This case report describes an exceptionally late mesh-related complication occurring 16 years after transobturator tape placement for stress urinary incontinence. The patient developed a recurrent vaginocutaneous fistula and abscess 9 years after partial mesh removal, highlighting the long-term risks associated with retained synthetic material. Clinical presentation included persistent purulent discharge and inguinal abscess, with MRI confirming infection of the remaining sling arm and fistulization to the thigh. Complete surgical excision led to full recovery. This case emphasizes the potential for delayed mesh complications, even after prolonged asymptomatic periods. It underscores the importance of considering mesh-related pathology in patients with atypical infections and a remote surgical history, the key role of imaging in diagnosis, and the need for individualized, multidisciplinary management. Long-term vigilance and thorough patient counseling remain essential.
OBJECTIVE:To evaluate the effectiveness and tolerability of dienogest in patients with endometriosis in real-world clinical practice. METHODS:This cross-sectional observational study was based on a self-administered questionnaire in which patients retrospectively reported their symptoms and quality of life before dienogest initiation, as well as perceived treatment effectiveness and tolerability. The questionnaire was distributed to patients followed for endometriosis within a regional endometriosis care network (April 2024-September 2025). Participants assessed symptom improvement, overall quality of life before and during treatment, the frequency of adverse events, and treatment continuation or discontinuation. Changes in quality of life before and after treatment were analysed using the Wilcoxon test. RESULTS:A total of 146 patients were included. Complete resolution of dysmenorrhea was reported by 44.7% of patients with baseline dysmenorrhea (55/123). Overall quality of life significantly improved under treatment (4.4 ± 2.3 vs 5.5 ± 2.6; p<0.001). All patients reported at least one adverse event; the most frequent were fatigue (63.0%), decreased libido (58.3%), and mood disturbances (50.7%). Treatment was discontinued by 40.4% of patients, mainly due to adverse events. Some symptom improvements and adverse events varied according to treatment duration. CONCLUSIONS:In this real-world patient-reported study, patients reported improvement under dienogest treatment, particularly for dysmenorrhea and overall quality of life. However, frequent adverse events and treatment discontinuation suggest that tolerability may limit long-term adherence.
INTRODUCTION:Postpartum perineal pain is a common condition that may interfere with functional recovery. This study aimed to characterize its temporal evolution, anatomical distribution and functional impact during the first 90 days after vaginal birth. METHODS:Prospective cohort study including 106 women following vaginal delivery. Participants were assessed using structured digital questionnaires at eight time points (1, 2, 7, 15, 21, 30, 60 and 90 days postpartum). Pain intensity was measured using a numerical rating scale (PNRS), and location was recorded using a standardized neuroanatomical perineal map. Pain triggers, treatments and functional limitations were also documented. RESULTS:Perineal pain was highly prevalent in the immediate postpartum period and declined over time, but remained clinically relevant. At 15 days, 78% of women reported pain, decreasing to 50% at one month and 25% at two months. At 90 days, 13.3% still reported persistent pain, generally mild to moderate. Pain was most frequently localized in the lower vulvar and vulvoanal regions, with a modest right-sided predominance. Approximately one-third of women reported limitations in sitting, standing or walking. Women reporting persistent pain were less likely to have resumed sexual activity and more frequently reported continued analgesic use during follow-up. CONCLUSIONS:Postpartum perineal pain is common, functionally relevant and may persist for months after vaginal birth. Recognition of its temporal evolution, anatomical distribution and functional impact may facilitate a more comprehensive clinical assessment during the postpartum period.
