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Nagasaka M, Goto K, Gomez J, Hida T, Shu C, Lee C, Park K, Cho B, Lee J, Ou S, Bestvina C, Natale R, Haddish-Berhane N, Bhattacharya A, Verheijen R, Agrawal T, Knoblauch R, Govindan R. P50.04 Amivantamab in Combination With Chemotherapy in Patients With Advanced Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Baeten IGT, Hoogendam JP, Schreuder HWR, Jürgenliemk‐Schulz IM, Verheijen RHM, Zweemer RP, Gerestein CG. The influence of learning curve of robot-assisted laparoscopy on oncological outcomes in early-stage cervical cancer: an observational cohort study. BJOG 2021; 128:563-571. [PMID: 32627934 PMCID: PMC7818258 DOI: 10.1111/1471-0528.16399] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the learning curve of robot-assisted laparoscopy in early-stage cervical cancer and quantify impact on oncological outcomes. DESIGN Observational cohort study. SETTING Tertiary referral centre with one surgical team. POPULATION All women with early-stage cervical cancer treated consecutively with robot-assisted laparoscopy between 2007 and 2017. METHODS With multivariate risk-adjusted cumulative sum analysis (RA-CUSUM), we assessed the learning curve of robot-assisted laparoscopy of a single surgical team based on cervical cancer recurrence. Subsequently, a survival analysis was conducted comparing oncological outcomes of women treated during different phases of the learning curve. MAIN OUTCOME MEASURES Surgical proficiency based on recurrence, survival rates in the different learning phases. RESULTS One hundred and sixty-five women with cervical cancer underwent robot-assisted laparoscopy, with a median follow up of 57 months (range 3-132 months). The RA-CUSUM analysis demonstrated two phases of the learning curve: a learning phase of 61 procedures (group 1) and an experienced phase representing the 104 procedures thereafter (group 2). The 5-year disease-free survival was 80.2% in group 1 and 91.1% in group 2 (P = 0.040). Both the 5-year disease-specific survival and overall survival significantly increased after the learning phase. CONCLUSION The learning phase of robot-assisted laparoscopy in early-stage cervical cancer in this institutional cohort is at least 61 procedures, with higher survival rates in the women treated thereafter. The learning curve of robot-assisted laparoscopy affects oncological outcomes and warrants more attention in the design of future studies. TWEETABLE ABSTRACT The learning curve of robot-assisted laparoscopy in early-stage cervical cancer affects oncological outcomes and warrants more attention.
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Affiliation(s)
- IGT Baeten
- Division of Imaging and OncologyDepartment of Gynaecological OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - JP Hoogendam
- Division of Imaging and OncologyDepartment of Gynaecological OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - HWR Schreuder
- Division of Imaging and OncologyDepartment of Gynaecological OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - IM Jürgenliemk‐Schulz
- Division of Imaging and OncologyDepartment of RadiotherapyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - RHM Verheijen
- Division of Imaging and OncologyDepartment of Gynaecological OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - RP Zweemer
- Division of Imaging and OncologyDepartment of Gynaecological OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - CG Gerestein
- Division of Imaging and OncologyDepartment of Gynaecological OncologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
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van der Peet-Schwering C, Verheijen R, Jørgensen L, Raff L. Effects of a mixture of Bacillus amyloliquefaciens and Bacillus subtilis on the performance of growing-finishing pigs. Anim Feed Sci Technol 2020. [DOI: 10.1016/j.anifeedsci.2020.114409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rusch P, Ind T, Kimmig R, Maggioni A, Ponce J, Zanagnolo V, Coronado PJ, Verguts J, Lambaudie E, Falconer H, Collins JW, Verheijen RHM. Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS). Facts Views Vis Obgyn 2019; 11:29-41. [PMID: 31695855 PMCID: PMC6822956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The Society of European Robotic Gynaecological Surgery (SERGS) aims at developing a European consensus on core components of a curriculum for training and assessment in robot assisted gynaecological surgery. METHODS A Delphi process was initiated among a panel of 12 experts in robot assisted surgery invited through the SERGS. An online questionnaire survey was based on a literature search for standards in education in gynaecological robot assisted surgery. The survey was performed in three consecutive rounds to reach optimal consensus. The results of this survey were discussed by the panel and led to consensus recommendations on 39 issues, adhering to general principles of medical education. RESULTS On review there appeared to be no accredited training programs in Europe, and few in the USA. Recommendations for requirements of training centres, educational tools and assessment of proficiency varied widely. Stepwise and structured training together with validated assessment based on competencies rather than on volume emerged as prerequisites for adequate and safe learning. An appropriate educational environment and tools for training were defined. Although certification should be competence based, the panel recommended additional volume based criteria for both accreditation of training centres and certification of individual surgeons. CONCLUSIONS Consensus was reached on minimum criteria for training in robot assisted gynaecological surgery. To transfer results into clinical practice, experts recommended a curriculum and guidelines that have now been endorsed by SERGS to be used to establish training programmes for robot assisted surgery.
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Affiliation(s)
- P Rusch
- Department of Obstetrics and Gynaecology, University Hospital Duisburg-Essen; Hufelandstr. 55, 45147 Essen, Germany. .
| | - T Ind
- Department of Gynaecological Oncology, The Royal Marsden, London, UK;,St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London,
| | - R Kimmig
- Department of Obstetrics and Gynaecology, University Hospital Duisburg-Essen; Hufelandstr. 55, 45147 Essen, Germany. .
| | - A Maggioni
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. .
| | - J Ponce
- Department of Gynaecological Oncology, Hospital Universitari de Bellvitge, c/ Feixa Llarga, sn, 08907 L’ Hospitalet de Llobregat. Barcelona, Spain.
| | - V Zanagnolo
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. .
| | - PJ Coronado
- Department of Gynaecological Oncology, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Avda. de Séneca, 2, Ciudad Universitaria, 28040 Madrid, Spain.
| | - J Verguts
- Division of Gynaecology, European Institute of Oncology, Via Ripamonti, 435,
20141 Milano, Italy. . ;,Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium;,Department of
Obstetrics and Gynaecology, Jessa Hospital, 3500 Hasselt, Belgium,
| | - E Lambaudie
- Department of Gynaecologic Oncology, Centre de Lutte Contre le Cancer Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France;,Aix Marseille Université, Site Timone, Timone 27, boulevard Jean Moulin, 13385 Marseille cedex 5, France.
| | - H Falconer
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet/University Hospital, 171 76 Stockholm, Sweden.
| | - JW Collins
- Department of Urology, Karolinska University Hospital, Karolinska Universitetssjukhuset, Solna, D1:01 171 76 Stockholm, Sweden.
| | - RHM Verheijen
- Department of Gynaecological Oncology, UMCU Cancer Center,
University Medical Center, Utrecht, Netherlands.
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5
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Garritsen FM, Verheijen RHM, Gerestein CG, van Zuilen AD, Oosterhaven JAF, van Dijk M, Bruijnzeel-Koomen CAF, Schuttelaar ML, de Bruin-Weller MS. Is there an increased risk of cervical neoplasia in atopic dermatitis patients treated with oral immunosuppressive drugs? J Eur Acad Dermatol Venereol 2017; 32:271-275. [PMID: 28925576 DOI: 10.1111/jdv.14593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral immunosuppressive drugs are frequently prescribed in young women with atopic dermatitis (AD). Immunocompromised patients may have a higher risk of developing high-risk HPV infections, cervical intra-epithelial neoplasia (CIN) and cervical carcinoma. Most literature on patients using oral immunosuppressive drugs is available in organ transplant patients. Literature on the risk of developing cervical carcinoma in AD patients treated with oral immunosuppressive drugs is lacking. At this moment, there is no clear guideline/consensus on this topic, but in daily practice, questions arise concerning whether this risk is increased and whether more intensive screening in women using immunosuppressive drugs should take place. OBJECTIVE To investigate the occurrence of cervical carcinoma in women with AD treated with oral immunosuppressive drugs. METHODS In this retrospective cohort study in two university medical centres in the Netherlands, all female adult AD patients receiving oral immunosuppressive drugs (cyclosporine A, azathioprine, methotrexate, mycophenolate mofetil, enteric-coated mycophenolate sodium and extended release tacrolimus) for more than 2 months between 1989 and 1 January 2014 were included. Patient files in the national histopathology register were screened for PAP3a, CIN I, CIN II, CIN III and cervical carcinoma. RESULTS A total of 257 female AD patients with one or more treatment episodes from 1989 until 1 January 2014 were identified and included in this study. In 189 patients (73.5%), results of cervical examination were reported in the national histopathology database. Median total duration of treatment in these 189 women was 407.0 days (IQR 243.0-940.0). No cervical carcinoma during or following immunosuppressive therapy was found in our patient group. CONCLUSIONS No intensified screening programme for cervical neoplasia seems necessary for women with AD using oral immunosuppressive drugs.
