OBJECTIVE: To evaluate interobserver agreement for the assessment of local tumor extension in women with cervical cancer, among experienced and less experienced observers, using transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI). METHODS: The TVS observers were all gynecologists and consultant ultrasound specialists, six with and seven without previous experience in cervical cancer imaging. The MRI observers were five radiologists experienced in pelvic MRI and four less experienced radiology residents without previous experience in MRI of the pelvis. The less experienced TVS observers and all MRI observers underwent a short basic training session in the assessment of cervical tumor extension, while the experienced TVS observers received only a written directive. All observers were assigned the same images from cervical cancer patients at all stages (n = 60) and performed offline evaluation to answer the following three questions: (1) Is there a visible primary tumor? (2) Does the tumor infiltrate > ⅓ of the cervical stroma? and (3) Is there parametrial invasion? Interobserver agreement within the four groups of observers was assessed using Fleiss kappa (κ) with 95% CI. RESULTS: Experienced and less experienced TVS observers, respectively, had moderate interobserver agreement with respect to tumor detection (κ (95% CI), 0.46 (0.40-0.53) and 0.46 (0.41-0.52)), stromal invasion > ⅓ (κ (95% CI), 0.45 (0.38-0.51) and 0.53 (0.40-0.58)) and parametrial invasion (κ (95% CI), 0.57 (0.51-0.64) and 0.44 (0.39-0.50)). Experienced MRI observers had good interobserver agreement with respect to tumor detection (κ (95% CI), 0.70 (0.62-0.78)), while less experienced MRI observers had moderate agreement (κ (95% CI), 0.51 (0.41-0.62)), and both experienced and less experienced MRI observers, respectively, had good interobserver agreement regarding stromal invasion (κ (95% CI), 0.80 (0.72-0.88) and 0.71 (0.61-0.81)) and parametrial invasion (κ (95% CI), 0.69 (0.61-0.77) and 0.71 (0.61-0.81)). CONCLUSIONS: We found interobserver agreement for the assessment of local tumor extension in patients with cervical cancer to be moderate for TVS and moderate-to-good for MRI. The level of interobserver agreement was associated with experience among TVS observers only for parametrial invasion. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
- MeSH
- Cervix Uteri diagnostic imaging MeSH
- Adult MeSH
- Gynecology statistics & numerical data MeSH
- Clinical Competence statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods statistics & numerical data MeSH
- Uterine Cervical Neoplasms diagnostic imaging pathology MeSH
- Observer Variation MeSH
- Radiology statistics & numerical data MeSH
- Reproducibility of Results MeSH
- Neoplasm Staging methods statistics & numerical data MeSH
- Ultrasonography methods statistics & numerical data MeSH
- Vagina diagnostic imaging MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Evaluation Study MeSH
OBJECTIVE: Laparoscopy is one of the diagnostic tools available for the complex clinical decision-making process in advanced ovarian, fallopian tube, and peritoneal carcinoma. This article presents the results of a survey conducted within the European Network of Gynaecological Oncology Trial (ENGOT) group aimed at reviewing the current patterns of practice at gynecologic oncology centers with regard to the evaluation of resection in advanced ovarian, fallopian tube, and peritoneal carcinoma. METHODS: A 24-item questionnaire was sent to the chair of the 20 cooperative groups that are currently part of the ENGOT group, and forwarded to the members within each group. RESULTS: A total of 142 questionnaires were returned. Only 39 respondents (27.5%) reported using some form of clinical (not operative) score for the evaluation of resection. The frequency of use of diagnostic laparoscopy to assess disease status and feasibility of resection was as follows: never, 21 centers (15%); only in select cases, 83 centers (58.5%); and routinely, 36 centers (25.4%). When laparoscopy was performed, 64% of users declared they made the decision to proceed with maximal effort cytoreductive surgery based on their personal/staff opinion, and 36% based on a laparoscopic score. To the question of whether laparoscopy should be considered the gold standard in the evaluation of resection, 71 respondents (50%) answered no, 66 respondents (46.5%) answered yes, whereas 5 respondents (3.5%) did not provide an answer. CONCLUSIONS: This study found that laparoscopy was routinely performed to assess feasibility of cytoreduction in only 25.4% of centers in Europe. However, it was commonly used to select patients and in a minority of centers it was never used . When laparoscopy was adopted, the treatment strategy was based on laparoscopic scores only in a minority of centers.
