Abstract Overview and Aims: Sentinel lymph node (SLN) biopsy in endometrial cancer has emerged as an alternative to systematic lymphadenectomy, with cervical indocyanin green injection being the preferred method. Study Design, Population and Methods: A prospective cohort study to assess the feasibility of SLN mapping in EC using ICG and near-infrared (NIR) fluorescence is ongoing at the authors’ Gynaecological Oncology Unit, in a Portuguese level III care hospital. The authors conducted a descriptive analysis of the clinicopathologic characteristics and discuss the process of implementing a novel technique. Results: A minimum number of 20 patients with EC of all histologies and grades recruited until publication was established. Of all 20 patients, 12 (12/20; 60.0%) had a total laparoscopic hysterectomy plus bilateral salpingo-oophorectomy (TLH/BSO) and SLN biopsy alone, and the remaining 8 patients underwent full retroperitoneal staging (8/20; 40.0%). At least 1 SLN was detected in all patients (20/20; 100%), bilaterally in 14 (14/20; 70%) and unilaterally in 6 (6/20; 30%). In 1 case, a third SLN was identified amongst presacral nodes. No isolated para-aortic SLNs were detected. The median number of SLNs removed per patient was 2.3 (range 1-3). Out of the 20 patients, 2 (2/20; 10%) had lymph node metastases and in both cases bilateral detection of SLN did not occur. The median operative time was 240 minutes, with total SLN mapping time of approximately 40 minutes per side. Median operative time was lower among patients undergoing an SLN mapping only, compared with patients undergoing a full lymphadenectomy (219min vs 280min). No cases of ICG injection-related complications occurred. Ultrastaging of sentinel lymph nodes was performed in all cases. Conclusions: This is the first published series of laparoscopic sentinel lymph node biopsy using ICG and NIR fluorescence in endometrial cancer, conducted in a Portuguese hospital.

Resumo Introdução e Objetivos: A biópsia de gânglio sentinela (BGS) no carcinoma do endométrio surgiu como alternativa à linfadenectomia sistemática, privilegiando-se a injeção intracervical de verde de indocianina. Métodos: Foi realizado um estudo coorte prospetivo com o intuito de avaliar a reprodutibilidade da BGS com verde de indocianina no carcinoma do endométrio, num Hospital Português de nível III. Procedeu-se à análise descritiva das caraterísticas clinico-patológicas da população estudada e discussão do processo de implementação da nova técnica. Resultados: Estabeleceu-se um mínimo de 20 doentes com carcinoma do endométrio até publicação, incluindo todos os graus e tipos histológicos. Entre as 20 doentes recrutadas, 12 (12/20; 60%) foram submetidas a histerectomia total e anexectomia bilateral (HTL/AB) e BGS e as 8 restantes a estadiamento retroperitoneal completo (8/20; 40%). Foi detetado pelo menos 1 gânglio sentinela (GS) em todos os casos (20/20; 100%), bilateralmente em 14 (14/20; 70%) e unilateralmente em 6 (6/20; 30%). Um terceiro GS sagrado foi identificado num caso. Não se identificaram GS para-aórticos. O número médio de GS removidos em cada doente foi 2.3 (intervalo 1-3). Entre as 20 doentes, 2 (2/20; 10%) apresentaram metastização ganglionar e em ambos os casos não foi possível identificar bilateralmente o GS. O tempo operatório médio foi 240 minutos e o tempo dedicado ao mapeamento ganglionar 40 minutos, unilateralmente. O tempo operatório médio foi inferior nas doentes submetidas a BGS, comparativamente à linfadenectomia sistemática (219 minutos vs 280 minutos). Não houve complicações associadas à injeção do marcador. Foi realizado ultraestadiamento em todos os casos. Conclusões: A presente publicação é a primeira série de casos portuguesa reportada de biópsia de gânglio sentinela com verde de indocianina, por via laparoscópica no carcinoma do endométrio.

