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Background: Breast cancer is the most common malignancy in women, and sentinel lymph node (SLN) biopsy is essential for accurate nodal staging while avoiding unnecessary axillary dissection. Aim: This study aimed to compare SLN detection rates between two dual-tracer techniques: indocyanine green plus patent blue (ICG + PB) and technetium-99m plus patent blue (99mTc + PB), and to identify factors associated with detection failure for each tracer. Methods: All clinically node-negative breast cancer patients undergoing SLN biopsy between January 2014 and December 2024 were retrospectively evaluated. SLN detection was considered successful when at least one node was identified intraoperatively and confirmed histologically. Multivariate analysis assessed clinical and tumor-related predictors of failure. Results: A total of 269 procedures (258 patients) were analyzed, including 152 ICG + PB and 117 99mTc + PB procedures. Detection rates were comparable between groups (95.4% vs. 94.9%, p = 0.96), with no significant differences in the number of SLNs retrieved or nodal positivity. Multivariate analysis identified increasing patient age as the only independent predictor of PB failure, while no variables were associated with ICG failure. Tumor location in the upper-inner quadrant was the sole predictor of 99mTc failure. Conclusions: ICG + PB and 99mTc + PB provide equivalent and high SLN detection rates. ICG appears to be a robust, radiation-free alternative with no identifiable predictors of failure, supporting its role as an effective mapping strategy, particularly in centers aiming to optimize workflow and patient safety, despite the limited available data on its efficacy.

BackgroundThe sentinel lymph node (SLN) biopsy may be an alternative to systematic lymphadenectomy in early cervical cancer. The SLN biopsy is less morbid and has been shown to have high sensitivity for metastasis detection. However, the sensitivity of the SLN technique might be overevaluated because SLNs are examined with ultra-staging, and non-sentinel nodes usually are examined only with routine techniques. This study aimed to validate the negative predictive value (NPV) of the SLN technique by the ultra-staging of SLNs and non-sentinel nodes (NSLNs). MethodsThe SENTICOL 1 study data published in 2011 were used. All nodes (i.e., SLNs and NSLNs) were secondarily subjected to ultra-staging. The ultra-staging consisted of sectioning every 200 µm, in addition to immunohistochemistry. Moreover, the positive slides and 10% of the negative slides were reviewed.ResultsThe study enrolled 139 patients, and SLNs were detected in 136 (97.8%) of these patiets. Bilateral SLNs were detected in 104 (76.5%) of the 136 patients. A total of 2056 NSLNs were identified (median, 13 NSLNs per patient; range 1–54). Of the 136 patients with SLNs, 23 were shown to have positive SLNs after serial sectioning and immunohistochemical staining. The NSLNs were metastatic in six patients. In the case of bilateral SLN detection, the NPV was 100%, with no false-negatives (FNs).ConclusionsThe pelvic SLN technique is safe and trustworthy for determining the nodal status of patients with early-stage cervical cancer. In the case of optimal mapping with bilateral detection, the NPV was found to be 100%.

Background: Breast-conserving surgery (BCS) is recommended for early-stage breast cancer, with the aim of removing tumors while preserving breast tissue. Achieving clear margins is crucial to minimizing re-excision and recurrence risks. The Histolog® Scanner (HS), a confocal laser microscopy device, enables real-time intraoperative margin assessments. This study describes surgeon training, HS integration into clinical practice, and its impact on surgical outcomes. Methods: One surgeon participated in an online training program related to Histolog image of breast tissue. We assessed the time and workload required for the surgeon’s training, as well as the implementation of the HS into the surgical workflow. We retrospectively analyzed patients who underwent BCS with an intraoperative margin assessment performed by the trained surgeon using HS between December 2022 and January 2025. The re-excision rate was collected, and sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the final pathology assessment as the gold standard. Results: The surgeon completed the online training in 6 h 22 min over six days. HS integration into the routine workflow occurred smoothly. Retrospective analysis included 68 consecutive patients representing two years of clinical practice. The surgeon using the HS exhibited a sensitivity of 100%, specificity of 96.3%, accuracy of 96.9%, PPV of 85.7%, and NPV of 100%. Intraoperative HS usage eliminated re-excision in all cases. Integrating the HS into routine BCS procedures provides a highly accurate intraoperative margin assessment and significant reduction of re-excision rates.

Adenomyosis is a benign condition commonly encountered in patients with infertility. While the definitive surgical management is hysterectomy, conservative surgical management is gaining attention in patients desiring future fertility. This review explores whether the surgical treatment of adenomyosis affects fertility outcomes for patients trying to conceive. The PubMed and Medline databases were searched using the keywords: “adenomyosis”, “surgery”, “radiofrequency”, “infertility”, “pregnancy”, “sterility”, “conception”, “miscarriage”, and “endometrial receptivity”. Abstracts were screened, and relevant articles were selected for review. This review reveals that surgery appears to improve fertility outcomes with or without medical therapy; however, the risk of uterine rupture remains high and the best technique to reduce this risk is still not known. More studies are needed to formulate the best surgical approach for preserving fertility in treating adenomyosis and to establish standardized guidelines.

