Universitatsfrauenklinik Ulm

Neu-Ulm, Germany

Universitatsfrauenklinik Ulm

Neu-Ulm, Germany
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Schochter F.,Universitatsfrauenklinik Ulm | Ebner F.,Universitatsfrauenklinik Ulm
Gynakologe | Year: 2017

Surgical lymph node staging of vulvar cancer is associated with a high perioperative and postoperative morbidity of long duration. Preoperative imaging studies (magnetic resonance imaging, computed tomography, positron emission tomography and ultrasound) can be very costly or the required case numbers are lacking. Inguinal ultrasound with a specificity of >90% and sensitivity of nearly 80% is the most promising method but is not yet accurate enough to replace surgical staging. Tumor size and location determine the extent of lymph node staging. An increasing number of publications support the sentinel lymph node concept in the early stages of vulvar cancer. The current national guidelines recommend an inguinal lymphadenectomy for multifocal tumors or a tumor diameter of 4 cm or larger. As a result of the increasing rate of metastasis and according to the current data situation pelvic lymphadenectomy can also can be considered for extensive inguinal metastases and known lymph node involvement along the pelvic lymphatic system; however, the impact on the clinical outcome has not yet been completely established. Special constellations, such as whether radical removal of contralateral inguinal lymph nodes is necessary in the case of lateral and unilateral lymph node metastases, still need to be answered by prospective trials. In summary, no imaging method with sufficient certainty is currently known, which can replace surgical lymph node staging in vulvar cancer for tumor stages pT1b and above. The establishment of the sentinel lymph node concept in the early stages of vulvar cancer has enabled substantial progress in the reduction of postoperative morbidity. © 2017 Springer Medizin Verlag GmbH

PubMed | Breast Unit, Rotkreuzklinikum Munich, University of Cologne, Schwanebecker Chaussee and 4 more.
Type: | Journal: Breast (Edinburgh, Scotland) | Year: 2017

Patients with bilateral breast cancer (BBC) are usually excluded from participating in clinical trials and little is known about the response and outcome of BBC to neoadjuvant chemotherapy compared to unilateral BC (UBC).We prospectively captured the information on patients with BBC in our database treated within four neoadjuvant chemotherapy trials and collected retrospectively the rate of pathological complete response (pCR) defined as ypT0 ypN0, ypT0/is ypN0, ypT0 ypNX, clinical and histologic parameters. Synchronous carcinoma in the contralateral breast was considered as the non-indicator lesion. Patients with UBC only treated within the same neoadjuvant trials performed the control group.From the 6727 patients treated within 4 German neoadjuvant trials 119 (1.8%) patients have been identified with the diagnosis of BBC. The pCR rate (ypT0 ypN0) was 12.6% in the non-indicator lesion group versus 10.9% the indicator lesion group versus 20.9% for patients with unilateral disease (p=0.003). There were more advanced tumor stages and positive axillary lymph nodes in the indicator lesion than in the nonindicator lesion or in UBC. In 52.5% the molecular subtype was identical between indicator and non-indicator lesion with more triple negative and HER2 positive BC in the group of UBC. The disease free survival rate (DFS) was 25.8% for patients with UBC versus 39.6% for patients with BBC.The selection for the indicator lesion was based on tumor size, nodal status and inclusion criteria. Patients with BBC patients had a lower pCR rate and a lower DFS.

Varga D.,Universitatsfrauenklinik Ulm | Wischnewsky M.,University of Bremen | Atassi Z.,Universitatsfrauenklinik Ulm | Wolters R.,University of Bremen | And 4 more authors.
Oncology | Year: 2010

Background and Objective: Guidelines for the treatment of early-onset breast cancer have been proposed in several countries, but to date, their impact on outcomes is unverified. The objective of this study was to evaluate the association between guideline-adherent versus nonadherent treatment and recurrence-free survival (RFS) and overall survival (OAS) in early-onset breast cancer patients. Methods: A total of 1,778 patients were included in the study, of whom 111 were 35 years or younger and 1,667 were between 36 and 55 years. RFS and OAS were compared between the two groups, with respect to multiple parameters. All survival data were adjusted for tumor characteristics and analyzed with respect to guideline adherence according to the German Step 3 guidelines. Results: Statistically significant differences between the two groups (<35 years, 36-55 years) were observed with regard to breast surgery (p = 0.002) and hormone therapy (p = 0.006). Both groups were treated identically in terms of guideline adherence concerning axillary dissection (p = 0.9), radiation therapy (p = 0.7) and chemotherapy (p = 0.556). Young breast cancer patients whose treatment adhered to guideline recommendations had increased RFS and OAS [RFS: p = 0.030, hazard ratio (HR) 2.95, 95% confidence interval (CI) 1.11-7.83; OAS: p ≤ 0.001, HR 2.92, 95% CI 2.01-4.23]. Conclusion: Guideline-adherent treatment for early-onset breast cancer patients significantly improves OAS and RFS and should therefore be demanded for all patients. © 2010 S. Karger AG, Basel.

