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Background: Cervical cancer ranks among the most prevalent tumors in low-income countries, with the Pap test as one of the primary screening tools. The Pap smear detects abnormal cells, the CLART test identifies specific HPV genotypes, and HPV self-sampling allows for self-collected HPV testing. This study aimed to evaluate the feasibility of the first smartphone-based health device for home-collection HPV testing. Methods: Enrolled patients during the gynecological examination underwent three different samplings: Pap smear, HPV DNA genotyping test CLART, and vaginal HPV-Selfy swab. Each patient received a kit including an activation code, vaginal swab, and instructions. After performing the self-sample, patients returned the kit to our laboratory. Both the samples collected by the gynecologist and those collected by the patients themselves were analyzed. Results: A total of 277 patients were enrolled, with 226 self-collected swabs received for analysis. The assay yielded valid results for both self-collected and clinician-collected swabs in 190 patients. When comparing these results with paired clinician-taken vaginal swabs, we observed an agreement of 95.2% (Cohen’s Kappa: 0.845). We report an agreement of 93.7% (Cohen’s Kappa: 0.798). Conclusions: The study demonstrated the feasibility of HPV-Selfy as a complementary tool in cervical cancer screening, especially where adherence to traditional surveillance is low.

Introduction/BackgroundMyometrial invasion (MI) and tumor free distance (TFD) from serosa are associated with an increased risk of relapse in patients with endometrioid endometrial carcinoma (EEC). The extent of the MI has been recognized as an essential prognostic risk factor; instead the TFD doesn’t have the same prognostic role, but may be associated with a higher risk of recurrence.The aim of our study was to investigate the role of the percentage of MI related to TFD as prognostic risk factor.MethodologyIn our retrospective study we enrolled all FIGO Stage IB EEC with at least one year follow up treated in our institution. All patients were stratified in three different subgroups based on tumor invasion in the myometrial layer and TFD, calculating the actual percentage of involved myometrial thickness (Group1: 50–69,9%, Group 2: 70–89,9% and Group 3: 90–100%).We correlated the subgroups with several variables as sentinel lymph node (SLN) status, tumor grading, lymphovascular space invasion (LVSI), and local/distant recurrence.ResultsTwenty-one patients met the inclusion criteria. Four patients were included in the group 1 and one (25%) of them had positive SLN for micrometastasis. In the second group we found 11 patients: 5 (45%) of them had positive SLN and 1 showed local relapse (9%). Moreover one patient had concomitant breast cancer (9%). The group 3 included 6 patients: 2 (33%) were positive for SLN and 1 (16%) of them also had distant relapse.ConclusionPercentage of MI related to TFD represents a promising prognostic risk factor that seems to be associated with an increased risk of relapse such as SLN positivity, especially in those patients with more than 70% of myometrial invasion. Further studies with larger sample size are required to evaluate the relation between MI and TFD as prognostic risk factor in EEC.DisclosuresNone.Abstract 909 Table 1

Introduction/BackgroundThe patient is a 47 years old woman with a history of endometrioid endometrial carcinoma FIGO stage IAG2. During a routine follow-up, abdominal CT-scan demonstrated an enlarged para-aortic lymph node suspected for recurrence. PET-TC scan revealed a bulky lymph node with a diameter about 60 mm with no other site of disease. This video describes step-by-step the complete removal of paraaortic bulky nodes by the extraperitoneal laparoscopic approachMethodologyIn November 2022, the patient underwent lymph node excision by an extraperitoneal laparoscopic approach. After trocar placement, CO2 was insufflated through the pre-peritoneal space. A blunt detachment of adipose tissue was performed, the left psoas and ureter were isolated. After identification of left common iliac artery and para-aortic area, the bulky node was isolated and removed with an endobag.ResultsEstimated intraoperative blood loss were 200cc. Operative time were 4 hours. The patient was discharged on post operative day 2, no minor or major complications were observed, the final pathology revealed lymph node recurrence of endometrioid adenocarcinoma. After tumor board the patient underwent 4 cycles of Platinum-based chemotherapy and radiotherapy in the para-aortic area. At this moment the patient is free of disease.ConclusionLaparoscopic extraperitoneal lymph node debulking performed by expert gynecologic oncologist seems to be feasible with several advantages comparing to the traditional technique in terms of reduced intraoperative blood loss, less post-operative pain, rapid post-surgery recovery and thereby allowing for early introduction to adjuvant treatment.DisclosuresNone.