[...]a bold new frontier is waiting to be explored regarding the way we approach and treat this disease. [...]in Contribution 2, the authors tackle the problem of mental health and quality of life in adolescents with this disease, showing that adjuvant hormonal therapy with dienogest after surgery significantly reduces pain symptoms. [...]knowledge will support the development of more targeted medical therapies and enable the refinement of surgical techniques tailored to individual patient needs. [...]a more integrative, multidisciplinary approach should be a cornerstone in advancing treatment options. Khashchenko, E.P.; Uvarova, E.V.; Chuprynin, V.D.; Pustynnikova, M.Y.; Fatkhudinov, T.K.; Elchaninov, A.V.; Gardanova, Z.R.; Ivanets, T.Y.; Vysokikh, M.Y.; Sukhikh, G.T. Pelvic Pain, Mental Health and Quality of Life in Adolescents with Endometriosis after Surgery and Dienogest Treatment.

Introduction/BackgroundTo assess the opinion of a panel of experts and obtain consensus on several issues from the ESGO recommendations on the management of endometrial cancer.Abstract 2022-RA-787-ESGO Table 1List of recomendationsMethodologyA Delphi survey was carried out among a panel of French and French-speaking Swiss experts. The questionnaire included 58 questions divided into 8 categories: characterization of experts, histo-molecular characteristics, radiological data, management of low-risk, intermediate-risk, intermediate-high-risk, high-risk and metastatic cancers. The experts were asked to reply on a 9-point scale, both on the validity and the clarity of each suggestion. After the answers were analysed, a second round was sent to the same experts for selected suggestions. To be accepted, each proposal had to obtain a median greater than or equal to 7/9.ResultsThe study was conducted between December 2021 and March 2022. 58 (57.4%) of 101 experts responded in the first round and 41 proposals were found. 5 questions were voted redundant and 19 discordant. These questions were reworded and partially split and at the end of the 2nd round, out of the 20 proposals 16 were validated and 4 rejected. In total, the study presents an analysis of 61 questions.ConclusionThese consensual recommendations are expected to standardize the management of endometrial cancer in France and French-speaking Switzerland and to optimize clinical practices.

Introduction/BackgroundFrozen section of sentinel lymph node (SLN) in gynecological cancer requires the presence of a pathologist on site, which is not possible in all Centers.Patients who cannot benefit from frozen section in cervical cancer have to wait for the definitive pathology and to undergo re-intervention in case of negative SLN.In this study we would like to test an alternative technique of lymph node analysis during surgery.Recently a confocal laser microscopy scanner became available for evaluation of intraoperative margins in lumpectomy for breast cancer.The Histolog Scanner (CE mark since 2018) is a digital microscopy scanner for high-resolution imaging of the surface of fresh tissue. It is based on a novel ultra-fast confocal microscopy technology. Its innovative design makes it highly practical for quick assessment on the point-of-care and the clinician is one touch on the screen away from visualizing cancerous cells immediately on a surgical specimen.MethodologyWe will collect images of the lymph nodes of different histological types of gynecological cancers and compare them to the definitive pathological analysis, in order to create a learning program of the intra-operative analysis that will be carried out by the surgeon.The lymph nodes will be cut in half with the same technique used for the frozen section, analyzed with a confocal microscope and then sent individually to the pathology laboratory.ResultsOnce an image-library has been established and a learning program has been created, routine use will save time and avoid a second operation for patients who can benefit from the frozen section.ConclusionThe aim of this study is to collect images of the lymph nodes of gynecological cancers in order to create an image-library that can allow surgeons to analyze the lymph nodes intraoperatively, instead of the classic frozen section.DisclosuresNo conflit interest.Abstract 650 Figure 1

Objective Herein we analyzed FSH-R polymorphism at position 307 aiming (a) to assess the prevalence of the three allelic variants ( Ala307Ala, Ala307Thr and Thr307Thr ) in relation to the type of ovary and (b) to clarify if the allelic variant could influence the responsiveness to exogenous FSH. Study design We prospectively studied a group of 106 Italian women undergoing in vitro fertilization (IVF), among which 40 were subjects with polycystic ovary syndrome (PCOS) and 66 were normo-ovulatory women with a normal ovarian morphology at transvaginal ultrasound. DNA extraction, denaturing high-performance liquid chromatography (dHPLC) and DNA sequencing were used to detect the FSH-R 307 polymorphic genotype and the whole exon 10 was analyzed. Results The heterozygote variant Ala307Thr was significantly more frequent than the homozygote variants in women with PCOS, whereas in normo-ovulatory women with normal ovary the three allelic variants had a comparable prevalence. Women bearing the Ala307Thr variant showed a higher ovarian responsiveness to exogenous FSH than normo-ovulatory subjects. Conclusions The heterozygote FSH-R polymorphism Ala307Thr is significantly more frequent in women with PCOS than in normo-ovulatory subjects and is more frequently associated with a higher ovarian responsiveness to exogenous FSH.