Wolters R.,University of Bremen | Wockel A.,Universitatsfrauenklinik Ulm | Wischnewsky M.,University of Bremen | Kreienberg R.,Universitatsfrauenklinik Ulm
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen | Year: 2011

Purpose: The development and implementation of the "Interdisciplinary S3 Guideline for the Diagnosis, Treatment and Follow-up Care of Breast Cancer" (3) is intended to optimise national health services. This guideline already serves both as a basis for the certification of German breast centres and for the external comparative quality assurance based on guideline based quality indicators. Nevertheless, the effects of the implementation on relevant outcomes have not been examined so far. Methods: The retrospective cohort study analyses data of 3,976 female patients with primary breast cancer which were collected at the University of Ulm and co-operating certified breast centres between 2001 and 2005. Based on the S3 guideline, an analysis model was developed to allow for the examination of guideline-adherent therapy on the basis of the guideline recommendations, and the effects of guideline-adherent compared to not guideline-adherent therapy on overall (OAS) and recurrence-free survival (RFS) were examined subsequently. Results: In total, 2,063 (51.9%) of the 3,976 patients were treated in adherence the guideline. In 1,913 (48.1%) patients deviations from the guideline recommendations in at least one of the therapeutic options were found. The variable "guideline-adherent treatment" had significant influence on RFS [p < 0.001; HR = 2.20; 95% CI (1.74 to 2.79)] and OAS (p < 0.001; HR = 2.57; 95% CI (1.96 to 3.37)], each adjusted for age, tumour size, nodal status and grading. RFS decreases with the number of deviations from guideline recommendations [1 to 2 deviations: p < 0.001; HR = 2.04; 95% CI (1.60 to 2.60); ≥ 3 deviations: p < 0.001; HR = 3.64; 95% CI (2.43 to 5.45), also adjusted for age, tumour size, nodal status and grading]. Similar results were found for the OAS. Conclusion: Patients with breast cancer should be treated in adherence to guideline recommendations. Deviations and barrier factors will have to be evaluated in the future in order to further optimise both the guideline and guideline-adherent therapy.

Hampl M.,Heinrich Heine University Düsseldorf | Janni W.,Universitatsfrauenklinik Ulm
Gynakologe | Year: 2012

Whereas decades ago, vulvar cancer was a tumor primarily diagnosed in older women, nowadays, this tumor is increasingly seen in younger women. The rising incidence is mainly due to the increasing number of young women presenting with these tumors. Depending on the age of the women, persistent infection with high-risk human papillomavirus is responsible for the development of these lesions in 30-50% of the cases. More than 50% (our own data) of the tumors are located between the clitoris and urethra. Standard treatment is tumor resection with sufficient margin or (partial) vulvectomy and complete inguinofemoral lymphadenectomy or sentinel node biopsy in specialized centers. New therapy options include reconstruction of the vulva with local skin flaps to improve esthetic and functional outcome especially in young, sexually active women. © Springer-Verlag Berlin Heidelberg 2012.

Bock C.,Ludwig Maximilians University of Munich | Rack B.,Ludwig Maximilians University of Munich | Huober J.,Universitatsfrauenklinik Ulm | Andergassen U.,Ludwig Maximilians University of Munich | And 2 more authors.
Future Oncology | Year: 2014

Aim: Circulating tumor cells (CTCs) appear as potential candidates to predict the ability of breast tumors to metastasize. Moreover, epithelial-mesenchymal transition (EMT) and stem cell features are major mechanisms for metastasis. Patients & methods: Using a triple fluorescence technique, the expression of EMT (N-cadherin) and stem cell markers (CD133) was analyzed in CTCs detected via cytokeratin in blood samples from 26 metastatic breast cancer patients. Results: We detected CTCs in 100% of the patients (n = 831 CTCs). In total, 67% of the CTCs were N-cadherin and CD133 negative. Nonetheless, 87.8 and 57.6%, respectively, of the CTCs that expressed one marker coexpressed the other. Both double-negative and double-positive CTCs were present in more than 90% of the patients. Within the CTCs of each patient, we demonstrated striking heterogeneities of marker expressions, cell shapes, clusters and sizes. Conclusion: These data outline the importance of characterizing CTCs, especially through stem cell and EMT markers. © 2014 Future Medicine Ltd.