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Affiliation(s)
- F M Garritsen
- Department of Dermatology, University Medical Center, Utrecht, The Netherlands
| | - R H M Verheijen
- Department of Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - C G Gerestein
- Department of Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - A D van Zuilen
- Department of Nefrology, University Medical Center, Utrecht, The Netherlands
| | - J A F Oosterhaven
- Department of Dermatology, University Medical Center, Groningen, The Netherlands
| | - M van Dijk
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | | | - M L Schuttelaar
- Department of Dermatology, University Medical Center, Groningen, The Netherlands
| | - M S de Bruin-Weller
- Department of Dermatology, University Medical Center, Utrecht, The Netherlands
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van Kalleveen IML, Hoogendam JP, Raaijmakers AJE, Visser F, Arteaga de Castro CS, Verheijen RHM, Luijten PR, Zweemer RP, Veldhuis WB, Klomp DWJ. Boosting the SNR by adding a receive-only endorectal monopole to an external antenna array for high-resolution, T 2 -weighted imaging of early-stage cervical cancer with 7-T MRI. NMR Biomed 2017; 30:e3750. [PMID: 28574604 DOI: 10.1002/nbm.3750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to investigate the signal-to-noise ratio (SNR) gain in early-stage cervical cancer at ultrahigh-field MRI (e.g. 7 T) using a combination of multiple external antennas and a single endorectal antenna. In particular, we used an endorectal monopole antenna to increase the SNR in cervical magnetic resonance imaging (MRI). This should allow high-resolution, T2 -weighted imaging and magnetic resonance spectroscopy (MRS) for metabolic staging, which could facilitate the local tumor status assessment. In a prospective feasibility study, five healthy female volunteers and six patients with histologically proven stage IB1-IIB cervical cancer were scanned at 7 T. We used seven external fractionated dipole antennas for transmit-receive (transceive) and an endorectally placed monopole antenna for reception only. A region of interest, containing both normal cervix and tumor tissue, was selected for the SNR measurement. Separated signal and noise measurements were obtained in the region of the cervix for each element and in the near field of the monopole antenna (radius < 30 mm) to calculate the SNR gain of the endorectal antenna in each patient. We obtained high-resolution, T2 -weighted images with a voxel size of 0.7 × 0.8 × 3.0 mm3 . In four cases with optimal placement of the endorectal antenna (verified on the T2 -weighted images), a mean gain of 2.2 in SNR was obtained at the overall cervix and tumor tissue area. Within a radius of 30 mm from the monopole antenna, a mean SNR gain of 3.7 was achieved in the four optimal cases. Overlap between the two different regions of the SNR calculations was around 24%. We have demonstrated that the use of an endorectal monopole antenna substantially increases the SNR of 7-T MRI at the cervical anatomy. Combined with the intrinsically high SNR of ultrahigh-field MRI, this gain may be employed to obtain metabolic information using MRS and to enhance spatial resolutions to assess tumor invasion.
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Affiliation(s)
| | - J P Hoogendam
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | | | - F Visser
- Department of Radiology, UMC Utrecht, the Netherlands
| | | | - R H M Verheijen
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | - P R Luijten
- Department of Radiology, UMC Utrecht, the Netherlands
| | - R P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, the Netherlands
| | - W B Veldhuis
- Department of Radiology, UMC Utrecht, the Netherlands
| | - D W J Klomp
- Department of Radiology, UMC Utrecht, the Netherlands
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Hoogendam J, Zweemer R, Hobbelink M, van den Bosch M, Verheijen R, Veldhuis W. Feasibility and accuracy of 99mTc SPECT-MRI fusion for the selective assessment of sentinel nodes in cervical cancer patients with unsuspicious <10-mm lymph nodes. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- E Jauniaux
- Academic Department of Obstetrics and Gynaecology Institute for Women's Health University College London London UK
| | - RHM Verheijen
- Division of Surgical Oncology Department of Gynaecological Oncology UMC Utrecht Cancer Centre Utrecht the Netherlands
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9
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Veersema S, Schreuder H, Verheijen R. Hysteroscopic Resection of a Placental Site Trophoblastic Nodule With a Hysteroscopic Tissue Removal System. J Minim Invasive Gynecol 2015; 22:S142. [DOI: 10.1016/j.jmig.2015.08.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Farag S, Verheijen R, Kerst M, Cats A, Huitema A, Steeghs N. 3437 Imatinib pharmacokinetics in a large observational cohort of gastrointestinal stromal tumor patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Louwers JA, Zaal A, Kocken M, Papagiannakis E, Meijer CJLM, Verheijen RHM. Women's Preferences of Dynamic Spectral Imaging Colposcopy. Gynecol Obstet Invest 2014; 79:239-43. [PMID: 25413738 DOI: 10.1159/000367921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The focus of testing the dynamic spectral imaging (DSI) colposcope has been on the technical characteristics and clinical performance. However, aspects from a patient's perspective are just as important. METHODS This study was designed as a substudy of the DSI validation study, a prospective comparative, multicenter clinical trial to assess the clinical performance of DSI colposcopy. All women included in this study were asked to complete two questionnaires: a patient characteristics questionnaire and a patient satisfaction questionnaire. RESULTS In the initial study a total of 239 women were included in the intention-to-treat cohort. Of these, 230 women (96.2%) completed both questionnaires. When assessing the women's preferences for some of the possible uses of DSI colposcopy, a high level of agreement was noted for all potential implementations. In general, women found the additional time DSI colposcopy took acceptable: just 15 women (6.5%) thought the time DSI colposcopy took made them feel uncomfortable. Furthermore, women ranked test accuracy as the most important characteristic, followed by (more) rapid testing and comfort. Quick notification of the results and costs were considered the least important characteristics. CONCLUSION Women are willing to accept discomfort in the form of an additional or longer test if there is clinical benefit.
