Day 2 :
Keynote Forum
Daniel U Reimer
Medical University Innsbruck, Austria
Keynote: Vulvovaginal reconstruction in vulvar cancer
Time : 10:00-10:45
Biography:
Daniel U Reimer fi nished his Medical study at Medical University Innsbruck in 1998. After a Post-doc position at the Division of Biochemical Pharmacology, MUI (1998-
2001) he did his specialization in Obstetrics and Gynecology at the Department of Obstetrics and Gynecology, MUI. From 2008-2011, he performed an ESGO accredited
sub-specialization in Gynecologic Oncology. After his habilitation in 2012, he worked as Senior Consultant at the Department of Gynecology and Oncologic Surgery,
Charité Berlin from 2012-2014. To date he is working as Senior Consultant in Gynecologic Oncology at the Deaprtment of Obstetrics and Gynecology in Innsbruck and as
Senior Scientist at Charité Berlin.
Abstract:
In 2014, the SEER database recorded 2.4 newly diagnosed vulvar cancers per 100,000 women in the US; the number of deaths
has been stable since the 80’s with 0.5 per 100,000. Approximately 0.3% of women will be diagnosed with vulvar cancer at
some point during their lifetime. Surgery aiming to achieve local control is the primary goal of treatment of neoplastic disease
that involves the external female genitalia. In fact, traditional radical surgery produces anatomic distortion due to loss of the
specifi c skin contour. Despite an intention to reduce surgical radicality during the last years, an impaired quality of life based on
sexual dysfunction and/or disturbed body image remains a major obstacle. Th us, surgical techniques restoring important parts
of vulvovaginal form and function are decisively warranted and should be a central part of vulvar surgery. Here in we describe
indication, surgical procedure, and potential complications of various skin fl ap techniques with either random vascularization or
based on vascular territories.
Keynote Forum
Paulina Cegla
Greater Poland Cancer Centre, Poland
Keynote: Infl uence of 18F-FDG-PET/CT on the treatment planning in patients with cervical cancer
Biography:
Paulina Cegla has graduated Poznan University of Medical Science in 2013 with Master of Electroradiology Degree. In 2017 she starts PhD at the same University. Since
2011 she works as a Nuclear Medicine Radiographer in Department of Nuclear Medicine in Greater Poland Cancer Centre. She presented over 20 scientifi c works in
European and World Conferences of Nuclear Medicine and several articles in reputed journals
Abstract:
In female gynecologic cancer, positron emission tomography in combination with computed tomography (PET/CT) is useful in
patients with locally advanced cervical cancer prior to radical combination of therapy. Th is study is more accurate than other
imaging methods, because it allows to assess local lymph nodes and the presence of distant metastases during one study. Some
studies were done where author suggest that 18F-FDG-PET/CT study can change management of patients treatment due to
identifi cation of para-aortic lymph node or distant metastasis in advanced stages. Aim of this study was to evaluate the usefulness
of 18F-FDG-PET/CT on the treatment in cervical cancer patients. A retrospective analysis was performed on 200 previously
untreated patients with a histologically confi rmed cervical cancer, admitted to the Department of Radiotherapy and Gynecological
Oncology at the Greater Poland Cancer Center between May 2009 and May 2013 for treatment planning. PET scans were acquired
on Gemini TF PET/CT scanner 60min aft er IV injection of 2-[(18)F]-fl uoro-2-deoxy-D-glucose with the mean activity of 364±75
MBq, with the area being examined extending from the calvaria, to half way down the thigh. Th e reconstructed PET images were
evaluated on a dedicated workstation. Tumour volumes were calculated using semiautomatic segmentation method; for metabolic
activity SUVmax was used. 18F-FDG-PET/CT has a signifi cant infl uence in assessing the severity of the disease, especially in the
evaluation of lymph nodes outside the pelvis and in the selection of the appropriate method of radiotherapy. PET-CT is a powerful
tool in the treatment planning of cervical cancer with the regard to the optimal choice of therapeutic procedure (based on FDGPET/
CT scan 1/3 of patients required radical change of treatment procedure).
- Gynecology | Gynecologic Cancer | Cosmetic Gynecology
Chair
Paulina Cegla
Greater Poland Cancer Centre, Poland
Session Introduction
Qu Ang
Peking University Third Hospital, China
Title: Preliminary results of nimotuzumab plus concurrent IMRT and chemotherapy on cervical cancer
Biography:
Qu Ang is the Attending Physician of the Department of Radiation Oncology, Peking University Third Hospital. Her research direction is on radiotherapy on gynecologic
cancer, including EBRT, HDR and LDR brachytherapy.
Abstract:
Objective: To evaluate the safety and effi cacy of nimotuzumab plus concurrent intensity-modulated radiation therapy (IMRT)
and chemotherapy of unresectable cervical cancer.
Methods: From December 2013 to February 2017, 34 patients with cervical cancer on stage (FIGO) IB2-IVB were received
concurrent chemoradiotherapy plus nimotuzumab. Th e prescription dose of radiation was 50.4 Gy/28f on pelvic fi eld with or
with not extended fi eld radiation. An additional 30-36 Gy to Point A were delivered with high-dose-rate techniques. Cisplatin
of 40 mg/m2 and nimotuzumab of 200mg were infused intravenously once weekly during RT for 6 weeks. Th e main outcome
measure was toxicity evaluated by CTCAE 4.0. Secondary outcome measure was short-term outcome evaluated by RESIST1.1.
Result: Th e median of followed up time was 23.4 months (8.3-45.5 months). Almost all patients were local advantaged
cancer except 2 patients with distant metastases. All patients received external radiotherapy. 2 patients were not treated with
brachytherapy. 6 patients failed to fi nish radiotherapy within 56 days. All of 34 patients received concurrent treatment with
nimotuzumab for 6 times. 2 patients refused chemotherapy. Th ere was no life-threatening toxicity. Grade 1/2 of nausea,
vomiting and diarrhea were 70.6% (24/34), 32.4% (11/34) and 52.9% (18/34), respectively. Grade 3 of leucopenia, granulopenia,
thrombocytopenia and anemia were 52.9% (18/34), 17.6% (6/34), 14.7% (5/34), and 11.8% (4/34) respectively. Grade 3 of
nausea and vomiting were 8.8% (3/34) and 2.9% (1/34), respectively. No grade 3 of anorectal infl ammation. Rectovaginal
fi stula was observed in one case 6 months aft er radiotherapy, and operation was performed. Surgical treatment of intestinal
obstruction was performed in one case. 2 cases got vaginal stenosis. Th e objective response rate was 100%. Complete response
was achieved in 29 cases (85.3%) and partial response in 5 cases (14.7%).
