COMPARISON OF ULTRASOUND-GUIDED TRUCUT NEEDLE BIOPSY AND LAPAROSCOPY IN THE DIAGNOSIS OF HIGH-GRADE SEROUS OVARIAN CANCER
Yıl 2025,
Cilt: 26 Sayı: 1, 5 - 9, 27.01.2025
Cem Yağmur Özdemir
,
Dağhan Arda Arıöz
,
Nayif Çiçekli
,
Betül Ahat
,
Hüseyin Çoşkun
,
Hacer Demir
,
Öznur Öner
,
Dağıstan Tolga Arıöz
Öz
OBJECTIVE: We aimed to compare tru-cut biopsy with laparoscopy
in the diagnosis of high-grade serous ovarian cancer
(HGSC) in our clinic.
MATERIAL AND METHODS: Our retrospective study included
patients who underwent surgery for HGSC between January
2013 and December 2023. Patients with pathologically confirmed
(FIGO 2018) stage III or IV HGSC underwent neoadjuvant
chemotherapy (NACT) and interval debulking surgery (IDS)
were performed. Exclusion criteria were patients with stage
I and II ovarian cancer and who did not receive NACT. Additionally,
patients with non-high-grade serous ovarian cancer or
non-gynecological conditions were excluded. As a result, 60
patients were included in the study. Participants were categorized
into two groups, namely, Group 1 (Patients diagnosed with
HGSC by tru-cut biopsy before NACT) and Group 2 (Patients diagnosed
with HGSC by diagnostic laparoscopy before NACT).
Time-to-event analyses were conducted using the Kaplan- Meier
method and log-rank test. Statistical significance was defined
when p < 0.05.
RESULTS: Out of the 60 patients, 32 patients were diagnosed
by tru-cut biopsy and 28 patients with laparoscopy. The overall
survival (OS) of Group 1 was 53.1%, and for Group 2, it was
71.4% (p = 0.371). The progression-free survival (PFS) rate was
56.3 for Group 1 and 64.3% for Group 2 (p = 0.464). No significant
difference was detected in terms of recurrence, OS and
PFS. We found a significant difference between Group 1 and
Group 2 only in terms of hospitalization time (p < 0.001).
CONCLUSIONS: HGSC is a histopathological subgroup of ovarian
cancer that is difficult to diagnose and manage. While primary
debulking surgery remains in the background, the importance
of tru-cut biopsy in terms of short hospital stay should
not be forgotten in the diagnostic evaluation of patients.
Etik Beyan
The present study was approved by the Ethical Committee of Afyonkarahisar Health Sciences University Hospital (grant no: 2024/3) and the research was continued in accordance with the Declaration of Helsinki. Informed consent was obtained from all patients during their hospitalization.
Destekleyen Kurum
This research received no external funding.
Teşekkür
We would like to thank Saygin Alkan and Nagihan Ozdemir for the figure edits.
Kaynakça
-
1. Shah S, Cheung A, Kutka M, Sheriff M, Boussios S. Epithelial ovarian cancer: providing evidence of predisposition genes. International Journal of Environmental Research and Public Health. 2022;19(13):8113.
-
2. Torre LA, Trabert B, De Santis CE, et al. Ovarian cancer statistics, 2018. CA Cancer Journal for Clinicians.
2018;68(4):284-96.
-
3. Onda T, Satoh T, Saito T, et al. Comparison of treatment invasiveness between upfront debulking surgery
versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and
peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602. European
Journal of Cancer. 2016;64:22-31.
-
4. Asp M, Mockute I, Måsbäck A, Liuba K, et al. Tru-Cut Biopsy in Gynecological Cancer: Adequacy, Accuracy,
Safety and Clinical Applicability. Journal of Multidisciplinary Healthcare. 2023;1367-77.
-
5. Verschuere H, Froyman W, Van den Bosch T, et al. Safety and efficiency of performing transvaginal
ultrasound-guided tru-cut biopsy for pelvic masses. Gynecologic Oncology. 2021;161(3):845-51.
-
6. Odajima S, Ueda K, Hosoya S, et al. Clinical availability of tumour biopsy using diagnostic laparoscopy for
advanced ovarian cancer. In Vivo. 2021;35(6):3325-31.
-
7. Armstrong, DK, Alvarez RD, Bakkum-Gamez JN et al. Ovarian cancer, version 2.2020, NCCN clinical practice
guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2021;19(2):191-226.
-
8. Llueca A, Climent MT, Escrig J, Carrasco P, Serra A. Validation of three predictive models for suboptimal
cytoreductive surgery in advanced ovarian cancer. Scientific Reports. 2021;11(1): 8111.
-
9. Piedimont S, Bernardini MQ, Ding, A. Validation of the Integrated Prediction Model algorithm for outcome of
cytoreduction in advanced ovarian cancer. International Journal of Gynecologic Cancer. 2023;33(7):1077-1082.
-
10. Egger EK, Buchen MA, Recker F. et al. Predicting incomplete cytoreduction in patients with advanced ovarian
cancer. Frontiers in Oncology. 2022;12:1060006.