Objective To evaluate the feasibility and effectiveness of vaginal ethanol sclerotherapy (EST) for ovarian endometriomas, with a focus on recurrence and subsequent fertility outcomes. Materials and Methods We conducted a retrospective study including all patients who underwent vaginal EST at the Strasbourg University Hospitals from January 2015 to March 2024. Diagnosis was based on transvaginal ultrasound, with MRI confirmation in selected cases. The primary endpoint was recurrence, defined as reappearance of an endometrioma >30 mm at least one month after treatment. Secondary outcomes were postoperative complications and fertility outcomes. Results Among 129 procedures scheduled, 118 were performed and analyzed. Three cases required conversion to laparoscopy. The mean patient age was 32 years, and 87% had a history of infertility. Endometriomas had a mean diameter of 50 mm; 28% of treated ovaries had a prior surgical history. The recurrence rate was 12.7% (15/118), with a mean time to recurrence of 3 months and mean cyst diameter of 55 mm. Perioperative complications included three alcohol leaks (2.5%) and one hemoperitoneum (0.8%). Postoperative complications occurred in 1.6% of cases, including one infected hematoma and one peritonitis. Among patients desiring pregnancy (n=86), 41.9% conceived, 69.4% of which resulted in live births. Most pregnancies (83.3%) were achieved through assisted reproductive technology. Conclusion Vaginal EST appears to be a feasible and safe alternative to cystectomy, with a low recurrence rate and a favorable impact on fertility outcomes. It may represent a promising fertility-preserving option for women with endometriomas and diminished ovarian reserve.
OBJECTIVE:To examine the association between socioeconomic status (SES) on long-acting reversible contraception (LARC) discontinuation. METHODS:We analyzed a national cohort of women born between 1980-1984 in the National Longitudinal Survey of Youth (NLSY97). We used 2005-2021 NSLY97 cycles, including the first cycle respondents were ≥18 years, sexually active, and using LARC. Respondents were tracked until they either reported using non-LARC contraception, were not using any contraceptives, became pregnant, or were lost to follow-up. SES characteristics were ascertained at respondents' first eligible cycle, including: Family income relative to the Federal Poverty Level (FPL), insurance, education, and employment. LARC discontinuation was categorized as stopping contraception, switching to non-LARC contraception, pregnancy, or continuing LARC throughout the study. Mixed-effects multinomial logistic regression with cluster-robust standard errors modeled continued LARC use as a function of SES. RESULTS:Our cohort contained 435 women contributing 893 interviews. At the last interview, 23% of respondents still used LARC, 19% stopped contraception, 20% switched to another contraceptive, and 38% became pregnant. On multivariable regression, respondents between 300-399% FPL had an increased likelihood of stopping LARC (relative risk ratio [RRR]: 7.65; 95% confidence interval [CI]: 1.72, 33.93; p=0.007) while respondents between 100-199% FPL had a decreased likelihood of becoming pregnant (RRR: 0.28; 95% CI: 0.13, 0.61; p=0.001). There were no other significant associations between SES and LARC discontinuation. CONCLUSIONS:Our analysis found no consistent relationship between SES and LARC discontinuation. While SES may influence the decision to initiate LARC, SES may not influence the decision to discontinue LARC.
In recent years, the fertility and parenthood of transgender men have emerged as significant medical and societal subjects. Since the 2016 french legal reform, transgender men have been able to retain their reproductive organs, opening the door to discussions regarding their fertility and pathways to parenthood. To evaluate the medical, legal, and ethical issues associated with the fertility of transgender men in France, we have analysed three scenarios adapted from real clinical cases and contrasted them with the existing literature: a termination of pregnancy (abortion), a medical termination of pregnancy (TOP), and a continued pregnancy. These cases illustrate the specific challenges encountered in practice: lack of awareness regarding reproductive risks, legal hurdles in accessing abortion and medical termination of pregnancy, the impact of bodily dysphoria during pregnancy, issues surrounding legal parentage, and the still-limited utilization of oocyte cryopreservation. The literature confirms that testosterone does not constitute a reliable method of contraception and that parenthood for transgender men remains hindered by medical, social, and legal barriers. The management of fertility in transgender men must be multidisciplinary, inclusive, and tailored to legislative developments in order to meet growing needs in contraception, oocyte preservation, and parenthood.
