Alice Lytwyn

McMaster University, Hamilton, Ontario, Canada

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Publications (53)197.78 Total impact

  • J Murphy · N.P. Varela · L Elit · A Lytwyn · M Yudin · M Shier · V Wu · S El-Khatib
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    ABSTRACT: The purpose of this guideline is to help ensure the provision of high-quality colposcopy practices in the province of Ontario, including those conducted as diagnostic procedures in follow-up to an abnormal cervical screening test. This document updates the recommendations published in the 2008 colposcopy guideline from Cancer Care Ontario, The Optimum Organization for the Delivery of Colposcopy Service in Ontario. A systematic review of guidelines was conducted to evaluate the existing evidence and recommendations concerning these key aspects of colposcopy: □ Training, qualification, accreditation, and maintenance of competence□ Practice setting requirements□ Operational practice□ Quality indicators and outcomes. This guideline provides recommendations on training and maintenance of competence for colposcopists in the practice settings in which colposcopic evaluation and treatments are conducted. It also provides recommendations on operational issues and quality indicators for colposcopy. This updated guideline is intended to support quality improvement for colposcopy for all indications, including the follow-up of an abnormal cervical screening test and work-up for lower genital tract lesions that are not clearly malignant. The recommendations contained in this document are intended for clinicians and institutions performing colposcopy in Ontario, and for policymakers and program planners involved in the delivery of colposcopy services.
    No preview · Article · Aug 2015 · Current Oncology
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    ABSTRACT: Objective. Morphologically, β-HCG secreting somatic carcinoma can be difficult to distinguish from epithelioid trophoblastic tumors (ETT). However, their distinction is critical due to their potentially differing prognoses and choice of chemotherapy. Presence of biparental alleles in ETT can be identified with molecular testing. We describe a patient who presented with metastatic carcinoma and elevated serum β-HCG and contrast this to an ETT in another patient. Data and Results. A 32-year-old female with recent possible miscarriage presented with pulmonary emboli and was found to have an increased serum β-HCG, a retroduodenal mass, and multiple nodules in her lungs, liver, and para-aortic lymph nodes. Biopsy showed a β-HCG and p63 positive epithelioid neoplasm with otherwise noncontributory immunohistochemistry. Molecular testing for biparental alleles in repeated length polymorphisms was negative, consistent with somatic origin. The second patient was a 35-year-old pregnant female with increased serum β-HCG and a uterine epithelioid tumor positive for β-HCG. Clinical and pathologic findings were characteristic of ETT and molecular testing was not required. These 2 cases illustrate that β-HCG secreting tumors of different etiologies may have similar appearances, and when clinical and/or IHC findings are inconclusive, molecular testing may be useful.
    Full-text · Article · May 2015
  • W Jimenez · J Maxwell · D Daya · M Sur · L Elit · L Eiriksson · C Reade · A Lytwyn

    No preview · Article · May 2015 · International Journal of Gynecological Cancer

  • No preview · Article · May 2015 · International Journal of Gynecological Cancer
  • Noori Akhtar-Danesh · Laurie Elit · Alice Lytwyn
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    ABSTRACT: Objective: The main objective of this article was to investigate the trends in relative survival in women diagnosed with invasive squamous cell vulvar cancer in the United States during the periods of 2004 to 2011 and to examine how these trends are associated with the stage of tumor at diagnosis. Methods: We identified patients with primary invasive squamous cell vulvar cancer and recorded tumor stage in the Surveillance, Epidemiology, and End Results cancer registry database. Women younger than 40 years were excluded because of small number of patients in this age group. A flexible parametric model was used to estimate 1- and 2-year relative survival ratios and excess mortality rate. Results: In total, 4647 women were identified with invasive squamous cell vulvar cancer and known tumor stage in the data set. One- and two-year relative survival ratios increased over time for women with tumors staged I to III but it decreased for women with tumor staged IV. The excess mortality rate was much larger for stage IV compared to the other stages. Conclusions: Trends in relative survival ratio for invasive vulvar cancer patients have opposite directions depending on the stage of tumor. The mechanism of such behavior is not fully known and yet to be examined in future studies. However, this finding highlights the importance of early detection of preinvasive and early stage disease.
