Simone Ferrero

• Professor (Assistant) at Azienda Ospedaliera Universitaria San Martino di Genova

STUDY QUESTION Can patients with uterine smooth muscle tumours of uncertain malignant potential (STUMP) be effectively and safely managed with fertility-sparing treatment? SUMMARY ANSWER This multicentre retrospective study demonstrates that fertility-sparing management for patients diagnosed with STUMP is both feasible and safe. WHAT IS KNOWN AL...

Human papillomavirus (HPV) is a major cause of cervical cancer, a significant health concern worldwide. Despite advances in screening methods, including the Pap test and the HPV DNA test, limitations remain in accurately predicting which HPV infections will progress to cervical intraepithelial neoplasia (CIN) and, eventually, invasive cancer. This...

Introduction: Endometriosis and pelvic inflammatory disease (PID) are gynecological conditions affecting women of reproductive age and causing pain symptoms. The symptoms caused by these conditions are similar; thus, the differential diagnosis may be challenging. The treatment of these conditions is very different because PID is treated with antib...

Background: Bowel endometriosis is one of the more severe manifestations of deep endometriosis; it may cause pain and intestinal symptoms. The noninvasive diagnosis of bowel endometriosis is of crucial importance in planning the management of patients affected by this condition. Objectives: This review aims to describe how transvaginal ultrasono...

Early-onset neonatal sepsis (EONS), a serious infection in newborns within 3 days, is challenging to diagnose. The current methods often lack accuracy, leading to unnecessary antibiotics or delayed treatment. This study investigates the role of the frozen section examination of placental membranes and umbilical cord (FSMU) to improve EONS diagnosis...

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), ESHRE, the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparos...

Introduction: Uterine fibroids, the most prevalent benign tumors among reproductive-age women, pose treatment challenges that range from surgical interventions to medical therapies for symptom control. Progestins and estroprogestins effectively manage uterine bleeding by suppressing dysfunctional endometrium over fibroids. While GnRH agonists repr...

Objective To compare survival outcomes and patterns of recurrence between endometriosis-associated ovarian cancer patients and non-endometriosis-associated ovarian cancer patients. Methods This retrospective study included data of consecutive patients with endometrioid or clear cell ovarian cancer treated at the Fondazione IRCCS Istituto Nazionale...

Introduction/Background Prospective multicenter validation of a decision support tool (TRACE 4 OC and the implemented version TRACE 4 OC+) for the triage of adnexal masses at ultrasound (US) based on radiomics and machine learning and comparison with IOTA ADNEX model. Methodology From a multicenter consecutive series of women scheduled for surgery...

The number of original studies looking at fertility preservation in women with endometriosis is relatively low. Embryo cryopreservation and oocyte cryopreservation are the most common fertility preservation techniques used in patients with endometriosis. Clinical data on ovarian tissue cryopreservation in women with endometriosis are very scanty. I...

Approximately 20 years ago, studies performed in the animal model of endometriosis suggested that endometrial autografts placed throughout the pelvic peritoneum caused infertility by interfering with ovulation. Based on this background, some studies investigated if ovarian endometrioma influenced the frequency of ovulation in the affected ovary. In...

Up to 30% of women with endometriosis exhibit some form of tubal involvement. Tubal endometriosis is a heterogeneous disease. It may infiltrate only the tubal serosa or subserosa (peritoneal endometriosis), infiltrate the myosalpinx, and grow into the tubal lumen. Tubal endometriosis lacks specific clinical symptoms, and, in most patients, transvag...

Although intrauterine inseminations (IUI) with or without superovulation have been widely used in treating endometriosis-related infertility, the available studies are limited by small sample size, experimental design, and heterogenous study populations. IUI is effective in improving fertility in women with stages I–II endometriosis compared with e...

The assessment of tubal patency is similar in women with endometriosis and those with other causes of infertility. The patency of the fallopian tubes can be assessed by hysterosalpingography (HSG), hystero-salpingo contrast sonography (HyCoSy), and laparoscopic chromopertubation. HSG allows to evaluate the tubal patency in patients with endometrios...

Introduction: Endometriosis is an estrogen-dependent disease that gives rise to pelvic pain and infertility. Although estroprogestins and progestins currently stand as the first-line treatments for this condition, demonstrating efficacy in two-thirds of patients, a significant portion of individuals experience only partial relief or symptom recurr...

Preoperative sonographic staging in patients with suspected parametrial endometriosis is essential to plan the surgical intervention and to anticipate the need for a multidisciplinary approach, and hence optimize surgical outcome. The results of a recent metanalysis suggest that defining more accurately the ultrasonographic criteria of parametrial...