Conclusion: Nimotuzumab plus concurrent IMRT and chemotherapy may represent an eff ective and well-tolerated treatment
in patients with unresectable cervical cancer.
Paulina Cegla
Greater Poland Cancer Centre, Poland
Title: Dual tracer FLT-FDG-PET/CT in the assessment of biological parameters for simulated treatment planning in patients with cervical cancer
Biography:
Paulina Cegla has completed her graduation at Poznan University of Medical Science, Poland in 2013 with a Master degree in Electroradiology. In 2017, she started her
PhD at the same University. Since 2011 she is working as a Nuclear Medicine Radiographer in Department of Nuclear Medicine at Greater Poland Cancer Centre. She
has presented over 20 scientifi c works in European and World Conferences of Nuclear Medicine and several articles in reputed journals.
Abstract:
Aim: Th e assessment of metabolic activity and the extend of the tumor mass has an increasing importance for radiotherapy
planning and patients prognosis. Th e aim of the study was to compare biological parameters of primary tumor assessed by
18F-FDG and 18F- fl uorothymidine (FLT) positron emission tomography (PET)/computer tomography (CT) in patients with
cervical cancer and infl uence on radiotherapy planning.
Materials & Methods: Respectively 39 women with histologically confi rmed cervical cancer underwent dual tracer PET/
CT examinations performed for radiotherapy. PET scans were acquired on separate days (within one week) 60 min aft er
IV injection of 300 MBq of 18F- fl uorodeoxyglucose (FDG) and 300 MBq of 18F-FLT. Th e reconstructed PET images were
evaluated using a dedicated workstation for metabolic tumor parameters, such as SUVmax, metabolic tumor volume (MTV),
total lesion glycolysis (TLG) and heterogeneity for primary tumor and compared using t-test.
Results: Th ere was signifi cant diff erences in the volumes calculated from FLT-gross tumor volume (GTV) and FDG-GTV
(29.86±25.17 vs. 37.10±30.7; p=0.02). Th e SUVmax, TLG and heterogeneity were in general lower for FLT-GTV than FDGGTV
(9.35±10.06 vs. 11.46±4.05, p=0.13; 136.14±138.59 vs. 281.48±322.95, p=0.002; 0.6±0.05 vs. 0.63±0.5, p=0.02 respectively)
however, in three patients SUV values for FLT-GTV were higher than for FDG-GTV. Depending on severity of the disease
patients were divided into three groups.
Conclusion: In this limited study FLT-GTV tends to show lower measured volumes as a consequence of the lower thimidine
uptake within tumor mass as compared to glucose metabolism. Our preliminary results found statistically signifi cant diff erences
between metabolic and volumetric parameters in patients with disease limited only to cervix and disease limited to the cervix
and iliac lymph nodes either FDG or FLT.
Ghufran Jassim
Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain
Title: Knowledge attitudes and practices regarding cervical cancer and screening among women visiting primary health care centers in Bahrain
Time : 14:45-15:15
Biography:
Ghufran Jassim has completed her graduation in Medicine at Arabian Gulf University in Bahrain. She was trained as a Family Physician and completed the Arab Board
and Irish Board in Family Medicine. She has practiced as a Consultant Family Physician in Bahrain since then. She received her Master’s degree in Health Policy and
Population Studies from Arabian Gulf University. She joined RCSI- Bahrain in 2008, and in 2014 she has completed her PhD in General Practice from the Royal College
of Surgeons in Ireland. In 2015 she has completed one year program in Global Clinical Scholars Research Training at Harvard Medical School-Harvard University. Last
year she has completed her graduation from the Health Education Profession Diploma program at RCSI. Currently, she is a full time Senior Lecturer at Royal College of
Surgeons in Ireland- Bahrain. Her research interests are child and women health, breast cancer, non-communicable diseases and evidence based medicine. She has
published many articles in international peer reviewed journals and presented in many international and local conferences. She is the Chief Editor of the Journal of Bahrain
Medical Society. Recently, she has taken up a new role as the academic coordinator for career development for medical students.
Abstract:
Background: Cervical cancer is one of the most common cancers among women, with 80% of the cases occurring in developing
countries. Cervical cancer is largely preventable by eff ective screening programs. Th is has not been possible with opportunistic
screening and its low use in the Kingdom of Bahrain. Th e objective of this study was to explore the knowledge, attitudes, and
practices of women attending primary care health centres for cervical cancer screening.
Methods: Th is was a cross-sectional study of 300 women attending primary health care centres in Bahrain. We used a validated
tool comprised of 45 items to collect data through face-to-face interviews between December 2015 and February 2016.
Descriptive data are presented for demographic data, and frequency distributions with percentages are presented for each item
of the knowledge and attitude questionnaire.
Results: Th e mean age±SD of the participants was 37.24±11.89 years, they were mostly married (221; 73.7%), and had a high
school or higher education (261; 87%). Over 64% (194 participants) had never heard of a Pap smear procedure and only 3.7%
(11 participants) had heard about the human papillomavirus (HPV) vaccine. Nearly 64% (192 participants) believed that a Pap
smear was helpful in detecting pre-cancer and cancer of the cervix, and 44.3% (133 participants) believed that they should have
a Pap smear at least every three years. Regarding the practice, only 40.7% (122 participants) had a Pap smear in their lifetime.
Th e majority of participants felt embarrassed when examined by a male doctor (250; 83.3%) and few underwent a Pap smear
screening if they were never married (69; 23.0%).
Conclusions: Th e participants demonstrated a wide range of knowledge and attitudes towards cervical cancer screening.
However, the majority demonstrated positive attitudes towards the HPV vaccine.
Süleyman Eserdağ
International Society of Aesthetic Genital Surgery and Sexology, Turkey
Title: Where are we in aesthetic genital surgeries for a better feminine life?
Biography:
Süleyman EserdaÄŸ is a Cosmetic Gynecologist and Sexual Therapist Based in Istanbul, Turkey. He has10 years of specialist experience in the biggest maternity hospital
in Turkey, known as ‘Zekai Tahir Burak Educational and Research Hospital’ He is the owner of the 3 clinics in the 3 biggest cities of Turkey, known as ‘Hera Clinics’. He is
a Sexologist Fellow by European Federation of Sexology (EFS) and European Society of Sexual Medicine (ESSM). He founded and is the President of the International
Society of Aesthetic Genital Surgery and Sexology (ISAGSS). Based in Ankara, Turkey, Dr Eserdag trained at Zekai Tahir Burak Women’s Health and Educational Hospital,
the largest maternity hospital in Turkey. He worked as Chief of Gynecology at Kazan National Hospital .
