Wednesday, October 18, 2017

Does all ovarian cancer originate in fallopian tube? Increasing evidence suggests so!

John Hopkins Medicine

Most-and possibly all ovarian cancer originates not in ovaries, but instead in the distal end of fallopian tubes attached to them, reports the findings of multi-center ovarian cancer genetics study published October 17, 2017 in Journal Nature Communications.

Douglas A. Levine, MD, director of the Division of Gynecologic Oncology at Perlmutter and professor of Obstetrics and Gynecology at NYU School of Medicine said in a news release, "Based on a better understanding of its origins, our study suggests new strategies for the prevention and early detection of ovarian cancer."

Serous tubal intra-epithelial carcinoma (STIC) are identified as precursors in ~50% cases of advanced high-grade serous carcinomas (HGSCs) of the pelvis. STIC have helped us a lot in understanding the origin of ovarian malignancies. It was originally diagnosed in fimbrial part fallopian tube when researchers examined the serial sections of this area in tube samples in cases of women who underwent prophylactic bilateral salpingo-oophorectomy(BSO).

This discovery led researchers to identify many cases of presumed ovarian cancer to be of tubal origin because of presence of a STIC.

The researchers in this study identified a total of 96 bio specimens’ samples, with or without STIC. 

The median age of the women was 59 years, with majority being Caucasians, with nearly 50% of women in FIGO stage IIIC and all women had HGSCs. Presence or absence of STIC did not change the clinical features or median survival.

In depth a morphologic, immunohistochemical, and molecular analysis of the samples failed to identify any difference in genetic profile of cells from HGSCs vs those from STIC in fallopian tube.
"We found no differences in the 20,000 genes that we can identify," says Levine. "This leads us to believe that that these ovarian cancers all originate in the fallopian tubes."

In fact, HGSCs had molecular profiles more similar to normal fallopian tube epithelium than to ovarian surface epithelium or peritoneum.

This study findings have several implications for early diagnosis of ovarian malignancy. If biomarkers can be identified on these tubal cells, then one day we may be able to diagnose ovarian malignancy by blood test. Since the tube is connected to the uterus, direct tissue sampling can also be carried out in future.

If the study finding is confirmed, then only removing the tubes may reduce the women’s risk of ovarian malignancy in patients with BRCA1 and 2 mutations. In fact, the NYU Langone Health center is  currently participating in a study Women Choosing Surgical Prevention or WISP trial, which is comparing the quality of life in women who have undergo only  salpingectomy as compared to salpingo-oophorectomy.

The researchers believe that it may take years before the study findings are confirmed and translate into actual clinical practice. But, at this stage the study holds a lot of meaning for gynecological oncologists and the evidence is sufficient to support incidental salpingectomy in average-risk women.

Tuesday, October 17, 2017

Esaote releases MyLab9 Ultrasound Systems, setting new standards in image clarity and performance

Esaote, the Italian ultrasound manufacturer, today unveiled its brand-new flagship MyLab9 ultrasound system at JFR 2017 (Journées Françaises de la Radiologie - French Imaging Congress) in Paris.

It is designed to provide services at hospitals, clinics and private offices as it can be easily carried from one room to other because of easy to unplug and quick boot-up and stand-by mode.   

It is uniquely designed incorporating non-composite single crystal probe technology for generating images that have a stunning display quality, are clear, have better color contrast, thereby, assisting physicians in wide range of diagnostic procedure.

Its ultra-ergonomics design offers a floating keyboard tablet-like touchscreen and full HD wide format screen. The system hardware has a solid-state hard disk (SSD), latest Intel® Core™ i7 processor, and Windows® 10 that offers unparalleled data security and ease of processing.

Designed according to needs of busy radiology practitioner it’s easyMode, inbuilt software offers ‘one touch’ image optimization technology through intelligent real-time algorithm that adjusts to the illumination of the room. This results in superior image quality along with reducing the use of number of controls by the operator. This increases productivity at the same time reducing the musculoskeletal fatigues experienced often by ultrasound operators.

Massimo Rosa, Esaote Chief Global Marketing Officer said in a news release “Today economic constraints, and the increase in average life expectancy, are opposing forces. The MyLabTM9 eXP provides advanced diagnostic capabilities and clinical efficacy to respond effectively to the most demanding healthcare needs expanding the access to innovative technologies for more customers.”

MyLab™9, Uncompromised Ease-of-Use

Monday, October 16, 2017

Endometriosis fertility index can accurately predict a women’s chances of conception after laparoscopy

courtesy:Can stock photos

The Endometriosis fertility index can accurately predict the possibility of non-ART conception or the need of ART for achieving pregnancy after surgical resection of moderate-severe (Stage III–IV) endometriosis reports the results of study published in Human Reproduction. The study confirmed that adnexal function is deciding factor in evaluation of fertility prognosis after the surgery.

There is no evidence based guidelines about post-surgery fertility management of women who have undergone surgery for severe endometriosis. Physicians differ in their approach about the length of conservative treatment and that sometimes add years and causes unnecessary delays.

The researchers in this study from Australia, led by Dr. Sarah Maheux-Lacroix of the Royal Hospital for Women in Randwick, looked into data of 279 women who had undergone laparoscopic surgery for stage III-IV and were trying to become pregnant.

Endometriosis fertility index was first published in 2010 and is a robust tool to predict fertility after surgical staging of endometriosis.

The EFI is combines obstetrical and surgical factors to predict a woman’s chance of becoming pregnant. In addition to all the components of the revised-American Society of Reproductive Medicine score, it also includes a detailed evaluation of the fallopian tubes, fimbriae, and ovaries, and accounts for any adnexal dysfunction after surgery.

The researchers calculated EFI for all these women based on detailed operative reports and surgical images plus the obstetric history of women.

The average follow-up was 4 years during which 147 women (63%) gave birth, of which 94 conceived naturally without ART.

None of the women with EFI 0-2 conceived, while 91% women with EFI 9-10 had live births in 5 years period after surgery.

Similarly, women with EFI 0-2 had a success rate of 38% with ART, while those with EFI 9-10 had a success rate of 71%.

So, low EFI was significant in predicting failure to conceive (P = 0.003) in addition to other factors which adversely affected the pregnancy rates like being older than 40 years (P = 0.027), having uterine fibroids (P = 0.037) and history of previous resection (P = 0.019) or incomplete resection (P = 0.028).

The only drawback of the study was its retrospective nature.

The researchers concluded that the tool can be used to predict the fertility prognosis in women after surgery for endometriosis. Depending on the EFI score, the obstetrician can advise patients about timed intercourse or refer the patients  for ART, without wasting precious years.