Daniela Fischerova

• MD, PhD, Associate Professor
• Consultant at Charles University in Prague

Background: While sentinel lymph node (SLN) biopsy has been integrated into international guidelines for endometrial cancer, a standardized technique is still lacking. This study addresses whether the concurrent use of two tracers, technetium-99 (Tc) and indocyanine green (ICG), administered intracervically through distinct techniques, enhances the...

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) with the European Society of Gynaecological Oncology (ESGO) jointly developed clinically relevant and evidence‐based statements on performing ultrasound‐guided biopsies in gynecological oncology. The objective of this Consensus Statement is to assist clinicians, including...

The narrative review article is focused on the strengths and limitations of modern imaging methods in the preoperative differential diagnosis of uterine mesenchymal tumours. In order to tailor the surgical procedures, imaging methods, namely ultrasound and magnetic resonance imaging (MRI), should be taken into account as well as clinical symptoms,...

Objectives To assess the diagnostic performance of ultrasonography in pre-operative assessment of lymph nodes in patients with cervical cancer, to compare the outcomes for pelvic and para-aortic regions, and to detect macrometastases and micrometastases separately. Methods Patients were retrospectively included if they met the following inclusion...

Background We previously proposed two cfDNA-based scores (genome-wide z-score and nucleosome score) as candidate non-invasive biomarkers to further improve pre-surgical diagnosis of ovarian malignancy. We aimed to investigate the added value of these cfDNA-based scores to the predictors of the ADNEX model (Assessment of Different NEoplasias in the...

Background In addition to the diagnostic accuracy of imaging methods, patient-reported satisfaction with imaging methods is important. Objective To report a secondary outcome of the prospective international multicenter Imaging Study in Advanced ovArian Cancer (ISAAC Study), detailing patients’ experience with abdomino-pelvic ultrasound, whole-bod...

In recent years the role of diagnostic imaging by pelvic ultrasound in the diagnosis and staging of gynecological cancers has been growing exponentially. Evidence from recent prospective multicenter studies has demonstrated high accuracy for pre-operative locoregional ultrasound staging in gynecological cancers. Therefore, in many leading gynecolog...

Simple Summary Constant technological development of modern imaging has led to substantial improvement in management and decision-making in the diagnostic and prognostic process of many different neoplasms. This also applies to cervical cancer. The main evidence, providing the base of recently updated ESGO-ESTRO-ESP recommendations (2023) on the ma...

Following the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) joint guide-lines (2018) for the management of patients with cervical cancer, treatment decisions should be guided by modern imaging techniques. After five years (2023), an update...

Background: Several diagnostic prediction models to help clinicians discriminate between benign and malignant adnexal masses are available. This study is a head-to-head comparison of the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model with that of the Risk of Ovarian Malignancy Algorithm (ROMA). Methods: This is...

Cell-free DNA (cfDNA) mediated early cancer detection is based on detecting alterations in the cfDNA components. However, the underlying pathology can usually not be readily identified. We built a reference atlas based on the methylome of multiple cancer and blood-cell types and developed MetDecode, an epigenetic signature-based deconvolution algor...

In this study, we conducted a comparative analysis of demographic, histopathological, and sonographic characteristics between pre- and postmenopausal women diagnosed with endometrial cancer, while also examining sonographic and anthropometric features in ‘low’ and ‘intermediate/high-risk’ cases, stratified by menopausal status. Our analysis, based...

Introduction The objective of this study is to compare the overall accuracy of US, PET/CT and DW/MRI in preoperative assessment of lymph nodes (LNs) in cervical cancer. Primary end-point is the overall accuracy of imaging in detection of pelvic LN macrometastases and to prove non-inferioriy of US to other methods. Main secondary end-points include...

Introduction/Background Soft tissue tumors arising from peripheral nerve sheath tumors (PNSTs) may ocasionally be observed in the pelvic retroperitoneum during gynecologycal examination. These are usually benign, although a very low risk of malignant transformation has been reported. The purpose of this study was to describe the clinical and sonogr...

