- Obstetrics and Gynecology
- Minimally invasive gynecologic surgery
- Pelvic pain
- Alternatives to hysterectomy
- Heavy periods
- Ovarian masses/cysts
Clinical Associate Professor, Obstetrics & Gynecology
Director, Minimally Invasive Gynecologic Surgery, Stanford University (2015 - Present)
Honors & Awards
Phi Beta Kappa Honor Society, Dartmouth College (June 2002)
Rufus Choate Scholar, Dartmouth College (June 2002)
Alpha Omega Alpha Honor Society, University of California, San Francisco (May 2007)
Medical Residents Excellence Award, North American Menopause Society (October 2009)
Winner of UCSF Creative Writing Contest, University of California, San Francisco, Academic Diversity Program (June 2010)
AAGL Special Resident in Minimally Invasive Gynecology, American Association of Gynecologic Laparoscopists (AAGL) (June 2010)
First prize in Bay Area Resident Research, San Francisco Gynecological Society (June 2011)
Best Video in the Category of Education, American Association of Gynecologic Laparoscopists (AAGL) (November 2012)
First Prize Video Award at ACOG 2013 Annual Clinical Meeting Film Festival, American Congress of Obstetricians and Gynecologists (ACOG) (May 2013)
Kurt Semm award for the Best Video in the Category of Laparoscopic Hysterectomy Surgeries, American Association of Gynecologic Laparoscopists (AAGL) (November 2013)
Carlo Romanini Award for the Best Video in the Category of Endometriosis, American Association of Gynecologic Laparoscopists (AAGL) (November 2013)
Boards, Advisory Committees, Professional Organizations
Member, American Congress of Obstetricians and Gynecologists (ACOG) (2007 - Present)
Member, American Association of Gynecologic Laparoscopists (AAGL) (2010 - Present)
Peer Reviewer, Journal of Minimally Invasive Gynecology (2011 - Present)
Residency: University of California at San Francisco School of Medicine (2011) CA
Medical Education: University of California at San Francisco School of Medicine (2007) CA
Board Certification: American Board of Obstetrics and Gynecology, Obstetrics and Gynecology (2014)
Fellowship: University of Pittsburgh Medical Center (2013) PA
BA, Dartmouth College, NH (2002)
Community and International Work
Availability of anti-retroviral therapy in Kisumu, Kenya
Kenya Medical Research Institute
Opportunities for Student Involvement
J. William Fulbright Scholarship in Mokpo, South Korea
Fulbright US Scholar Program
Opportunities for Student Involvement
Detection of Circulating Tumor DNA in Patients With Uterine Leiomyomas.
JCO precision oncology
The preoperative distinction between uterine leiomyoma (LM) and leiomyosarcoma (LMS) is difficult, which may result in dissemination of an unexpected malignancy during surgery for a presumed benign lesion. An assay based on circulating tumor DNA (ctDNA) could help in the preoperative distinction between LM and LMS. This study addresses the feasibility of applying the two most frequently used approaches for detection of ctDNA: profiling of copy number alterations (CNAs) and point mutations in the plasma of patients with LM.By shallow whole-genome sequencing, we prospectively examined whether LM-derived ctDNA could be detected in plasma specimens of 12 patients. Plasma levels of lactate dehydrogenase, a marker suggested for the distinction between LM and LMS by prior studies, were also determined. We also profiled 36 LM tumor specimens by exome sequencing to develop a panel for targeted detection of point mutations in ctDNA of patients with LM.We identified tumor-derived CNAs in the plasma DNA of 50% (six of 12) of patients with LM. The lactate dehydrogenase levels did not allow for an accurate distinction between patients with LM and patients with LMS. We identified only two recurrently mutated genes in LM tumors (MED12 and ACLY).Our results show that LMs do shed DNA into the circulation, which provides an opportunity for the development of ctDNA-based testing to distinguish LM from LMS. Although we could not design an LM-specific panel for ctDNA profiling, we propose that the detection of CNAs or point mutations in selected tumor suppressor genes in ctDNA may favor a diagnosis of LMS, since these genes are not affected in LM.