Endometrial cancer (EC) is the most frequent gynecological cancer. The ESGO/ESTRO/ESP 2020 guidelines identify prognostic groups based on morpho molecular characteristics. This study aims to evaluate the clinical applicability of NGS analysis to define an appropriate risk class and to improve the diagnostic and prognostic stratification of ECs. Cas...

Adenomyosis, characterized by the growth of endometrial tissue within the uterine wall, poses significant challenges in treatment. The literature primarily focuses on managing abnormal uterine bleeding (AUB) and dysmenorrhea, the main symptoms of adenomyosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid provide limited support...

Adenomyosis, characterized by the growth of endometrial tissue within the uterine wall, poses significant challenges in treatment. The literature primarily focuses on managing abnormal uterine bleeding (AUB) and dysmenorrhea, the main symptoms of adenomyosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid provide limited support...

Endometrial cancer (EC) is the most frequent gynaecological malignancy. The ESGO/ESTRO/ESP 2020 guidelines identify prognostic groups based on morpho-molecular characteristics. This study aims to evaluate the clinical applicability of NGS analysis to define an appropriate risk class and application for a better diagnostic and prognostic stratificat...

Endometrial cancer is an emerging disease with an increase in prevalence of aggressive histotypes in recent years. Background: In the present study, potential histopathological and immunohistochemical prognostic markers were investigated. Consecutive cases of high-grade non-endometrioid carcinoma (HG-NEC) of the endometrium were considered. Methods...

The objective of this work is to assess the 5-year outcomes of patients undergoing conization for high-grade cervical lesions that simultaneously present as risk factors in the persistence of HPV infection and the positivity of surgical resection margins. This is a retrospective study evaluating patients undergoing conization for high-grade cervica...

Objective To compare the ultrasonographic features of uterine scars and clinical symptoms after cesarean delivery (CD) using barbed and conventional smooth sutures. Methods This case–control study enrolled women who underwent primary CD at 37 weeks of pregnancy or later. The uterus was closed using either double‐layer unidirectional barbed suture...

Objective: To compare outcomes after hysterectomy and hysterectomy plus sentinel node mapping (SNM) in endometrial cancer (EC) patients. Materials and methods: This is a retrospective study, collecting data of EC patients treated between 2006 and 2016 in nine referral centers. Results: The study population included 398 (69.5%) and 174 (30.5%)...

Introduction/Background To compare outcomes after hysterectomy and hysterectomy plus sentinel node mapping (SNM) in endometrial cancer (EC) patients. Methodology This is a retrospective study, collecting data from EC patients treated between 2006 and 2016 in nine referral centers. Results The study population included 398 (69.5%) and 174 (30.5%)...

Introduction/Background Multicenter prospective clinical validation of the radiomic machine learning model (TRACE4OC) applied to transvaginal ultrasound (US) in predicting the risk of malignancy of adnexal masses. Methodology From a multicenter prospective consecutive series of women scheduled for surgery of adnexal masses, we collected and evalua...

Study Objective To evaluate ultrasonographic findings as a first-line imaging tool to indirectly predict the presence of parametrial endometriosis (PE) in women with suspected deep endometriosis (DE) undergoing surgery. Design Retrospective analysis of a prospectively collected database (ULTRA-PARAMETRENDO I study; NCT05239871). Setting Referral...

Introduzione La revisione della cavità uterina (RCU) è una delle procedure chirurgiche ostetrico-ginecologi-che maggiormente eseguite al mondo, riconoscendo tra le principali e più frequenti indicazioni il trattamento chirurgico dell'aborto, la ritenzione di materiale deciduo-coriale o placentare a seguito di parto e i sanguinamenti uterini anomali...

Introduzione Le cisti ovariche sono entità di comune riscontro in donne di tutte le età. Esse possono essere sia di natura organica che funzionale. Quando di natura organica, si tratta per lo più di tumori be-nigni quali teratomi maturi (cisti dermoidi), cistoadeno(fibro)mi sierosi (Figura 1) e cistoadenomi mucinosi (Figura 2); ma in una percentual...

Introduction: Uterine fibroids are the most common benign gynecological tumors affecting women of reproductive ages. Although surgery is a definitive choice for treating them, several medical approaches have been investigated to control their symptoms. However, the main issue of currently employed drugs for uterine fibroids is the long-term safety...

Background To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer. Methods This is a retrospective, a multi-institutional study evaluating 90-day surgery-related outcomes of patients undergoing treatment for early-stage cervical cancer bef...

Objective: Women undergoing premature surgical menopause following risk-reducing bilateral salpingo- oophorectomy (RRSO) experience early loss of estrogens. This causes, mainly in the first months after surgical proce-dure, a relevant worsening of global sexual health. This study aims to assess the efficacy of non-hormonal, prolonged- release hyalu...