- MeSH
- Surgical Oncology statistics & numerical data MeSH
- Cytoreduction Surgical Procedures * MeSH
- Gynecology statistics & numerical data MeSH
- Laparoscopy statistics & numerical data MeSH
- Humans MeSH
- Ovarian Neoplasms diagnosis surgery MeSH
- Fallopian Tube Neoplasms diagnosis surgery MeSH
- Peritoneal Neoplasms diagnosis surgery MeSH
- Surveys and Questionnaires MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
INTRODUCTION AND HYPOTHESIS: Members of the International Urogynecological Association (IUGA) come from different geographic locations and practice settings. A member survey regarding practice patterns provides valuable information for practitioners and researchers alike, and allows the IUGA to discover areas to focus on education and information dissemination. METHODS: A questionnaire was developed by the IUGA Research and Development committee and distributed electronically to IUGA surgeons. Answers were analyzed in reference to demographics, geographic distribution, and academic affiliation. RESULTS: Five hundred sixty-four members answered the questionnaire, representing a 28 % response rate, and closely reflecting the geographic distribution of IUGA membership. Preferred surgical treatment for uncomplicated SUI was the mid-urethral trans-obturator sling (49.7 %). Vaginal mesh was mainly used for repair of recurrent POP (20.4 %). Pessary use was offered "always" or "frequently" by 61.5 %, with no difference in academic affiliation, but significant differences based on region of practice. Compared to practitioners in non-academic centers, those with academic affiliation utilized Urodynamic studies (UDS) and Magnetic Resonance Imaging (MRI) more frequently in the evaluation of POP. Regions of practice significantly influenced the majority of practice patterns, with the highest impact found in the use of robotic assistance. CONCLUSIONS: Many practice patterns in the evaluation and treatment of POP and SUI depend on academic affiliation and geographic location. Practice patterns are not always based on most recent evidence-based data.
- MeSH
- Surgical Mesh utilization MeSH
- Adult MeSH
- Gynecology statistics & numerical data MeSH
- Internationality MeSH
- Practice Patterns, Physicians' statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging utilization MeSH
- Young Adult MeSH
- Pessaries utilization MeSH
- Pelvic Organ Prolapse surgery MeSH
- Surveys and Questionnaires MeSH
- Urinary Incontinence, Stress surgery MeSH
- Suburethral Slings utilization MeSH
- Ultrasonography utilization MeSH
- Urology statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVE: The aim of the study was to analyze the current management of endometrial cancer across Spain and to evaluate the use and applicability of the national and international guidelines. MATERIALS AND METHODS: An electronic 30-question survey was distributed among all Spanish Society of Obstetrics and Gynecology-registered specialists dedicated to gynecologic oncology in Spain by e-mail. Data were collected anonymously and analyzed using SPSS program. RESULTS: One hundred forty-five (17.8%) surveys were collected. Significant differences were observed between tertiary hospitals and secondary or private hospitals in terms of appropriate (according to European Society of Gynaecologic Oncology guidelines) nodal staging in low-risk cases (96 [95%] vs 27 [61.4%], respectively; P < 0.001), appropriate nodal staging in intermediate-risk cases (96 [95%] vs 39 [88.6%], respectively; P = 0.004), appropriate treatment in advanced-stage cases (63 [67.7%] vs 13 [40.6%], respectively; P < 0.001), and surgical treatment of relapses (87 [93.5%] vs 18 [56.3%], respectively; P = 0.004) but nonsignificant in the rate of complete paraaortic lymphadenectomy performance (82 [81.2%] vs 28 [63.6%], respectively; P = 0.056). Similar results have been observed when comparing centers with less than 20 cases per year to centers with more than 40 cases annually, with significant differences in the management of low-risk and intermediate-risk endometrial cancers. CONCLUSIONS: This cross-sectional study demonstrates a broad heterogeneity of care giving between the clinical national and international guidelines and the actual practice in Spain. Although most of the responders refer to base their endometrial cancer management on Spanish and European Society of Gynaecologic Oncology guidelines (64.1%), many discrepancies have been observed, mainly in the management of intermediate-risk cases and follow-up. It may be caused by the lack of consensus on certain points, lack of facilities in lower case load centers, and also due to disagreement or unawareness on the current knowledge.
