Daniela Giuliani
University of Milano-Bicocca
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International Journal of Gynecological Cancer | 2012
Alessandro Buda; Federica Elisei; Maurizio Arosio; Carlotta Dolci; Mauro Signorelli; Patrizia Perego; Daniela Giuliani; Dario Recalcati; Giorgio Cattoretti; Rodolfo Milani; Cristina Messa
Objective The purpose of this study was to assess whether there is an additional value of single-photon emission computed tomography/computed tomography (SPECT/CT) over lymphoscintigraphy (LSG) alone for sentinel node (SN) mapping in endometrial and cervical cancer. Methods Ten women with clinically cervical stage IA2 to stage IB1 and 25 women with stage I endometrial cancer underwent preoperative LSG for SN mapping. Technetium Tc 99m albumin nanocolloid was injected submucosally at 4 points of the cervix. Patients underwent SPECT/CT emission-transmission study at least 3 hours after standard planar images. Methylene blue was injected into the cervix just before surgery under general anesthesia. All patients underwent hysterectomy, bilateral salpingo-oophorectomy, and radical regional nodal dissection. Hot and/or blue nodes were labeled as SNs. Results Conventional planar imaging detection rate was 50%, whereas the detection rate of at least one SN with SPECT/CT was 91% (32/35); bilateral detection was achieved in 7 (39%) of 18 women in planar and in 17 (53%) of 32 women in SPECT/CT imaging, respectively. Bilateral detection was achieved in 57% of women (20/35). Sentinel nodes were located in external and internal iliac nodes (66%), obturator nodes (5%), internal iliac nodes (11%), common iliac nodes (9%), and presacral nodes (9%). Lymph node involvement was identified in 5 patients (14%). Sentinel node correctly predicted lymph node involvement in all node-positive patients. Sentinel node sensitivity and negative predictive value of SPECT/CT were 100%. Conclusions Single photon emission computed tomography/computed tomography seems to improve intraoperative identification of SNs and provides additional useful information about the anatomic location of SNs compared to planar LSG in cervical and endometrial cancer.
International Journal of Gynecological Cancer | 2010
Mauro Signorelli; Robert Fruscio; Tiziana Dell'Anna; Alessandro Buda; Daniela Giuliani; Lorenzo Ceppi; Rodolfo Milani
Background: The role of lymphadenectomy in low-grade endometrial stromal sarcoma (ESS) is controversial. The risk of nodal metastases ranges from 0% to 44%, but data are inconclusive. The objective of this study and of the literature review was to investigate the incidence of nodal involvement in macroscopically early-stage tumors. Methods: All consecutive patients with histologically proven uterine low-grade ESS who underwent surgery in our institution were considered eligible for the analysis. Until July 2006, pelvic systematic lymphadenectomy was performed based on the physicians choice, whereas after July 2006, all women with apparent early-stage tumor underwent systematic pelvic nodes dissection. Results: From January 1985 to March 2009, 64 women were surgically treated and 19 underwent bilateral systematic pelvic lymphadenectomy. The median count of nodes removed was 20 (range, 11-30). Nodal involvement was depicted in 3 of 19 women but only in 1 in 16 (5%) women with apparent early-stage disease. Specifically, we did not find nodal metastases in 9 women with macroscopically early-stage tumors treated after July 2006. According to the literature review, the risk of nodal metastases is 5% (range, 0%-16%) in early-stage disease. Conclusions: There is no indication to offer a systematic lymphadenectomy in apparent early-stage low-grade ESS according to our analysis and to the literature review. Retroperitoneal surgery should be limited in case of bulky nodal disease or in case of nodal recurrences.
British Journal of Cancer | 2016
Robert Fruscio; Lorenzo Ceppi; Silvia Corso; Francesca Galli; Tiziana Dell'Anna; Federica Dell'Orto; Daniela Giuliani; Annalisa Garbi; Stefania Chiari; Costantino Mangioni; Rodolfo Milani; Irene Floriani; Nicoletta Colombo; Cristina Bonazzi
Background:The objective of this study is to evaluate the safety of fertility-sparing surgery (FSS) for early-stage epithelial ovarian cancer (EOC).Methods:A retrospective analysis was performed to identify patients treated for early-stage EOC and to compare the clinical outcomes of patients treated with FSS and radical surgery (RS).Results:A total of 1031 patients were treated at two Institutions, 242 with FSS (group A) and 789 with RS (group B). Median duration of follow-up was 11.9 years. At univariate analyses, FSS was associated with decreased risk of relapse (P=0.002) and of tumour-related death (P=0.001). Multivariate analysis did not confirm the independent positive role of FSS neither on relapse-free interval (RFI) nor on cancer-specific survival (CSS). Tumour grade was associated with shorter RFI (P<0.001) and shorter CSS (P=0.001). The type of treatment did not influence CSS or RFI in any grade group. We also found a significant association between low-grade tumours and younger age.Conclusions:Fertility-sparing surgery is an adequate treatment for patients with stage I EOC. The clinical outcome of patients with G3 tumours, which is confirmed to be the most important prognostic factor, is not determined by the type of treatment received.