View details for DOI 10.1200/po.18.00409
View details for PubMedID 32232185
View details for PubMedCentralID PMC7105159
- Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful? JOURNAL OF MAGNETIC RESONANCE IMAGING 2019; 49 (7): E271–E281
- Rising From the Ashes: Minimally Invasive Surgery in the Wake of Power Morcellation. Obstetrics and gynecology 2019; 134 (2): 225–26
Techniques in minimally invasive surgery for advanced endometriosis
CURRENT OPINION IN OBSTETRICS & GYNECOLOGY
2016; 28 (4): 316-322
Surgery can be an important treatment option for women with symptomatic endometriosis. This review summarizes the recommended preoperative work up and techniques in minimally invasive surgery for treatment of deeply infiltrating endometriosis (DIE) involving the obliterated posterior cul-de-sac, bowel, urinary tract, and extrapelvic locations.Surgical management of DIE can pose a challenge to the gynecologic surgeon given that an extensive dissection is usually necessary. Given the high risk of recurrence, it is vital that an adequate excision is performed. With improved imaging modalities, preoperative counseling and surgical planning can be optimized. It is essential to execute meticulous surgical technique and include a multidisciplinary surgical team when indicated for optimal results.Advanced laparoscopic skills are often necessary to completely excise DIE. A thorough preoperative work up is essential to provide correct patient counseling and incorporation of the preferred surgical team to decrease complications and optimize surgical outcomes. Surgical management of endometriosis is aimed at ameliorating symptoms and preventing recurrence.
View details for DOI 10.1097/GCO.0000000000000291
View details for Web of Science ID 000379586200015
View details for PubMedID 27273310
Impact of the 2014 Food and Drug Administration Warnings Against Power Morcellation
JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY
2016; 23 (4): 548-556
To determine whether members of the AAGL Advancing Minimally Invasive Gynecologic Surgery Worldwide (AAGL) and members of the American College of Obstetricians and Gynecologists Collaborative Ambulatory Research Network (ACOG CARN) have changed their clinical practice based on the 2014 Food and Drug Administration (FDA) warnings against power morcellation.A survey study.Participants were invited to complete this online survey (Canadian Task Force classification II-2).AAGL and ACOG CARN members.An online anonymous survey with 24 questions regarding demographics and changes to clinical practice during minimally invasive myomectomies and hysterectomies based on the 2014 FDA warnings against power morcellation.A total of 615 AAGL members and 54 ACOG CARN members responded (response rates of 8.2% and 60%, respectively). Before the FDA warnings, 85.8% and 86.9%, respectively, were using power morcellation during myomectomies and hysterectomies. After the FDA warnings, 71.1% and 75.8% of respondents reported stopping the use of power morcellation during myomectomies and hysterectomies. The most common reasons cited for discontinuing the use of power morcellation or using it less often were hospital mandate (45.6%), the concern for legal consequences (16.1%), and the April 2014 FDA warning (13.9%). Nearly half of the respondents (45.6%) reported an increase in their rate of laparotomy. Most (80.3%) believed that the 2014 FDA warnings have not led to an improvement in patient outcomes and have led to harming patients (55.1%).AAGL and ACOG CARN respondents reported decreased use of power morcellation during minimally invasive gynecologic surgery after the 2014 FDA warnings, the most common reason cited being hospital mandate. Rates of laparotomy have increased. Most members surveyed believe that the FDA warnings have not improved patient outcomes.
View details for DOI 10.1016/j.jmig.2016.01.019
View details for PubMedID 26827905
- Differences in Menstrual Cytokine Profiles of Women with and without Symptomatic Uterine Fibroids. F&S science 2023
What predicts durable symptom relief of uterine fibroids treated with MRI-guided focused ultrasound? A multicenter trial in 8 academic centers.