    No preview · Article · Nov 2014 · International Journal of Gynecological Cancer
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    ABSTRACT: An APTIMA specimen collection and transportation (SCT) kit was developed by Hologic/Gen-Probe. To compare cervical SCT samples to PreservCyt and SurePath samples and self-collected vaginal samples to physician-collected vaginal and cervical SCT samples. To determine ease and comfort of self-collection with the kit. Each woman (n = 580) self-collected a vaginal SCT, then filled out a questionnaire (n = 563) to determine ease and comfort of self-collection. Colposcopy physicians collected a vaginal SCT and cervical PreservCyt, SCT, and SurePath samples. Samples were tested by APTIMA HPV (AHPV) assay. Agreement between testing of cervical SCT and PreservCyt was 91.1% (κ = 0.82), and that of SurePath samples was 86.7% (κ = 0.72). Agreement of self-collected vaginal SCT to physician-collected SCT was 84.7% (κ = 0.68), and that of self-collected vaginal to cervical SCT was 82.0% (κ = 0.63). For 30 patients with CIN2+, AHPV testing of cervical SCT was 100% sensitive and 59.8% specific compared with PreservCyt (96.6% and 66.2%) and SurePath (93.3% and 70.9%). Vaginal SCT sensitivity was 86.7% for self-collection and 80.0% for physician collection. Most patients found that vaginal self-collection was easy, 5.3% reported some difficulty, and 87.6% expressed no discomfort. Cervical samples collected with the new SCT kit compared well to traditional liquid-based samples tested by AHPV. Although there was good agreement between self-collected and physician-collected samples with the SCT, in a limited number of 30 women, vaginal sampling identified fewer with CIN2+ precancerous cervical lesions than cervical SCT sampling. Comfort, ease of use, and detection of high-risk HPV demonstrated that the kit could be used for cervical and vaginal sampling.
    No preview · Article · Jun 2014 · Sexually transmitted diseases
  • Noori Akhtar-Danesh · Laurie Elit · Alice Lytwyn
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    ABSTRACT: Aim: The aim of this study is to estimate trends in incidence and relative survival in women diagnosed with invasive squamous cell vulvar cancer in the United States (U.S.) and Canada over the periods of 1973-2010 for U.S. and 1992-2008 for Canada. Methods: We identified patients with primary invasive squamous cell vulvar cancers in the Surveillance, Epidemiology, and End Results cancer registry database and the Canadian Cancer Registry dataset. Women younger than 40 years were excluded because of the small number of patients in this age group. A flexible parametric model was used to estimate two- and five-year relative survival ratios and excess mortality rate. Results: In total 15,041 patients diagnosed with invasive squamous cell vulvar cancer were included in this analysis. The incidence rate of vulvar cancer increased in both U.S. and Canada. Two- and five-year relative survival ratios decreased over time for both countries, particularly for patients 80 years and over. Conclusions: The incidence rate of invasive vulvar cancer continued to increase in U.S. and Canada while its two- and five-year relative survival ratios gradually decreased for all age groups over the last few decades. Also, excess mortality rate reaches to its peak after about 6 months from diagnosis and then starts to decline. This is the first report that examine relative survival ratio for vulvar cancer in Canada and U.S. and serves as a basis for future similar studies.
    No preview · Article · May 2014 · Gynecologic Oncology
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    ABSTRACT: Use of a new collection kit for vaginal and cervical sampling was reported as easy by the majority of 692 women and not uncomfortable (by 87.4% of those ≥25 years old and 78.8% of those <25 years old). By Aptima testing, patient- and physician-collected samples agreed strongly for Chlamydia trachomatis (99.6% to 99.3%; κ = 0.93 to 0.89) and T. vaginalis (99.6% to 98.9%; κ = 0.97 to 0.78).