Abstract:
Aesthetic- Plastic genital operations and energy based genital cosmetic managements are the fastest growing segment
within all of the aesthetic surgeries. Th ese operations are being done for aesthetic, functional, hygienic, medical and for
sexual purposes. Labiaplasty, vaginal tightening and perineoplasty operations are the most globally demanded operations by
the patients. On the other hand, genital laser, radiofrequency and PRP (Platelet Rich Plasma) are the non-invasive methods
which can be applied for functional and cosmetic reasons as well. Th e patient’s needs, expectancy and tissue anatomy should
be very well evaluated before the surgery to get best results. And the surgeon should have training before starting these kinds
of operations.
- Gynecology | Gynecologic Cancer | Uro-Gynecology | Gynecologic Cancer: Case Reports
Chair
Daniel U Reimer
Medical University Innsbruck, Austria
Session Introduction
Rafal Kuzlik
SaskaMed Clinic, Poland
Title: Radiofrequency - new solution for treatment of vaginal laxity, urinary incontinence and sexual disorders
Biography:
Rafal Kuzlik MD, PhD, specialist in obstetrics and gynecology. Plastic and reconstrative gynecologist with over twenty years of professional experience. He is endoscopist
and oncological surgeon. Specialist in ultrasound imaging. Doctor Rafal Kuzlik received a lot of certifi cates confi rming participation in numerous courses and trainings. He
published many scientifi c papers. Co-author of two books (in Polish): „Plastic Gynecology” and „Physiotherapy after plastic surgical procedures”. Doctor is the author of two
new surgery methods in the fi eld of plastic gynecology: ”One Cut technique” as simultaneus labia minora and clitoral hood reduction and „Double „O” technique” - reposition
of the clitoris. He is also trainer of radio frequency methods in the fi eld of non surgical treatment of female genital problems. Owner and principal of SaskaMed Clinic in
Warsaw, Poland. Principal of Obs&Gyn Ward in EMC St. Anna Hospital in Piaseczno, Poland. The founder of Polish Academy of Plastic and Reconstractive Gynecology.
Abstract:
Introduction: Vaginal laxity, urinary incontinence and sexual disfunction, Th ey are very serious problems of many women. All
over the world there are many devices to treat patients with these disorders.
Objectives: To prove, that radiofrequency is a safe procedure with fast results.
Materials and methods: 24 patients took part in the study, aged between 30 and 70 y.o. with vaginal laxity and urinary
incontinence. Excluding criteria: vagina’s width over 3 fi ngers, level of SUI over second degree, vaginal bleeding, unproper
PAP smear or other pathologies of the vagina and uterus, Besides vaginal and urinary problems, sexual satisfaction was taken
under consideration. In the study Th ermiVa was used as radiofrequency device. 3 examinations were made: before, aft er fi rst
and second procedure. All procedures were performed with temperature 45-47 º C.
Results: Over 30% of improvement was observed. Conclusions: Radiofrequency procedures using Th ermiVa are safe and
eff ective, without any side eff ects.
Qu Ang
Peking University Third Hospital, China
Title: Dosimetry and efficacy analysis of 125i radioactive seeds implantation for cervical cancer with pelvic recurrent after radiotherapy
Biography:
Qu Ang is the Attending Physician of the Department of Radiation Oncology, Peking University Third Hospital. Her research direction is on radiotherapy on gynecologic cancer, including EBRT, HDR and LDR brachytherapy
Abstract:
Purpose: Pelvic recurrent aft er radiotherapy of cervical cancer was diffi cult to treat. Th e implantation of radioactive 125I seeds
was suitable for recurrent patients aft er radiotherapy. Th erefore, we evaluated the effi cacy of radioactive 125I seeds implantation
for pelvic recurrent cervical cancer aft er radiotherapy. Th e dosimetric parameters aff ecting outcome were further analyzed to
guidance therapy.
Methods: A retrospective analysis was made with pelvic recurrent cervical cancer aft er radiotherapy from July 2005 to October
2015 in our hospital with 125I seeds implantation, under ultrasound or CT guidance. Treatment planning was performed before
implantation to estimate the number, activity of the seeds. Th e seeds numbers ranged from 10-140 with a median numbers
of 62.5 and the activity of seeds ranged from 0.5-0.8 mCi with a median activity of 0.7 mCi. Dosimetric verifi cation was
performed using CT scan immediately aft er 125I seeds implantation. D90, D100, V100, V150and V200 was evaluated in postoperative
plan. Th e Kaplan-Meier method was used to calculate the local progression free survival (LPFS) rate and overall survival (OS)
rate. Th e Log-rank test and Cox regression were used for univariate and multivariate analysis.
Results: All of the 36 patients received pelvic radiotherapy previously, 13.88%(5/36) of the patients received re-irradiation.
Th e median dose of cumulative radiotherapy was 56 (42-107) Gy EQD2. Th e interval time of the last radiotherapy to 125I
implantation was 12 (2-60) months. 15 cases were central recurrence (41.67%, 15/36), and 21 cases were pelvic wall recurrence
(58.33%, 21/36). Th e median follow-up time was 11.5 months (2-30 months). Vaginal fi stula occurred in 1 case. No other
severe adverse eff ects. Th e downgrade rate of pain was 79.2% (19/24). Th e short-term local control rate was 88.9% (32/36).
1-year and 2-year local progression-free survival (LPFS) rate were 34.9% and 20%, respectively. 1-year and 2-year OS rate
were 52% and 19.6%, respectively. Multivariate analysis showed that the location of the recurrence volume of lesion and D90
was signifi cantly related to LPFS (P<0.05). And the location of the recurrence was also signifi cantly related to OS (P<0.05).
33 cases were entered in dosimetric analysis. D90 was 128.5±47.4 Gy, D100 was 50.4±23.7 Gy, and V100 was 86.7%±12.9%.
Univariate analysis showed that D100, D90, V100 were signifi cantly associated with LPFS (P<0.05). D90>105 Gy and <105 Gy,
1-year LPFS were 53.3% and 0% (P<0.05), respectively. D100>55 Gy and <55 Gy, 1-year LPFS were 49.2% and 15.8% (P<0.05),
respectively. V100>91% and <91%, 1-year LPFS were 55% and 15.6% (P<0.05), respectively. Multivariate analysis showed D100
was the independent factors.