To identify variables predictive of durable clinical success after MRI-guided focused ultrasound (MRgFUS) treatment of uterine fibroids.In this prospective, multicenter trial, 99 women with symptomatic uterine fibroids were treated using MRgFUS. Pelvic MRI was obtained at baseline and treatment day. The Uterine Fibroid Symptom-Quality of Life questionnaire was used to calculate a symptom severity score (SSS) at baseline and 6, 12, 24, and 36 months following treatment. Clinical, imaging, and treatment variables were correlated with symptom reduction sustained through the 12- and 24-month time points using univariable and multivariable logistic regression analyses. A novel parameter, the ratio of non-perfused volume to total fibroid load (NPV/TFL), was developed to determine association with durable outcomes.Post-treatment, mean symptom severity decreased at the 6-, 12-, 24-, and 36-month follow-ups (p < 0.001, all time points). In univariable analysis, three variables predicted treatment success (defined by ≥ 30-point improvement in SSS) sustained at both the 12-month and 24-month time points: increasing ratio of NPV/TFL (p = 0.002), decreasing total fibroid load (p = 0.04), and the absence of T2-weighted Funaki type 2 fibroids (p = 0.02). In multivariable analysis, the NPV/TFL was the sole predictor of durable clinical success (p = 0.01). Patients with ratios below 30% had less improvement in SSS and lacked durable clinical response compared with those between 30-79 (p = 0.03) and ≥ 80% (p = 0.01).Increased non-perfused volume relative to total fibroid volume was significantly associated with durable reduction of symptoms of abnormal uterine bleeding and bulk bother.Patient selection for sustained clinical benefit should emphasize those with likelihood of achieving high ablation ratios, as determined by imaging (e.g., device access, Funaki type) and by considering the total fibroid load, not just the primary symptomatic fibroid.Clinical trial ID: NCT01285960.• Patient selection/treatment approach associated with durable symptom relief in MRI-guided focused ultrasound ablation of uterine fibroids remains unclear. • The ablation ratio, non-perfused volume/total fibroid volume, was positively associated with sustained symptom relief in both bleeding and bulk bother at 1- and 2-year follow-ups. • Selecting patients with imaging features that favor a high ratio of ablation to total fibroid load (including non-targeted fibroids) is the main factor in predicting durability of symptom relief after uterine fibroid treatment.
View details for DOI 10.1007/s00330-023-09984-4
View details for PubMedID 37553488
View details for PubMedCentralID 4561549
Women Physicians Receive Lower Press Ganey Patient Satisfaction Scores in a Multi-Center Study of Outpatient Gynecology Care.
American journal of obstetrics and gynecology
BACKGROUND: Emerging data suggests patient satisfaction data is subject to inherent biases that negatively impact women physicians.OBJECTIVE: To describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care.STUDY DESIGN: This was a multi-site, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from five unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 - April 2022. The primary outcome variable was likelihood to recommend a physician and individual survey responses served as the unit of analysis. Patient demographic data was collected through the survey, including self-reported age, gender, and race/ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic/LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and p-values for these analyses are reported and results were considered statistically significant at p<0.05. Analysis was performed using SAS (version 9.4, SAS Institute Inc., Cary, NC).RESULTS: Data were obtained from 15,184 surveys for 130 physicians, the majority were women (n=95, 73%) and White (n=98, 75%), and patients were also predominantly White (n=10,495, 69%). A little over half of all visits were race concordant, meaning both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% CI: 0.69 - 0.95). Patient age had a statistically significant relationship with score, with patients 63 and older having over a three-fold increase in odds of providing a topbox score (OR=3.10, 95% CI = 2.12 - 4.52) compared to the youngest patients. After adjustment, patient and physician race/ethnicity showed similar effects on the odds of a topbox likelihood to recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood to recommend score when compared to White physicians and patients (OR=0.89, 95% CI = 0.81 - 0.98 and OR = 0.62, 95% CI = 0.48 - 0.79 respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood to recommend score (OR=1.27, 95% CI = 1.21 - 1.33 and OR = 1.03, 95% CI = 1.01 - 1.06 respectively). Physician age quartile was not significantly associated with odds of a topbox likelihood to recommend score.CONCLUSIONS: Women gynecologists are 18% less likely to receive top patient satisfaction scores compared to men in this multi-site, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given they provide data currently being used to understand patient-centered care.
View details for DOI 10.1016/j.ajog.2023.06.023
View details for PubMedID 37330126
DIFFERENCES IN MENSTRUAL CYTOKINE PROFILES OF WOMEN WITH AND WITHOUT UTERINE FIBROIDS
ELSEVIER SCIENCE INC. 2022: E104-E105
View details for Web of Science ID 000891804600257
Sigma-1 Receptor Changes Observed in Chronic Pelvic Pain Patients: A Pilot PET/MRI Study.