Introduction/Background To assess the interobserver-reality agreement on ovarian cancer staging, when the true-status of examined locations is known after surgery, biopsy or subsequent response to neoadjuvant treatment. Methodology Twenty-five participants divided in two groups with variable experience in ultrasound ovarian cancer staging were inc...

Introduction/Background In addition to the diagnostic accuracy of imaging methods, patient-reported satisfaction with imaging methods is important. The aim is to report patients‘ experience with ultrasound, whole-body computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) for preoperative ovarian cancer s...

Background As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) first published in 2017 evidence-based guidelines for the management of patients with vulvar cancer. Objective To update the ESGO guidelines based on the new evidence addressing...

In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer,...

In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer,...

In 2018, the European Society of Gynecological Oncology (ESGO) jointly with the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) published evidence-based guidelines for the management of patients with cervical cancer. Given the large body of new evidence addressing the management of cervical cancer,...

Simple Summary Maximal-effort debulking surgery is the recommended approach for advanced-stage ovarian cancer. The role of imaging is to provide a preoperative systematic and structured report of tumour dissemination with special emphasis on key sites that preclude optimal resectability in ovarian cancer surgery. Imaging methods cannot reliably det...

We report a rare case of primary nodal, poorly differentiated endometrioid carcinoma associated with Lynch syndrome. A 29-year-old female patient was referred by her general gynecologist for further imaging with suspected right-sided ovarian endometrioid cyst. Ultrasound examination by an expert gynecological sonographer at tertiary center revealed...

Introduction/Background Pelvic exenteration (PE) remains a standard of care procedure in patients with recurrent pelvic malignancies, especially after primary radiotherapy. New procedures allow to reach free surgical margins in selected patients with tumours attaching/invading pelvic side-wall structures. However, little has been published about qu...

Introduction/Background The aim of the European multicentric prospective study (ISAAC study, Imaging Study on Advanced ovArian cancer) was to test the non-inferiority of abdomino-pelvic ultrasound compared to computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in prediction of surgical outcome in patie...

Background The role of adjuvant treatment in the intermediate-risk group of patients with early-stage cervical cancer is controversial and is supported by a single randomized Gynecologic Oncology Group (GOG) 92 study performed more than 20 years ago. Recent retrospective studies have shown excellent local control in this group of patients after rad...

Objective: To summarize recent data and knowledge of laparoscopic power morcellation. Methods: Review of articles. Results: Laparoscopic morcellation has been introduced to gynecologic surgery in 90s. In 2014, Food and Drug Administration announced negative statement about the morcellation use due to the risk of potential spreading of malignan...

Background: Cell-free DNA (cfDNA) analysis holds great promise for non-invasive cancer screening, diagnosis, and monitoring. We hypothesized that mining the patterns of cfDNA shallow whole-genome sequencing datasets from patients with cancer could improve cancer detection. Methods: By applying unsupervised clustering and supervised machine learn...

This is a case report of a rare finding of an extragonadal yolk sac tumor in a 37-year-old patient who presented with shortness of breath and abdominal bloating. During imaging and staging surgery, the findings were strongly suggestive of an extragonadal advanced tumor presenting with peritoneal dissemination, predominantly affecting omentum, with...

Background Up to 26% of patients with early-stage cervical cancer experience relapse after primary surgery. However, little is known about which factors influence prognosis following disease recurrence. Therefore, our aims were to determine post-recurrence disease-specific survival (PR-DSS) and to identify respective prognostic factors for PR-DSS....

Background: Tumors can influence peripheral immune macroenvironment, thereby creating opportunities for non-invasive serum/plasma immunobiomarkers for immunostratification and immunotherapy designing. However, current approaches for immunobiomarkers’ detection are largely quantitative, which is unreliable for assessing functional peripheral immunod...

Background Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have impl...

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis...

There are multiple classifications in imaging and surgery of endometriosis and in this article, we offer a review of the main evaluation systems. The International Deep Endometriosis Analysis group consensus is the leading document for ultrasound assessment, while magnetic resonance imaging is guided by the European Society for Urogenital Radiology...

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence‐based statements on the preoperative diagnosis of...