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Affiliation(s)
- J A Louwers
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
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Hoogendam JP, Verheijen RHM, Wegner I, Zweemer RP. Oncological outcome and long-term complications in robot-assisted radical surgery for early stage cervical cancer: an observational cohort study. BJOG 2014; 121:1538-45. [DOI: 10.1111/1471-0528.12822] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- JP Hoogendam
- Department of Gynaecological Oncology; Woman and Baby Division; University Medical Centre Utrecht; Utrecht the Netherlands
| | - RHM Verheijen
- Department of Gynaecological Oncology; Woman and Baby Division; University Medical Centre Utrecht; Utrecht the Netherlands
| | - I Wegner
- Department of Gynaecological Oncology; Woman and Baby Division; University Medical Centre Utrecht; Utrecht the Netherlands
| | - RP Zweemer
- Department of Gynaecological Oncology; Woman and Baby Division; University Medical Centre Utrecht; Utrecht the Netherlands
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van der Marel J, van Baars R, Quint WGV, Berkhof J, del Pino M, Torné A, Ordi J, Wentzensen N, Schiffman M, van de Sandt MM, Lindeman J, Jenkins D, Helmerhorst TJM, Verheijen RHM, ter Harmsel B, Alonso I. The impact of human papillomavirus genotype on colposcopic appearance: a cross-sectional analysis. BJOG 2014; 121:1117-26. [DOI: 10.1111/1471-0528.12668] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J van der Marel
- Department of Research and Development; DDL Diagnostic Laboratory; Rijswijk the Netherlands
| | - R van Baars
- Department of Research and Development; DDL Diagnostic Laboratory; Rijswijk the Netherlands
| | - WGV Quint
- Department of Research and Development; DDL Diagnostic Laboratory; Rijswijk the Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics; VU University Medical Centre; Amsterdam the Netherlands
| | - M del Pino
- Institut Clinic of Gynecology, Obstetrics and Neonatology; Hospital Clínic-Institut d′Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - A Torné
- Institut Clinic of Gynecology, Obstetrics and Neonatology; Hospital Clínic-Institut d′Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
| | - J Ordi
- Department of Pathology; CRESIB (Centre de Recerca en Salut Internacional de Barcelona)-Hospital Clínic; Barcelona Spain
| | - N Wentzensen
- Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda MD USA
| | - M Schiffman
- Division of Cancer Epidemiology and Genetics; National Cancer Institute; Bethesda MD USA
| | - MM van de Sandt
- Department of Research and Development; DDL Diagnostic Laboratory; Rijswijk the Netherlands
| | - J Lindeman
- Department of Research and Development; DDL Diagnostic Laboratory; Rijswijk the Netherlands
| | - D Jenkins
- Department of Research and Development; DDL Diagnostic Laboratory; Rijswijk the Netherlands
| | - TJM Helmerhorst
- Department of Obstetrics & Gynaecology; Erasmus University Medical Center; Rotterdam the Netherlands
| | - RHM Verheijen
- Division of Woman and Baby; Gynaecological Oncology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - B ter Harmsel
- Department of Obstetrics and Gynaecology; Reinier de Graaf Groep; Delft the Netherlands
- Department of Gynaecology; Roosevelt Kliniek; Leiden the Netherlands
| | - I Alonso
- Institut Clinic of Gynecology, Obstetrics and Neonatology; Hospital Clínic-Institut d′Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
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Manchanda R, Godfrey M, Wong-Taylor L, Halaska M, Burnell M, Grabowski J, Gultekin M, Haidopoulos D, Zapardiel I, Vranes B, Kesic V, Zola P, Colombo N, Verheijen R, Bossart M, Piek J. The need for accredited training in gynaecological oncology: a report from the European Network of Young Gynaecological Oncologists (ENYGO). Ann Oncol 2013; 24:944-52. [DOI: 10.1093/annonc/mds588] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Breijer MC, Peeters JAH, Opmeer BC, Clark TJ, Verheijen RHM, Mol BWJ, Timmermans A. Capacity of endometrial thickness measurement to diagnose endometrial carcinoma in asymptomatic postmenopausal women: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2012; 40:621-629. [PMID: 23001905 DOI: 10.1002/uog.12306] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Measurement of endometrial thickness is an important tool in the assessment of women with postmenopausal bleeding, but the role of endometrial thickness measurement by ultrasound in asymptomatic women is unclear. The aims of this study were to determine: (1) the normal endometrial thickness measured by ultrasonography, (2) the prevalence of serious endometrial pathology and (3) the sensitivity and specificity of endometrial thickness measurement by transvaginal ultrasonography (TVS) for diagnosing premalignant and malignant endometrial disease in asymptomatic postmenopausal women. METHODS A MEDLINE and EMBASE search (from inception to January 2011) was performed. Articles reporting on endometrial thickness measurement in the diagnosis of endometrial carcinoma and atypical hyperplasia in asymptomatic postmenopausal women not using hormone replacement therapy (HRT) were selected. Endometrial thickness and the prevalence of endometrial (pre)malignancies were recorded. If possible, 2 × 2 tables were extracted. RESULTS Thirty-two studies reporting on 11100 women were included. The estimated mean endometrial thickness was 2.9 mm (95% CI, 2.6-3.3 mm). The pooled estimated prevalences of endometrial carcinoma and atypical endometrial hyperplasia were 0.62% (95% CI, 0.42-0.82%) and 0.59% (95% CI, 0.22-0.96%), respectively. Summary estimates for sensitivity and specificity of TVS endometrial thickness measurement in the prediction of endometrial carcinoma were 0.83 (95% CI, 0.19-1.00) and 0.72 (95% CI, 0.23-0.95) for a 5-mm cut-off and 0.33 (95% CI, 0.04-0.85) and 0.94 (95% CI, 0.92-0.96) for a 6-mm cut-off. CONCLUSIONS The results from this systematic review do not justify the use of endometrial thickness as a screening test for endometrial carcinoma and atypical endometrial hyperplasia in asymptomatic postmenopausal women not using HRT.
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Affiliation(s)
- M C Breijer
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
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Lybol C, Centen DW, Thomas CMG, ten Kate-Booij MJ, Verheijen RHM, Sweep FCGJ, Ottevanger PB, Massuger LFAG. Fatal cases of gestational trophoblastic neoplasia over four decades in the Netherlands: a retrospective cohort study. BJOG 2012; 119:1465-72. [DOI: 10.1111/j.1471-0528.2012.03480.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Rijkaart DC, Berkhof J, van Kemenade FJ, Coupe VMH, Rozendaal L, Heideman DAM, Verheijen RHM, Bulk S, Verweij W, Snijders PJF, Meijer CJLM. HPV DNA testing in population-based cervical screening (VUSA-Screen study): results and implications. Br J Cancer 2012; 106:975-81. [PMID: 22251922 PMCID: PMC3305964 DOI: 10.1038/bjc.2011.581] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 12/07/2011] [Accepted: 12/08/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) testing is more sensitive than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN). We evaluated the performance of high-risk HPV (hrHPV) testing in routine screening. METHODS In all, 25,871 women (29-61) enrolled in our population-based cohort study were offered both cytology and hrHPV testing. High-risk HPV-positive women with normal cytology and an age-matched subcohort of hrHPV-negative women with normal cytology were invited for repeat testing after 1 and/or 2 years and were referred for colposcopy if they presented with abnormal cytology and/or a positive hrHPV test. The hrHPV-positive women with borderline or mild dyskaryosis (BMD) and all women with moderate dyskaryosis or worse (>BMD) were directly referred for colposcopy. Women with BMD and an hrHPV-negative test were advised to repeat cytology at 6 and 18 months and were referred for colposcopy if the repeat cytology test was abnormal. The main outcome measure was CIN grade 3 or worse (CIN3+). Results were adjusted for non-attendance at repeat testing. RESULTS The hrHPV-positive women with abnormal cytology had a CIN3+ risk of 42.2% (95% confidence interval (CI): 36.4-48.2), whereas the hrHPV-positive women with normal cytology had a much lower risk of 5.22% (95% CI: 3.72-7.91). In hrHPV-positive women with normal cytology, an additional cytology step after 1 year reduced the CIN3+ risk to only 1.6% (95% CI: 0.6-4.9) if the repeat test was normal. The CIN3+ risk in women with hrHPV-positive normal cytology was higher among women invited for the first time (29-33 years of age) (9.1%; 95% CI: 5.6-14.3) than among older women (3.0%; 95% CI: 1.5-5.5). CONCLUSION Primary hrHPV screening with cytology triage in women aged 30 years is an effective way to stratify women on CIN3+ risk and seems a feasible alternative to cytological screening. Repeat cytology after 1 year for hrHPV-positive women with normal cytology is however necessary before returning women to routine screening.
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Affiliation(s)
- D C Rijkaart
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - F J van Kemenade
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - V M H Coupe
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - L Rozendaal
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - R H M Verheijen
- Division of Woman and Baby, Gynaecological Oncology, University Medical Center, Utrecht, The Netherlands
| | - S Bulk
- Department of Medical Genetics, University Medical Center, Utrecht, The Netherlands
| | - W Verweij
- SALTRO, Primary Health Care Laboratory, Utrecht, The Netherlands
| | - P J F Snijders
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
| | - C J L M Meijer
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 Amsterdam, The Netherlands
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Zaal A, Louwers JA, Berkhof J, Kocken M, ter Harmsel WA, Graziosi GCM, Spruijt JWM, Balas C, Papagiannakis E, Snijders PJF, Meijer CJLM, van Kemenade FJ, Verheijen RHM. Agreement between colposcopic impression and histological diagnosis among human papillomavirus type 16-positive women: a clinical trial using dynamic spectral imaging colposcopy. BJOG 2012; 119:537-44. [DOI: 10.1111/j.1471-0528.2012.03280.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Louwers JA, Berkhof J, Zaal A, Kocken M, Rozendaal L, Heideman DAM, van Baal WM, Snijders PJF, Verheijen RHM, Meijer CJLM. HrHPV-testing in a university hospital gynecology outpatient clinic: recommendations for clinical practice. Gynecol Oncol 2011; 124:518-24. [PMID: 22115855 DOI: 10.1016/j.ygyno.2011.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To study the effect of hrHPV-testing on the detection of CIN2/3+ in women referred to a gynecology outpatient clinic, and to assess a useful risk profile in relation to the referral reason to identify who should be tested for cervical pathology. METHODS This study was designed as an observational cohort study. In the first six months of 2007, we categorized the referral reason of 1149 consecutive women who visited our gynecology outpatient clinic and assessed the risk for CIN2/3+ as found by cytology or co-testing with a hrHPV-test and cytology. RESULTS Three different categories of referral reasons were identified; women with presumed cervix pathology, women with presumed endometrial pathology and women with other referral indications. The cumulative 18-month CIN2+ and CIN3+ risks were highest in the group with presumed cervical disease (adjusted risks 11.1% and 5.4% respectively) and lowest in the miscellaneous group with no suspicion of cervical and/or endometrial pathology (adjusted risks 4.1% and 1.8% respectively). HrHPV-testing detected significantly more CIN2/3+ lesions than cytology (relative detection rate: 1.42 (95%CI 1.05-1.92) and 1.38 (95%CI 0.95-2.05) respectively). CONCLUSIONS The high (>2%) cumulative 18-month CIN2/3+ risk in patients with presumed cervical and/or endometrial pathology warrants routine cervical testing. In these women a hrHPV-test should be added to cytology because this identifies a significant number of additional women with a substantial risk of CIN2/3+ lesions who would not be identified with cytology alone. Women referred for other reasons should not have cervical testing beforehand, because of their low risk of CIN2/3+.