Frontiers in pain research (Lausanne, Switzerland)
2021; 2: 711748
Introduction: Chronic pelvic pain is a highly prevalent pain condition among women, but identifying the exact cause of pelvic pain remains a significant diagnostic challenge. In this study, we explored a new diagnostic approach with PET/MRI of the sigma-1 receptor, a chaperone protein modulating ion channels for activating nociceptive processes. Methods: Our approach is implemented by a simultaneous PET/MRI scan with a novel radioligand [18F]FTC-146, which is highly specific to the sigma-1 receptor. We recruited 5 chronic pelvic pain patients and 5 healthy volunteers and compared our PET/MRI findings between these two groups. Results: All five patients showed abnormally increased radioligand uptake on PET compared to healthy controls at various organs, including the uterus, vagina, pelvic bowel, gluteus maximus muscle, and liver. However, on MRI, only 2 patients showed abnormalities that could be potentially associated with the pain symptoms. For a subset of patients, the association of pain and the abnormally increased radioligand uptake was further validated by successful pain relief outcomes following surgery or trigger point injections to the identified abnormalities. Conclusion: In this preliminary study, sigma-1 receptor PET/MRI demonstrated potential for identifying abnormalities associated with chronic pelvic pain. Future studies will need to correlate samples with imaging findings to further validate the correlation between S1R distribution and pathologies of chronic pelvic pain. Trial Registration: The clinical trial registration date is June 2, 2018, and the registration number of the study is NCT03195270 (https://clinicaltrials.gov/ct2/show/NCT03556137).
View details for DOI 10.3389/fpain.2021.711748
View details for PubMedID 35295458
PET/MR imaging of sigma-1 receptor pinpoints previously undetectable abnormalities in chronic pelvic pain
SOC NUCLEAR MEDICINE INC. 2020
View details for Web of Science ID 000568290500161
- Are fibroid and bony pelvis characteristics associated with urinary and pelvic symptom severity? MOSBY-ELSEVIER. 2019
Are Fibroid and Bony Pelvis Characteristics Associated with Urinary and Pelvic Symptom Severity?
American journal of obstetrics and gynecology
BACKGROUND: Urinary and pelvic floor symptoms are often attributed to size and location of uterine fibroids. However, direct supporting evidence linking increased size to worsening symptoms is scant and limited to ultrasound evaluation of fibroids. Because management of fibroids is targeted towards symptomatic relief, identification of fibroid and pelvic characteristics associated with worse symptoms is vital to optimizing therapies and preventing needless interventions.OBJECTIVES: We examined the correlation between urinary, pelvic floor and fibroid symptoms, and fibroid size and location using precise uterine fibroid and bony pelvis characteristics obtained from magnetic resonance imaging (MRI).STUDY DESIGN: A retrospective review (2013-2017) of a multidisciplinary fibroid clinic identified 338 women examined via pelvic MRI, Pelvic Floor Distress Inventory questionnaire (PFDI; score 0-300), and a Uterine Fibroid Symptoms questionnaire (UFS; score 1-100). Multiple linear regression analysis was used to assess the influence of clinical factors and MRI findings on scaled PFDI and UFS scores. Data were analyzed in STATA.RESULTS: Our cohort of 338 women had a median PFDI of 72.7 (IQR 41-112.3). Increased PFDI score was associated with clinical factors of higher BMI (p<0.001), non-commercial insurance (p<0.001), increased parity (p=0.001) and history of incontinence surgery (p=0.003). Uterine volume, dominant fibroid volume, dimension and location, and fibroid location relative to the bony pelvis structure did not reach significance when compared with pelvic floor symptom severity. The mean UFS score was 52.0 (SD 23.5). Increased UFS score was associated with dominant submucosal fibroid (p=0.011) as well as BMI (p<0.0016), and a clinical history of anemia (p<0.001) or any hormonal treatment for fibroids (p=0.009).CONCLUSION: Contrary to common belief, in this cohort of women presenting for fibroid care, size and position of fibroids or uterus were not associated with pelvic floor symptom severity. Whereas, bleeding symptom severity was associated with dominant submucosal fibroid and prior hormonal treatment. Careful attention to clinical factors such as BMI and medical history is recommended when evaluating pelvic floor symptoms in women with uterine fibroids.