Buck G.,Universitatsfrauenklinik Ulm | Kreienberg R.,Universitatsfrauenklinik Ulm
Gynakologe | Year: 2010

The subspecialty of pediatric and adolescent gynecology has long been an integral part of gynecological practice and cooperation with pediatricians, pediatric surgeons, pediatric urologists, and psychologists is also well established. To an increasing extent adolescents are posing their gynecological questions directly to gynecologists. This requires particular dedication in dealing with young patients and naturally expert knowledge of the disorders and diseases typical for this phase in the adolescent's life. In view of the dismal increase in teen pregnancies and abortions, attention paid to this age group has been intensified in recent years. Irregardless of whether special consultation services for pediatric and adolescent gynecology or girl/teen consultation sessions are offered, this enormous chance should be seized to address prophylaxis regarding contraception, infections, and lifestyle questions such as nutrition, smoking, and sports. © 2010 Springer-Verlag.

A 21-year-old primipara at 30+3 weeks of gestation presented with symptoms of acute pancreatitis. Since she additionally complained of dyspnea, chest X-ray and computed tomography examinations were performed. A left-sided enterothorax was seen with stomach and bowel dislocation. Owing to the high maternal and fetal risk, an emergency laparotomy was carried out in which a congenital diaphragmatic defect in the left trigonum lumbocostale (Bochdalek hernia) was found. In addition to a cesarean section, relocation of the stomach and colon was performed with closure of the diaphragmatic defect. © Springer-Verlag 2014.

De Gregorio N.,Universitatsfrauenklinik Ulm | Ebner F.,Universitatsfrauenklinik Ulm | Schwentner L.,Universitatsfrauenklinik Ulm | Friedl T.W.P.,Universitatsfrauenklinik Ulm | And 5 more authors.
Gynecologic Oncology | Year: 2013

Objectives. Inguinal lymphadenectomy in vulvar malignancies is associated with significant morbidity, especially in patients over 70 years old. Under certain conditions, surgical guidelines recommend biopsy and evaluation of the sentinel node in early vulvar cancer. The purpose of our study is to evaluate ultrasonography as a predictor of inguinal lymph node involvement. Methods. A retrospective study was performed with 60 patients who had vulvarmalignancies (92% of which were squamous cell carcinomas) and who were treated at our hospital between 2002 and 2012. The patients ranged in age from 35 to 89 years, with a median age of 76 years. In total, 118 groin scans were retrospectively evaluated for sonographic evidence of lymph node involvement (i.e., absence of fatty hilum, irregular shape, cortical region diameter and vascularization pattern). The results were then compared with histopathologically confirmed lymph node status. Results. Histopathologically confirmed lymph node status was available for 107 of the inguinal nodes examined by ultrasound, and lymph node metastases were found in 38 (35.5%) cases. The presence or absence of inguinal lymph node metastases was correctly identified by sonography in 92 (86.0%) of the scanned areas. Sensitivity was 76.3%, specificity was 91.3%, and positive and negative predictive values were 82.9% and 87.5%, respectively. Conclusions. Ultrasonography of the inguinal lymph nodes showed a relatively high sensitivity and specificity for predicting inguinal tumor metastases. However, our results indicate that surgical lymph node staging is still needed to precisely determine inguinal lymph node status in vulvar cancer, especially because a missed lymph node-metastasis is often fatal. © 2013 Elsevier Inc. All rights reserved.

de Gregorio N.,Universitatsfrauenklinik Ulm | Ebner F.,Universitatsfrauenklinik Ulm
Gynakologe | Year: 2016

In the last decade a trend from abdominal access for hysterectomy to a laparoscopic approach could be observed. This article deals “close minded” with the abdominal (AHE) vs. laparoscopic hysterectomy in form of a classic pro-con discussion. To get this straight: The authors dislike the grim discussion about surgical techniques. There are several hysterectomy variations of which each one has benefits and disadvantages. Also this article should not present a detailed list of complications (i. e. LAVH has more urogenital injuries, secondary wound healing is more common with AHE, …), but should provide a general reasoning for the surgical indication. The authors agree that the correct technique is the one the surgeon feels comfortable with and the patient is satisfied. © 2016 Springer-Verlag Berlin Heidelberg

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