Conclusions: Radioactive 125I seeds implantation was a safe, eff ective salvage treatment for pelvic recurrent cervical cancer
aft er radiotherapy. It could relieve the pain for patients undergone multiple treatment aft er relapse. 125I radioactive seed
implantation was recommended for patients with recurrent in pelvic wall, compared with recurrent in central pelvic. D100>55Gy
or D90>105Gy or V100>91% could signifi cantly improve the local control.
Biography:
Roshan Prajapati has pursued his MBBS from Chuvash State University Medical Academy, Russia. He completed her MD in Medical Oncology from Zhengzhou University.
Presently he is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. He received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi Cancer Institute.
Abstract:
Background: Epithelial ovarian cancer (EOC) is the leading cause of death in women with gynecological malignancy.
Approximately 70% of women with EOC are diagnosed with advanced stage of disease, which is associated with high morbidity
and mortality. Currently, standard primary therapy for patients with advanced EOC is primary debulking surgery (PDS)
aiming to remove all visible tumor tissue, followed by adjuvant chemotherapy (ACT) with paclitaxel and carboplatin. EOC
is one of the most sensitive of all solid tumors to cytotoxic drugs, with over 80% of women showing a response to standard
chemotherapy combining taxane and platinum. Due to inadequate screening tools and a lack of early clinical symptoms,
approximately 70% of women with EOC are diagnosed with advanced stage of disease, which is associated with high morbidity
and mortality. Recently, interval debulking surgery (IDS) aft er a short course of neoadjuvant chemotherapy (NACT), usually
three cycles of chemotherapy, has become a possible alternative treatment option to standard treatment in patients unable to
undergo complete resection during PDS.
Objectives: To evaluate the benefi ts and toxicity of nano particle formulation paclitaxel (nanoxel) in advanced ovarian cancer
as neo adjuvant chemotherapeutic agent instead of conventional paclitaxel.
Design: Retrospective descriptive study.
Methods: Th e case records of patient presenting with advanced ovarian cancer stage IIIc to IV who received neo adjuvant
chemotherapy prior interval cytoreductive surgery between 2016 Jan to 2017 Jan at Bhaktapur Cancer Hospital were analyzed.
Demographic and clinical data were reviewed.
Result: Total of 32 patients, received NACT, and all patients received nano paclitaxel and carboplatin based regimen weekly
day 1, day 8 and day 15 every 4 weeks. Out of 32 patients, 15 (46.87%) patients were of high grade serous adenocarcinoma,
5(15.62%) were of mucinous cystadenocarcinoma, and rest of 12 (37.5%) were of other histology. 26 patients were presented
with stage IIIC, 6 patients with stage IV. On the basis of CT scan report and clinical examination, the clinical effi cacy and
toxicities were evaluated, 6(18.75%) obtained complete response to NACT, 24(74%) obtained partial response, and 2(6.25%)
were non-responder to NACT. All the patients who received neo adjuvant nano paclitaxel based chemotherapy were observed
for its toxicity and no any signifi cant results were found.
Conclusion: Nano particle formulation paclitaxel
Sristee Shrestha Prajapati
Bhaktapur Cancer Hospital, Nepal
Title: Outcome of staging laparotomy in ovarian mass in limited resource centre
Biography:
Sristee Shrestha Prajapati has pursued her MBBS from Dagestan State Medical Academy, Russia. She completed her MD in Obstetrics & Gynecology from Zhengzhou
University. Presently she is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. She received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi
Cancer Institute in 2015.
Abstract:
Background: Ovarian cancer is the second most common gynecologic cancer in women and the leading cause of death caused
by gynaecologic malignancy. Th e clinical diagnosis of ovarian malignancy is problematic, given the nonspecifi c nature of
presentation and the diffi culty in obtaining a histological diagnosis prior to defi nite treatment. Surgery plays a fundamental
role in treating this challenging disease. Goals of primary surgery for ovarian cancer are to establish diagnosis, proper staging,
and determination of prognosis and optimal cytoreduction of gross disease before chemotherapy for improved outcome.
Objectives: Th e objective of this study is to evaluate the benefi ts and risks of staging laparotomy in diagnosis of ovarian
tumor; to correlate CA 125 with benign and malignant ovarian tumor and to determine the age distribution in the benign and
malignant ovarian tumor.
Design: Retrospective descriptive study
Methods: Th e case records of patient presenting with ovarian masses that underwent staging laparotomy between 2016 May
to 2017 September at Bhaktapur Cancer Hospital were analyzed. Demographic and clinical data were reviewed. Correlation of
CA 125 in both malignant and benign cases was studied.
Results: 44 patients with ovarian masses undergoing staging laparotomy were included with age variation from 19 to 88. Th e
mean age was 52 years. 15 (34%) were malignant cases, 2 (4.5%) cases had borderline tumor and remaining 27 (61%) benign.
Th e mean age group in malignant cases, borderline cases and benign cases were 45, 64 and 55 years respectively. P value is
signifi cant (P=0.0234). Th is study shows mean value of CA 125 as 212.8 in malignant cases, 9.8 and 80.49 in borderline tumor
and benign cases respectively. P value signifi cant (p=0.0315). Out of 15 malignant cases, 8(53.3%) cases were in stage Ia,
1(7%) case in stage Ic and 6(40%) cases were in stage IIIc. Among malignant cases 4 out of 15 had lymphovascular invasion,
in which 2 out of 4 had omental metastasis and 2 out of 4 had lymph node metastasis. All these 4 cases were stage IIIc. Th e
CA 125 level was signifi cantly high in 4 out of 6 malignant cases ranging from 400 to 1000 units/ml with stage IIIc whereas 1
case with sarcoma had 20 units/ml, and another with mature cystic teratoma with squamous cell carcinoma had 24.4 units/ml.
In 27 benign cases, 1 had raised CA 125 level upto 862 units/ml with diagnosis of abdominal tuberculosis with mature cystic
teratoma whereas 3 cases of endometriosis had CA 125 level ranging from 150-200 units/ml.
Conclusion: Detection of pelvic mass with raised CA 125 level raises suspicion for ovarian malignancy, but there are various
benign pelvic conditions that are associated with raised CA 125 level. Th is is more important in the Nepalese subcontinent
where genital tuberculosis and endometriosis is common as seen in our case series where 11.11 % of cases of benign pelvic
masses with raised CA 125 level turned out to be endometrioma. However, 26.66% of malignant cases had signifi cantly raised
CA 125 level. Th e use of frozen section service for immediate intra-operative reporting is highly attractive for the gynecologic
oncology surgeon. It allows for a single optimal operative staging procedure where indicated and, likewise, for a non-staging
procedure if not required.