    Preview · Article · Dec 2013 · Journal of clinical microbiology
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    ABSTRACT: Liquid-based cytology (LBC) has been widely used for cervical cancer screening. Despite numerous studies and systematic reviews, to the authors' knowledge few large studies to date have focused on biopsy-confirmed cervical lesions and controversy remains concerning its diagnostic accuracy. The objective of the current study was to assess LBC for detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) and cancer. A pooled analysis of LBC using data from 13 population-based, cross-sectional, cervical cancer screening studies performed in China from 1999 to 2008 was performed. Participants (n = 26,782) received LBC and human papillomavirus testing. Women found to be positive on screening were referred for colposcopy and biopsy. The accuracy of LBC for detecting biopsy-confirmed CIN of type 2 or worse (CIN2+) as well as CIN type 3 or worse (CIN3+) lesions was analyzed. Of 25,830 women included in the analysis, CIN2+ was found in 107 of 2612 with atypical squamous cells (4.1%), 142 of 923 with low-grade squamous intraepithelial neoplasia (15.4%), 512 of 784 with high-grade squamous intraepithelial neoplasia (65.3%), 29 of 30 with squamous cell carcinoma (96.7%), 4 of 27 with atypical glandular cells (14.8%), and 85 of 21,454 with normal cytology results (0.4%). No invasive cancers were found to have atypical squamous cells, atypical glandular cells, or cytologically normal slides. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of LBC for detecting CIN2+ were 81.0%, 95.4%, 38.3%, 99.3 %, and 94.9%, respectively. Although Hybrid Capture 2 was more sensitive than LBC, the specificity, positive predictive value, and overall accuracy of LBC were higher than those of Hybrid Capture2 at 85.2%, 18.6%, and 85.5%, respectively. The results of the current study indicate that the performance of LBC can effectively predict the risk of existing CIN2+ and may be a good screening tool for cervical cancer prevention in a developing country. Cancer (Cancer Cytopathol) 2013;. © 2013 American Cancer Society.
    No preview · Article · Sep 2013 · Cancer Cytopathology
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    ABSTRACT: Invasive squamous cell carcinoma of the vulva with ≤1 mm stromal invasion is classified as stage 1A. Cancer staging systems state that the depth of invasion should be measured from the epithelial-stromal junction of the adjacent most superficial dermal papilla to the deepest point of the invasive tumor. Measurement of the depth of invasion guides patient management. Even though this measurement is critical, no studies have reported the reliability among pathologists for determining the cutoff point of ≤1 mm stromal invasion in vulvar cancer. We assessed agreement among pathologists for determining whether a vulvar tumor is invasive, for the depth of invasion, and for tumor thickness. Forty-five cases of vulvar squamous cell carcinoma with a depth of invasion of ≤5 mm were chosen. Eleven gynecologic pathologists independently reviewed the slides and, for a subset of cases, pictorially recorded measurements on photographs. The number of cases that were reported as invasive by the 11 pathologists ranged from 21 to 44. The number of cases that were reported as showing a depth of invasion of ≤1 mm ranged from 7 to 27. Eight pathologists provided measurements for all lesions reported as invasive, the remaining 3 pathologists stated that they were unable to measure 2, 7, and 16 lesions, respectively. Mean κ for diagnosing vulvar carcinoma as invasive was 0.24 and for measuring the depth of invasion and thickness was 0.51 and 0.49, respectively. There was only fair agreement in determining whether the lesion was invasive. In cases in which pathologists agreed upon the diagnosis of invasion, agreement on depth was moderate. When using the recommended cancer staging method, interpretation of the location of the most superficial dermal papilla varied among pathologists. Measuring thickness did not improve agreement. This is the first study that has assessed the reliability of the diagnosis of invasion in vulvar cancer among gynecologic pathologists, the interobserver agreement for reporting the critical 1 mm threshold of depth of stromal invasion, and the way in which the International Federation of Gynecology and Obstetrics method is used by pathologists.
