Alice Pellegrini

Electrochemotherapy can be used as palliative treatment in patients with repeated loco-regional recurrence of squamous vulvar cancer: a preliminary study

OBJECTIVE Electrochemotherapy (ECT) is an attractive treatment for solid cutaneous tumours with a good response rate (55-92%). No studies have evaluated ECT performed in vulvar cancer. The aim of our study was to evaluate the safety, local tumour efficacy and relief of symptoms of ECT treatment in patients affected by recurrence of squamocellular vulvar cancer (V-SCC) unsuitable for standard treatments. METHODS We enrolled nine patients with histological diagnosis of recurrence of V-SCC. Intravenous bleomycin was injected under general sedation after an accurate mapping of all lesions and ECT was performed. Patients were reviewed after one, three and six months. Response to therapy was evaluated using RECIST criteria and quality of life (QoL) was evaluated via questionnaires. RESULTS The median age was 84 years (range 80-90 years). The main location of recurrences was the vulva (87.5%). Multiple lesions were present in 25% of cases. No peri-operative complications were observed. Response to therapy was complete in 62.5% of patients, partial in 12.5%, no change was observed in 12.5% and progression of disease in 12.5% of patients respectively. Evaluation of symptoms showed a significant reduction of pain, bleeding, odour (p < 0.04) and urinary discomfort (p < 0.04). We observed two relapses at four and seven months after treatment. After nine months fifty percent of patients were alive. CONCLUSIONS Our preliminary study showed that ECT is a suitable procedure in elderly patients with loco-regional vulvar cancer relapses. ECT can be used as palliative therapy and the treatment relieves symptoms and improves QoL.

Single or repeated gonadotropin‐releasing hormone agonist treatment avoids hysterectomy in premenopausal women with large symptomatic fibroids with no effects on sexual function

The aim of our study was to explore the effects on symptoms and female sexual function of the medical management with gonadotropin‐releasing hormone agonist (GnRHa) in women of more than 45 years old compared to surgical management.

Positive predictive value of breast lesions of uncertain malignant potential (B3): Can we identify high risk patients? The value of a multidisciplinary team and implications in the surgical treatment

BACKGROUND AND AIM The use of conventional needle core biopsy for palpable masses and vacuum-assisted needle core biopsy for microcalcifications has significantly increased the preoperative diagnosis rate, but the strategy for those patients with lesions of uncertain malignant potential (B3) still remains controversial. The aim of this study was to evaluate the positive predictive value (PPV) of the malignancy of B3 lesions in order to establish their correct management in the setting of a multidisciplinary care pathway. METHODS Data from all patients who had a Needle Core Biopsy (NCB) or a Vacuum-Assisted Needle Core Biopsy (VANCB) between 2005 and 2014 were retrospectively collected and analyzed. The B3 patients were discussed by the Multidisciplinary Team (MDT) deciding for surgery or for follow-up, based on a score in which clinical-instrumental factors and environmental factors were considered. The PPV of malignancy of all surgically excised B3 lesions was calculated. RESULTS One hundred and seventy-eight B3 NCBs were included in the study and Atypical Epithelial Proliferation of Ductal Type (AEDPT) was the most represented subcategory. The final histopathology report of the 128 patients operated on showed 94 benign and 34 malignant lesions. The PPV of B3 patients referred to surgery was 26.5%. CONCLUSION B3 patients should be evaluated by a breast MDT in order to make the right therapeutic decision, in particular for patients with contrasting clinical/diagnostic findings. Larger prospective studies are required to assess the definitive PPV of each B3 subcategory.