- Gynecology | Gynecologic Cancer | Reproductive Medicine
Chair
Paulina Cegla
Greater Poland Cancer Centre, Poland
Session Introduction
Ping Jiang
Peking University Third Hospital, China
Title: Clinical Application of 3D-printing individual template assisted HDR 192Ir interstitial brachytherapy for central recurrence of GYN after pelvic EBRT.
Biography:
Ping Jiang is an Associate Professor in Radiation Oncology Department in Peking University 3rd Hospital. She works mainly in radiotherapy for malignant tumor, especially in domain of radiation on GYN and thoracic malignant tumor, HDR and LDR brachytherapy in recurrent GYN. She has published many papers as first author. Her research results are oral presented in ESTRO, JASTRO and ABS. She is the member of Youth committee of Chinese Medical Association Radiotherapy Branch and Youth committee of Beijing Medical Association Radiotherapy Branch. She is in charge of national important research and development project, digital diagnosis and treatment equipment research and development
Abstract:
Purpose: To evaluate the feasibility of 3D-printing individual template assisted interstitial brachytherapy for recurrence of
GYN aft er pelvic external beam irradiation.
Materials & Methods: 11 patients in our center from Aug 9, 2016 to Dec 1, 2017 diagnosed with central recurrence of GYN
aft er pelvic adjuvant EBRT or radical chemoradiotherapy, they all received 192Ir HDR interstitial brachytherapy under CT
guidance with 3D-printing template assisted. Th ey all fi rstly, undertook CT simulation with lithotomy position. Secondly,
preplan with virtual needle insertion and template with needle passage were designed 3D template would be printed and
verifi ed by both physicist and physician. Th irdly, the patients accept 192Ir HDR interstitial brachytherapy under anesthesia.
Among them, 5 cases under local anesthesia with 3D-printing vaginal insertion template and 6 cases under epidural anesthesia
with 3D-printing combined vaginal and perineal insertion template. GTV prescription doses are 5-6 Gy/f, 2-6 f, 1-2 f/W totally
45 fraction treatment of 11 patients. Dosimetry parameters of GTV V100, D100 and D90, organ at risk D2cc of rectum, bladder
and intestine were recorded and analyzed. Complications and early toxicities were analyzed.
Results: Totally 229 needles were inserted for 45 applications, median 6 (3-9) needles per fraction, mean inserting depth
was 8.3±3.4 cm (2-13.7 cm), mean CT scan 3 (1-5) times, during CT guidance procedure. Actual dosimetry parameters of
median V100,D100 and D90 were 83±4.5% 3.0±1.3 Gy and 5±1.7 Gy respectively per fraction; median D2cc of rectum and bladder
was 3.4±1.0 Gy and 3.55±2.15 Gy respectively per fraction. Th ere were no acute puncture side eff ects such as hemorrhea,
perforation of bowel and hematuria recorded. Early side eff ect of grade I/II urethritis were found in 45% patients and relieved
aft er symptomatic treatment.
Conclusion: 3D-printing individual template assisted interstitial brachytherapy for recurrence of GYN aft er pelvic external
beam irradiations under CT guidance have good dosimetry parameters. It is clinically feasible and high effi ciency with low
complications. However long-term clinical outcomes should be further investigated.
Wassil Nowicky
Nowicky Pharma-Ukrainian Anti-Cancer Institute, Austria
Title: Anti-cancer preparation NSC-631570 (Ukrain) and its effi cacy in the treatment of breast cancer
Time : 12:20-12:50
Biography:
Wassil Nowicky is the Director of Nowicky Pharma and President of the Ukrainian Anti-Cancer Institute, Vienna, Austria. He has fi nished his study at the Radiotechnical Faculty of the Technical University of Lviv, Ukraine in 1955 with graduation in Diplom-Ingeniueur in 1960 with title nostrifi cated in Austria in 1975.
He became the very first scientist in the development of the anticancer protonic therapy and is the inventor of the preparation against cancer with a selective effect on basis of celandine alkaloids NSC-631570. He used the factor that cancer cells are more negative charged than normal cells and invented the celandine alkaloid with a positive charge thanks to which it accumulates in cancer cells very fast. He is an author of over 300 scientifi c articles dedicated to cancer research. He is a member of the New York Academy of Sciences, member of the European Union for Applied Immunology and of the American Association for scientifi c progress, Honorary Doctor of the Janka Kupala University in Hrodno, Doctor Honoris Causa of the Open International University on complex medicine in Colombo, Honorary Member of the Austrian Albert Schweitzer Society. He has received the award for merits of National guild of pharmacists of America; the award of Austrian Society of sanitary,hygiene and public health services and others.
Abstract:
In a controlled clinical study conducted at the University Grodno (Grodno, Belarus), aft er the therapy with NSC-631570 the
hardening of the tumor, a slight increase in the tumor size (5-10%) and proliferation of connective tissues were observed. Th e
tumours appeared harder and slightly enlarged aft er NSC-631570 therapy, and were easier to detect by ultrasound or radiological
examination. Metastatic lymph nodes were also hardened and sclerotic (fi brous). Tumours and metastatic lymph nodes were
clearly demarcated from healthy tissue and therefore easier to remove. Complications such as prolonged lymphorrhoea (leakage
of lymph onto the skin surface), skin necrosis (death of skin tissue), suppuration of the wound, and pneumonia, all occurred
in patients from the two NSC-631570 groups at only half the rate that they appeared in patients from the control group. Based
on the results of this study the scientists from Grodno recommended the use of NSC-631570, at the higher dosage, in all breast
cancer operations. Other parameters were also evaluated, e.g. hormones (T3, T4, cortisol, progesterone, estradiol, prolactin),
immune values (lymphocytes, immune globulins, complement, phagocytic activity, morphologic and cytochemical changes),
amino acids and their derivates in plasma and in the tumor tissue. Th e eff ect of NSC-631570 on the various parameters in
breast cancer patients has been studied. Best results were achieved with higher dosage of NSC-631570. Almost every patient
noted the improvement of the general well-being, sleep and appetite. During the surgery, the tumors as well as involved lymph
nodes were presented sclerotic and well demarcated from the surrounding tissue. Th is alleviated the surgical removal of the
tumor considerably. In the tumor tissue, increased concentration of the amino acid proline was revealed indicating augmented
production of connective tissue that demarcates the tumor from surrounding tissue. NSC-631570 improved also the amino
acid balance of patients. NSC 631570 is the very fi rst proton anticancer preparation and due to this aft er administration it
accumulates in tumors very fast that can be seen under the UV-light thanks to its the autofl uorescence. Besides this preparation
it can regenerate the immune system and works as an immunomodulating agent. Th e selective eff ect of the NSC 631570 has
been confi rmed by 120 universities and research centers in the world. Until now this preparation has been tested on over 100
cancer cell lines and on 12 normal cell lines. Th e researchers who conducted studies with the anticancer preparation NSC-
631570 concluded that the anticancer drug NSC-631570 exerts its cytotoxic eff ects on both mouse and human breast cancer
cell lines in a dose and time dependent manner. Weeks following NSC-631570 treatment, cells maintained a reduced capacity
to proliferate.
