Giorgia Garganese1,2, Luigi Pedone Anchora3, Simona Maria Fragomeni4, Giulia Mantovani5, Angela Santoro6, Stefano Gentileschi7,8, Giacomo Corrado3, Andrea Lombisani3, Valentina Lancellotta9, Luca Tagliaferri9, Gian Franco Zannoni6,10, Giovanni Scambia2,3, Frediano Inzani6. 1. Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy. 2. Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy. 3. Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy. 4. Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy. simona.fragomeni@gmail.com. 5. Chirurgia Pelvica Mini-invasiva, International School of Surgical Anatomy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, VR, Italy. 6. Unità di Gineco-Patologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 7. Unità di Chirurgia Plastica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 8. Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy. 9. Unità Operativa Complessa di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 10. Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy.
Abstract
INTRODUCTION: Paget disease is a rare neoplasm of the skin that mainly involves the vulvar region. Vulvar Paget's disease (VPD) can spread beyond the apparent edges of the lesion resulting in a high risk of involved surgical margins. Our aim is to verify the efficacy of a preoperative vulvo-vaginal intensive clock mapping in the prediction of the invasiveness and the extension of VPD. MATERIALS AND METHODS: All consecutive patients with primary VPD referred to our institution from July 2005 to December 2018 were subjected to a preoperative intensive biopsy mapping (clock mapping) of the vulvo-vaginal area: inside and outside the vulvar skin visible lesion, according to o'clock positions, and in the vagina. Patients with positive biopsies "only inside" or "also beyond" the visible lesion were included, respectively, in Group A and B. Surgical excision was drawn passing by the points with negative histology. Pathological findings of mapping biopsies were compared with those from radical surgery. RESULTS: A total of 28 women were enrolled. After clock mapping definitive histology: 17 (60.7%) and 11 (39.3%) patients were included in Group A and B. Definitive histology showed non-invasive, micro-invasive and invasive VPD, respectively, in 13 (46.4%), 11 (39.3%) and 4 (14.3%) patients, with 4 patients further upstaged. Overall, negative margins were found in 14 (50%) patients: 9 (32.1%) from Group A and 5 (17.9%) from Group B. In 23 cases (82.1%), clock mapping identified free surgical margins along the vulvo-perineal skin excision front. CONCLUSIONS: Preoperative clock mapping emerged as potentially useful workup tool to predict invasiveness and extension of VPD, to tailor surgical excision.
INTRODUCTION: Paget disease is a rare neoplasm of the skin that mainly involves the vulvar region. Vulvar Paget's disease (VPD) can spread beyond the apparent edges of the lesion resulting in a high risk of involved surgical margins. Our aim is to verify the efficacy of a preoperative vulvo-vaginal intensive clock mapping in the prediction of the invasiveness and the extension of VPD. MATERIALS AND METHODS: All consecutive patients with primary VPD referred to our institution from July 2005 to December 2018 were subjected to a preoperative intensive biopsy mapping (clock mapping) of the vulvo-vaginal area: inside and outside the vulvar skin visible lesion, according to o'clock positions, and in the vagina. Patients with positive biopsies "only inside" or "also beyond" the visible lesion were included, respectively, in Group A and B. Surgical excision was drawn passing by the points with negative histology. Pathological findings of mapping biopsies were compared with those from radical surgery. RESULTS: A total of 28 women were enrolled. After clock mapping definitive histology: 17 (60.7%) and 11 (39.3%) patients were included in Group A and B. Definitive histology showed non-invasive, micro-invasive and invasive VPD, respectively, in 13 (46.4%), 11 (39.3%) and 4 (14.3%) patients, with 4 patients further upstaged. Overall, negative margins were found in 14 (50%) patients: 9 (32.1%) from Group A and 5 (17.9%) from Group B. In 23 cases (82.1%), clock mapping identified free surgical margins along the vulvo-perineal skin excision front. CONCLUSIONS: Preoperative clock mapping emerged as potentially useful workup tool to predict invasiveness and extension of VPD, to tailor surgical excision.
Authors: Beverly Long; Adam R Schmitt; Amy L Weaver; Michaela McGree; Jamie N Bakkum-Gamez; Jerry Brewer; William A Cliby Journal: Gynecol Oncol Date: 2017-09-19 Impact factor: 5.482
Authors: Ronald Boellaard; Roberto Delgado-Bolton; Wim J G Oyen; Francesco Giammarile; Klaus Tatsch; Wolfgang Eschner; Fred J Verzijlbergen; Sally F Barrington; Lucy C Pike; Wolfgang A Weber; Sigrid Stroobants; Dominique Delbeke; Kevin J Donohoe; Scott Holbrook; Michael M Graham; Giorgio Testanera; Otto S Hoekstra; Josee Zijlstra; Eric Visser; Corneline J Hoekstra; Jan Pruim; Antoon Willemsen; Bertjan Arends; Jörg Kotzerke; Andreas Bockisch; Thomas Beyer; Arturo Chiti; Bernd J Krause Journal: Eur J Nucl Med Mol Imaging Date: 2014-12-02 Impact factor: 9.236