- MeSH
- Guideline Adherence statistics & numerical data MeSH
- Adult MeSH
- Gynecology methods standards statistics & numerical data MeSH
- Medical Oncology methods standards statistics & numerical data MeSH
- Practice Patterns, Physicians' statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Endometrial Neoplasms diagnosis therapy MeSH
- Cross-Sectional Studies MeSH
- Surveys and Questionnaires MeSH
- Practice Guidelines as Topic MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Spain MeSH
BACKGROUND: Surgical treatment of advanced ovarian cancer is a subject of fast development. The aim of this survey was to collect data on current surgical treatment from selected European gynecological oncology centers. METHODS: A questionnaire has been sent to gynecological oncology centers from 18 countries across Europe, which are presented on the ESGO Web site. Data were collected on an anonymous basis. All questions were related to the cytoreductive surgery of advanced ovarian cancer. RESULTS: Response rate reached 63%, and data from 17 European countries were analyzed. The median number of new patients with ovarian cancer treated annually in a single centre was 95. Whereas 19% of centers perform infracolic omentectomy only, 81% carry on total omentectomy. Approximately half of the centers conduct appendectomy in all patients with advanced ovarian cancer, 1/3 only if the appendix is macroscopically involved. Lymphadenectomy is carried out in 20% of centers in all cases but in 31% only if no residual disease is achieved. Proportion of patients in whom colorectal resection is performed ranged from less than 5% to more than 40%. Colorectal resection, splenectomy and liver resection are conducted by gynecological oncologist in 27%, 46%, and 12%, respectively. CONCLUSIONS: There were substantial differences in the spectrum and complexity of procedures performed in patients with advanced ovarian cancer among large European gynecologic oncology centers. Tendency to more complex surgery was shown in centers with a higher number of cases. Selected bowel and upper abdominal procedures are already performed by gynecological oncologists in large proportion of centers, without existence of well-established postgraduate training program.
- MeSH
- Gynecologic Surgical Procedures statistics & numerical data MeSH
- Gynecology education statistics & numerical data MeSH
- Medical Oncology education statistics & numerical data MeSH
- Practice Patterns, Physicians' statistics & numerical data MeSH
- Humans MeSH
- Ovarian Neoplasms surgery MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
- MeSH
- Gynecology classification statistics & numerical data trends MeSH
- Incidence MeSH
- Medical Oncology classification statistics & numerical data trends MeSH
- Humans MeSH
- Mortality trends MeSH
- Uterine Cervical Neoplasms epidemiology mortality MeSH
- Endometrial Neoplasms epidemiology mortality MeSH
- Breast Neoplasms epidemiology classification mortality MeSH
- Ovarian Neoplasms epidemiology mortality MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Geographicals
- Czech Republic MeSH
In the study the results of the relation between infant (neonatal + post-neonatal) mortality and the gynaecological and unemployment factors are presented. The fi ndings are based on Bayesian modelling and indicate the possible infl uence of the unemployment situation on mortality, whereas no correlation was found as regards access to the availability of gynaecological health care. The main conclusion is that elevated unemployment which could be referred to a poor socioeconomic situation (amongst other factors) may force pregnant women to pay more attention to improving their life conditions, than to suffi cient medical controlling.
- MeSH
- Gynecology methods statistics & numerical data trends MeSH
- Data Interpretation, Statistical MeSH
- Infant Mortality trends MeSH
- Pregnancy Complications epidemiology mortality prevention & control MeSH
- Physicians economics statistics & numerical data MeSH
- Humans MeSH
- Unemployment statistics & numerical data trends MeSH
- Social Conditions economics statistics & numerical data trends MeSH
- Check Tag
- Humans MeSH
- Publication type
- Comparative Study MeSH
- Geographicals
- Poland MeSH
- MeSH
- Choriocarcinoma epidemiology therapy MeSH
- Gynecology statistics & numerical data MeSH
- Humans MeSH
- Uterine Neoplasms diagnosis epidemiology therapy MeSH
- Uterine Cervical Neoplasms diagnosis epidemiology therapy MeSH
- Ovarian Neoplasms diagnosis epidemiology therapy MeSH
- Vulvar Neoplasms diagnosis epidemiology therapy MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Comparative Study MeSH