Objective: A lower rate of anterior uterine wall defects after cesarean section, during which double layer barbed suture was employed for closing uterine wall, has been preliminary reported (NCT04825821). This study aims to estimate the impact of this suture on the thickness of III trimester lower uterine segment (SUI) in pregnancy subsequent cesar...

L’endometriosi profonda è definita convenzionalmente dalla presenza di lesioni endometriosiche con una profondità maggiore di 5 mm. Nonostante la terapia medica sia spesso raccomandata come prima linea, essa non è curativa per le pazienti affette da endometriosi profonda, per cui la chirurgia è spesso richiesta per il controllo della sintomatologia...

La miomectomia isteroscopica ha rappresentato una rivoluzione per il trattamento chirurgico dei miomi uterini sottomucosi evitando l’approccio laparotomico e consentendo una riduzione dei costi e della degenza ospedaliera con ottimi risultati. La prima resezione isteroscopica di un mioma uterino è stata descritta nel 1976 ; da allora, numerose evol...

Objective Sentinel lymph node mapping (SNM) has gained popularity in managing apparent early-stage endometrial cancer (EC). Here, we evaluated the long-term survival of three different approaches of nodal assessment. Methods This is a multi-institutional retrospective study evaluating long-term outcomes of EC patients having nodal assessment betwe...

Danazol and aromatase inhibitors have been used to treat endometriosis and adenomyosis because of their hypoestrogenic effects. Several randomized controlled trials showed the efficacy of danazol in treating endometriosis-related pain; however, danazol causes significant androgenic adverse effects that limit its long-term use. Aromatase inhibitors...

Background: Cervical dysplasia persistence/recurrence has a great impact on women’s health and quality of life. In this study, we investigated whether a prognostic nomogram may improve risk assessment after primary conization. Methods: This is a retrospective multi-institutional study based on charts of consecutive patients undergoing conization be...

Endometriosis is a chronic systemic disease that can cause pain, infertility, and reduced quality of life in those affected. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Diagnostic test accuracy research in endometriosis can be difficult due to verification bias, as not all patients with endometriosis u...

Correspondence to the original research entitled "Effects of ranibizumab and zoledronic acid on endometriosis in a rat model" published by Ozdemir et al. Keywords Ranibizumab · Endometriosis · Medical therapy · Zoledronic acid · Rat model Dear editor, We read with great interest an original research entitled "Effects of ranibizumab and zoledronic a...

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of CO...

Study Objective Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate the long-term survival of three different approaches of nodal assessment. Design A retrospective study evaluating long-term outcomes (at least 3 years of follow-up). Setting Multi-institut...

Objectives Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate the long-term survival of three different approaches of nodal assessment in low, intermediate, and high-risk EC. Methods This is a multi-institutional retrospective study evaluating long-term ou...

Objective To assess if patients with endometriosis and adenomyosis have macroscopic and/or microscopic placental alterations. Materials and Methods This prospective case-control study included pregnant women with endometriosis (n=253) or adenomyosis (n=133) and healthy controls (n=772). The diagnosis of endometriosis and adenomyosis was based on tr...

Introduction/Background* Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate the long-term survival of three different approaches of nodal assessment in low, intermediate, and high-risk EC. Methodology This is a multi-institutional retrospective study evalu...

Introduction In puerperium, the hypoestrogenic state induced by delivery and subsequently sustained by lactation may lead to vaginal dryness, burning, and itching sensation, contributing to the onset of sexual dysfunction. Material and methods This was a prospective, randomized, controlled, open-label study (NCT04560283) for evaluating the effects...

Objective To investigate factors predicting the risk of developing 90-day postoperative complications and lymphatic-specific morbidity in patients undergoing surgical staging for high-risk endometrial cancer. Methods This is a multi-institutional retrospective cohort study. Patients affected by apparent early-stage high-risk endometrial cancer (en...

Introduction : Uterine myomas and endometriosis are painful, benign hormone-dependent diseases affecting women of reproductive age. Substantial efforts have been made to develop innovative medical options for treating these gynecologic diseases. Elagolix and relugolix have been approved in some countries for treating endometriosis and uterine myoma...

Intrauterine pathologies are common in postmenopausal women and clinicians must identify signs and symptoms accurately to provide the adequate diagnosis and treatment. The quality of life (QoL) and sexuality of women are important outcomes to be considered to provide adequate clinical management of the postmenopausal patient with gynecologic pathol...

Introduction: Preoperative assessment of deep endometriotic (DE) nodules is necessary to inform patients about the possible treatments and provide informed consent in case of surgery. This study aims to investigate the diagnostic performance of rectal water-contrast transvaginal ultrasonography (RWC-TVS) and sonovaginography (SVG) in women with su...

Objective: The use of three-dimensional (3D) transvaginal ultrasonography (TVS) has been investigated for the diagnosis of deep endometriosis (DE). This study aimed to evaluate if 3D reconstructions improve the performance of TVS) in assessing the presence and characteristics of bladder endometriosis (BE). Design: This was a single-center compar...