View details for PubMedID 30711512
Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful?
Journal of magnetic resonance imaging : JMRI
BACKGROUND: Pelvic ultrasound (US) diagnosis of uterine fibroids may overlook coexisting gynecological conditions that contribute to women's symptoms.PURPOSE: To determine the added value of pelvic MRI for women diagnosed with symptomatic fibroids by US, and to identify clinical factors associated with additional MRI findings.STUDY TYPE: Retrospective observational study.POPULATION: In all, 367 consecutive women with fibroids diagnosed by US and referred to our multidisciplinary fibroid center between 2013-2017.FIELD STRENGTH/SEQUENCE: All patients had both pelvic US and MRI prior to their consultations. MRIs were performed at 1.5 T or 3 T and included multiplanar T2 -weighted sequences, and precontrast and postcontrast T1 -weighted imaging.ASSESSMENT: Demographics, symptoms, uterine fibroid symptom severity scores, and health-related quality of life scores, as well as imaging findings were evaluated.STATISTICAL TESTS: Patients were separated into two subgroups according to whether MRI provided additional findings to the initial US. Univariate and multivariate regression analyses were performed.RESULTS: Pelvic MRI provided additional information in 162 patients (44%; 95% confidence interval [CI] 39-49%). The most common significant findings were adenomyosis (22%), endometriosis (17%), and partially endocavitary fibroids (15%). Women with pelvic pain, health-related quality of life scores less than 30 out of 100, or multiple fibroids visualized on US had greater odds of additional MRI findings (odds ratio [OR] 1.68, 2.26, 1.63; P = 0.02, 0.004, 0.03, respectively), while nulliparous women had reduced odds (OR 0.55, P = 0.01). Patients with additional MRI findings were treated less often with uterine fibroid embolization (14% vs. 36%, P < 0.001) or MR-guided focused US (1% vs. 5%, P = 0.04), and more often with medical management (17% vs. 8%, P = 0.01).DATA CONCLUSION: Pelvic MRI revealed additional findings in more than 40% of women presenting with symptoms initially ascribed to fibroids by US. Further evaluation using MRI is particularly useful for parous women with pelvic pain, poor quality of life scores, and/or multiple fibroids.LEVEL OF EVIDENCE: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.
View details for PubMedID 30614145
- Minimally Invasive Surgery for Uterine Fibroids with Contained Tissue Extraction CURRENT WOMENS HEALTH REVIEWS 2018; 14 (1): 42–47
- Utility of MRI in deeply infiltrating endometriosis MOSBY-ELSEVIER. 2016: S513
- Impact of the 2014 FDA Warnings Against Laparoscopic Power Morcellation. Journal of minimally invasive gynecology 2015; 22 (6S): S77-?
- Conservative Laparoscopy for the Obliterated Posterior Cul-De-Sac. Journal of minimally invasive gynecology 2015; 22 (6S): S128-?
- Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy GYNECOLOGICAL SURGERY 2015; 12 (2): 89–93
Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy.
2015; 12 (2): 89-93
Studies have shown an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Patient variables associated with dehiscence have not been well described. This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n = 31) were matched by surgical mode to the next five total hysterectomies (n = 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight women (BMI < 25) to experience a dehiscence (p = 0.02). When stratified by hysterectomy route, obese women were 86 % less likely to have a dehiscence following robotic-assisted total hysterectomy (RAH) and TLH than normal weight women (p = 0.04). Further, increasing age was protective of dehiscence in this subgroup of women (p = 0.02). Older age and obesity were associated with a decreased risk of dehiscence following RAH and TLH but not following other routes. Increased risk of dehiscence following TLH observed in previous studies may be partially due to patient characteristics.