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Affiliation(s)
- J A Louwers
- VU University Medical Center, Department of Pathology, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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20
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Cibula D, Abu-Rustum NR, Dusek L, Zikán M, Zaal A, Sevcik L, Kenter GG, Querleu D, Jach R, Bats AS, Dyduch G, Graf P, Klat J, Lacheta J, Meijer CJLM, Mery E, Verheijen R, Zweemer RP. Prognostic significance of low volume sentinel lymph node disease in early-stage cervical cancer. Gynecol Oncol 2011; 124:496-501. [PMID: 22120175 DOI: 10.1016/j.ygyno.2011.11.037] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 11/13/2011] [Accepted: 11/16/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Evaluate prognostic significance of low volume disease detected in sentinel nodes (SN) of patients with early stages cervical cancer. Although pathologic ultrastaging of SN allows for identification of low volume disease, including micro-metastasis and isolated tumor cells (ITC), in up to 15% of cases, prognostic significance of these findings is unknown. METHODS A total of 645 records from 8 centers were retrospectively reviewed. Enrolled in our study were patients with early-stage cervical cancer who had undergone surgical treatment including SN biopsy followed by pelvic lymphadenectomy and pathologic ultrastaging of SN. RESULTS Macrometastasis, micrometastasis, and ITC were detected by SN ultrastaging in 14.7%, 10.1%, and 4.5% patients respectively. False negativity of SN ultrastaging reached 2.8%. The presence of ITC was not associated with significant risk, both for recurrence free survival and overall survival. Overall survival was significantly reduced in patients with macrometastasis and micrometastasis; hazard ratio for overall survival reached 6.85 (95% CI, 2.59-18.05) and 6.86 (95% CI, 2.09-22.61) respectively. Presence of micrometastasis was an independent prognostic factor for overall survival in a multivariable model. CONCLUSION Presence of micrometastasis in SN in patients with early stage cervical cancer was associated with significant reduction of overall survival, which was equivalent to patients with macrometastasis. No prognostic significance was found for ITC. These data highlight the importance of SN biopsy and pathologic ultrastaging for the management of cervical cancer.
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Affiliation(s)
- D Cibula
- Gynecological Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic.
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21
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Schreuder HWR, Wolswijk R, Zweemer RP, Schijven MP, Verheijen RHM. Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG 2011; 119:137-49. [PMID: 21981104 DOI: 10.1111/j.1471-0528.2011.03139.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robotic assisted laparoscopic surgery is growing rapidly and there is an increasing need for a structured approach to train future robotic surgeons. OBJECTIVES To review the literature on training and learning strategies for robotic assisted laparoscopic surgery. SEARCH STRATEGY A systematic search of MEDLINE, EMBASE, the Cochrane Library and the Journal of Robotic Surgery was performed. SELECTION CRITERIA We included articles concerning training, learning, education and teaching of robotic assisted laparoscopic surgery in any specialism. DATA COLLECTION AND ANALYSIS Two authors independently selected articles to be included. We categorised the included articles into: training modalities, learning curve, training future surgeons, curriculum design and implementation. MAIN RESULTS We included 114 full text articles. Training modalities such as didactic training, skills training (dry lab, virtual reality, animal or cadaver models), case observation, bedside assisting, proctoring and the mentoring console can be used for training in robotic assisted laparoscopic surgery. Several training programmes in general and specific programmes designed for residents, fellows and surgeons are described in the literature. We provide guidelines for development of a structured training programme. AUTHORS' CONCLUSIONS Robotic surgical training consists of system training and procedural training. System training should be formally organised and should be competence based, instead of time based. Virtual reality training will play an import role in the near future. Procedural training should be organised in a stepwise approach with objective assessment of each step. This review aims to facilitate and improve the implementation of structured robotic surgical training programmes.
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Affiliation(s)
- H W R Schreuder
- Division of Women and Baby, Department of Gynaecological Oncology, University Medical Centre Utrecht, The Netherlands.
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22
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Schreuder HWR, van den Berg CB, Hazebroek EJ, Verheijen RHM, Schijven MP. Laparoscopic skills training using inexpensive box trainers: which exercises to choose when constructing a validated training course. BJOG 2011; 118:1576-84. [PMID: 21981275 DOI: 10.1111/j.1471-0528.2011.03146.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To obtain face and construct validity for a new training course to be used in any type of box/video trainer and to give a comprehensive overview of validated exercises for box/video training. DESIGN Cross-sectional study. SETTING University Medical Centre. POPULATION Students, residents and consultants. METHODS Participants (n = 42) were divided into three groups according to their laparoscopic experience: 'Novices' (n = 18), 'Intermediates' (n = 14) and 'Experts' (n = 10). A laparoscopic training course consisting of six exercises was constructed. To emphasise precision, a penalty score was added. Every participant performed two repetitions of the exercises; total score per exercise was calculated. To determine face validity, participants filled in a questionnaire after completion of the exercises. An evidence-based literature search for validated box/video trainer exercises was performed. MAIN OUTCOME MEASURES Face and construct validity. RESULTS The mean score of the 'experts' was set as the training target. Total scores appeared to be positively correlated with individual's laparoscopic experience. The overall score and the score for each exercise were significantly higher in the intermediate and expert groups when compared with the novice group (P ≤ 0.001). All participants completed the questionnaire. The overall assessment of the exercises was considered to be good. The course was found to be most appropriate for training residents year 1-3. CONCLUSION Face and construct validity for an inexpensive course for box/video training was established. A comprehensive and practical overview of all validated and published exercises for box/video trainers is provided to facilitate an inexpensive, but optimal and tailored selection for training purposes.
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Affiliation(s)
- H W R Schreuder
- Department of Gynaecological Oncology Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
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23
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Louwers JA, Zaal A, Kocken M, ter Harmsel WA, Graziosi GCM, Spruijt JWM, Berkhof J, Balas C, Papagiannakis E, Snijders PJF, Meijer CJLM, van Kemenade FJ, Verheijen RHM. Dynamic spectral imaging colposcopy: higher sensitivity for detection of premalignant cervical lesions. BJOG 2010; 118:309-18. [DOI: 10.1111/j.1471-0528.2010.02806.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Reed N, Millan D, Verheijen R, Castiglione M. Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v31-6. [PMID: 20555098 DOI: 10.1093/annonc/mdq205] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Reed
- Beatson Oncology Centre, Glasgow, UK
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25
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Verheijen R, Osswald IK, Dietrich R, Haasnoot W. Development of a One Step Strip Test for the Detection of (Dihydro)streptomycin Residues in Raw Milk. FOOD AGR IMMUNOL 2010. [DOI: 10.1080/09540100099607] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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26
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Armstrong D, Coleman R, White A, Bicher A, Gibbon D, Old L, Verheijen R, Weil S, Phillips M, Chakrabarti D. 8000 Efficacy and safety of farletuzumab, a humanized monoclonal antibody to folate receptor alpha, in platinum-sensitive relapsed ovarian cancer subjects: preliminary data from a phase-2 study. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71522-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Cancer is a genetic disease. Breast cancer tumorigenesis can be described as a multi-step process in which each step is thought to correlate with one or more distinct mutations in major regulatory genes. The question addressed is how far a multi-step progression model for sporadic breast cancer would differ from that for hereditary breast cancer. Hereditary breast cancer is characterized by an inherited susceptibility to breast cancer on basis of an identified germline mutation in one allele of a high penetrance susceptibility gene (such as BRCA1, BRCA2, CHEK 2, TP53 or PTEN). Inactivation of the second allele of these tumour suppressor genes would be an early event in this oncogenic pathway (Knudson's "two-hit" model). Sporadic breast cancers result from a serial stepwise accumulation of acquired and uncorrected mutations in somatic genes, without any germline mutation playing a role. Mutational activation of oncogenes, often coupled with non-mutational inactivation of tumour suppressor genes, is probably an early event in sporadic tumours, followed by more, independent mutations in at least four or five other genes, the chronological order of which is likely less important. Oncogenes that have been reported to play an early role in sporadic breast cancer are MYC, CCND1 (Cyclin D1) and ERBB2 (HER2/neu). In sporadic breast cancer, mutational inactivation of BRCA1/2 is rare, as inactivation requires both gene copies to be mutated or totally deleted. However, non-mutational functional suppression could result from various mechanisms, such as hypermethylation of the BRCA1 promoter or binding of BRCA2 by EMSY. In sporadic breast tumorigenesis, at least three different pathway-specific mechanisms of tumour progression are recognizable, with breast carcinogenesis being different in ductal versus lobular carcinoma, and in well differentiated versus poorly differentiated ductal cancers. Thus, different breast cancer pathways emerge early in the process of carcinogenesis, ultimately leading to clinically different tumour types. As mutations acquired early during tumorigenesis will be present in all later stages, large-scale gene expression profiling using DNA microarray analysis techniques can help to classify breast cancers into clinically relevant subtypes.