The aim of the study was to evaluate the usefulness of 4D Power Doppler tissue evaluation to discriminate between normal ovaries and ovarian cancer tumors. This was a prospective observational study. Twenty-three cases of surgically confirmed ovarian High Grade Serous Carcinoma (HGSC) were analyzed. The control group consisted of 23 healthy patient...

Models predicting recurrence risk (RR) of cervical cancer are used to tailor adjuvant treatment after radical surgery. The goal of our study was to compare available prognostic factors and to develop a prognostic model that would be easy to standardise and use in routine clinical practice. All consecutive patients with early-stage cervical cancer t...

Background SENTIX (ENGOT-CX2/CEEGOG-CX1) is an international, multicentre, prospective observational trial evaluating sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. We report the final preplanned analysis of the secondary end-points: SLN mapping and outcomes of intraoperative SLN...

Objective To evaluate the performance of diagnostic prediction models for ovarian malignancy in all patients with an ovarian mass managed surgically or conservatively. Design Multicentre cohort study. Setting 36 oncology referral centres (tertiary centres with a specific gynaecological oncology unit) or other types of centre. Participants Consec...

Background: Mesonephric-like adenocarcinoma (M-LAC) is a rare, recently described tumor occurring in the uterine corpus and ovary, which shares the same morphological and immunohistochemical features with the more common mesonephric adenocarcinoma (MAC), which mostly arises the uterine cervix. Despite the similarities between these tumors, the his...

The data on the prognostic significance of low volume metastases in lymph nodes (LN) are inconsistent. The aim of this study was to retrospectively analyze the outcome of a large group of patients treated with sentinel lymph node (SLN) biopsy at a single referral center. Patients with cervical cancer, stage T1a-T2b, common tumor types, negative LN...

Background: Optimizing and ensuring the quality of surgical care is essential to improve the management and outcome of patients with cervical cancer.To develop a list of quality indicators for surgical treatment of cervical cancer that can be used to audit and improve clinical practice. Methods: Quality indicators were developed using a four-ste...

Objectives: To develop a pre-operative risk model using endometrial biopsy results, clinical and ultrasound variables to predict the individual risk of lymph node metastases in women with endometrial cancer. Methods: A mixed effects logistic regression model was developed on 1501 prospectively included women with endometrial cancer subjected to...

Purpose of Review For uterine cervical cancer, the recently revised International Federation of Gynecology and Obstetrics (FIGO) staging system (2018) incorporates imaging and pathology assessments in its staging. In this review we summarize the reported staging performances of conventional and novel imaging methods and provide an overview of promi...

Objectives: To validate ultrasound measurements and subjective ultrasound assessment (SA) to detect deep myometrial invasion (MI), and cervical stromal invasion (CSI) in patients with endometrial cancer and to compare their performance between low and high-grade endometrial cancer, and to validate published prediction models to identify high-risk...

Abstract OBJECTIVE: To describe the sonographic characteristics of a lymphocele after pelvic and/or paraaortic lymphadenectomy for gynecological malignancy, analyze and identify ultrasound characteristics related to the symptomatic and asymptomatic lymphoceles. MATERIALS AND METHODS: This is a retrospective analysis of ultrasound examination data...

Objective To describe the sonographic characteristics of a lymphocele after pelvic and/or paraaortic lymphadenectomy for gynecological malignancy, analyze and identify ultrasound characteristics related to the symptomatic and asymptomatic lymphoceles. Materials and methods This is a retrospective analysis of ultrasound examination data collected c...

Objectives To describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more adv...

Objectives: The role of adjuvant radiotherapy for lymph node-negative stage IB patients with tumor-related negative prognostic factors is not uniformly accepted. It is advocated based on the GOG 92 trial, which was initiated in 1989. The aim of the current study is to report the oncological outcome of "intermediate risk" patients treated by tailor...

Regrettably, the author metadata used for the previous correction (doi: https://doi.org/10.1007/s00428-018-2380-7 ) contained an error in the tagging of W. Glenn McCluggage's name; this has been corrected. No further adjustments have been made to the Correction, or the original Guideline paper (doi: https://doi.org/10.1007/s00428-018-2362-9 ).

