5 Questions for…Betty Suh-Burgmann
Kaiser Permanente physician researcher Betty Suh-Burgmann established a new standardized approach for assessing ovarian cancer risk that prevents patients from having unnecessary surgery.
Ovarian Cystadenomas: Growth Rate and Reliability of Imaging Measurements
To evaluate the growth rate of benign ovarian cystadenomas and the degree of variability in ultrasound measurements. Two independent retrospective cohorts of women found to have benign cystadenomas at surgery were identified. To assess growth rate, ultrasounds on women in…
COVID-19 vaccination not tied to postmenopausal bleeding
Kaiser Permanente study does not support anecdotal reports that postmenopausal bleeding was common after COVID-19 vaccination.
Accuracy of Magnetic Resonance Imaging for Identifying Ovarian Cancer in a Community-Based Setting
Introduction: Many ovarian or adnexal masses have an indeterminate appearance on ultrasound that can raise concerns about cancer. Although magnetic resonance imaging (MRI) has been reported to reliably distinguish between benign and malignant masses, studies evaluating the accuracy of MRI…
Ultrasound characteristics of early stage high-grade serous ovarian cancer
Survival from ovarian cancer is strongly dependent on the stage at diagnosis. Therefore, when confronted with a woman with an isolated adnexal mass, clinicians worry about missing the opportunity to detect cancer at an early stage. High-grade serous ovarian cancers…
Implementation of large-scale HPV self-testing for cervical cancer screening
The goal of this project is to determine the best strategy for integrating a home-testing option for cervical cancer screening. The most sensitive screening test for cervical cancer and precancer is a PCR-based test for human papilloma virus (HPV), which…
Standardized ultrasound-based risk stratification for detection of ovarian cancer
This project, initiated in 2014, led to the development and large-scale implementation of a system for risk stratifying ovarian abnormalities seen on ultrasound to ensure that similar abnormalities are described in a similar way by radiologists. The system also allows…
Cytological sampling of fallopian tubes using a hysteroscopic catheter: A multi-center study
To assess the feasibility of a novel hysteroscopic catheter to collect fallopian tube cytologic samples and to correlate cytologic findings with histopathology. This was a prospective, multicenter, single-arm pilot study. Women undergoing salpingo-oophorectomy for a pelvic mass suspicious for malignancy…
Outcomes of Robotic Hysterectomy for Treatment of Benign Conditions: Influence of Patient Complexity
Robotic hysterectomy may offer advantages for complex cases over the conventional laparoscopic approach. To assess the association of surgical approach (robotic vs conventional) with blood loss, risks of readmission, reoperation, complications, and average operative time. In a retrospective cohort study,…
Detection of early stage ovarian cancer in a large community cohort
Although detecting ovarian cancer at early stage is a highly meaningful clinical goal, no studies have evaluated early stage disease presentation in a large community-based population and how it differs from that of late stage disease. Electronic medical records were…
Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting.
This multidisciplinary consensus update aligns prior Society of Radiologists in Ultrasound (SRU) guidelines on simple adnexal cysts with recent large studies showing exceptionally low risk of cancer associated with simple adnexal cysts. Most small simple cysts do not require follow-up.…
Prospective Validation of a Standardized Ultrasonography-Based Ovarian Cancer Risk Assessment System
To evaluate the performance of a system that standardizes ovarian cancer risk assessment and reporting on ultrasonography. We conducted a prospective community-based cohort study of average-risk women undergoing ultrasonography in 2016 using a reporting system that requires adnexal masses to…
Large-Scale Implementation of Structured Reporting of Adnexal Masses on Ultrasound
The aim of this article is to describe the development and implementation of structured reporting of adnexal mass findings on pelvic ultrasound in a large integrated health care delivery system. A structured reporting system that includes standardized terminology for describing…
Prospective Case-Control Study of Abnormal Bleeding after Outpatient Corticosteroid Injection
This study is aimed at evaluating the incidence of bleeding among women having outpatient corticosteroid injection compared to matched controls, using mailed surveys and electronic health records. Prospective survey study of women receiving outpatient corticosteroid injection for joint or back…
The Value of Ultrasound Monitoring of Adnexal Masses for Early Detection of Ovarian Cancer
Although ultrasound has so far been found to be ineffective as a screening tool for ovarian cancer, it is commonly used as a means of evaluating or following ovarian or adnexal masses once they are detected. We review the use…
Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses
