Erich Burghardt

Prognostic factors and operative treatment of stages IB to IIB cervical cancer

Between 1971 and 1985, a total of 325 cases of cervical cancer, Stages IB to IIB, in which operation was performed were evaluated with a view toward prognostic factors and survival rates. In radical abdominal operations, a complete resection of parametrial tissue was the goal. Extensive lymphadenectomy of the pelvis was performed. Operative specimens were processed by giant sections comprising cervix, lateral parametria, and vaginal cuff. Lymph nodes were cut by step-serial sections. Exact measurements of tumor sizes were done along with investigations of parametrium and lymph nodes. Tumors were classified according to a ratio of tumor size to size of cervix. Incidence of lymph node involvement increased with tumor size, reaching a maximum of 68.3% in the group with a ratio from 70% to 80%. Direct spread into the parametrium was rarely found, even in larger tumors occupying the entire cervix. parametrial lymph nodes were most often involved; these were scattered over the entire ligament. Five-year survival rates reached 88.1% in patients with no nodal involvement and 60.9% with nodal involvement. In the latter, the results depended on the number of nodal groups involved and the diameter of metastases. Parametrial involvement alone had no influence on healing rates, but when pelvic nodes were simultaneously involved, the results were less satisfactory. Survival rates based on tumor size differed only between the group with a ratio up to 20% and the large-tumor groups, with rates ranging from 97.5% to 70.9%. There was no statistical difference between Stages IB (31.1% positive nodes) and IIB (44.1% positive nodes) with regard to survival rates (82.2% and 76.9%, respectively).

Pelvic lymphadenectomy in operative treatment of ovarian cancer

From the end of 1979 to September, 1985, radical pelvic lymphadenectomy was performed at the Graz Clinic in 123 cases of Stages IA to IV ovarian cancer following maximum debulking procedure. In 97 patients lymphadenectomy was done primarily. In 26 it was performed during a follow-up operation to chemotherapy. The frequency of pelvic node involvement was 61.8% in the total material and 78.0% in 82 cases of Stage III disease only; 75.0% positive nodes were found in Stage III after chemotherapy. Aortic nodes were positive in 41.4%, but only when pelvic nodes were also positive. The 5-year actuarial survival rate for Stage III disease was 53.0% after pelvic lymphadenectomy compared with 13.0% without. In cases with negative nodes the survival rate was 74.7%; with positive nodes the survival rate was 45.9%.

Microinvasive carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics Stage IA).

In 1985 the International Federation of Gynecology and Obstetrics (FIGO) subdivided Stage IA cervical cancer and specified metric criteria to demarcate Stage IA from Stage IB. Early stromal invasion (Stage IA1) denotes the first invasive protrusions of a carcinoma in situ into the stroma. Microcarcinomas (Stage IA2) are small cancers a number of orders of magnitude larger than Stage IA1 lesions and with a maximum depth of invasion of 5 mm and a maximum horizontal spread of 7 mm; larger lesions are classified as Stage IB. This study reviews 486 patients previously classified as having Stage IA disease. This yielded 344 Stage IA1 and 101 Stage IA2 lesions; 41 cancers were reclassified as Stage IB. Three hundred nine, 89, and 38 patients were followed for ± 5 years. One (0.3%) patient with Stage IA1 disease re‐presented with Stage IIB disease 12 years after conization. Five (5.6%) patients with Stage IA2 lesions developed invasive recurrences; three died. None of the 38 patients reclassified as having a Stage IB lesion, including 16 who were treated conservatively, developed a recurrence. The FIGO classification is not a guideline for treatment. Stage IA1 lesions can be treated conservatively, but treatment in Stage IA2 must be individualized. Risk factors such as vascular space involvement and confluency are of high sensitivity but low specificity.

Magnetic resonance imaging in cervical cancer: A basis for objective classification

Conventional clinical staging of cervical cancer is subjective because it is based on palpatory findings and inadequate because it cannot assess the single most important prognostic factor--tumor size. To determine the exactitude of in vivo MRI measurements of tumor volume, 22 patients with invasive cervical cancer were studied before surgery. The volumes obtained by MRI correlated well (r = 0.983) with those obtained by histomorphometric analysis of the surgical specimens, but only weakly with clinical stage. MRI may provide a basis for precise classification of cervical cancer and for objective comparison of surgery and radiotherapy.

