Johanna U Mäenpää

Publications (7)15.76 Total impact

• Article: The preoperative assessment of deep myometrial invasion by three-dimensional ultrasound versus MRI in endometrial carcinoma.

  Sami K Saarelainen, Lea Kööbi, Ritva Järvenpää, Marita Laurila, Johanna U Mäenpää
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  ABSTRACT: To evaluate the usefulness of three-dimensional ultrasound (3D US), magnetic resonance imaging (MRI) and three-dimensional power Doppler angiography (3D-PDA) in the preoperative assessment of myometrial invasion in endometrial carcinoma. A prospective observational study. University hospital. Twenty consecutive patients diagnosed with endometrial carcinoma. Preoperative 3 T MRI and 3D US examinations were performed, and the depth of myometrial invasion was assessed. The vascularity indices, vascularization index, flow index and vascularization flow index, were calculated by 3D-PDA. The results were compared with the final histopathology report after a surgical staging. In detecting deep myometrial invasion, the sensitivity of 3D US, MRI and their combination was 50, 91.7 and 100%, respectively. The specificity was 87.5, 50 and 50%, respectively. There were no significant differences in the 3D-PDA vascularity indices between the two groups. MRI appears to be more sensitive than 3D US in detecting deep invasion, while 3D US has a better specificity.
  Acta Obstetricia Et Gynecologica Scandinavica 05/2012; 91(8):983-90. · 1.77 Impact Factor
• Article: Preoperative assessment of endometrial carcinoma by three-dimensional power Doppler angiography.

  S K Saarelainen, M H Vuento, P Kirkinen, J U Mäenpää
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  ABSTRACT: Preoperative evaluation of the depth of myometrial invasion in endometrial carcinoma is challenging. The objective of this study was to evaluate the usefulness of three-dimensional power Doppler angiography (3D-PDA) in this setting. Sonographic and histological data on 100 consecutive cases of endometrial carcinoma were analyzed. The endometrial and myometrial vascular indices VI (vascularization index), FI (flow index) and VFI (vascularization flow index) were calculated by 3D-PDA. The results were compared with a complete surgical staging. The mean ( ± SD) age of patients was 67.1 ± 8.8 (range, 33-87) years. Forty-six patients had deep (≥ 50%) myometrial invasion. Eight patients had metastases, seven of them with deep invasion. Three patients were found to have carcinomas of non-uterine origin on histology, and these were excluded from further statistical analysis. The median endometrial and myometrial vascular indices were higher in the group with deep invasion than in the group without. Following multivariable analysis of the indices only the endometrial FI was independently associated with deep invasion (OR, 1.061; 95% CI, 1.023-1.099; P = 0.001). However, a greater endometrial volume was also an independent predictor of deep invasion (OR, 1.109; 95% CI, 1.011-1.215; P = 0.028). Our study suggests that endometrial and, to a lesser degree, myometrial vascular indices and endometrial volume correlate with the depth of myometrial invasion in endometrial carcinoma.
  Ultrasound in Obstetrics and Gynecology 09/2011; 39(4):466-72. · 3.01 Impact Factor
• Article: Toremifene use does not alter serum inhibin A and B levels during mid-luteal phase in women with premenstrual mastalgia.

  Sinikka Oksa, Tiina Luukkaala, Johanna U Mäenpää
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  ABSTRACT: To find out if there is any link between the therapeutic effect of toremifene on premenstrual mastalgia and luteal phase serum inhibin A and/or B levels. Forty-eight patients participating in a randomized cross-over trial on toremifene vs. placebo for premenstrual mastalgia gave three blood samples during the luteal phase of the menstrual cycle: the first at baseline, the second during the third toremifene/placebo cycle, and the third during the third placebo/toremifene cycle, respectively. The blood samples were analyzed for inhibin A and B with respective specific two-site enzyme-linked immunosorbent assays. Toremifene (20 mg/d) and placebo were administered during the luteal phase only. When all the toremifene-treated cycles were compared with all the placebo cycles and with the baseline, the median inhibin A levels were 42, 38, and 40 pg/ml, respectively (baseline versus toremifene, p = 0.638; baseline versus placebo, p = 0.468; and toremifene versus placebo, p = 0.365). The median inhibin B levels were at baseline 19 ng/l, during placebo 20 ng/l, and during toremifene 17 ng/l (baseline versus toremifene, p = 0.983; baseline versus placebo, p = 0.519; and toremifene versus placebo, p = 0.880). A luteal administration of toremifene does not seem to result in any changes in mid-luteal concentrations of inhibin A or B in serum.
  Gynecological Endocrinology 02/2010; 26(2):114-7. · 1.58 Impact Factor
• Article: Pelvic exenteration for gynecological malignancies: an analysis of 15 cases operated on at a single institution.

  Johanna U Mäenpää, Katri Kangasniemi, Tiina Luukkaala
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  ABSTRACT: We analyzed retrospectively the outcome of 15 patients treated with pelvic exenteration (nine total and six anterior) for gynecological cancer (six vaginal, four endometrial, three cervical, one vulvar, and one ovarian) from 1987 through 2008. Four operations were for primary tumors and 11 for recurrences. Eight patients had received prior radiotherapy. Median operation time was 310 (range 180-520) min, and median blood loss was 2,500 (range 600- 8,000) mL. Thirteen patients had altogether 59 postoperative complications, 25 (42%) early and 34 (58%) late. One patient each died of complications during the early and late postoperative phases, respectively. Both had received previous radiotherapy. By 31 January 2009, six patients had died, while five and four patients were alive with or without disease, respectively. Only one pelvic recurrence was found. The median progression-free survival was 8.9 months. Although pelvic exenteration was not totally devoid of mortality, the procedure provided a good local control, with mostly manageable complications.
  Acta Obstetricia Et Gynecologica Scandinavica 11/2009; 89(2):279-83. · 1.77 Impact Factor
• Article: Port-site metastasis following laparoscopic hysterectomy and bilateral salpingo-ophorectomy for endometrial carcinoma.