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Affiliation(s)
- P Kenemans
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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28
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Abstract
The aims of this review were to summarise the various methods of digital colposcopy and to provide an overview of their efficacy. We conducted a literature search and focused on papers that described a technique for colposcopy, other than conventional colposcopy, and compared this with conventional colposcopy and/or histology and included digitalisation of the process. All papers have been classified in one of the following categories: digital imaging and telecolposcopy, spectroscopy, computerised colposcopy, optical coherence tomography and confocal microcolposcopy. Among the most promising developments is spectroscopy, allowing a more or less automated analysis and interpretation of the colposcopic image.
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Affiliation(s)
- J A Louwers
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
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30
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ten Kate-Booij MJ, Lok CAR, Verheijen RHM, Massuger LFAG, van Trommel NE. [Trophoblastic diseases]. Ned Tijdschr Geneeskd 2008; 152:2219-2224. [PMID: 19009808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hydatidiform mole is the most frequently-occurring gestational trophoblastic disease (GTD). Patients with GTD have elevated human chorionic gonadotrophin (HCG) produced by the trophoblast. After evacuation of the mole, weekly serum HCG determinations can be used to assess whether the trophoblast is persisting or regressing based on the standardised normal Nijmegen serum HCG regression curve. The serum HCG pattern is used to establish the diagnosis 'persistent trophoblastic disease'. Treatment with monochemotherapy in the form of methotrexate is the treatment of choice. For about 80% of women with a persistent trophoblastic disease following a molar pregnancy this treatment will lead to a complete remission of the disorder. If resistance to methotrexate occurs then a combined therapy is indicated. A recently developed, and as yet unvalidated, normogram for the serum HCG level during methotrexate treatment might in the near future be able to identify patients with methotrexate resistance at an early stage. Hysterectomy or curettage may be indicated as part of therapy in selected patients. The incidence of choriocarcinoma after a live birth is estimated at 1 in every 40,000 full-term pregnancies. These patients have a high risk for resistance to methotrexate (75%). Treatment of these patients with primary combination therapy at a specialised medical centre is then indicated.
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Affiliation(s)
- M J ten Kate-Booij
- Amphia Ziekenhuis, locatie Langendijk, afd. Obstetrie en Gynaecologie, Langendijk 75, 4819 EV Breda.
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31
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Heideman DAM, Snijders PJF, Berkhof J, Verheijen RHM, Helmerhorst TJM, Meijer CJLM. Vaccination against HPV: indications for women and the impact on the cervical screening programme. BJOG 2008; 115:938-46. [DOI: 10.1111/j.1471-0528.2008.01779.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nowee ME, Dorsman JC, Piek JMJ, Kosma VM, Hämäläinen K, Verheijen RHM, van Diest PJ. HER-2/neu and p27Kip1 in progression of Fallopian tube carcinoma: an immunohistochemical and array comparative genomic hybridization study. Histopathology 2007; 51:666-73. [PMID: 17927588 DOI: 10.1111/j.1365-2559.2007.02850.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine expression of p53, HER-2/neu and p27(Kip1) in serous Fallopian tube carcinoma (FTC) in relation to stage and grade, and to investigate DNA copy number changes of HER-2 and P27KIP1 as a potential mechanism of altered expression status. METHODS AND RESULTS Immunohistochemistry was performed on 28 serous FTCs and 10 normal Fallopian tubes. p53 protein accumulated and p27(Kip1) was down-regulated significantly in early-stage FTCs compared with normal Fallopian tubes. HER-2/neu overexpression was absent in normal Fallopian tubes and in all stage I FTCs (n = 6) but present in 57% (12/21) of advanced-stage FTCs. No differences in expression between grade 2 and 3 tumours were detected. HER-2 gain/amplification was found by array comparative genomic hybridization in 23% (3/13) of analysed FTCs and all showed overexpression. HER-2/neu overexpression also occurred without DNA copy number changes in three other cases. For p27(Kip1), expression and DNA copy number were unrelated. CONCLUSIONS p53 accumulation and p27(Kip1) down-regulation seem to be early events in Fallopian tube carcinogenesis. HER-2/neu showed overexpression, caused by gain/amplification in 50%, and may be involved in progression of FTC. These data contribute to a better understanding of the molecular carcinogenesis of FTC and to possible new therapeutic approaches.
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Affiliation(s)
- M E Nowee
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
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Nowee ME, Snijders AM, Rockx DAP, de Wit RM, Kosma VM, Hämäläinen K, Schouten JP, Verheijen RHM, van Diest PJ, Albertson DG, Dorsman JC. DNA profiling of primary serous ovarian and fallopian tube carcinomas with array comparative genomic hybridization and multiplex ligation-dependent probe amplification. J Pathol 2007; 213:46-55. [PMID: 17668415 DOI: 10.1002/path.2217] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary serous ovarian carcinoma (OVCA) and serous Fallopian tube carcinoma (FTC), both belonging to the BRCA-linked tumour spectrum, share many properties and are treated similarly. However, a detailed molecular comparison has been lacking. We hypothesized that comparative genomic studies of serous OVCAs and FTCs should point to gene regions critically involved in their tumorigenesis. Array comparative genomic hybridization (array CGH) analysis indicated that serous OVCAs and serous FTCs displayed common but also more distinctive patterns of recurrent changes. Targeted gene identification using a dedicated multiplex ligation-dependent probe amplification (MLPA) probe set directly identified EIF2C2 on 8q as a potentially important driver gene. Other previously unappreciated gained/amplified genes included PSMB4 on 1q, MTSS1 on 8q, TEAD4 and TSPAN9 on 12p, and BCAS4 on 20q. SPINT2 and ACTN4 on 19q were predominantly found in FTCs. Gains/amplifications of CCNE1 and MYC, often in conjunction with changes in genes of the AKT pathway, EVI1 and PTK2, seemed to be involved at earlier stages, whereas changes of ERBB2 were associated with advanced stages. The only BRCA1-mutated FTC shared common denominators with the sporadic tumours. In conclusion, the data suggest that serous OVCAs and FTCs, although related, exhibit differences in genomic profiles. In addition to known pathways, new genes/pathways are likely to be involved, with changes in an miRNA-associated gene, EIF2C2, as one important new feature. Dedicated MLPA sets constitute potentially important tools for differential diagnosis and may provide footholds for tailored therapy.