The management of women with asymptomatic adnexal masses should aim to balance potential benefit with potential harm. While masses with highly worrisome features or other signs of malignancy should be referred for surgery, the vast majority of masses have an…
Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50
The discovery of a complex adnexal mass in an older woman often raises concern for cancer. We evaluate outcomes for a large population-based cohort of women older than age 50 years with a small complex adnexal mass reported on ultrasound,…
Abnormal vaginal bleeding after epidural steroid injection: a paired observation cohort study
OBJECTIVE: The use of epidural steroid injections has increased dramatically, but knowledge of potential adverse effects is lacking. An association between steroid injection and subsequent abnormal vaginal bleeding has been suspected clinically, but evidence has been limited to anecdotal reports.…
The value of additional pathology comments indicating suspicion of adenocarcinoma among women diagnosed preoperatively with complex atypical endometrial hyperplasia
Over 40% of women with a preoperative diagnosis of complex atypical hyperplasia (CAH) will have endometrial cancer at hysterectomy. CAH diagnoses are often qualified by comments indicating suspicion of cancer. We examine whether these comments correlate with cancer found at…
Preservation of fertility after partial resection of bilateral ovarian cystadenofibromas: a case report
BACKGROUND: Benign cystadenofibromas and adenofibromas may represent precursors to malignant lesions. CASE: A 20-year-old woman undergoing infertility treatment was found to have cystadenofibromas involving both ovaries, with no separable normal ovarian tissue visible. Because complete resection of the tumors would…
Complex atypical endometrial hyperplasia: the risk of unrecognized adenocarcinoma and value of preoperative dilation and curettage
OBJECTIVE: To evaluate whether preoperative dilation and curettage (D&C) lowers the risk of unexpected cancer at hysterectomy. METHODS: Women with complex atypical endometrial hyperplasia on sampling from January 2000 to May 2008 who underwent hysterectomy within 6 months were identified…
Cytoreductive surgery for gynecologic malignancies–new standards of care
Studies on cytoreductive surgery for advanced ovarian and primary peritoneal cancer have consistently shown a strong correlation between cytoreduction and survival, with the best survival observed in patients who have no visible residual disease after successful cytoreductive surgery. Recent data…
Long-term outcomes following conservative surgery for borderline tumor of the ovary: a large population-based study
OBJECTIVES: To examine outcomes in women treated with conservative surgery for borderline ovarian tumor in a large population-based cohort with long-term follow-up. METHODS: Women treated by conservative surgery for borderline tumor of the ovary from 1982-2004 within a large HMO…
On maintaining the balance
Recent studies have shown an association of loop electrocautery excision procedure (LEEP) with subsequent obstetric complications, including preterm birth. These data necessitate a reevaluation of how LEEP is used, particularly in cases where the presence of a high-grade lesion has…
Long-term administration of intravaginal dehydroepiandrosterone on regression of low-grade cervical dysplasia–a pilot study
Although many dysplastic cervical lesions regress spontaneously, treatment is common due to concern for progression. Lesions persist or progress in women whose immune systems are unable to clear infection by human papillomavirus (HPV). Dehydroepiandrosterone (DHEA) is an adrenal steroid that…
Risk factors for cervical stenosis after loop electrocautery excision procedure.
OBJECTIVE: To assess frequency of and identify risk factors for the development of cervical stenosis after loop electrosurgical excision procedure. METHODS: We reviewed outpatient charts of women treated by loop excision for cervical dysplasia between August 1996 and January 1998…
Surveillance for endometrial cancer in women receiving tamoxifen.
Recent studies showing a protective effect of tamoxifen in women at high risk for breast cancer have expanded the indications of the drug. While acting as an estrogen antagonist in the breast, tamoxifen can have estrogenic effects on the endometrium;…
Expression of the HPV E7 oncoprotein mimics but does not evoke a p53-dependent cellular DNA damage response pathway.
Acute expression of the human papillomavirus E7 oncoprotein in preimmortal human fibroblasts induces changes in the abundances of multiple cellular regulatory proteins. These alterations include a destabilization of the retinoblastoma tumor suppressor protein pRB, stabilization of the tumor suppressor protein…
Atypical squamous cells of undetermined significance: management patterns at an academic medical center.
OBJECTIVE: Our intent was to compare the management of patients with atypical squamous cells of undetermined significance on cytologic screening at an academic center to published guidelines. STUDY DESIGN: We reviewed the management of 223 atypical squamous cells of undetermined…