  Johanna U Mäenpää, Reita Nyberg, Jyrki Parkkinen
  European journal of obstetrics, gynecology, and reproductive biology 02/2009; 143(1):61-2. · 1.97 Impact Factor
• Article: Sentinel node and vulvar cancer: a series of 47 patients.

  Reita H Nyberg, Marjo Iivonen, Jyrki Parkkinen, Tapio Kuoppala, Johanna U Mäenpää
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  ABSTRACT: There is growing interest to apply the sentinel node technique in the treatment of vulvar cancer. All charts of the patients operated on for vulvar cancer at Tampere University Hospital from January 1, 2001 through June 30, 2005 were retrospectively reviewed. Demographic, clinical, and histopathological information was collected from each patient. The sentinel lymph node mapping was done intraoperatively either with a combination of the radioisotope and dye techniques (40 patients) or with the dye technique alone (7 patients). The sentinel lymph node was dissected separately for histopathological evaluation, and then a routine inguinal lymphadenectomy was performed. The final FIGO surgical Stage distribution was: Stage I, 11 (23%); Stage II, 14 (30%); Stage III, 21 (45%); and Stage IV, 1 (2%). Sentinel lymph node was identified in 46 (98%) women with either one or both of the methods. In Stage I-II, the sentinel lymph node identification rate was 25/25 (100%) with the combined method. The only patient with unidentified sentinel lymph node had lymphatic spread beyond inguinal area or Stage IV disease. Eighteen of the sentinel lymph nodes (39%) were positive for tumor cells, and in 5 cases additional metastatic nodes were found. One patient with macroscopically enlarged metastatic inguinal nodes and Stage III disease had a negative sentinel lymph node. In the 25 patients with Stage I-II disease, the false-negative rate of the sentinel lymph node method was 0/4, giving a negative predictive value of 1.00. A sentinel node identification rate of 98% with a false-negative rate of 0% in the patients with Stage I-II disease is an encouraging finding.
  Acta Obstetricia Et Gynecologica Scandinavica 02/2007; 86(5):615-9. · 1.77 Impact Factor
• Article: Sequential gemcitabine-carboplatin followed by paclitaxel-carboplatin in the first-line treatment of advanced ovarian cancer: A phase II study.

  Johanna U Mäenpää, Seija E Grénman, Jyrki T Jalkanen, Tapio A Kuoppala, Arto O Leminen, Ulla S Puistola, Päivi M Vuolo-Merilä, Merja H Yliskoski
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  ABSTRACT: To determine the feasibility and efficacy of sequential gemcitabine-carboplatin followed by paclitaxel-carboplatin in the first-line treatment of advanced epithelial ovarian cancer, with the response rate as the primary endpoint. After primary laparotomy, 56 patients with FIGO Stages III-IV disease were given 4 cycles of gemcitabine 1000 mg/m2 d1,8 and carboplatin AUC5 (44 patients) or AUC6 (12 patients) d1 q3wk followed by 4 cycles of paclitaxel 175 mg/m2 d1 and carboplatin AUC5/6 q3wk. Of the tumors, 43 were serous, 6 clear cell, 4 endometrioid, and 3 anaplastic type. Thirty-seven (66.1%) of the patients were suboptimally debulked. Forty-seven patients were evaluable for response by CA-125 criteria, and 46 (98%) responded. Thirty patients (after gemcitabine-carboplatin) and 24 (after paclitaxel-carboplatin) were evaluable for response by CT (RECIST criteria), respectively. After the four gemcitabine-carboplatin cycles, the objective response rate was 83% (6 CR, 19 PR). Following completion of the whole sequential regimen, 7 patients showed a CR and 15 a PR, respectively, giving a response rate of 92%. The median progression-free survival was 12.8 months after a median follow-up of 19 months (range 7-35 months). The median overall survival has not been reached yet. The main toxicity was neutropenia as 139/221 (62.9%) of the gemcitabine-carboplatin cycles and 92/181 (50.8%) of the paclitaxel-carboplatin cycles, respectively, were associated with Grades 3-4 neutropenia. Neutropenia was reported as a serious adverse event in 5.7% of the cycles, and G-CSF support was needed in 18.4% of the cycles. Only the gemcitabine-carboplatin cycles were associated with a marked thrombocytopenia (32.1% Grades 3-4). Of the other side effects, marked allergy occurred in 14/52 (27%) exposed to paclitaxel. A total of 14 patients discontinued the treatment prematurely: 3 due to lack of efficacy, 1 due to protocol violation, and 10 due to toxicity (4 allergic reactions to paclitaxel, 3 complicated neutropenias, 1 fever, and 2 unspecified toxicities). The mean relative dose intensities were: gemcitabine 84.0%, paclitaxel 85.4%, and carboplatin 96.5%. Of the gemcitabine-carboplatin cycles and paclitaxel-carboplatin cycles, 32% and 38% were delayed, respectively. Gemcitabine d8 dose had to be omitted in 8% of the cycles. The sequential regimen of gemcitabine-carboplatin followed by paclitaxel-carboplatin is feasible in chemotherapy-naive ovarian cancer. Although its use is associated with a marked neutropenia, the neutropenia is manageable.
  Gynecologic Oncology 05/2006; 101(1):114-9. · 3.89 Impact Factor