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Affiliation(s)
- M E Nowee
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
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Bulkmans NWJ, Berkhof J, Rozendaal L, van Kemenade FJ, Boeke AJP, Bulk S, Voorhorst FJ, Verheijen RHM, van Groningen K, Boon ME, Ruitinga W, van Ballegooijen M, Snijders PJF, Meijer CJLM. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet 2007; 370:1764-72. [PMID: 17919718 DOI: 10.1016/s0140-6736(07)61450-0] [Citation(s) in RCA: 462] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tests for the DNA of high-risk types of human papillomavirus (HPV) have a higher sensitivity for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) than does cytological testing, but the necessity of such testing in cervical screening has been debated. Our aim was to determine whether the effectiveness of cervical screening improves when HPV DNA testing is implemented. METHODS Women aged 29-56 years who were participating in the regular cervical screening programme in the Netherlands were randomly assigned to combined cytological and HPV DNA testing or to conventional cytological testing only. After 5 years, combined cytological and HPV DNA testing were done in both groups. The primary outcome measure was the number of CIN3+ lesions detected. Analyses were done by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN20781131. FINDINGS 8575 women in the intervention group and 8580 in the control group were recruited, followed up for sufficient time (> or =6.5 years), and met eligibility criteria for our analyses. More CIN3+ lesions were detected at baseline in the intervention group than in the control group (68/8575 vs 40/8580, 70% increase, 95% CI 15-151; p=0.007). The number of CIN3+ lesions detected in the subsequent round was lower in the intervention group than in the control group (24/8413 vs 54/8456, 55% decrease, 95% CI 28-72; p=0.001). The number of CIN3+ lesions over the two rounds did not differ between groups. INTERPRETATION The implementation of HPV DNA testing in cervical screening leads to earlier detection of CIN3+ lesions. Earlier detection of such lesions could permit an extension of the screening interval.
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Affiliation(s)
- N W J Bulkmans
- Department of Pathology, VU University Medical Centre, Amsterdam, Netherlands
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Mota F, Vergote I, Trimbos JB, Amant F, Siddiqui N, Del Rio A, Verheijen R, Zola P. Classification of radical hysterectomy adopted by the Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer. Int J Gynecol Cancer 2007; 18:1136-8. [PMID: 18021216 DOI: 10.1111/j.1525-1438.2007.01138.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Piver classification of radical hysterectomy for the treatment of cervical cancer is outdated and misused. The Surgery Committee of the Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer (EORTC) produced, approved, and adopted a revised classification. It is hoped that at least within the EORTC participating centers, a standardization of procedures is achieved. The clinical indications of the new classification are discussed.
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Affiliation(s)
- F Mota
- Department of Gynecology, University Hospital of Coimbra, Coimbra, Portugal.
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Verbruggen MB, Zweemer RP, Piek JMJ, van Unnik GA, van Diest PJ, Gille JJP, Menko FH, Dorsman JC, Verheijen RHM. A case of loss of heterozygosity in the BRCA2 gene of a borderline ovarian tumor: case report and review of literature. Int J Gynecol Cancer 2007; 17:1143-7. [PMID: 17386038 DOI: 10.1111/j.1525-1438.2007.00924.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Germline BRCA1 and BRCA2 mutations highly increase the risk of breast and female adnexal cancer. The role of these genes in the tumorigenesis of other malignancies is still under debate. Borderline ovarian tumors (BOT) are occasionally found in families with a strong history of breast and/or female adnexal cancer with or without proven germline mutations. We investigated whether a BOT arising in a germline BRCA2 mutation carrier could be attributed to this mutation, in which case BOT should be added to the BRCA2 related tumor spectrum. Tumor DNA of a serous borderline ovarian tumor (sBOT) of a 55-year-old female carrier of a pathogenic BRCA2 mutation (6085G>T) was analyzed for loss of heterozygosity (LOH) of BRCA2. The sBOT cells, unexpectedly, revealed loss of the mutant allele of BRCA2, while ovarian stroma cells and peripheral blood lymphocytes contained both wild-type and mutant allele of BRCA2. The finding that no loss of the wild-type BRCA2 allele was found in the tumor tissue but loss of the mutant allele was seen suggests that sBOT are not part of the BRCA2 related tumor spectrum. In the literature BOT's in germline BRCA1 and BRCA2 mutation carriers are described incidentally, while in patients with a BOT a germline BRCA1 or BRCA2 mutation is rarely found. Therefore, we conclude that borderline ovarian tumors are neither part of the BRCA1- nor the BRCA2- related tumor spectrum.
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Affiliation(s)
- M B Verbruggen
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
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Hermsen BBJ, Verheijen RHM, Menko FH, Gille JJP, van Uffelen K, Blankenstein MA, Meijer S, van Diest PJ, Kenemans P, von Mensdorff-Pouilly S. Humoral immune responses to MUC1 in women with a BRCA1 or BRCA2 mutation. Eur J Cancer 2007; 43:1556-63. [PMID: 17532207 DOI: 10.1016/j.ejca.2007.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 03/06/2007] [Accepted: 04/02/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Breast cancer patients with early disease and a natural humoral response to MUC1 have a favourable prognosis, suggesting a possible role of MUC1 antibodies (ab) in controlling haematogenous tumour dissemination and outgrowth. The aim of the study was to evaluate humoral immune responses to MUC1 in women at hereditary high risk of breast cancer to investigate whether this immune response could play a role in the prevention of disease. MATERIALS AND METHODS CA15.3 (U/mL), and IgG and IgM ab to MUC1 (arbitrary units per mL, Arb-U/mL) were measured in serum samples obtained from 422 women at hereditary high risk of breast/ovarian cancer, of whom 127 BRCA1/2 carriers, attending the Familial Cancer Clinic of the VU University Medical Centre, and from 370 age-matched healthy controls. Serum samples obtained from women who developed breast cancer (N=12) or breast cancer recurrence (N=17), and from women who underwent prophylactic mastectomy (N=12) and had no breast lesions were also tested. RESULTS CA15.3 ranked significantly higher in mutation carriers than in controls (P=0.03). MUC1 IgG ab levels ranked significantly lower in BRCA1/2 mutation carriers than in controls (P=0.003). MUC1 IgG levels were not significantly different (P=0.53) between women who developed primary breast cancer (median 0.72Arb-U/ml, range 0.52-2.44Arb-U/ml) and women who underwent prophylactic mastectomy and had no breast lesions (median 1.04Arb-U/ml, range 0.43-2.88Arb-U/ml). CONCLUSION Serum levels of natural IgG ab to MUC1 are lower in BRCA1/2 mutation carriers than in healthy controls. Furthermore, in contrast to previous results in women with sporadic breast cancer, no elevated MUC1 IgG ab were seen in women at hereditary high risk who developed breast cancer. Prophylactic immunotherapy with MUC1 substrates may be a strategy to reduce the risk of breast cancer in BRCA1/2 mutation carriers, strengthening tumour immune surveillance.
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Affiliation(s)
- B B J Hermsen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, De Boelenlaan 1117, 1081 HV Amsterdam, The Netherlands.
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Abstract
OBJECTIVE To compare current cytological follow up of women treated for high-grade cervical intraepithelial neoplasia (CIN) with follow up by high-risk human papillomavirus (HPV) testing together with cytology. DESIGN A cost-effectiveness modelling study. SETTING Gynaecology clinics in the Netherlands. POPULATION Women treated for high-grade CIN. METHODS A Markov model was developed to compare six follow-up strategies with HPV testing with current cytological follow up at 6, 12, and 24 months. Model parameter estimation was based on three Dutch follow-up studies and a Dutch population-based screening cohort. MAIN OUTCOME MEASURES The number of CIN2/3 cases missed after 5 years follow up, the number of diagnostic procedures, and costs involved. RESULTS Strategies with adjunct HPV testing were more effective than current follow up (reduction in missed CIN2/3 cases 32-77%, corresponding to a number needed to treat of 192-455) and less inconvenient (reduction in repeat smears 28-65%). A particularly attractive strategy was HPV testing alone at 6 months and both HPV and cytological testing at 24 months after treatment. This strategy yielded a high detection rate of post-treatment CIN, did not lead to an increase in colposcopy rate, and was 49 Euro per woman cheaper than the current strategy. CONCLUSIONS Our model supports the use of high-risk HPV testing for monitoring women treated for high-grade CIN.
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Affiliation(s)
- V M H Coupé
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.
