[Fine-needle aspiration in gynecologic oncology].
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Biomedical subjects
Publications and source records attributed to B U Sevin.
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During the years 1969 to 1982, 16 patients with primary malignant melanoma of the vulva were entered into the Tumor Registry at the University of Miami Jackson Memorial Medical Center. The mean age was 55, with a range of 18 to 89 years. Treatment was primarily by radial vulvectomy with bilateral groin and pelvic node dissection. Survival was correlated to FIGO staging, Clark and Breslow classifications, and lymph node involvement. Survival correlated best to tumor thickness and Clark levels. Patients with Clark level 2 or less and less than 1.5 mm depth of penetration had the best prognosis. Lymph node involvement was present in 25% of the patients, and there were no survivors in this group. There were no instances of positive pelvic nodes when the groin nodes were negative, and routine pelvic lymphadenectomy is not recommended.
Between June, 1966, and June, 1981, 92 pelvic exenterations were performed by gynecologic oncologists at Jackson Memorial Hospital/University of Miami Medical Center. The decrease in postoperative morbidity and mortality and the improved 5-year survival rate probably were related to improvement in hospital facilities and more refined surgical techniques. Urinary and gastrointestinal complications occurred with equal frequency during the period of study and were more common in patients who had received previous radiation therapy. On the basis of our experience, recommendations to decrease gastrointestinal and urinary complications further are presented.
In this randomized, double-blind study, the effectiveness of a single-agent prophylactic antibiotic in reducing infections after radical abdominal hysterectomy with pelvic and para-aortic lymphadenectomy was compared with a placebo. A total of 12 doses of cefoxitin (2g) or placebo were given to 70 patients, starting the evening before surgery. Because of tumor spread beyond the cervix, radical hysterectomy was not performed in 17 patients who were, therefore, excluded from the study. Analysis of 53 patients who completed the study revealed that 15% of cefoxitin patients had surgical site-related infections compared with 52% of placebo patients (P = .005). Significant differences between the groups were also observed in nonsurgical site-related infections (23 versus 48%), overall morbidity (58 versus 89%), and the need for additional antibiotic therapy (38 versus 67%). Socioeconomic status was a significant risk factor with 57% of staff patients demonstrating increased site-related infections as compared with 17% of private patients (P = .002). No clinically significant side effects were observed. The authors recommend the use of antibiotic prophylaxis in patients undergoing radical abdominal hysterectomy for gynecologic malignancies.
Of 87 patients who were treated at the author's institution for primary cancer of the vagina, 31 had undergone total hysterectomy for benign disease. In this group of 31 patients, vaginal bleeding was the most common presenting symptom, although there were eight patients who were entirely asymptomatic and were diagnosed on routine examination. The stage of cancer was more advanced in the symptomatic patients than in the asymptomatic patients. There were seven patients with stage 0 disease, and four of these were asymptomatic and diagnosed by routine Papanicolaou smear. Overall, Papanicolaou smears were positive in 12 of 19 patients tested, a sensitivity rate of 63%. The authors recommend that patients who have a hysterectomy for benign disease continue to have Papanicolaou smears taken from the vaginal vault at regular intervals.
Forty patients with recurrence following radical surgery for early invasive cancer of the cervix were studied. Fifty-eight percent of the recurrences were observed within the first 12 months after surgery and 83% within the first 2 years. The site of recurrence was found to influence diagnosis, symptomatology, clinical findings, prognosis, cause of death, and therapy. The prognosis for patients with recurrent cervical cancer was poor, with only 5 patients (13%) surviving free of disease after 5 years. One patient is presently alive and without disease for more than 2 years. Patients who did not receive a potentially curative course of radiation therapy at the time of diagnosis of the recurrence had a poor prognosis. None of the patients managed by exenterative procedures or chemotherapy survived. Guidelines are suggested for follow-up after primary radical hysterectomy and pelvic node dissection.
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Eight cases of invasive cervical carcinoma detected after cryotherapy for presumably noninvasive cervical lesions are reported. Three of these patients died from their disease less than 2 years following definitive therapy. The potential dangers of a less-than-optimal work-up of patients prior to freezing are analyzed and discussed in detail. Possible explanations for failures of cryotherapy are discussed, and guidelines for prevention of failures are presented.