Abstract Overview and Aims: The incidence of women in their antenatal and postpartum period who require hospitalization in the Intensive Care Unit (ICU), has been repeatedly used as a marker of quality for health services. In Portugal there are currently few studies that report on obstetric complications and the need for a more multidisciplinary approach after admission to an ICU. The main objective of this study is to determine the probability for intensive care admission need of this Centre’s obstetric population. The secondary objectives are to characterize the obstetric population, it’s risk factors and outcomes. Study design: Descriptive and retrospective study Population: All women hospitalized at an ICU in our Centre, during pregnancy or in the 42 days postpartum, in 2013 and 2020. Methods: We assessed the electronic and physical records of our eligible population and analyzed relevant variables such as maternal age, body mass index, gestational age at admission, and delivery route. Neonatal variables, such as weight at delivery, apgar scores and adverse neonatal outcomes were also evaluated. Results: During the study period, 41 women required hospitalization in ICU, out of a total of 14 688 births. The most frequent diagnosis at admission were hypertensive disorders and postpartum hemorrhage. Mean age was 30.4 years. Most admissions were in the postpartum period (97,6%). We observed two maternal deaths and one fetal death. Conclusions: The admission rate to the ICU was 2.8 per 1000 births. Most admissions occurred in the postpartum period (97.6%), with the most common reasons being hypertensive disorders (56.1%) and postpartum hemorrhage (31.7%). The maternal mortality rate was 0.14 per 1000 births. These results were similar to those found in other international and national studies.

Resumo Objetivo Comparar a abordagem laparoscópica com a laparotômica no estadiamento cirúrgico do carcinoma do endométrio. Métodos Avaliação retrospectiva de uma coorte de mulheres com diagnóstico préoperatório de cancro do endométrio submetida a estadiamento cirúrgico. As principais variáveis do estudo foram: morbilidade e mortalidade, tempo de internamento hospitalar, eventos adversos peri-operatórios e taxa de recorrência. A análise dos dados foi realizada com o programa SPSS v25 (IBM Corp, Armonk, NY, EUA), para as variáveis categóricas utilizou-se o teste do Qui-quadrado e o teste de Fisher, e para as variáveis contínuas o teste t de Student. Resultados A amostra foi constituída por 162 doentes. 138 pacientes preencheram os critérios de inclusão, 41 das quais foram submetidas a estadiamento por laparoscopia e 97 por laparotomia. As conversões de laparoscopia para laparotomia ocorreram em 2 doentes (4,9%) e foram secundárias a dificuldades técnicas e má exposição. A laparoscopia teve menos eventos adversos pós-operatórios quando comparada à laparotomia (7,3% versus 23,7%, respectivamente; p = 0,005), mas taxas semelhantes de complicações intraoperatórias, apesar do tempo operatório significativamente maior (mediana 175 a 130 minutos, respetivamente; p < 0,001). A permanência hospitalar foi significativamente menor na abordagem laparoscópica (mediana de 3 versus 7 dias, respectivamente; p < 0,001). Não houve diferenças nas taxas de recorrência ou mortalidade. Conclusão O estadiamento cirúrgico laparoscópico para carcinoma do endométrio é exequível e seguro. As doentes apresentam uma menor taxa de complicações pósoperatórias e tempo de internamento mais curto quando comparados aos da abordagem por laparotomia.

Abstract Objective To compare laparoscopy with laparotomy for surgical staging of endometrial cancer. Methods A cohort of women with preoperative diagnosis of endometrial cancer who underwent surgical staging was retrospectively evaluated. The main study end points were: morbidity and mortality, hospital length of stay, perioperative adverse events and recurrence rate. Data analysis was performed with the software SPSS v25 (IBM Corp., Armonk, NY, USA), categorical variables using a Chi-square and Fisher test, and continuous variables using the Student t-test. Results Atotal of 162 patientswere analyzed. 138 patientsmet the inclusion criteria, 41of whom underwent staging by laparoscopy and 97 by laparotomy. Conversions from laparoscopy to laparotomy happened in 2 patients (4.9%) and were secondary to technical difficulties and poor exposure. Laparoscopy had fewer postoperative adverse events when compared with laparotomy (7.3% vs 23.7%, respectively; p = 0.005), but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 175 vs 130 minutes, respectively; p < 0.001). Hospital stay was significantly lower in laparoscopy versus laparotomy patients (median, 3 vs 7 days, respectively; p < 0.001). No difference in recurrence or mortality rates were observed. Conclusion Laparoscopic surgical staging for endometrial cancer is feasible and safe. Patients have lower postoperative complication rates and shorter hospital stays when compared with the approach by laparotomy.