Paul H Sugarbaker
Washington Cancer Institute, Washington, USA
Title: Optimizing the management of advanced ovarian malignancy using cytoreductive surgery plus regional and systemic chemotherapy
Biography:
Paul H Sugarbaker has completed his college education at Wheaton College in Illinois. He graduated from Cornell University Medical College in New York (USA) and from there he went for his surgical training at the Peter Bent Brigham Hospital in Boston (MA, USA), now known as Brigham and Women’s Hospital. He received a Master’s degree in Immunology at the Harvard School of Arts and Sciences in 1983. At the NIH he was a Senior Investigator from 1976 to 1986. After a brief stay in Atlanta at the Emory Clinic he moved back to Washington (DC, USA) to become the Medical Director of the Washington Cancer Institute. He has been at the Washington Cancer Institute since 1989. Currently, he is the Director for the Program in Peritoneal Surface Oncology. His interests are in gastrointestinal cancer, gynecologic malignancy and mesothelioma. For many years his work focused on liver metastases. Currently, his clinical and investigative work is directed at the peritoneal surface component of gastrointestinal cancer dissemination, referred to as peritoneal metastases. He is a strong critic of surgical tradition; he believes that major changes in the technology of cancer resection are necessary. His theme, ‘it’s what the surgeon doesn’t see that kills the patient’, summarizes the concepts behind many of his publications both in the peer-reviewed medical literature and in the lay press. In his opinion, perioperative intravenous and intraperitoneal chemotherapy are an essential planned part of many cancer interventions
Abstract:
Background: Ovarian cancer presents in a majority of patients with cancer dissemination widely distributed on the peritoneal
surfaces of the abdomen and pelvis. In a substantial proportion of patient’s not only peritoneal metastases but also lymph nodal
metastases will be present at the time of diagnosis.
Methods: Th e procedures required for complete surgical removal of all clinical evidence of ovarian cancer is pursued using
complete cytoreductive surgery (CRS). Th is may be performed either before or aft er neoadjuvant systemic chemotherapy.
At the time of surgery hyperthermic intraperitoneal chemotherapy (HIPEC) is used to improve the control of peritoneal
metastases. As the patient recovers from CRS plus HIPEC, combined intraperitoneal and systemic chemotherapy are initiated
for a six month interval.
Results: Cytoreductive surgery is associated with marked improvement in survival especially when all visible evidence of
disease is removed. In addition, HIPEC has been shown in randomized controlled trials to improve survival, primarily by
limiting the recurrence of peritoneal metastases. Also, long-term normothermic intraperitoneal chemotherapy (NIPEC-LT)
combined with systemic chemotherapy has been shown in randomized trials to show signifi cant benefi ts.
Conclusions: Combinations of complete CRS, HIPEC combined in the operating room with CRS and then NIPEC-LT plus
systemic chemotherapy will optimize the long-term survival of patients with advanced ovarian malignancy. Th e clinical
evidence for these benefi ts can be organized into an evidence-based treatment plan for this disease.
Roshan Prajapati
Bhaktapur Cancer Hospital, Nepal
Title: Ovarian cancer: Single Institutional based data
Biography:
Roshan Prajapati has pursued his MBBS from Chuvash State University Medical Academy, Russia. He completed her MD in Medical Oncology from Zhengzhou
University. Presently he is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. He received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi Cancer Institute.
Abstract:
Background: Ovarian cancer oft en has no symptoms at the early stages, so the disease is generally advanced when it is
diagnosed. Ovarian cancer is the seventh most common cancer in women worldwide and 18 most common cancer overall.
Epithelial ovarian cancer (EOC) is the leading cause of death in women with gynecological malignancy. Due to inadequate
screening tools and a lack of early clinical symptoms, approximately 70% of women with EOC are diagnosed with advanced
stage of disease, which is associated with high morbidity and mortality.
Methods: All detailed data of ovarian carcinoma taken from hospital registry of 2017.
Result: Ovarian carcinoma is the 13th common cancer in Bhaktapur Cancer Hospital and second most common gynaecological
cancer aft er cervical carcinoma. It consists of 2.3% of all cancer in 2017. Out of which 40% were referred from other centres
for adjuvant chemotherapy and palliative chemotherapy. 60% had undergone surgery in Bhaktapur Cancer Hospital. Medium
age is 49 years (22-75). 10% had borderline tumours, 15% had mucinous cystadenocarcinoma and 51% had high grade serous
adenocarcinoma. 55% has received neo adjuvant chemotherapy followed by interval cytoreductive surgery.
Conclusion: Ovarian carcinoma has been found to be a second leading gynaecological malignancy. Patient usually presented
in advanced disease. Most common histopathological fi nding is high grade serous adenocarcinoma.
- Gynecology | Gynecologic Oncology | OB/GYN
Chair
Daniel U Reimer
Medical University Innsbruck, Austria
Session Introduction
Ping Jiang
Peking University Third Hospital, China
Title: Clinical application of 192Ir HDR interstitial brachytherapy and 125I seeds LDR permanent implantation for recurrence of GYN after pelvic EBRT
Time : 14:50-15:20
Biography:
Ping Jiang is an Associate Professor in Radiation Oncology Department in Peking University 3rd Hospital. She works mainly in radiotherapy for malignant tumor, especially in domain of radiation on GYN and thoracic malignant tumor, HDR and LDR brachytherapy in recurrent GYN. She has published many papers as firstauthor. Her research results are oral presented in ESTRO, JASTRO and ABS. She is the member of Youth committee of Chinese Medical Association Radiotherapy Branch and Youth committee of Beijing Medical Association Radiotherapy Branch. She is in charge of national important research and development project, digital diagnosis and treatment equipment research and development
Abstract:
Purpose: To evaluate the feasibility of 192Ir HDR interstitial brachytherapy and125I LDR permanent implantation brachytherapy
for recurrence of GYN aft er pelvic external beam irradiation.