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Hermsen BBJ, Olivier RI, Verheijen RHM, van Beurden M, de Hullu JA, Massuger LF, Burger CW, Brekelmans CT, Mourits MJ, de Bock GH, Gaarenstroom KN, van Boven HH, Mooij TM, Rookus MA. No efficacy of annual gynaecological screening in BRCA1/2 mutation carriers; an observational follow-up study. Br J Cancer 2007; 96:1335-42. [PMID: 17426707 PMCID: PMC2360170 DOI: 10.1038/sj.bjc.6603725] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BRCA1/2 mutation carriers are offered gynaecological screening with the intention to reduce mortality by detecting ovarian cancer at an early stage. We examined compliance and efficacy of gynaecological screening in BRCA1/2 mutation carriers. In this multicentre, observational, follow-up study we examined medical record data of a consecutive series of 888 BRCA1/2 mutation carriers who started annual screening with transvaginal ultrasonography and serum CA125 between 1993 and 2005. The women were annually screened for 75% of their total period of follow-up. Compliance decreased with longer follow-up. Five of the 10 incident cancers were interval tumours, diagnosed in women with a normal screening result within 3–10 months before diagnosis. No difference in stage distribution between incident screen-detected and interval tumours was found. Eight of the 10 incident cancers were stage III/IV (80%). Cancers diagnosed in unscreened family members had a similar stage distribution (77% in stage III/IV). The observed number of cases detected during screening was not significantly higher than expected (Standardized Incidence Ratio (SIR): 1.5, 95% confidence interval: 0.7–2.8). For the subgroup that was fully compliant to annual screening, a similar SIR was found (1.6, 95% confidence interval: 0.5–3.6). Despite annual gynaecological screening, a high proportion of ovarian cancers in BRCA1/2 carriers are interval cancers and the large majority of all cancers are diagnosed in advanced stages. Therefore, it is unlikely that annual screening will reduce mortality from ovarian cancer in BRCA1/2 mutation carriers.
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Affiliation(s)
- B B J Hermsen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - R I Olivier
- Department of Gynaecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R H M Verheijen
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - M van Beurden
- Department of Gynaecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L F Massuger
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C W Burger
- Departments of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C T Brekelmans
- Department of Medical Oncology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M J Mourits
- Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - K N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - H H van Boven
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T M Mooij
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M A Rookus
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- E-mail:
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Green JA, Berns EMJJ, Coens C, van Luijk I, Thompson-Hehir J, van Diest P, Verheijen RHM, van de Vijver M, van Dam P, Kenter GG, Tjalma W, Ewing PC, Teodorovic I, Vergote I, van der Burg MEL. Alterations in the p53 pathway and prognosis in advanced ovarian cancer: a multi-factorial analysis of the EORTC Gynaecological Cancer group (study 55865). Eur J Cancer 2006; 42:2539-48. [PMID: 16965910 DOI: 10.1016/j.ejca.2006.06.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 06/20/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE The study was designed to determine independent prognostic variables in suboptimally debulked advanced ovarian cancer patients entered in the randomised phase III study EORTC 55865. EXPERIMENTAL DESIGN Retrospectively collected paraffin blocks from 169 patients with stages IIb-IV epithelial ovarian cancer, taken at primary debulking surgery, were analysed. All patients were treated with cyclophosphamide and cisplatin (CP), and followed up for a median of 10 years. Expression of p53, bcl-2, P21, Ki-67 and HER-2 status was assessed by immunohistochemistry (IHC). RESULTS Expression of p21, a downstream effector of the p53 gene, was found to be a favourable prognostic factor for survival (HR 0.58, CI 0.36-0.94, p=0.025) in addition to FIGO stage (HR 1.54, CI 1.08-2.21, p=or<0.02). For progression free survival (PFS), both p21 (HR 0.52) and Ki-67 (HR 0.6) were significant factors. CONCLUSION P21 overexpression is a positive prognostic factor for survival and PFS in advanced ovarian carcinoma with residual lesions of more than 1 cm.
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Affiliation(s)
- J A Green
- Division of Surgery and Oncology, University of Liverpool, United Kingdom, and Department of Gynecologic Oncology, Free University Hospital, Amsterdam, The Netherlands.
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van Seters M, ten Kate FJW, van Beurden M, Verheijen RHM, Meijer CJLM, Burger MPM, Helmerhorst TJM. In the absence of (early) invasive carcinoma, vulvar intraepithelial neoplasia associated with lichen sclerosus is mainly of undifferentiated type: new insights in histology and aetiology. J Clin Pathol 2006; 60:504-9. [PMID: 16714399 PMCID: PMC1994523 DOI: 10.1136/jcp.2005.031989] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Differentiated vulvar intraepithelial neoplasia (VIN) is presumed to be the precursor of invasive squamous cell carcinoma (SCC) of the vulva. It is commonly assumed that differentiated VIN is related to lichen sclerosus (LS). However, evidence for this is limited to a small number of studies describing epithelial alterations adjacent to vulvar SCC. AIM To study the histology and human papillomavirus (HPV) status in patients with a history of both LS and VIN without coexistent SCC. METHODS Original biopsy specimens and surgical specimens of patients retrieved from the pathology files were revised for the presence of LS, VIN and (early) invasive SCC, specifically focused on the two different types of VIN: differentiated and undifferentiated. Thereafter, VIN lesions were tested for the presence of HPV DNA. RESULTS Twenty-seven patients fulfilled the criteria for LS and VIN without SCC. In all 27 patients, LS was found to be related to undifferentiated VIN. Grading yielded the following results: VIN 1 (n=10), VIN 2 (n=11) and VIN 3 (n=6). Additionally, VIN lesions from 26 patients could be tested for the presence of HPV DNA. HPV DNA, predominantly type 16, was present in 8 (31%) of them. Seven of these eight patients had VIN 2 or 3. During follow-up, three patients progressed to (early) invasive carcinoma. In two of these patients, differentiated VIN was observed overlying early invasive SCC. CONCLUSIONS VIN related to LS without coexisting SCC is likely to be undifferentiated, in contrast to what was previously thought. HPV DNA was demonstrated in 31% of the lesions, and was strongly related to high-grade VIN.
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Affiliation(s)
- M van Seters
- Department of Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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43
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van der Groep P, Bouter A, van der Zanden R, Siccama I, Menko FH, Gille JJP, van Kalken C, van der Wall E, Verheijen RHM, van Diest PJ. Distinction between hereditary and sporadic breast cancer on the basis of clinicopathological data. J Clin Pathol 2006; 59:611-7. [PMID: 16603649 PMCID: PMC1860390 DOI: 10.1136/jcp.2005.032151] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND About 5% of all breast cancer cases are attributable to germline mutations in BRCA1 or BRCA2 genes. BRCA mutations in suspected carriers, however, may be missed, which hampers genetic counselling. MATERIALS AND METHODS Different clinicopathological features were compared between 22 breast cancers from carriers of proved BRCA1 mutations and 604 cancers from sporadic controls. In addition, 5 BRCA2-related breast cancers and 66 breast cancers of untested patients at intermediate risk and 19 breast cancers of untested patients at high risk of hereditary disease on the basis of family history were evaluated. RESULTS A "probably sporadic" class (age >or=54 years and epidermal growth factor receptor (EGFR) negative; 68% of cases) with a 0% chance of BRCA1-related breast cancer containing 79% of the sporadic cases was yielded by using a decision tree with age, Ki67 and EGFR. A 75% chance of BRCA1-related breast cancer was shown by the "probably BRCA1-related" class (age <54 years and Ki67 >or=25%; 8% of cases) with 82% of the BRCA1-related cases but only 1.4% of the sporadic cases. Most cases at intermediate or high risk of hereditary disease on the basis of family history could be classified with high probability as either probably BRCA1 related or probably sporadic. CONCLUSION Breast carcinomas can be classified with a high level of certainty as sporadic or related to BRCA1 germline mutations by using a decision tree with age, Ki67 and EGFR. This can be clinically useful in mutation analysis in families with a borderline risk of hereditary disease.
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Affiliation(s)
- P van der Groep
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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44
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du Bois A, Quinn M, Thigpen T, Vermorken J, Avall-Lundqvist E, Bookman M, Bowtell D, Brady M, Casado A, Cervantes A, Eisenhauer E, Friedlaender M, Fujiwara K, Grenman S, Guastalla JP, Harper P, Hogberg T, Kaye S, Kitchener H, Kristensen G, Mannel R, Meier W, Miller B, Neijt JP, Oza A, Ozols R, Parmar M, Pecorelli S, Pfisterer J, Poveda A, Provencher D, Pujade-Lauraine E, Randall M, Rochon J, Rustin G, Sagae S, Stehman F, Stuart G, Trimble E, Vasey P, Vergote I, Verheijen R, Wagner U. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol 2006; 16 Suppl 8:viii7-viii12. [PMID: 16239238 DOI: 10.1093/annonc/mdi961] [Citation(s) in RCA: 331] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A du Bois
- Department of Gynecology & Gynecologic Oncology, Wiesbaden, Germany.