Objective: To describe clinical and ultrasound characteristics of ovarian pure clear cell carcinoma. Methods: This is a retrospective study performed in 11 ultrasound centers. From the International Ovarian Tumor Analysis (IOTA) database we identified 105 patients with a histologically confirmed pure clear cell carcinoma of the ovary who had und...

Objectives: To investigate ultrasound features and the best cut-off value of CA125/CEA ratio to discriminate benign and primary malignant ovarian neoplasms from ovarian metastases in selected groups of morphological ovarian masses: multilocular masses with 5 or more locules and multilocular-solid masses. Methods: Patients with multilocular (≥5 l...

Background: Despite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer. Objective: The European Society of Gyn...

Two corrections were made to the above publication following its original online publication on 4th May 2018.

Background: Despite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer. Objective: The European Society of Gyn...

Background: Despite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer. Objective: The European Society of Gyn...

Objective: To describe the clinical and ultrasound characteristics of ovarian pure endometrioid carcinoma. Methods: This is a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database we identified 161 patients with a histological diagnosis of pure endometrioid carcinoma, who had undergone preoperative ultras...

Objective: The preoperative assessment of structural and functional changes in renal tumors using contrast-enhanced pulse inversion harmonic imaging (CEUS) and contrast-enhanced computed tomography (CECT). Materials and methods: All consecutive patients referred to two tertiary hospitals for surgery on suspicion of a malignant renal lesion, who...

Objectives: The aim of this study was to assess the detection rate, false-negative rate and sensitivity of SLN in LN staging in tumors over 2cm on a large cohort of patients. Methods: Data from patients with stages pT1a - pT2 cervical cancer who underwent surgical treatment, including SLN biopsy followed by systematic pelvic lymphadenectomy, wer...

Objectives: To describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology. Methods: Prospective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound exami...

The aim of this study was to assess the diagnostic accuracy of subjective ultrasound evaluation of myometrial invasion of endometrial cancer and to compare its accuracy to objective methods. All consecutive patients with histologically proven endometrial cancer, who underwent ultrasound evaluation followed by surgical staging between January 2009 a...

Background: The aim of this study was to assess and compare the performance of different ultrasound-based International Ovarian Tumor Analysis (IOTA) strategies and subjective assessment for the diagnosis of early stage ovarian malignancy. Methods: This is a secondary analysis of a prospective multicenter cross-sectional diagnostic accuracy study t...

Objectives: To evaluate the utility of pre-operative diagnostic models for ovarian cancer based on ultrasound and/or biomarkers for referring patients to specialized oncology care. The investigated models were RMI, ROMA, and three models from the International Ovarian Tumor Analysis (IOTA) group (LR2, ADNEX, and the Simple Rules risk score, SRRisk...

Objective: Ovarian juvenile granulosa cell tumor has an interesting association with multiple enchondromatosis (Ollier disease and Maffucci syndrome) and should be considered a leading diagnosis when an ovarian mass is found in young patients with these conditions. Besides the association with nonskeletal malignancies, there is a high risk of malig...

Objective: To describe the technique and report experiences with pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after extensive pelvic procedures. Methods: Surgical technique of MRAM harvest and transposition is carefully described. The patients in whom pelvic floor reconstruction with MRAM after either infral...

We report six cases of anastomosing hemangioma of the ovary. All lesions were unilateral and arose in 43 to 81 year old females. In all but one patient, the tumor was asymptomatic and represented incidental finding. The exception was a tumor associated with massive ascites and elevated CA 125. The tumors were, on cut section, spongy and dark violet...

Objectives: The aim of this prospective study was to examine the accuracy of ultrasound in predicting the rectosigmoid tumor infiltration in patients with epithelial ovarian cancer. Methods: Patients referred for suspicious pelvic mass underwent ultrasound examination within the standard protocol for the assessment of tumor infiltration. We pros...

Objective: The aim of our study was to compare the sensitivity of various methods and their combinations in the follow-up of patients with cervical cancer after fertility-sparing surgery (FSS). Methods: Included were women with cervical cancer in stages IA2 to IB2 who underwent FSS, which includes pelvic lymphadenectomy, sentinel lymph node biop...