Materials & Methods: Pelvic recurrence of GYN includes central recurrence and pelvic sidewall recurrence, diff erent site of
relapse associate diff erent management in our center. In our study, all recurrence patients aft er pelvic adjuvant external beam
radiotherapy (EBRT) or radical chemoradiotherapy. 11 patients in our center diagnosed with central recurrence of GYN,
they received 192Ir HDR interstitial brachytherapy under CT guidance with 3D-printing template assisted. Among them, 5
cases under local anesthesia with vaginal insertion template and 6 cases under epidural anesthesia with combined vaginal and
perineal insertion template. GTV prescription dose was 5-6 Gy/f, 2-6 f, 1-2 f/W. Totally 45 fraction treatment of 11patients.
21 patients with pelvic sidewall recurrence received 125I seeds implantation under the CT guidance with 3D-PNCT assistant.
Prescription D90 of GTV was 120-150 Gy, Th e local control probabilities were calculated and complications and early toxicities
were analyzed by the Kaplan-Meier method (SPSS 16.0).
Results: 11 patients with central recurrence, totally 229 needles were inserted for 45 FDR applications, median 6 (3-9) needles
per fraction, mean inserting depth was 8.3±3.4 cm (2-13.7 cm), mean CT scan 3 (1-5) times, during CT guidance procedure.
Actual dosimetry parameters of median V100 were 83±4.5%. Early side eff ects of grade I/II urethritis were found in 45%
patients and relieved aft er symptomatic treatment. Totally response rate (1 month later) was 91%, 1 lesions had complete
remission CR (9%) and 9 had partial remission PR (82%). Among 21 patients with sidewall recurrence, 669 (median 47, 25-
113) seeds implanted, total 132 needles (median 9, 6-21) were implanted actually. Th e activity of 125 I seeds ranged from 0.3
mCi to 0.8 mCi (median: 0.69 mCi). Th e total number of seeds implanted ranged from 3 to 89 (median: 20). Actual dosimetry
parameters of median V100 were 93±4.5%. Totally response rate (1 month later) was 85%, 3 lesions had complete remission
CR (14%) and 15 had partial remission PR (71%). severe complications were not seen.
Conclusion: 192Ir HDR interstitial brachytherapy for central recurrence and 125I LDR permanent implantation for pelvic
sidewall recurrence of GYN under CT guidance have good dosimetry parameters. It is clinically feasible and high effi ciency
with low complications. However long-term clinical outcomes should be further investigated.
Sristee Shrestha Prajapati,
Rajiv Gandhi Cancer Institute, India
Title: Neo Adjuvant Chemotherapy (NACT) followed by radical surgery in Locally Advanced Cancer Cervix (LACC): A retrospective study
Time : 15:20-15:50
Biography:
Sristee Shrestha Prajapati has pursued her MBBS from Dagestan State Medical Academy, Russia. She completed her MD in Obstetrics & Gynecology from
Zhengzhou University. Presently she is working as a Physician and Surgeon in Bhaktapur Cancer Hospital, Nepal. She received IMA Fellowship (Gynae Oncology) from Rajiv Gandhi Cancer Institute in 2015
Abstract:
(RT) in a locally advanced cervical cancer by eliminating of micrometastases and shrinking of the primary tumour bulk to
achieve radical operability. Th e aim of this study is to evaluate the effi cacy of NACT in the patients with locally advanced cancer
cervix (LACC), to determine the percentage of LACC patients who needed adjuvant radiation aft er treatment with NACT and
surgery and to evaluate the disease-free interval (DFI) at two years in these patients aft er this treatment.
Methods & Materials: From 2007 to 2013 a retrospective data collection of women undergoing radical hysterectomy for
cervical cancer FIGO Ib2 to IIb, aft er neo-adjuvant chemotherapy conducted at Rajiv Gandhi Cancer Institute and Research
Centre, New Delhi, India. Th e median age group was 52 years with the range of 30 to 80 years.
Results: Total of 103 women, received NACT, out of which 45 patients received TIP regimen (paclitaxel + ifosphamide +
cisplatin) and 58 received CP regimen (carboplatin + paclitaxel). Out of 103 patients, 5 (4.85%) patients were of adenocarcinoma,
7(6.79%) were of adenosquamous, and rest of 91 (94.1%) were of squamous cell carcinoma. 23 patients were presented with
stage IB2, 4 patients with stage IIA and 76 patients were in stage IIB. On the basis of MRI report and clinical examination,
the clinical effi cacy was evaluated, 28(27.18%) obtained complete response to NACT, 66(64%) obtained partial response, and
6(5.82%) were non-responder to NACT. Furthermore the effi cacy of NACT was measured in terms of optimal pathological
response, 16(15.53%) obtained complete response, 35(33.98%) obtained near complete response, and 52(50.48%) obtained
partial response. Adjuvant treatment was given for adverse factors in histopathology report, such as in 23 patients LVSI was
present, 20 patients had positive pelvic lymph nodes, 2 had parametium involvement, 3 got positive margins, and 35 patients
had more than 50% of stromal involvement. 8 out of 23 (34%) patients in stage IB2, 2 out of 4 patients (50%) in stage IIA, and
17 out of 76 patients (22%) in stage IIB were spared from the adjuvant radiotherapy as received optimal pathological response
to NACT followed by radical surgery. Recurrences were noted in 16(15.53%) patients i.e. 4(3.88%) with local recurrence and
12(11.65%) presented with distant recurrence.
Conclusion: NACT can eff ectively eliminate and downstage the locally advanced cervical cancer so that resectability improves
and increases the chances of wide surgical resection with tumor free margins which otherwise is not possible. With the judicious
use of NACT followed by radical surgery, adjuvant treatment can be avoided in patients with pathological cure, which can be
preserved for later salvage treatment, if recurrence occurs during follow up. Th e results of NACT followed by radical surgery
in LACC patients is encouraging, however, long term follow up and large randomized control trials should be carried out to
make this approach as standard of care within this group of the patients.
Oluwatosin Motunrayo Rotimi
University of KwaZulu-Natal, South Africa
Title: Knowledge and attitude towards cervical cancer screening among fi rst year female students on the Howard College Campus at the University of KwaZulu-Natal, 2015
Time : 16:10-16:40
Biography:
Oluwatosin Motunrayo Rotimi is currently a PhD (Public health) student at University of KwaZulu-Natal, Durban, South Africa. She qualifi ed as a medical doctor
at Ladoke Akintola University of Technology, Ogbomoso, Nigeria where she obtained her Bachelor of Medicine and Bachelor of Surgery (MBBS). She received a
diploma in Tropical Medicine and Health from the University of Pretoria, South Africa and Postgraduate Diploma in HIV management from Stellenbosch University,
South Africa. She obtained her Master’s Degree in Public Health at University of KwaZulu-Natal. She has worked extensively in medical research and also practiced
as a medical doctor. Her research interests are cervical cancer, cervical cancer screening, HIV and infectious diseases.