    No preview · Article · Sep 2013 · The American journal of surgical pathology
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    ABSTRACT: A variety of terms have been used over the years to define a set of early invasive squamous carcinomas of the uterine cervix that can be treated by local excision only. The Lower Anogenital Squamous Terminology consensus group has recommended that the term “superficially invasive squamous cell carcinoma” (SISCCA) be used for any genital invasive squamous carcinoma that can be managed by local excision only. The definition of SISCCA varies by genital site. A diagnosis of SISCCA of the uterine cervix requires that the invasive lesion was not visualized, has been completely excised, has a depth of invasion no more than 3 mm, and has a horizontal extent of no more than 7 mm. Lymphovascular invasion may or may not be present and should be noted. Superficially invasive squamous cell carcinoma of the uterine cervix is synonymous with an International Federation of Gynecology and Obstetrics stage IA1 carcinoma. This review addresses morphologic challenges that can be seen in the diagnosis of SISCCA including the identification of early invasion, measurements of depth and horizontal extent, and the assessment of circumferential involvement and margin status.
    No preview · Article · Jul 2013 · Pathology Case Reviews
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    ABSTRACT: Correlation of intraoperative frozen section diagnosis with final diagnosis can be an important component of an institution’s quality assurance process. We performed a quality assurance review of 1207 frozen section diagnoses from 812 surgical cases performed in the Hamilton Regional Laboratory Medicine Programme during a 6-month period in 2007. We reviewed the frozen section and permanent slides from all potentially discordant cases using a multiheaded microscope to arrive at a consensus pertaining to the type and reason for error. We reviewed the clinical record to determine whether there had been a potential adverse impact on immediate clinical management. Frozen sections were most commonly requested for head and neck, nervous system and female genital tract specimens. Twenty-eight frozen sections (3%) were deferred. We identified 24 discordant diagnoses involving 3% of cases and 2% of specimens. The organ systems showing the greatest frequency of discordance relative to the total number from that system were the nervous system, head and neck, and the lungs. Of the errors identified, most occurred owing to diagnostic misinterpretation, followed by problems related to tissue sampling. There was a potential adverse impact on immediate clinical management in 14 cases. Our results add to the Canadian data on the correlation between frozen sections and permanent sections; we note comparability to the concordance rates reported in the literature.
    No preview · Article · Jun 2013 · Canadian journal of surgery. Journal canadien de chirurgie
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    ABSTRACT: Studies have suggested serous tubal intraepithelial carcinoma (STIC) of the fallopian tube to be a putative precursor to ovarian and peritoneal serous carcinoma. It has been recommended that resected fallopian tube specimens should be rigorously examined for STIC, especially in women at high risk of serous carcinoma, such as those with BRCA mutations or with a strong family history. The SEE-FIM protocol allows for the greatest surface area of the tube to be histologically assessed. There have been suggestions that multiple deeper sections should be examined if the initial hematoxylin and eosin (H&E) sections are negative; however, whether this identifies more cases of STIC has not rigorously examined. We examined deeper sections from 56 cases of pelvic carcinoma in which the initial H&E sections of the fallopian tubes were negative for STIC. All initial and deeper sections underwent consensus review by panel of experts in gynecologic pathology. These cases are part of a larger study in which we had examined 300 consecutive bilateral salpingectomies using the SEE-FIM protocol and a single-H&E section per block and had identified 68 cases of pelvic serous carcinoma, of which 12 were associated with STIC. We calculated the sensitivity of a single-H&E section to detect STIC, as compared with examination of multiple deeper sections, and reevaluated the clinicopathologic data of the parent study in light of the additional cases of STIC. In the 56 cases initially negative for STIC, 4 cases of STIC were identified after examination of multiple deeper sections of the fallopian tubes. The single-H&E section SEE-FIM approach therefore detected only 75% (95% confidence interval, 51%-90%) of STIC that was present. Three of these new cases were associated with primary ovarian serous carcinoma and 1 with primary peritoneal serous carcinoma. All 3 new cases associated with ovarian carcinoma were noted in women without neoadjuvant chemotherapy. In considering the data from the parent study, we calculated a statistically significant lower incidence of STIC in women with ovarian serous carcinoma who received neoadjuvant chemotherapy as compared with those who did not (P=0.042). Our study demonstrated that additional cases of STIC can be detected if deeper sections are examined. These additional cases also highlighted a statistically significant difference in the incidence of STIC associated with ovarian serous carcinoma who received neoadjuvant chemotherapy relative to those who did not. Consideration to this should be given in future studies of the prevalence of STIC and to routine examination of salpingectomy specimens from women at high risk for pelvic serous carcinoma.