-
11. Hasson HM. A modified instrument and method for laparoscopy. American Journal of Obstetrics &
Gynecology. 1971;110: 886-87.
-
12. Vlasák P, Bouda J, Kostun J, et al. Diagnostic reliability, accuracy and safety of ultrasound-guided biopsy
and ascites puncture in primarily inoperable ovarian tumours. Anticancer Research. 2020:40(6): 3527-34.
-
13. Zikan M, Fischerova D, Pinkavova I, Dundr P, Cibula D. Ultrasound‐guided tru‐cut biopsy of abdominal and
pelvic tumors in gynecology. Ultrasound in Obstetrics & Gynecology. 2020;36(6):767-72.
-
14. Fischerova D, Cibula D, Dundr P, et al. Ultrasound-guided tru-cut biopsy in the management of advanced
abdomino-pelvic tumors. International Journal of Gynecologic Cancer. 2020;18(4):833-37.
-
15. Shah SZ, Shahid S, Hussain S, et al. Outcome of Ultrasound Guided Trucut Biopsy of Adnexal Masses with
Suspected Malignancy. Journal of Islamabad Medical & Dental College. 2022;11(3);158-63.
-
16. Nasioudis D, Arevalo O, Gysler S, et al. Impact of delayed interval cytoreductive surgery on the survival of
patients with advanced stage high-grade epithelial ovarian carcinoma. International Journal of Gynecologic
Cancer. 2024;34(1):131-37.
-
17. Lee YJ, Chung YS, Lee JY, et al. Role of diagnostic laparoscopy in deciding primary treatment in advanced-
stage ovarian cancer. Journal of Gynecologic Oncology. 2023; 34(2):e17.
-
18. Brun JL, Rouzier R, Selle F, et al. Neoadjuvant chemotherapy or primary surgery for stage III/IV ovarian cancer:
contribution of diagnostic laparoscopy. BMC Cancer. 2009;9:1-8.
-
19. Agostini A, Mattei S, Ronda L, et al. Prevention of port-site metastasis after laparoscopy. Gynécologie,
Obstétrique & Fertilité. 2002;30(11):878-81.
-
20. Lin CJ, Chen HJ. The investigation of laparoscopic instrument movement control and learning effect.
BioMed Research International. 2013;(1):349825.
-
21. Jochum F, Vermel M, Faller E, et al. Three and five-year mortality in ovarian cancer after minimally invasive
compared to open surgery: a systematic review and meta-analysis. Journal of Clinical Medicine.
2020;9(8):2507.
HİGH GRADE SERÖZ OVER KANSERİ TANISINDA ULTRASON EŞLİĞİNDE TRUCUT İĞNE BİYOPSİSİ VE LAPAROSKOPİNİN KARŞILAŞTIRILMASI
Yıl 2025,
Cilt: 26 Sayı: 1, 5 - 9, 27.01.2025
Cem Yağmur Özdemir
,
Dağhan Arda Arıöz
,
Nayif Çiçekli
,
Betül Ahat
,
Hüseyin Çoşkun
,
Hacer Demir
,
Öznur Öner
,
Dağıstan Tolga Arıöz
Öz
AMAÇ: Kliniğimizde high grade seröz over kanseri (HGSC) tanısında
tru-cut biyopsi ile laparoskopiyi karşılaştırmayı amaçladık.
GEREÇ VE YÖNTEM: Retrospektif olarak tasarlanan çalışmamıza
Ocak 2013 ile Aralık 2023 tarihleri arasında HGSC tanısıyla
opere edilen hastalar dahil edildi. Patolojik olarak doğrulanmış
(FIGO 2018) evre III veya IV HGSC hastalarına neoadjuvan kemoterapi
(NACT) ve ardından interval debulking cerrahisi (IDS)
uygulandı. Hariç tutma kriterleri, evre I ve II over kanseri olguları
ve NACT almayan hastalardı. Ayrıca non-HGSC veya non-jinekolojik
olgular çalışma dışı bırakıldı. Sonuç olarak çalışmaya 60
hasta dahil edildi. Katılımcılar iki gruba ayrıldı; grup 1 (NACT
öncesi tru-cut biyopsi ile HGSC tanısı alan hastalar) ve grup 2
(NACT öncesi tanısal laparoskopi ile HGSC tanısı alan hastalar).
Sağkalım analizleri, Kaplan Meier ve log-rank testi kullanılarak
yapıldı. İstatistiksel anlamlılık p <0.05 olduğunda tanımlandı.
BULGULAR: 60 hastanın 32'sine tru-cut biyopsi, 28'ine laparoskopi
ile tanı konuldu. Grup 1'in genel sağkalım oranı (OS) %53,1
ve grup 2 için %71,4 idi (p = 0,371). Progresyonsuz sağkalım
(PFS) oranı grup 1 için 56,3 ve grup 2 için %64,3 idi (p = 0,464).
Nüks, OS ve PFS açısından iki grup arasında anlamlı fark saptanmadı.
Grup 1 ile grup 2 arasında sadece hastanede kalış süresi
açısından anlamlı fark bulduk (p<0,001).