Early squamous cell carcinoma of the uterine cervix II. Clinical results of a cooperative study in the management of 419 patients with early stromal invasion and microcarcinoma

Abstract Clinical studies and therapeutic modalities in 285 patients with early stromal invasion and 134 patients with microcarcinoma collected from six different university hospital departments of gynecology are presented as a contribution to the controversial problem concerning the proper treatment of early cervical cancer. In all six departments, clinical investigation and histologic studies are carried out in a comparable manner. Of the patients, 72% with early stromal invasion and 41% with microcarcinoma were treated with conization or with abdominal, respectively vaginal hysterectomy only, i.e., not with the usual radical cancer therapy. After long-term follow-up, no patient with early stromal invasion has died; in three patients who died from microcarcinoma, a causal relationship seems to have existed between the fatal cause and microcarcinoma. Our own results and comparable data reported in the literature allow the conclusion that in patients with early stromal invasion or microcarcinoma, a restricted cancer therapy may be possible, just as in patients with carcinoma in situ . If intraluminal tumor invasion is demonstrated in the diagnostic biopsy, an additional lymphadenectomy is advisable. A radical extirpation of parametrial tissues is in no case necessary.

Simultaneous colposcopy and cytology used in screening for carcinoma of the cervix.

Abstract Colposcopy is particularly useful as a specific method of early diagnosis of preclinical carcinoma of the cervix, when used in conjunction with cytology. Thus used, it compensates greatly for any error of cytology. This fact is demonstrated by the results of routine examinations of 18,112 patients in whom 306 preclinical carcinomas were discovered. A second advantage of colposcopy is the ability to aim a punch biopsy with great accuracy and to avoid many unnecessary biopsies. Furthermore colposcopy has great importance as a method of teaching and investigating pathological changes of the ectocervix.

Diagnosis and surgical treatment of cervical cancer

9. 10. Introduction Natural history 2.1. Morphologic aspects 2.2. The role of human papillomaviruses 2.3. The transition to invasive growth Colposcopy 3.1. Cytology and colposcopy 3.2. Cervicography Histologic evaluation Morphometry Imaging techniques 6.1. Ultrasonography 6.2. Computed tomography 6.3. Magnetic resonance imaging 6.4. Comparative studies of imaging techniques 6.5. MRI tumormetry 6.6. Lymph node involvement Spread to the lymph nodes Clinical staging 8.1. Stage1 8.1.1. Stage Ia 8.1.2. Stage Ib 8.2. Stage II 8.2.1. Stage IIa 8.2.2. Stage IIb 8.3. Stage IIIa Staging laparotomy Surgical treatment 10.1. 10.2. 10.3. 10.4. Principles Local radicality Lymphadenectomy Treatment according to stage 10.4.1. Cervical intraepithelial neoplasia 10.4.2. Microinvasive carcinoma 10.4.2.1. Stage Ial 10.4.2.2. Stage Ia 182 182 182 184 186 187 190 191 192 193 195 195 195 195 195 195 196 197 199 199 199 201 201 201 201 202 202 202 202 202 204 204 204 205 205 205

Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer

One hundred eighty patients with ovarian cancer underwent complete pelvic lymphadenectomy (n = 75) or pelvic and paraaortic lymphadenectomy (n = 105). Twenty-one patients underwent a preoperative biopsy of the scalene lymph nodes. The incidence of positive lymph nodes was 24% in stage I (n = 37), 50% in stage II (n = 14), 74% in stage III (n = 114), and 73% in stage IV (n = 15). Of the 105 patients who underwent pelvic and paraaortic lymphadenectomy, 13 (12%) had positive pelvic and negative paraaortic nodes and 10 (9%) had positive paraaortic and negative pelvic nodes. Positive scalene nodes were found in four patients (19%) later shown to have stage IV disease. One hundred forty patients were studied for number of involved nodes and node groups, size of nodal metastases, residual tumor, and survival. Of the 81 patients with positive nodes, most had only one or two positive node groups or one to three positive individual nodes. A few patients had seven to eight involved node groups with up to 44 positive nodes. Greater numbers of positive nodes were found in stage III than stage IV. The size of the largest nodal metastasis was not related to the clinical stage or survival, but did correlate with the number of positive nodes. Stage III patients with no residual tumor had a significantly lower rate of lymph node involvement than those with tumor residual (P less than 0.01). Actuarial 5-year survival rates of patients with stage III disease and no, one, or more than one positive nodes were 69, 58, and 28%, respectively.

Über Gefäßverödungen in Uterusmyomen

ZusammenfassungBei der Untersuchung von Myomgefäßen wurden in den Kapseln und den Randgebieten von Myomen neben zahlreichen Polstergefäßen auch Gefäße gesehen, deren Lumina durch Neubildung vorwiegend längsverlaufender Muskulatur und elastischen Gewebes verschlossen waren. Die Muskelneubildung erfolgt meist von der Intima aus, aber auch in den äußeren Gefäßwandschichten unter Schwund der präexistenten zirkulären Strukturen und Umwandlung der Gefäße in muskulär-elastische Stränge. Es wird auf die Rolle mechanischer Momente, insbesondere der Zugbeanspruchung der Gefäße bei dem Zustandekommen solcher Veränderungen hingewiesen und ihre Bedeutung für die Ausbildung der regressiven Veränderungen der Myome erwogen.