Abstract:
Cervical cancer continues to be a major cause of morbidity and mortality among women in the developing world. It is currently
the second most commonly reported cancer among women in South Africa. Approximately one in every 26 South African
women will develop cervical cancer during their lifetime. Organized cytology-based screening programs using Papanicolaou
smear testing continues to be the single most eff ective tool in reducing deaths due to cervical cancer. Despite the creation of
a national cervical cancer screening program, fi ndings have shown low level of knowledge of cervical cancer and screening
methods among university female students in South Africa. Th is study presents the assessment of the level of knowledge
of cervical cancer screening among fi rst year female students on the Howard College Campus (HCC) at the University of
KwaZulu-Natal (UKZN); to determine their attitudes towards cervical cancer screening and; to examine the factors infl uencing
their knowledge and attitude towards cervical screening. An observational cross-sectional study design with both descriptive
and analytic components was implemented. Th e study was conducted on the HCC at the UKZN. A proportional stratifi ed
random sampling technique was used to select 244 fi rst year female students aged 18 to 25 years. Data was collected using
a standardized structured self-administered questionnaire. Th e data was analyzed using descriptive and analytic statistics.
Th e results show fairly good level of awareness of cervical cancer (75.4%) and cervical cancer screening method (Pap smear)
(70.9%). However, knowledge of cervical cancer risk factors, symptoms, screening methods and treatment was poor.
Fahimeh Molaahmadi
Royan Institute for Reproductive Biomedicine, Iran
Title: Couples' psychological adjustment related to perceptions of the fertility problem
Time : 16:40-17:10
Biography:
Fahimeh Molaahmadi has completed her Midwifery degree from Iran University of Medical Sciences. Presently she is working in Royan Institute on infertility. She has international oral papers and publications.
Abstract:
Introduction: How are the couples undergoing assisted reproductive technologies perceptions and long-term emotional
adjustment to art? Several studies revealed eff ective coping depends on the characteristics of the stressor, meaning of infertility
and social support as predictors of the emotional adjustment to unsuccessful IVF and lack of adaptation in terms of the
inability to regain control, personality characteristics.
Materials & Methods: A total number of couples completed the adjustment of illness scale (AIS). Women fulfi lled the scale in
ovum pick-up day, but men completed the tool separately. Th e total mean score of this scale ranged from 0 to 72. Responses
were as 7-point Likert scale. Th e total mean score of 12 statements obtained by the couples was assessed according to clinical
and demographic characteristic. Th is was a cross-sectional study on 300 infertile couples referred to Royan Institute, a fertility
center, in Tehran, Iran within recruitment was done as convenience samples.
Results: Th e mean age of participants was 34.47±5.99. Nearly half of couples (43.6%) suff ered from male infertility. Most of
them (78%) did not report any history of abortion, but half had a history of failure of infertility treatment. One-way ANOVA
did not show any signifi cant diff erence between male and female in total mean score of AIS by cause of infertility (p=0.6) and
education level (p=0.27). Comparison of total mean score of couples with and without a history of failure and abortion did not
show any signifi cant diff erence between male and women (p=0.89 and p=0.89, respectively).
Conclusion: Th e total mean score of AIS was 42.59±9.93 (42.45±10.62 in males, 42.75±9.23 in females; p=0.72). Our fi ndings
indicated that all infertile clients need to have psychological interventions and counseling leading to upgrade their adjustment
with problem-oriented infertility.
Ama Afrah
University of Ghana, Ghana
Title: Reducing inter and intra observer differences using biomarkers in histological diagnosis of invasive cervical cancers and cervical intraepithelial neoplasia in Ghanaian women
Time : 17:10-17:40
Biography:
Ama Afrah is Master of Philosophy in pathology from University of Ghana, Legon.She is certifi ed from American society for Colposcopy and cervical pathology.
Presently Ama afrah is working in Korle – Bu Teaching Hospital and Cray Med Lab Services.
Abstract:
cancer and cervical intraepithelial neoplasia in women. Criteria for grading of these lesions by pathologist based on digression
in growth and degree of invasiveness among other abnormalities have been aff ected by inter and intra-observer diff erences
resulting in poor reproducibility. Diagnosis disagreement in histopathology between colleague residents or between residents
and pathology consultants can result in over/unnecessary treatment that will incur more to a poor woman or under treatment
that will put the life of a woman with cervical lesion at risk of metastatic disease with low survival rate. Ki-67, a proliferative
marker is useful in grading of cervical cancer and cervical intraepithelial neoplasia by giving uniform and reliable outcome
independent of inter and intra-observer diff erences.
Aim: To demonstrate the level of expression of Ki-67 antigen in invasive cervical cancer and cervical intraepithelial neoplasia
in Ghanaian women by reducing observer diff erences.
Methodology: Using indirect immunohistochemical method, 116 diagnostic cervical samples with varying grades of cervical
intraepithelial neoplasia and invasive cancer selected retrospectively and randomly were analyzed for level of expression of
Ki-67. Kappa analysis was used to assess the level of agreement between resident colleagues as well as between residents and
consultants in histological diagnosis and immunohistochemistry.
Results: Th e levels of Ki-67 expression in malignant lesions were higher than in premalignant lesions which were also higher
than in normal cervix. Th e inter observer diff erences between consultants, pathologist and residents was higher than intra
observer diff erences. Th e levels of Ki-67 could distinguish post-menopausal atrophy from dysplasia.
Conclusion: Due to semi quantitation of Ki-67 protein there exist some level of inter observer diff erence using Ki-67 grading
of tumours but as compared to that which exist for histomorphological grading of tumours, the former is better. Inter observer
diff erence using Ki-67 grading as compared to histomorphological grading of tumours were better using kappa analysis. Ki-67
score can distinguish between reactive lesions and dysplasia. Ki-67 analysis therefore should serve compliment to histological
grading of tumour for the objective, reproducible, and reliable classifi cation of dysplastic changes in cervical epithelium
especially for proper patient management to increase chance of survival or reduce unnecessary treatment. However, the
fi ndings and conclusions of this study are limited by the small sample size of participants, and a much larger population-based
study would be required to validate our fi ndings.