SONUÇ: HGSC, tanısı ve tedavisi zor olan over kanserinin histopatolojik
bir alt grubudur. İleri evre over kanserinde primer debulking
cerrahisi güncel yaklaşımda geri planda kalırken, hastaların
tanısal değerlendirmesinde tru-cut biyopsinin hastanede
kalış süresinin kısa olması açısından önemi unutulmamalıdır.
Kaynakça
-
1. Shah S, Cheung A, Kutka M, Sheriff M, Boussios S. Epithelial ovarian cancer: providing evidence of predisposition genes. International Journal of Environmental Research and Public Health. 2022;19(13):8113.
-
2. Torre LA, Trabert B, De Santis CE, et al. Ovarian cancer statistics, 2018. CA Cancer Journal for Clinicians.
2018;68(4):284-96.
-
3. Onda T, Satoh T, Saito T, et al. Comparison of treatment invasiveness between upfront debulking surgery
versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and
peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602. European
Journal of Cancer. 2016;64:22-31.
-
4. Asp M, Mockute I, Måsbäck A, Liuba K, et al. Tru-Cut Biopsy in Gynecological Cancer: Adequacy, Accuracy,
Safety and Clinical Applicability. Journal of Multidisciplinary Healthcare. 2023;1367-77.
-
5. Verschuere H, Froyman W, Van den Bosch T, et al. Safety and efficiency of performing transvaginal
ultrasound-guided tru-cut biopsy for pelvic masses. Gynecologic Oncology. 2021;161(3):845-51.
-
6. Odajima S, Ueda K, Hosoya S, et al. Clinical availability of tumour biopsy using diagnostic laparoscopy for
advanced ovarian cancer. In Vivo. 2021;35(6):3325-31.
-
7. Armstrong, DK, Alvarez RD, Bakkum-Gamez JN et al. Ovarian cancer, version 2.2020, NCCN clinical practice
guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2021;19(2):191-226.
-
8. Llueca A, Climent MT, Escrig J, Carrasco P, Serra A. Validation of three predictive models for suboptimal
cytoreductive surgery in advanced ovarian cancer. Scientific Reports. 2021;11(1): 8111.
-
9. Piedimont S, Bernardini MQ, Ding, A. Validation of the Integrated Prediction Model algorithm for outcome of
cytoreduction in advanced ovarian cancer. International Journal of Gynecologic Cancer. 2023;33(7):1077-1082.
-
10. Egger EK, Buchen MA, Recker F. et al. Predicting incomplete cytoreduction in patients with advanced ovarian
cancer. Frontiers in Oncology. 2022;12:1060006.
-
11. Hasson HM. A modified instrument and method for laparoscopy. American Journal of Obstetrics &
Gynecology. 1971;110: 886-87.
-
12. Vlasák P, Bouda J, Kostun J, et al. Diagnostic reliability, accuracy and safety of ultrasound-guided biopsy
and ascites puncture in primarily inoperable ovarian tumours. Anticancer Research. 2020:40(6): 3527-34.
-
13. Zikan M, Fischerova D, Pinkavova I, Dundr P, Cibula D. Ultrasound‐guided tru‐cut biopsy of abdominal and
pelvic tumors in gynecology. Ultrasound in Obstetrics & Gynecology. 2020;36(6):767-72.
-
14. Fischerova D, Cibula D, Dundr P, et al. Ultrasound-guided tru-cut biopsy in the management of advanced
abdomino-pelvic tumors. International Journal of Gynecologic Cancer. 2020;18(4):833-37.
-
15. Shah SZ, Shahid S, Hussain S, et al. Outcome of Ultrasound Guided Trucut Biopsy of Adnexal Masses with
Suspected Malignancy. Journal of Islamabad Medical & Dental College. 2022;11(3);158-63.
-
16. Nasioudis D, Arevalo O, Gysler S, et al. Impact of delayed interval cytoreductive surgery on the survival of
patients with advanced stage high-grade epithelial ovarian carcinoma. International Journal of Gynecologic
Cancer. 2024;34(1):131-37.
-
17. Lee YJ, Chung YS, Lee JY, et al. Role of diagnostic laparoscopy in deciding primary treatment in advanced-
stage ovarian cancer. Journal of Gynecologic Oncology. 2023; 34(2):e17.
-
18. Brun JL, Rouzier R, Selle F, et al. Neoadjuvant chemotherapy or primary surgery for stage III/IV ovarian cancer:
contribution of diagnostic laparoscopy. BMC Cancer. 2009;9:1-8.
-
19. Agostini A, Mattei S, Ronda L, et al. Prevention of port-site metastasis after laparoscopy. Gynécologie,
Obstétrique & Fertilité. 2002;30(11):878-81.
-
20. Lin CJ, Chen HJ. The investigation of laparoscopic instrument movement control and learning effect.
BioMed Research International. 2013;(1):349825.
-
21. Jochum F, Vermel M, Faller E, et al. Three and five-year mortality in ovarian cancer after minimally invasive
compared to open surgery: a systematic review and meta-analysis. Journal of Clinical Medicine.
2020;9(8):2507.