Deni Karelović

Assessment of ovarian reserve after unilateral diathermy with thermal doses adjusted to ovarian volume

Abstract Women with polycystic ovary syndrome seem to have a larger ovarian reserve. However, regardless of a greater reserve, diminished ovarian reserve has been reported after laparoscopic diathermy. The aim of this article was to determine whether the doses adjusted unilateral laparoscopic ovarian drilling with diathermy (ULOD) diminishes ovarian reserve to compare with bilateral laparoscopic ovarian drilling with diathermy (BLOD). Ninety-six women were assigned in two groups. One group underwent ULOD receiving thermal doses (0–840 J per ovary) adjusted to volume one ovary. The other group underwent BLOD receiving fixed doses (600 J per ovary). Ovarian reserve markers [anti-Müllerian hormone (AMH); antral follicle count (AFC) and ovarian volume] were measured before and after surgery (1 and 6 months). Both groups showed a decrease in AMH after surgery, but it was significantly more distinct in the BLOD versus ULOD group (2.0 ng/mL versus 1.3 ng/mL; p = 0.018) in the first follow-up month and remained significantly different through the sixth follow-up month (1.9 ng/mL versus 1.15 ng/mL; p = 0.023). In contrast, in the sixth month, the ULOD versus BLOD showed a significantly greater increase AFC (p < 0.001) and volume (p = 0.013). Our findings evidenced that the dose-adjusted unilateral diathermy (60 J/cm3) does not have significant and long-term effects on ovarian reserve. Chinese abstract 患有多囊卵巢综合征的妇女似乎具有更多的卵巢储备，然而也有腹腔镜透热打孔术后卵巢储备功能降低的报道。本篇文章的目的为探究与双侧腹腔镜下卵巢打孔术(BLOD)相比，调整透热剂量单侧腹腔镜下卵巢打孔术(ULOD)对卵巢储备降低是否有影响。96名妇女被分为两组，一组接受了根据其一侧卵巢体积所调整透热剂量的ULOD（0-840J每卵巢），另一组接受了固定透热剂量的BLOD（600J每卵巢）。在术前和术后（1个月及6个月）均测定了卵巢储备指标[抗苗勒氏管激素（AMH）；窦卵泡计数（AFC）和卵巢体积] 。两组在术后都出现了AMH的降低，但在术后一个月BLOD组相较于ULOD组表现得更为明显（2.0ng/mL 比1.3ng/mL; p=0.018），术后六个月这种明显的区别仍然存在（1.9 ng/mL 比1.15 ng/mL; p=0.023）。与此相比，在第六个月ULOD组AFC与卵巢体积升高的幅度与BLOD组相比显著增多。研究结果表明根据卵巢体积调整剂量的单侧卵巢透热疗法(60 J/cm3)对卵巢储备功能无显著和长期的影响。

Reliability of sentinel node assay in vulvar cancer: The first Croatian validation trial

OBJECTIVE To evaluate the reliability of sentinel node assay in early stage vulvar cancer patients by using preoperative lymphoscintigraphy. METHODS Technetium-99m colloid albumin was injected intradermally around the tumor for lymphoscintigraphic mapping and intraoperative hand-held gamma probe detection of sentinel nodes. For all patients, sentinel node biopsy was followed by inguinofemoral lymphadenectomy, regardless of the sentinel lymph node status. RESULTS From December 2008 until May 2011, 25 consecutive patients with T1 or T2 stage of vulvar squamous cell cancer were enrolled. The median age of patients was 69 years (range, 48-79). The detection of sentinel lymph node was successful in all 25 patients. A total of 36 sentinel lymph nodes were harvested and metastatic carcinoma was identified in 12 sentinel nodes from 8 patients. There was 1 patient with metastatic non-sentinel lymph node despite the negative sentinel node. Two patients with negative sentinel nodes proven by routine histopathological examination were positive by immunohistochemical staining. The sensitivity, specificity and negative predictive value of sentinel node assay with immunohistochemistry included were 89%, 100%, and 94%, respectively. CONCLUSIONS Lymphoscintigraphy and sentinel lymph node biopsy under gamma-detecting probe guidance proved to be an easy and reliable method for the detection of sentinel node in early vulvar cancer. Immunohistochemical analysis improves the sensitivity for the detection of regional micrometastases. The sentinel node assay is highly accurate in predicting the status of the remaining inguinofemoral lymph nodes. Our results indicate that patients best suited to SLN assay have had a simple punch biopsy to confirm the diagnosis rather than a previous tumor excision. This technique represents a true advance in the selection of patients for less radical surgery.