    No preview · Article · May 2013 · International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists
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    ABSTRACT: Recent studies have demonstrated the value of ancillary techniques, including p57 immunohistochemistry and short tandem repeat genotyping, for distinguishing hydatidiform moles (HM) from nonmolar specimens and for subtyping HMs as complete hydatidiform moles (CHM) and partial hydatidiform moles (PHM). With rare exceptions, CHMs are p57-negative and androgenetic diploid; partial hydatidiform moles are p57-positive and diandric triploid; and nonmolar specimens are p57-positive and biparental diploid. Androgenetic/biparental mosaic/chimeric conceptions can have morphologic features that overlap with HMs but are genetically distinct. This study characterizes 11 androgenetic/biparental mosaic/chimeric conceptions identified in a series of 473 products of conception specimens subjected to p57 immunohistochemistry and short tandem repeat genotyping. Fluorescence in situ hybridization was performed on 10 to assess ploidy. All cases were characterized by hydropically enlarged, variably sized and shaped villi. In 5 cases, the villi lacked trophoblastic hyperplasia, whereas in 6 there was a focal to extensive villous component with trophoblastic hyperplasia and features of CHM. The villi lacking trophoblastic hyperplasia were characterized by discordant p57 expression within individual villi (p57-positive cytotrophoblast and p57-negative stromal cells), whereas the villous components having trophoblastic hyperplasia were uniformly p57-negative in both cell types. Short tandem repeat genotyping of at least 2 villous areas in each case demonstrated an excess of paternal alleles in all regions, with variable paternal:maternal allele ratios (usually >2:1); pure androgenetic diploidy was identified in those cases with a sufficiently sized villous component having trophoblastic hyperplasia and features of CHM. Fluorescence in situ hybridization demonstrated uniform diploidy in 7 cases, including 4 of 5 tested cases with trophoblastic hyperplasia and 3 of 5 cases without trophoblastic hyperplasia. Two cases without trophoblastic hyperplasia had uniformly diploid villous stromal cells but 1 had triploid and 1 had tetraploid cytotrophoblast; 1 case with trophoblastic hyperplasia had uniformly diploid villous stromal cells but a mixture of diploid, triploid, and tetraploid cytotrophoblast. In 3 cases with a CHM component, persistent gestational trophoblastic disease developed. These results indicate that androgenetic/biparental mosaic/chimeric conceptions are most often an admixture of androgenetic diploid (p57-negative) and biparental diploid (p57-positive) cell lines but some have localized hyperdiploid components. Recognition of their distinctive p57 expression patterns and genotyping results can prevent misclassification as typical CHMs, PHMs, or nonmolar specimens. The presence of androgenetic cell lines, particularly in those with a purely androgenetic CHM component, warrants follow-up because of some risk of persistent gestational trophoblastic disease.
    No preview · Article · Jan 2013 · International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists
  • Noori Akhtar-Danesh · Alice Lytwyn · Laurie Elit
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    ABSTRACT: Objective: To estimate and compare the five-year trends in excess mortality rate, net probability of death, and crude probability of death for patients diagnosed with epithelial invasive gynecological cancers in Canada. We compared these trends among ovarian, uterine, and cervical cancers. Methods: A flexible parametric model was used to estimate the three mortality indices for gynecological cancers. We incorporated age group, type of cancer, and year of diagnosis in the model to estimate these indices over a five-year period after diagnosis. Results: In total, 39,681 women who were diagnosed with epithelial invasive gynecological cancers were included in this analysis with a mean age of 57.9 (SD=15.1) years at diagnosis. Approximately 30% of patients were younger than 50 years old at diagnosis and 45% were between 50 and 69 years old. Ovarian cancer had the worst prognosis among the gynecological cancers based on all three mortality indices. Conclusions: The three mortality indices provide a clear insight in understanding the elements of mortality in population-based cancer studies where the underlying cause of death is not correctly identified, the accuracy of death certificates varies overtime and among countries, and death tends to be a multi-factorial event.