Resumo Objetivo O diagnóstico intraoperatório por congelação é umrecurso importante cujo uso empatologia ginecológica não tem sido suficientemente enfatizado. O objetivo do presente estudo foi avaliar as taxas de concordância entre o diagnóstico intraoperatório por congelação e o estudo anatomopatológico definitivo e determinar o quanto o diagnóstico intraoperatório por congelação é um método confiável. Métodos Um estudo retrospectivo de todos os diagnósticos intraoperatórios por congelação realizados em tumores uterinos e massas anexiais suspeitas entre janeiro e 2012 e dezembro de 2016 (excluindo metástases) no serviço de ginecologia e obstetrícia do Centro Hospitalar Tondela Viseu. Comparação do diagnóstico intraoperatório por congelação com o resultado do estudo definitivo em relação ao tipo histológico do tumor e profundidade de invasão miometrial. Resultados Um total de 286 casos foram elegíveis para o estudo, incluindo 102 (35.7%) tumores uterinos e 184 (64.3%) tumores ovarianos. A taxa global de casos deferidos foi de 5.2% (15/286). Entre os tumores uterinos, a acuidade de diagnóstico nos casos de carcinoma endometrial foi de 96.25% (77/80). Entre os tumores ovarianos, não se verificou concordância em 2 casos (1.1%), correspondendo a um tumor borderline do tipo seroso e a um adenocarcinoma de células claras intracístico. Conclusão O diagnóstico intraoperatório por congelação apresenta-se com um importante papel em situações selecionadas, sendo acompanhado de elevada taxa de sensibilidade e especificidade para tumores endometriais e ovarianos. A sua elevada acuidade diagnóstica encontra-se associada à possibilidade de obter um tratamento cirúrgico adequado na primeira abordagem cirúrgica

Abstract Objective Intraoperative frozen section (IFS) is a valuable resource, and its use in gynecological pathology has not been sufficiently emphasized. The main goal of the present study is to evaluate the reliability and agreement rates between IFS and the final paraffin section (PS) and determine how reliable IFS is. Methods A retrospective study of all IFSs performed on uterine tumors and suspicious adnexal masses between January 2012 and December 2016 (excluding metastases) at the department of obstetrics and gynecology of the Centro Hospitalar Tondela Viseu. Frozen versus permanent section diagnosis were compared regarding the histologic type of the tumor, and the depth of myometrial invasion. Results A total of 286 cases were eligible for the present study, including 102 (35.7%) IFSs of uterine tumors, and 184 (64.3%) IFSs of ovarian tumors. The overall rate of deferred cases was 5.2% (15/286). The accuracy of the diagnosis in cases of endometrial carcinoma was 96.25% (77/80). Among the ovarian tumors, misdiagnoses occurred in 2 cases (1.1%), corresponding to a borderline tumor (serous type) and a clear cell intracystic adenocarcinoma. Conclusion The IFS analysis plays an important role in selected situations and is associated to a high sensitivity and specificity in cases of ovarian and endometrial tumors. Its high accuracy is almost universally associated with the possibility of obtaining an optimal surgical treatment at the time of the first surgical approach.

Overview and aims: Standardization of screening tests lead to better care. The aim of this study was to describe and analyse screening practices during pregnancy among Portuguese Centres. Study Design and Methods: Written survey sent electronically to 41 public Portuguese Health Institutions which have an Obstetrics Department. Descriptive analysis of the collected data was performed. Results: Twenty-four surveys were obtained (58.5%). In most Centres combined aneuploidy screening is performed universally (79%). Preterm birth screening is performed through evaluation of cervical length at 20-22 weeks in most Centres (58%). A broad variety in performance was observed between Institutions regarding which infections were screened and their timing. Most institutions do perform preeclampsia screening (92%) and do not perform systematic evaluation of thyroid function in the absence of known pathology or signs/symptoms suggestive of thyroid disfunction. Conclusions: Although with some differences it was found that for preeclampsia, preterm birth and aneuploidy screening, the Centres have consistent practices