Due to the high number of cesarean sections over the last two decades, there has been a growing awareness of the post-surgical obstetric long-term sequelae (i.e., uterine scar defects and abnormal placentation) following this surgical procedure. Knotless barbed suture is an absorbable bidirectional and unidirectional monofilament, characterized by...

Background Ovarian carcinoma (OC) is one of the most widespread tumors in the world and is characterized by low survival rates. Objective To determine whether the levonorgestrel‐releasing intrauterine system (LNG‐IUS) can prevent OC. Search strategy The literature until December 2020 were systematically reviewed according to the PRISMA Statement...

Background The recurrence of deep infiltrating endometriosis (DIE) after its surgical excision is a big problem: postoperative treatment is crucial. Objective To compare two postoperative treatments: Dienogest and GnRH agonists. Design Prospective Randomized Controlled Trial (RCT). Patients 146 women submitted to laparoscopic eradication of DIE...

High grade Non-Endometrioid Carcinomas (HG-NECs) represent a growing concern in gynecologic oncology, constantly rising in incidence and mortality in many countries. This heterogenous group of neoplasms has been long classified as Type II according to Bokhman classification introduced more than 30 years. Recently TCGA introduced a four-tiered class...

Introduzione I leiomiomi uterini, noti anche come fibromi o semplicemente come miomi, sono di comune riscontro nella pratica diagnostica in ginecopatologia. Costituiscono l'indicazione primaria all' isterectomia per le donne in età riproduttiva e sono responsabili di oltre 200000 isterectomie all'anno negli Stati Uniti (1). Generalmente non costitu...

Objective To evaluate the outcomes of high-risk (HR) HPV-positive and -negative women affected by high-grade cervical dysplasia. Methods This is a retrospective multi-institutional study. Medical records of consecutive patients with high-grade cervical dysplasia undergoing conization between 2010 and 2014 were retrieved. All patients included had...

Objective Sentinel node mapping (SLN) has replaced lymphadenectomy for staging surgery in apparent early-stage low and intermediate risk endometrial cancer (EC). Only limited data about the adoption of SNM in high risk EC is still available. Here, we evaluate the outcomes of high-risk EC undergoing SNM (with or without back-up lymphadenectomy). Me...

Objectives To evaluate the maternal and perinatal outcomes of pregnancies affected by SARS‐CoV‐2 infection. Methods This was a multinational retrospective cohort study including women with a singleton pregnancy and laboratory‐confirmed SARS‐CoV‐2 infection, conducted in 72 centers in 22 different countries in Europe, the USA, South America, Asia a...

The microanatomy of the blood vessels of the villous tree represents a topic of interest and many issues remain still open. In particular the histology and the evolution of the muscular wall of the vessels should be clarified in relation with the gestational age and possible adaptative phenomena. The fundamental morphologic works of several outstan...

Endometrial Carcinoma represents an always relevant topic in gynecologic oncology requiring a multidisciplinary team for correct diagnosis and management. In this context, finding potential prognostic parameters appears crucial. In 2013 TGCA classification, implementing the most recent “-omics” techniques, demonstrated a significant correlation wit...

Background: Primary prevention through vaccination is a prophylactic approach aiming to reduce the risk of developing human papillomavirus (HPV)-related lesions. No mature and long-term data supported the adoption of vaccination in women undergoing conization. Methods: This is a retrospective multi-institutional study. Charts of consecutive patient...

Research question Several studies investigated the reproductive outcomes following surgical treatment of colorectal endometriosis, mainly segmental colorectal resection. This study examines pregnancy and live birth rates of women with rectosigmoid endometriosis not treated by surgery. Design A retrospective analysis of data collected between May 2...

Purpose To explore the psychological status of infertile women and men who had in-vitro fertilization (IVF) treatment interrupted or postponed because of the COVID-19 emergency. Materials and methods An electronic survey (NCT04400942) was e-mailed between April and June 2020 to couples whose IVF treatments have been interrupted or postponed due to...

Study Objective Sentinel node mapping (SLNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate long-term survival of two different approaches of nodal assessment in EC. Design This is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years) of EC pa...

Introduction Pharmacotherapy has a key role in endometriosis treatment and management, however, a significant proportion of patients have only intermittent or limited benefits with current treatment options. Therefore, novel therapeutic approaches are necessary. Areas covered This systematic review provides an overview of the efficacy and safety o...

Tisotumab vedotin (TV) is a humanized antibody-drug conjugate (ADC) directed against tissue factor, a protein involved in signaling pathways related to angiogenesis, cell adhesion, motility and survival. It has been reported that tissue factor is aberrantly expressed by many types of solid tumors and it is associated with negative oncological outco...