    No preview · Article · Aug 2012 · Gynecologic Oncology
  • Noori Akhtar-Danesh · Laurie Elit · Alice Lytwyn
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    ABSTRACT: Cervical cancer was estimated to affect approximately 1300 women in Canada in 2011, and 350 women were expected to die from this disease. We estimated the trends in the relative survival ratio for patients diagnosed with epithelial invasive cervical cancer in Canadian population during the period 1992-2005. A flexible parametric model was used to estimate the relative survival ratio. Relative survival ratio is defined as the observed survival among patients with cancer divided by the expected survival in the general population. We incorporated age group, histology of tumor, geographical region, and year of diagnosis in the model to predict 2- and 5-year relative survival ratios. A total of 13,424 patients with a diagnosis of epithelial invasive cervical cancer were included in this analysis, whose mean (SD) age was 49.3 (16.0) years at the time of diagnosis. The histologic classification of the cervical tumor was squamous for 75.4% of the cases followed by glandular for 18.5% of the cases. Other epithelial tumors accounted for 6.2% of the cases. The same pattern was observed for all regions. The glandular and the "other epithelial" cancers had the best and worst survival, respectively. Fifty percent of all cases were diagnosed in Ontario. This article indicates gradual improvements for relative survival ratio for all age groups, all types of tumor, and all geographical regions in Canada during the 1992-2005 period. The improvements may be related to evolutions in screening, diagnosis, and treatment. Further progress may be achieved by extending the screening coverage, possibly changing the screening test, or advances in treatment.
    No preview · Article · Jul 2012 · International Journal of Gynecological Cancer
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    ABSTRACT: Serous tubal intraepithelial carcinoma (STIC) has been implicated in the pathogenesis of pelvic serous carcinoma. We hypothesized that, if this is the case, the frequency of STIC should be substantially lower in endometrial serous carcinomas, in nonserous gynecologic malignancies, and in benign gynecologic neoplasms than in ovarian or peritoneal serous carcinomas. From 2007 to 2009 the fallopian tubes of 342 consecutive gynecologic cases were entirely submitted for histology using the Sectioning and Extensively Examining the FIMbriated end protocol. This study included 300 of these cases (277 TAH-BSO, 23 BSO) after exclusion. The hematoxylin and eosin-stained slides from the fallopian tubes were independently reviewed by 2 gynecologic pathologists who were blinded to all other findings; disagreements were resolved by a third pathologist. Among 46 cases of ovarian malignancies, STIC was identified in 6 (18.8%) of 32 cases of serous carcinoma, but not in any other subtype. Similarly, STIC coexisted in 4 (14.3%) of 28 cases of endometrial serous carcinoma; however, no STIC was identified in any of the 74 cases of nonserous endometrial malignancies. STIC was identified in 2 (28.6%) of 7 cases of peritoneal serous carcinoma. No STIC was identified among 15 nongynecologic malignancies, 90 cases of benign conditions, and 27 cases of other conditions including 4 cases of cervical adenocarcinoma in situ and high-grade cervical intraepithelial lesions, 8 cases of endometrial atypical complex hyperplasias, and 15 cases of ovarian borderline tumors. In conclusion, the fallopian tube may be the origin of some pelvic serous carcinomas. Other possibilities that may explain the origin of pelvic high-grade serous carcinoma are discussed. Given that STIC coexisted with 14% of endometrial serous carcinomas, a more unifying theory may be that gynecologic serous carcinomas and STIC are multifocal lesions.
