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 diagnostické zobrazování MeSH
- dospělí MeSH
- gynekologie statistika a číselné údaje MeSH
- klinické kompetence statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody statistika a číselné údaje MeSH
- nádory děložního čípku diagnostické zobrazování patologie MeSH
- odchylka pozorovatele MeSH
- radiologie statistika a číselné údaje MeSH
- reprodukovatelnost výsledků MeSH
- staging nádorů metody statistika a číselné údaje MeSH
- ultrasonografie metody statistika a číselné údaje MeSH
- vagina diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie 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
- chirurgická onkologie statistika a číselné údaje MeSH
- cytoredukční chirurgie * MeSH
- gynekologie statistika a číselné údaje MeSH
- laparoskopie statistika a číselné údaje MeSH
- lidé MeSH
- nádory vaječníků diagnóza chirurgie MeSH
- nádory vejcovodů diagnóza chirurgie MeSH
- peritoneální nádory diagnóza chirurgie MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie 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
- chirurgické síťky využití MeSH
- dospělí MeSH
- gynekologie statistika a číselné údaje MeSH
- internacionalita MeSH
- lékařská praxe - způsoby provádění statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- mladý dospělý MeSH
- pesary využití MeSH
- prolaps pánevních orgánů chirurgie MeSH
- průzkumy a dotazníky MeSH
- stresová inkontinence moči chirurgie MeSH
- suburetrální pásky využití MeSH
- ultrasonografie využití MeSH
- urologie statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články 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
- dodržování směrnic statistika a číselné údaje MeSH
- dospělí MeSH
- gynekologie metody normy statistika a číselné údaje MeSH
- lékařská onkologie metody normy statistika a číselné údaje MeSH
- lékařská praxe - způsoby provádění statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory endometria diagnóza terapie MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Španělsko 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
- gynekologické chirurgické výkony statistika a číselné údaje MeSH
- gynekologie výchova statistika a číselné údaje MeSH
- lékařská onkologie výchova statistika a číselné údaje MeSH
- lékařská praxe - způsoby provádění statistika a číselné údaje MeSH
- lidé MeSH
- nádory vaječníků chirurgie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- gynekologie klasifikace statistika a číselné údaje trendy MeSH
- incidence MeSH
- lékařská onkologie klasifikace statistika a číselné údaje trendy MeSH
- lidé MeSH
- mortalita trendy MeSH
- nádory děložního čípku epidemiologie mortalita MeSH
- nádory endometria epidemiologie mortalita MeSH
- nádory prsu epidemiologie klasifikace mortalita MeSH
- nádory vaječníků epidemiologie mortalita MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika 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
- gynekologie metody statistika a číselné údaje trendy MeSH
- interpretace statistických dat MeSH
- kojenecká mortalita trendy MeSH
- komplikace těhotenství epidemiologie mortalita prevence a kontrola MeSH
- lékaři ekonomika statistika a číselné údaje MeSH
- lidé MeSH
- nezaměstnanost statistika a číselné údaje trendy MeSH
- sociální podmínky ekonomika statistika a číselné údaje trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
- Geografické názvy
- Polsko MeSH
- MeSH
- choriokarcinom epidemiologie terapie MeSH
- gynekologie statistika a číselné údaje MeSH
- lidé MeSH
- nádory dělohy diagnóza epidemiologie terapie MeSH
- nádory děložního čípku diagnóza epidemiologie terapie MeSH
- nádory vaječníků diagnóza epidemiologie terapie MeSH
- nádory vulvy diagnóza epidemiologie terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