Gynecologic Oncology | 2017
Alessandro Buda; Giampaolo Di Martino; Stefano Restaino; Elena De Ponti; Giorgia Monterossi; Daniela Giuliani; Alfredo Ercoli; Federica Dell'Orto; Giorgia Dinoi; Tommaso Grassi; Giovanni Scambia; Francesco Fanfani
OBJECTIVE The role of lymphadenectomy in endometrial cancer is still uncertain. We aimed to evaluate the survival outcomes of two different strategies in apparent uterine confined disease by comparing sentinel lymph node (SLN) mapping and selective lymphadenectomy (LD). METHODS We retrospectively reviewed women with preoperative stage I endometrial cancer underwent surgical staging with either SLN mapping, or LD in two Italian centers. RESULTS Eight hundred and two women underwent surgical staging for preoperative stage I endometrial cancer were revised (145 Monza; 657 Rome). All patients underwent peritoneal washing, simple hysterectomy with bilateral salpingo-oophorectomy and nodal staging including SLN mapping, or LD. Overall 8229 lymph nodes were removed (1595 in Monza, 6634 in Rome). Pelvic lymphadenectomy was performed in 33.1% and 52.4% in Monza and Rome, respectively (p<0.001). Patients with positive pelvic LN were 16.7% and 7.3%, in SLN and LD groups, respectively (p=0.002). Disease-free survival (DFS) curves did not showed a statistically significant difference between centers and strategies adopted (SLN mapping, LD, SLN+LD) with a HR of 0.87 (95% CI 0.63-2.16; p=0.475). CONCLUSIONS Survival outcomes were similar for both strategies. The SLN strategy allowed to identify a higher rate of stage IIIC1 disease even with a lower median number of lymph node removed in SLN group. Applying a SLN algorithm does not impair the prognosis of endometrial cancer patients. The clinical impact and management of low volume metastasis in high-risk patients should be further clarify.
Journal of Minimally Invasive Gynecology | 2018
Alessandro Buda; Giampaolo Di Martino; Elena De Ponti; Paolo Passoni; Federica Sina; Claudio Reato; Francesca Vecchione; Daniela Giuliani
STUDY OBJECTIVE The goal of this study was to evaluate the intraoperative and perioperative surgical outcomes of 2 different florescence systems commonly used for sentinel lymph node (SLN) mapping in women with early-stage cervical cancer or endometrial cancer. DESIGN Case-control study (Canadian Task Force classification II-2). SETTING The Gynecology Oncology Surgical Unit of the San Gerardo Hospital, Italy. PATIENTS Thirty-four consecutive women with early stage-cervical cancer (stage IA-1B1) or apparent confined stage I endometrial cancer were included in the study. INTERVENTIONS Between October 2016 and May 2017, 34 patients underwent laparoscopic surgery with SLN mapping using indocyanine green dye: 22 women were mapped with the Storz 1S system (Karl Storz Endoscopy, Tuttlingen, Germany; Group A), whereas 12 women underwent planned surgery with the Novadaq PinPoint system (Novadaq, Mississauga, Ontario, Canada; Group B). MEASUREMENT AND MAIN RESULTS We compared the surgical and perioperative outcomes of Group A and Group B. Patients in Group B had a shorter duration of the SLN mapping time than those in Group A (p = .0003). The median number of SLNs removed was 2 (range, 0-5) in Group A and 2 (range, 1-3) in Group B (p = .501). Bilateral mapping was 77.3% in Group A and 83.3% in Group B (p = .334), respectively. No differences were recorded in terms of body mass index, length of hospital stay, type of tumor, bilateral mapping, or number of lymph nodes removed. Body mass index was found to have no impact on the duration of the mapping (p = .353). CONCLUSION From our preliminary experience we can conclude that both fluorescence systems are valid and applicable for SLN detection in the case of early-stage cervical or endometrial cancer. The PinPoint system seems to allow surgeons easier and faster identification of the SLNs, particularly in endometrial cancer patients.
Annals of Surgical Oncology | 2016
Alessandro Buda; Cinzia Crivellaro; Federica Elisei; Giampaolo Di Martino; Luca Guerra; Elena De Ponti; Marco Cuzzocrea; Daniela Giuliani; Federica Sina; Sonia Magni; Claudio Landoni; Rodolfo Milani
Annals of Surgical Oncology | 2016
Alessandro Buda; Federica Elisei; Sharon Palazzi; Elena De Ponti; Maurizio Arosio; Francesca Vecchione; Tiziana Dell’Anna; Marco Cuzzocrea; Beatrice Bussi; Daniela Giuliani; Giampaolo Di Martino; Cinzia Crivellaro
Annals of Nuclear Medicine | 2017
Federica Elisei; Cinzia Crivellaro; Daniela Giuliani; Carlotta Dolci; Elena De Ponti; Luca Montanelli; Maria La Manna; Luca Guerra; Maurizio Arosio; Claudio Landoni; Alessandro Buda
International Journal of Surgery Case Reports | 2012
Alessandro Buda; Daniela Giuliani; Nicola Montano; Patrizia Perego; Rodolfo Milani
International Journal of Gynecological Cancer | 2013
Mauro Signorelli; R. Fruscio; Tiziana Dell'Anna; Alessandro Buda; R Baldo; F Sina; Lorenzo Ceppi; Daniela Giuliani; Rodolfo Milani