    No preview · Article · Mar 2012 · International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists
  • Laurie Elit · Alice Lytwyn · Noori Akhtar-Danesh

    No preview · Article · Jan 2012 · Journal of Cancer Therapy
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    ABSTRACT: Background: Performance of HPV assays on less invasive specimens can be assessed through agreement of assays and specimen types as well as the ability to identify patients with precancerous lesions. Objectives: To compare the APTIMA HPV (AHPV) E6/E7 mRNA assay to the HC2 DNA test for high risk (HR) HPV performed on PreservCyt L-Pap cervical specimens and flocked self-collected vaginal swabs (SCVS) transported to the laboratory wet or dry. Results: Testing specimens from 100 women attending a colposcopy clinic showed 90.7% (k=0.81) agreement between HC2 and AHPV assays for PreservCyt specimens. Agreement was 80.2% (K=0.80) to 88.0% (K=0.76) between L-Pap and wet and dry SCVS respectively and 89.2% (K=0.77) between the 2 SCVS by AHPV testing. For HC2, the agreement was 90.6% (k=0.81) to 89.2% (k=0.78) between L-Pap and the 2 swabs and 96.0% (k=0.90) between wet and dry swabs. Using pathology (CIN2+) as the reference standard, SCVS tested by AHPV demonstrated sensitivities of 88.8% for dry and 90% for wet SCVS, compared to 86.4% for L-Pap samples. HC2 testing of wet and dry SCVS was 70.8% sensitive compared to 94.4% for L-Pap samples. Conclusion: SCVS collected with flocked nylon swabs transported wet or dry may serve as alternative specimens for HPV testing of women who are reluctant to have a pelvic examination.
    No preview · Article · Jan 2012 · Journal of Analytical Oncology
  • Noori Akhtar-Danesh · Laurie Elit · Alice Lytwyn
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    ABSTRACT: Ovarian cancer affects about 2600 women annually in Canada and about 1750 are expected to die from this disease. We estimated the trends in the relative survival ratio for patients diagnosed with epithelial invasive ovarian cancer in Canadian population between 1992 and 2005. A flexible parametric model was used to estimate the relative survival ratio. Relative survival ratio is defined as the observed survival among cancer patients divided by the expected survival in the general population. We incorporated age group, histology of tumour, and region of patient residence at the time of diagnosis into a model to predict two- and five-year relative survival ratios based on the year of diagnosis where the effect of each variable was adjusted for the effects of the other variables. A restricted cubic splines with five knots was used to include year of diagnosis in the model. In total 7771 patients diagnosed with epithelial invasive ovarian cancer were included in this analysis with the mean age of 59.6 (SD=13.5) years at the time of diagnosis. About 75% of the patients were 50 years and older at the time of diagnosis and relative survival ratio substantially decreased with age. The tumour type was serous for 43% of cases followed by endometrioid (30.5%), clear cell (14.5%), mucinous (9.5%), and transitional cell (2.5%). The same pattern was observed for all regions although with some variation in the proportions. The worst survival observed for serous tumours. About 50% of the cases were diagnosed in Ontario. This is the first report that compares relative survival ratio for epithelial invasive ovarian cancer among geographic regions of Canada where a higher relative survival ratio was observed in Ontario compared to the other regions. The relative survival decreased with age and showed geographic variation. The work indicates that advances in management of women with ovarian cancer have improved two- and five-year relative survival ratios.
    No preview · Article · Aug 2011 · Gynecologic Oncology

Publication Stats

1k Citations
197.78 Total Impact Points

Institutions

  • 2000-2015
    • McMaster University
      • • Department of Pathology and Molecular Medicine
      • • Department of Clinical Epidemiology and Biostatistics
      • • Department of Family Medicine
      Hamilton, Ontario, Canada
    • Women's College Hospital
      Toronto, Ontario, Canada
  • 1999-2003
    • University of Toronto
      Toronto, Ontario, Canada
  • 2001
    • Sunnybrook Health Sciences Centre
      Toronto, Ontario, Canada