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45
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Stuart G, Avall-Lundqvist E, du Bois A, Bookman M, Bowtell D, Brady M, Casado A, Cervantes A, Eisenhauer E, Friedlaender M, Fujiwara K, Grenman S, Guastalla JP, Harper P, Hogberg T, Kaye S, Kitchener H, Kristensen G, Mannel R, Meier W, Miller B, Oza A, Ozols R, Parmar M, Pfisterer J, Poveda A, Provencher D, Pujade-Lauraine E, Quinn M, Randall M, Rochon J, Rustin G, Sagae S, Stehman F, Trimble E, Thigpen T, Vasey P, Vergote I, Verheijen R, Vermorken J, Wagner U. 3rd International Ovarian Cancer Consensus Conference: outstanding issues for future consideration. Ann Oncol 2006; 16 Suppl 8:viii36-viii38. [PMID: 16239235 DOI: 10.1093/annonc/mdi965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vermorken JB, Parmar MKB, Brady MF, Eisenhauer EA, Hogberg T, Ozols RF, Rochon J, Rustin GJS, Sagae S, Verheijen RHM. Clinical trials in ovarian carcinoma: study methodology. Ann Oncol 2006; 16 Suppl 8:viii20-viii29. [PMID: 16239233 DOI: 10.1093/annonc/mdi963] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J B Vermorken
- Department of Oncology, University Hospital Antwerp, Edegem, Belgium.
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Kenemans P, Verstraeten RA, Verheijen RHM. Oncogenic pathways in hereditary and sporadic breast cancer. Maturitas 2004; 49:34-43. [PMID: 15351094 DOI: 10.1016/j.maturitas.2004.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Revised: 06/10/2004] [Accepted: 06/10/2004] [Indexed: 12/26/2022]
Abstract
Cancer is a genetic disease. Breast cancer tumorigenesis can be described as a multi-step process in which each step is thought to correlate with one or more distinct mutations in major regulatory genes. The question addressed is how far a multi-step progression model for sporadic breast cancer would differ from that for hereditary breast cancer. Hereditary breast cancer is characterized by an inherited susceptibility to breast cancer on basis of an identified germline mutation in one allele of a high penetrance susceptibility gene (such as BRCA1, BRCA2, CHEK 2, TP53 or PTEN). Inactivation of the second allele of these tumour suppressor genes would be an early event in this oncogenic pathway (Knudson's "two-hit" model). Sporadic breast cancers result from a serial stepwise accumulation of acquired and uncorrected mutations in somatic genes, without any germline mutation playing a role. Mutational activation of oncogenes, often coupled with non-mutational inactivation of tumour suppressor genes, is probably an early event in sporadic tumours, followed by more, independent mutations in at least four or five other genes, the chronological order of which is likely less important. Oncogenes that have been reported to play an early role in sporadic breast cancer are MYC, CCND1 (Cyclin D1) and ERBB2 (HER2/neu). In sporadic breast cancer, mutational inactivation of BRCA1/2 is rare, as inactivation requires both gene copies to be mutated or totally deleted. However, non-mutational functional suppression could result from various mechanisms, such as hypermethylation of the BRCA1 promoter or binding of BRCA2 by EMSY. In sporadic breast tumorigenesis, at least three different pathway-specific mechanisms of tumour progression are recognizable, with breast carcinogenesis being different in ductal versus lobular carcinoma, and in well differentiated versus poorly differentiated ductal cancers. Thus, different breast cancer pathways emerge early in the process of carcinogenesis, ultimately leading to clinically different tumour types. As mutations acquired early during tumorigenesis will be present in all later stages, large-scale gene expression profiling using DNA microarray analysis techniques can help to classify breast cancers into clinically relevant subtypes.
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Affiliation(s)
- P Kenemans
- Department of Obstetrics and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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48
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Lemmink KAPM, Verheijen R, Visscher C. The discriminative power of the Interval Shuttle Run Test and the Maximal Multistage Shuttle Run Test for playing level of soccer. J Sports Med Phys Fitness 2004; 44:233-9. [PMID: 15756160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
AIM The purpose of this study was to examine the discriminative power of the recently developed Interval Shuttle Run Test (ISRT) and the widely used Maximal Multistage 20 m Shuttle Run Test (MMSRT) for soccer players at different levels of competition. The main difference between the tests is that the exercise mode of the ISRT is not continuous but intermittent. Instead of 60 s of running per stage in the MMSRT, 30 s of running are alternated with 15 s of walking, twice per stage. METHODS Comparative study: within a 2-week period, 81 male soccer players at the Dutch premier league professional, premier league and 3rd division amateur levels performed the ISRT and the MMSRT. The total number of runs was scored for both tests. RESULTS Only the ISRT distinguished between levels of competition. In general, the ISRT correlated moderately with the MMSRT for players of different levels of competition (rP: 0.52-0.83). CONCLUSIONS In contrast to the MMSRT, the ISRT shows discriminative power for soccer players at different levels of competition supporting the validity of the ISRT for measuring endurance in a more soccer-specific way. As a result of the intermittent character of the ISRT the energetics of the ISRT and the MMSRT are not closely related.
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Affiliation(s)
- K A P M Lemmink
- Institute of Human Movement Sciences, University of Groningen, Groningen, The Netherlands.
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49
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Zielinski GD, Bais AG, Helmerhorst TJ, Verheijen RHM, de Schipper FA, Snijders PJF, Voorhorst FJ, van Kemenade FJ, Rozendaal L, Meijer CJLM. HPV Testing and Monitoring of Women After Treatment of CIN 3: Review of the Literature and Meta-analysis. Obstet Gynecol Surv 2004; 59:543-53. [PMID: 15199273 DOI: 10.1097/00006254-200407000-00024] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
According to the current guidelines in most western countries, women treated for cervical intraepithelial neoplasia grade 3 (CIN 3) are followed for at least 2 years after treatment by cytology.High-risk human papillomavirus (hrHPV) infections are necessary for the development and maintenance of CIN 3. HrHPV testing could be used to improve monitoring of women treated for CIN 3. This has prompted numerous studies for the implementation of hrHPV testing in monitoring of women treated for CIN 3. Included in this review are 20 studies, published between 1996 and 2003, comparing hrHPV testing with either resection margins or cervical cytology to predict recurrent/residual disease, and 11 of them could be used in a meta-analysis. In the meta-analysis of the 11 studies, the negative predictive value (NPV) for recurrent/residual disease of hrHPV testing was 98% (95% CI 97-99%), that of resection margins 91% (95% CI 87-94%), and that of cervical cytology 93% (95% CI 90-95%). When hrHPV testing was performed in conjunction with cytology, the sensitivity was 96% (95% CI 89-99%), specificity was 81% (95% CI 77-84%), the associated positive predictive value (PPV) was 46% (95% CI 38-54%), and the NPV was 99% (95% CI 98-100%). Combined hrHPV and cytology testing yielded the best test characteristics. We propose to include hrHPV testing in conjunction with cytology for monitoring women treated for CIN 3. Some follow-up visits for women testing negative for both hrHPV and cytology can be skipped. In western countries, this could mean that for women double negative at 6 months, retesting at 12 months should be skipped while keeping the 24-month follow-up visit.
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Affiliation(s)
- G D Zielinski
- The Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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50
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Abstract
PURPOSE To compare bleomycin with radiation in the G2 chromatid break assay. Controversy exists in the literature about whether G2 bleomycin chromatid-break sensitivity links with cancer predisposition in the same way as the G2 chromatid radiosensitivity test (the so-called 'G2 assay'). Although bleomycin is referred to as a 'radiomimetic' agent, it differs from radiation in the way the damage is induced. MATERIALS AND METHODS Epstein-Barr virus-immortalized lymphoblastoid cell lines from two head and neck squamous cell carcinoma patients, two breast cancer patients, two ataxia-telangiectasia patients and two normal control persons were used. Chromosomal damage was determined in cells exposed to 0.3-Gy radiation or 5 mU ml(-1) bleomycin. The numbers of chromatid breaks per cell and of aberrations per cell (i.e. breaks and gaps) were determined. RESULTS A strong positive correlation was found between the two different damage inducers (r=0.99; p<0.001). This correlation was similar for both the breaks per cell and the total aberrations per cell. Inclusion of gaps in the scoring of chromatid breaks was associated with a higher variability of the data, but this did not influence the outcome of this study. CONCLUSIONS Both bleomycin and radiation give the same sensitivity phenotypes as determined by the G2 assay of chromatid breaks. Thus, when no radiation facility is present, bleomycin seems to be a good alternative to radiation for this type of assay.
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Affiliation(s)
- A D Adema
- Section Tumor Biology, Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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