, being an interesting molecular approach for further improving future pest management strategies.
Habitat management improves biological control by increasing the abundance and fitness of natural enemies through the provision of floral resources along field edges or between crops. Among the ...natural enemies reliant on flower resources, green lacewings often stand out due to their abundance, predation capacity and polyphagy. We evaluated the impact of tailored flower strips on the enhancement of natural enemies, especially green lacewings, in three organic cabbage (
Brassica oleracea
) farms in Southern Sweden. Insects were sampled from the flower strips, and cabbage pests and predators were visually recorded in the crop. In a laboratory assay, the pollen feeding preferences of
Chrysoperla carnea
(Stephens, 1836) were evaluated in a dual-choice test. The pollen consumed by the Chrysopidae was extracted from laboratory and field specimens, then quantified and identified. Flower strips were found to attract predators and parasitoids, whose abundance increased as flowers bloomed. Cabbage plants next to the flower strips showed lower pest infestation as compared to cabbage plant control, although no significant differences were observed in the number of predators. Chrysopidae used flower strips as feeding, reproduction and shelter sites and mainly consumed pollen from
Phacelia tanacetifolia
Benth. Under laboratory conditions,
C. carnea
showed a preference for
P. tanacetifolia
and
Coriandrum sativum
L. pollen over
Borago officinalis
L. and
Fagopyrum esculentum
Moench. We show that tailored flower strips could be an efficient tool for enhancing beneficial arthropods and should be considered in integrated pest management for cabbage crops.
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