Liquid biopsy in the diagnosis of HPV DNA in breast lesions

AIM HPV DNA has never been investigated in nipple discharges (ND) and serum-derived extracellular vesicles, although its presence has been reported in ductal lavage fluids and blood specimens. MATERIALS & METHODS We analyzed 50 ND, 22 serum-derived extracellular vesicles as well as 51 pathologic breast tissues for the presence of 16 HPV DNA types. RESULTS We show that the presence of HPV DNA in the ND is predictive of HPV DNA-positive breast lesions and that HPV DNA is more represented in intraductal papillomas. We also show the presence of HPV DNA in the serum-derived extracellular vesicles. CONCLUSION Our data supports the use of liquid biopsy to detect HPV DNA in breast pathology.

The Neoadjuvant Net: A patient- and surgeon-friendly device to facilitate safe breast-conserving surgery in patients who underwent neoadjuvant treatment

The primary goal of the study was to describe an innovative and helpful tool in defining the minimal surgical margins necessary during breast-conserving surgery (BCS) after neoadjuvant treatment: the Neoadjuvant Net (NN). The secondary endpoint was to assess its usefulness in achieving postoperative disease-free margins and reducing Ipsilateral Breast Tumor Recurrences (IBRTs). The breast-conserving surgical technique together with the use of the Neoadjuvant Net is herein reported. Age, stage at diagnosis, clinical and pathological response, lymph node status, type of surgery, margin status, and incidence of local and distant recurrence were retrospectively analyzed. Seventy-five patients underwent BCS following medical treatment from 2000 to 2011. The majority of the patients had significant size reduction (63/75, 84%). Twenty-two had a complete clinical response but only 11 (11/75, 14.7%) showed a complete pathological response. Two patients (2/75, 2.67%) had infiltrated surgical margins. After a mean follow-up of seventy months, 3 patients (3/75, 4%) had IBRTs and 4 women had distant metastases (4/75, 5.34%). The NN is an easy-to-use, non-invasive instrument designed with the purpose of facilitating the surgeons task of reducing infiltrated margins and IBTRs.

M389 CLINICAL SIGNIFICANCE OF MICROINVASION IN BORDERLINE OVARIAN TUMOR AND ITS IMPACT ON SURGICAL MANAGEMENT

project of the safety, acceptability, feasibility and effectiveness of this method of cervical cancer screening in Roi Et Province, Thailand (“SAFE cohort”). Methods: The SAFE Cohort was actively recruited through postcards and home visits from village health workers. Previously VIApositive women were invited to the district hospital where they received follow-up VIA screening, colposcopically-directed biopsy and endocervical curettage (ECC). Previously VIA-negative women were invited to the nearest local health center where they received VIA screening. Those who were VIA-positive were subsequently offered treatment and referred for colposcopically-directed biopsy and ECC by a standardized colposcopist at the District Hospital. Results were aggregated and analyzed with descriptive statistics. Results: Of the 5,999 women in the SAFE cohort, which consisted of 798 VIA-positive (“Cohort A”) and 5,201 VIA-negative women (“Cohort B”), 5179 women were identified in the cancer registry. 1052 were excluded because they could not be located, declined to participate, were deceased, or for other reasons. Excluding those who died in the interim, the overall response rate was 79.8%. There were no significant differences (p < 0.05) in age, district, or initial VIA result between participants and non-participants. The majority of both cohorts (88.8% and 73.9% of cohort A and B, respectively) received some form of cervical cancer testing since their initial VIA screening, as per the SAFE study rescreen protocol, prior to being recruited for this follow-up study. The VIA positivity rate was 9.0% for Cohort A, and 4.1% for Cohort B. Only 2 women (0.8%) in Cohort A and 3 women (0.1%) in Cohort B had confirmed evidence of high-grade dysplasia, either by ECC or cervical biopsy. Conclusions: This follow-up study revealed that the rescreen protocol was successful in getting the majority of the SAFE cohort back within 5–6 years of initial screening. The VIA positivity rate on follow-up screening for both previously VIA-positive and VIAnegative cohorts was low, confirmed by pathological diagnosis. Based on these results, rescreening with VIA at longer intervals may be warranted in low-resource settings.