One third of retroperitoneal postchemotherapy lesions

The purpose of this study was to explore the incidence of late relapse in patients with malignant germ cell tumour (MGCT) in a population-based series, with emphasis on the mode of detection, survival, and the relevance of histological findings. The clinical records from a population-based cohort of patients with seminoma (n ¼ 1123) or non-seminoma (n ¼ 826) were evaluated for late relapses. Twenty-five patients developed a late relapse. The cumulative 10-year incidence rate was 1.3%. All 10 seminoma patients, but only eight of 15 non-seminoma patients relapsed with vital malignant tumour (P ¼ 0.02). Teratoma or necrosis was found in seven of nine primarily chemotherapy-treated non-seminoma patients with normal tumour markers at late relapse. Six of nine patients operated with limited retroperitoneal lymph node dissection as part of the primary treatment had relapsed retroperitoneally outside the original operation field. The 10-year cause-specific survival was 68% in all patients, 50% in patients relapsing with vital malignant tumour and 100% in those with teratoma/ necrosis before or after salvage chemotherapy. The 10-year incidence rate of late relapses of 1.3% might reflect the true incidence rate in a population-based cohort of MGCT patients, with cure in at least half of them.

No abstract

We carried out a prospective study comparing the performance of human papillomavirus (HPV) E6/E7 mRNA (PreTect HPVProofer; NorChip, Klokkarstua, Norway) and DNA (Amplicor HPV test; Roche Diagnostics, Basel, Switzerland) triage testing of women 6 to 12 months after atypical-squamous-cells-of-undetermined-significance (ASCUS) or low-grade-squamous-intraepithelial-lesion (LSIL) cytology in organized screening to predict high-grade cervical intraepithelial neoplasia of grade 2 or worse (CIN2؉) between screening rounds. Between January 2005 and April 2008, 692 study women with screening-detected ASCUS/ LSIL cytology 6 to 12 months earlier returned for HPV mRNA and DNA testing and repeat cytology. The median follow-up time was 3 years, using existing health care facilities. Follow-up test results were available for 625 women. Of the 145 CIN2؉ cases detected during the study period, 95 (65.5%) were HPV mRNA positive 6 to 12 months after screening-detected ASCUS/LSIL, 44 (30.4%) were HPV mRNA negative, and 6 (4.1%) were invalid. The corresponding HPV DNA results were 139 (95.9%), 5 (3.4%), and 1 (0.7%), respectively. The cumulative incidences of CIN2؉ 3 years after a negative HPV mRNA and DNA test were 10.3% (95% confidence interval [CI], 7.2 to 13.3%) and 1.8% (95% CI, 0.0 to 3.6%), respectively. The cumulative incidences of CIN2؉ 3 years after positive HPV mRNA and DNA tests were 52.8% (95% CI, 40.1 to 60.1%) and 41.3% (95% CI, 35.5 to 46.6%), respectively. In conclusion, both positive HPV mRNA and DNA test results have a high enough long-term prediction of CIN2؉ risk to consider referral to colposcopy as good practice when performed in delayed triage of women with ASCUS/LSIL cytology. In addition, the low CIN2؉ risk among women with a negative Amplicor HPV test in our study confirms its safe use in a clinical setting. The 2-year cumulative risk of invasive cervical cancer for women with cytological results of atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) has been reported to be in the range of 0.10% to 0.25% (20). High-risk human papillomavirus (HPV) is recognized as the main cause of cervical cancer (40), and HPV DNA testing in the follow-up of women with ASCUS/LSIL cytology has proven to be a very sensitive method to further identify those at increased risk of cervical cancer, albeit at the cost of low specificity (3). Immediate high-risk HPV DNA testing (i.e., reflex testing) has proven useful in identifying women with ASCUS cytology who should be referred promptly to colposcopy. However, application of reflex testing among women with LSIL cytology is disputed, as three of four women generally test positive for highrisk HPV DNA (3, 15).European guidelines for quality assurance in cervical cancer screening recommend several different follow-up algorithms for women with ASCUS and LSIL cytology, but there is no consensus on the use of any one algorithm for a given cytological diagnosis. The guidelines recommend that women with LSIL or ASCUS be referre...