View details for PubMedID 25960707
Brush Cytology of the Fallopian Tube and Implications in Ovarian Cancer Screening
JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY
2014; 21 (5): 851-856
To determine whether fallopian tube epithelial cells adequate for cytopathology can be obtained via a minimally invasive approach using brush cytology.Prospective feasibility study (Canadian Task Force classification II-1).Tertiary-care university-based teaching hospital.Ten patients who underwent laparoscopic hysterectomy, with or without adnexal surgery, because of benign indications.Attempted hysteroscopic and laparoscopic brush cytologic sampling of the fallopian tubes.ThinPrep slides and cell blocks were prepared and analyzed. P53 and KI-67 immunostaining was performed on cell block specimens if adequate cellularity was present. The first 5 patients underwent attempted hysteroscopic sampling of the fallopian tube, with successful collection only in 1 patient. The protocol was then modified to enable sampling of the fallopian tube laparoscopically as well as hysteroscopically. In the other 5 patients sampling of the fallopian tubes was successful laparoscopically, including successful sampling hysteroscopically in 1 patient. The brush biopsy catheter could not be passed through the entire length of the fallopian tube in either the hysteroscopic or laparoscopic approach. All cytologic findings were interpreted as benign, although findings of nuclear overlapping, crowding, and small nucleoli were initially considered benign atypia. Immunohistochemistry for P53 and KI-67 yielded uniformly negative findings.To our knowledge, this is the first study to describe endoscopic brush cytology of the fallopian tubes with correlated cytologic narrative. In the future, cytologic sampling of the fallopian tube may have implications for an ovarian cancer screening test.
View details for DOI 10.1016/j.jmig.2014.03.017
View details for Web of Science ID 000342117800023
Utilization of and charges for robotic versus laparoscopic versus open surgery for endometrial cancer
JOURNAL OF SURGICAL ONCOLOGY
2013; 107 (6): 653-658
To analyze the utilization and hospital charges associated with robotic (RS) versus laparoscopic (LS) versus open surgery (OS) in endometrial cancer patients.Hospital discharge data were extracted from Florida Agency for Health Care Administration between October 2008 and December 2009.Of 2,247 patients (median age: 64 years), 29% had RS, 10% had LS, and 61% had OS. The mean length of hospital stay was 1.6, 1.8, and 3.9 days for RS, LS, and OS, respectively (P < 0.001). The median hospital charge was $51,569, $37,202, and $36,492, for RS, LS, and OS (P < 0.001), with operating room charges ($22,600, $13,684, and $11,272) accounting for the major difference. Robotic surgery utilization increased by 11% (23-34%) over time.In this statewide analysis of endometrial cancer patients, the utilization of robotic surgery increased and is associated with higher hospital charges compared to laparoscopic and open procedures.
View details for DOI 10.1002/jso.23275
View details for Web of Science ID 000317939400017
View details for PubMedID 23129514
- Laparoscopic management of rectus sheath hematomas. Journal of the Society of Laparoendoscopic Surgeons 2013
Cytologic Findings in Experimental in vivo Fallopian Tube Brush Specimens
2013; 57 (6): 611-618
The fallopian tube is now recognized as a primary source of precursor neoplastic lesions for pelvic serous adenocarcinomas. Cytologic features of fallopian tube brushings from low-risk patients have not been well described.We describe the cytomorphology of tubal epithelium from prospectively collected experimental in vivo brushings from normal fallopian tubes of 7 low-risk patients. Liquid-based cytology slides and cell blocks were prepared and reviewed on all specimens.Fifteen brush cytology specimens were obtained, ten by laparoscopy, four by hysteroscopy and one following hysterectomy and bilateral salpingo-oophorectomy on an ex vivo specimen. Variable cytologic features were documented for background, cellularity, cellular architecture, cilia, nuclear overlap, mitoses, nuclear pleomorphism, nuclear membrane changes and nucleoli. Negative P53 and Ki-67 stain results were documented in available cell blocks. Histopathologic salpingectomy findings and clinical follow-up were benign.Moderate nuclear pleomorphism and nuclear overlap, prominent single and multiple nucleoli and background granular debris were common challenging cytologic findings in fallopian tube brushings from low-risk patients. With experience, cellular changes can be recognized as benign. Recognition of the range of normal fallopian tube cytology should help to minimize false-positive interpretations of cytology specimens obtained in association with risk-reducing salpingo-oophorectomies.
View details for DOI 10.1159/000353825
View details for Web of Science ID 000327925900013
View details for PubMedID 24107657
- Cytologic findings in experimental in vivo fallopian tube brush specimens Acta Cytologica 2013
- Total laparoscopic hysterectomy Female Pelvic Medicine and Reconstructive Surgery McGraw Hill Publishers. 2012