Background/Objectives: This study investigates which demographic, clinical and pathological factors of women with early-stage presurgical EC could be considered risk factors for the presence of different subtypes of metastases in sentinel lymph nodes (SLNs). Methods: This is a retrospective single-center study that collected data between December 2015 and April 2024. EC patients who underwent total hysterectomy with salpingo-oophorectomy and SLN mapping with indocyanine green (ICG) were recorded. Results: Data from 98 women with EC were analyzed. The endometrioid histotype was present in 85 (86%) women, and the non-endometrioid histotype was present in 13 (13%) women. High-grade EC (G3) was present in 21 (21.4%) patients, and low-grade EC (G1-G2) was present in 77 (78.6%) patients. The total number of women with SLN metastasis was 21/98 (21%). Of 21 women, 5 had MAC, 6 had MIC and 10 had ITCs. Conclusions: Preliminary analysis identified three risk factors for nodal involvement: age greater than 67 years, high-grade endometrial carcinomas and myometrial invasion greater than or equal to 50%. Lymphovascular space invasion, histotype 2 and p53 mutation showed a slight, but not statistically significant, tendency to be risk factors for SLN positivity. A deeper analysis with univariate uninominal logistic regression showed that high-grade EC is related to a greater probability of MACs, as shown in other studies, and that low-grade EC (grades 1 and 2) had a strong relationship with low-volume metastasis (LVM); further studies are needed to confirm these results.

Introduction/BackgroundVarious local flaps have been described for vulvar reconstructive surgery. This study aimed to evaluate the long-term follow up (FU), results and satisfaction of those patients who underwent Keystone perforator island flaps (KPIF) technique after radical vulvectomy.MethodologyWe analyzed demographics, complications, pathologic results, clinical and oncological outcomes of all patients undergone KPIF for vulvar cancer in our institution. The benefits, cosmetic results and satisfaction in term of patients’ quality of life were collected at discharge, after one month and during FU. The long-term FU was collected using oral interview and gynecological examination.ResultsFrom 2016 to 2023, we selected eleven patients (mean age 73 years) that underwent vulvectomy: nine for squamous cells vulvar cancer and two for Paget disease. The defects were successfully covered by the KPIF technique in all patients. Nine patients had a quick recovery and were discharged in postoperative day 5. Two patients were discharged after 20 days due to wound infections. Two patients were readmitted respectively on postoperative day 14 and day 21 due to flap dehiscence and surgical revision was required.One month after surgery all the wounds were completely healed and there were no differences in colour compared to the surrounding skin. Six months after surgery, all patients were satisfied, no one developed problems due to scarring even at the donor site and no discomfort in sitting or walking or urinary tract problem had experienced. After a mean time FU of 36 months two recurrences occurred within the first year after surgery, respectively vaginal and cutaneous. Both patients died for the progression of disease.ConclusionKPIF seems to be associated with low complication rates, rapid recovery and good cosmetic outcomes. This technique is well tolerated by patients over time with high satisfaction rates. Therefore, further studies with validated questionaries and larger sample size are needed.DisclosuresNone

Introduction/BackgroundThe aim of this preliminary retrospective study was to assess the feasibility and accuracy of Indocyanine Green (ICG) sentinel lymph node (SLN) sampling using a laparoscopic camera during vulvar cancer staging.MethodologyRetrospective study. Between 2016 and 2022, 9 women with diagnosis of vulvar cancer underwent radical vulvectomy and inguinofemoral lymphadenectomy; in 2 (22%) selected cases we performed ICG SLN mapping using the IMAGE1 laparoscopic camera combining with Tc99(m)-nanocolloid during open surgery.Abstract 2022-RA-1155-ESGO Figure 1Abstract 2022-RA-1155-ESGO Figure 2ResultsThe median age of patients was 73 (range 84–60) years. Mean operative time 212.5 minutes. The overall detection rate of SLN mapping was 100%. No post-operative short or long-term complications related to the procedure were observed.ConclusionReal-time NIR technology supported by the IMAGE1 S by Storz is a reliable system and represents a consolidated method for SLN mapping in selected cases with vulvar cancer.In our study we confirmed the feasibility of Hand-Assisted Laparoscopy during an open procedure to detect groin SLN with ICG in vulvar cancer. This approach can be used in combination with Tc99(m)-nanocolloid, increasing the detection rate or it can be an appropriate option to detect SLN in those countries where Tc99(m)-nanocolloid is not available or cannot be practiced.The use of laparoscopic camera for ICG SLN mapping seems to be accessible and inexpensive. Further studies are needed to evaluate the accuracy and oncological outcomes.

Introduction/BackgroundIn young women with a recurrence of borderline ovarian tumor (BOT) a second conservative treatment for the preservation of reproductive potential and endocrine function should be mandatory. In our study, we reported three cases of ovarian BOT recurrences assessed to oncofertility consultation and underwent fertility sparing surgery (FSS), highlighting the importance of the tailored clinical management in the context of a multidisciplinary meeting.MethodologyFrom July 2020 to April 2022, we managed three cases of young women with controlateral ovarian BOT recurrence after unilateral adnexectomy. Median age at diagnosis was 26 years (I.Q.R 25–28). After multidisciplinary meeting each patient has been addressed to oncofertility consultation with the gynecologic oncologist and the reproductive physician. Two patients had strong desire to conceive furthermore they underwent a controlled ovarian hyperstimulation (COH) with concomitant letrozole and ovarian cryopreservation. In one case the ART (assisted-reproductive-technology) procedures has been performed with tumor onsite.ResultsSecond surgery consisted in unilateral laparoscopic cystectomy in all cases. In those patients who have undergone COH, two and five mature oocytes were cryopreserved, respectively. After 11 months of surgery one patient became pregnant spontaneously and she gave birth at 39 weeks with an excellent obstetrical outcome. In one case the oocytes cryopreservation has been rejected by the patient, but the endocrine function has been preserved.ConclusionIn young women, with BOT ovarian recurrence, a second conservative treatment should be always considered and an oncofertility consultation should be recommended. Clinical management must be tailored on a case-by-case basis by a gynecologic oncologist and reproductive physician meeting.

Introduction/BackgroundThis report aimed to illustrate the video-guided application of the Keystone perforator island flaps (KPIF) technique in a patient with diagnosis of vulvar cancer.MethodologyEight patients were selected for the study: seven of them underwent radical vulvectomy for vulvar squamous cell carcinoma (SCC), and one underwent vulvar wide excision for Paget disease. The Keystone perforator island flaps technique was adopted for all these vulvar reconstruction. The team approach comprised both a gynecologic oncologist and a plastic surgeon in all procedures. The defects were successfully covered by the Keystone flap technique in all patients.ResultsBilateral Keystone flaps were taken from the medial and proximal region of the thigs, with incision lines coinciding with the natural skin folds. When flaps vitality was determined, each one was positioned along the perineal midline for labia majora and vaginal opening reconstruction. Final reconstructive step coincided with skin and vaginal mucosa suture. No post-operative short complications in the described case were observed.ConclusionThe Keystone technique is an extremely simple and effective solution, easily applicable and reproducible. KPIF technique warrants an excellent vascular supply and does not require delicate perforator dissection. Additionally, it is associated with minimal morbidity in donor sites, a lower risk of flap necrosis and lower intraoperative and postoperative complications. Keystone flap method also yields good aesthetic and functional results by preserving shape and contour, avoiding differences in skin coloration and preserving sensitivity with an excellent cosmetic outcome in terms of patient satisfaction and postoperative scars and with an acceptable complication rate. Further studies with larger sample size are required to evaluate the efficacy of this technique.