OBJECTIVE:To investigate the association between air travel during early pregnancy and the risk of spontaneous miscarriage. SETTING:This population-based retrospective cohort study included completed singleton pregnancies ending in either a first-trimester spontaneous miscarriage or a live birth between 2010 and 2019. Only pregnancies with a confirmed last menstrual period (LMP) date were included to ensure accurate temporal assessment of air travel in relation to pregnancy outcome. METHODS:Singleton pregnancies resulting in live birth were compared with those ending in spontaneous miscarriage during the first trimester. Air travel between 4 + 0 and 13+6 weeks of gestation was defined as the primary exposure. Spontaneous miscarriage was identified using ICD-9 codes. Multivariable logistic regression was performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS:A total of 439,990 pregnancies were analyzed, including 427,727 live births (97.2%) and 12,263 miscarriages (2.8%). Air travel during the first trimester was more common among women who experienced miscarriage compared to those with live births (0.01% vs. 0.00,014 %, P < 0.001). After adjustment for potential confounders, air travel was associated with more than fivefold higher odds of miscarriage (aOR 5.20, 95% CI 4.38-6.33). CONCLUSION:Air travel during the first trimester was associated with an increased risk of spontaneous miscarriage. While causality cannot be established, these findings may have implications for counseling women considering air travel during early pregnancy.
INTRODUCTION:Operative hysteroscopy is widely used for intrauterine pathologies, but the impact of hysteroscope diameter on intraoperative safety remains under-evaluated. This study compared intraoperative complications using 18 Fr versus 26 Fr operative hysteroscopes. MATERIAL AND METHODS:We conducted a prospective single-center observational study in a French university hospital. Women undergoing operative hysteroscopy for polypectomy, myomectomy, or endometrial resection between June 2023 and May 2024 were included without exclusion criteria. Procedures were performed by four senior surgeons who regularly used both systems. Hysteroscope selection (18 Fr vs 26 Fr) was at the surgeon's discretion based on clinical and technical considerations. The primary outcome was intraoperative complications. Secondary outcomes included procedure completeness, operative time, postoperative pain, and distension fluid deficit. RESULTS:A total of 117 procedures were analyzed (18 Fr, n=89; 26 Fr, n=28). Intraoperative complications occurred in 11 cases (9.4%), including 9 cervical lacerations and 2 uterine perforations. Complications were less frequent with the 18 Fr hysteroscope (5.6% vs 21.4%; OR 0.22; 95% CI, 0.06-0.78). Procedure completeness (89.8% vs 85.2%; p=0.51), operative time (18.2 ± 9.1 vs 23.0 ± 11.8 min; p=0.09), and postoperative pain (4.5% vs 3.6%; p=0.88) were similar. A fluid deficit ≥1500 mL occurred less frequently with 18 Fr (2.2% vs 14.3%; OR 0.14; 95% CI, 0.02-0.80). DISCUSSION:Smaller diameter hysteroscopes were associated with fewer intraoperative complications, particularly cervical trauma, without compromising procedural outcomes. CONCLUSION:Use of an 18 Fr operative hysteroscope was associated with improved intraoperative safety without loss of effectiveness or efficiency.
OBJECTIVES:To estimate the probability of histologically confirmed cervical high-grade intraepithelial lesions and cancer (HGIL+) among women referred for colposcopy after ASCH cytology, and to determine whether this probability differs when ASCH is reported as triage after a positive primary HPV test. METHODS:We conducted a retrospective two-center study including women referred for colposcopy following ASCH cytology between 2018 and 2024. ASCH was classified as either a primary screening result or triage after positive HPV testing. Clinical, cytological, colposcopic, and histological data were extracted. The primary outcome was histologically confirmed HGIL+, defined as high-grade cervical or vaginal intraepithelial lesion and/or cervical cancer diagnosed on biopsy and/or LLETZ specimen. RESULTS:Overall, 421 colposcopies performed after ASCH cytology were included. ASCH was reported as a primary screening result in 185 cases (43.9%) and as triage after positive HPV testing in 236 cases (56.1%). HGIL+ was diagnosed in 213 women (50.6%), including 202 cervical HGIL, five vaginal HGIL, and six cervical cancers. The HGIL+ rate did not differ significantly between primary cytology and HPV-positive triage: 102/185 (55.1%) versus 111/236 (47.0%) (p = 0.099). The HGIL+ rate varied significantly with age and was the lowest in women older than 50 years: 45.5% before 30 years, 56.3% between 30 and 50 years, and 40.5% after 50 years (p = 0.017). CONCLUSION:The probability of HGIL+ among women referred after ASCH cytology was approximately 50%. This probability was not significantly modified by HPV-positive triage context but appeared lower in women older than 50 years.
Recurrent implantation failure (RIF) remains a major challenge in assisted reproductive technology (ART), reflecting multifactorial and incompletely understood etiologies. Although embryonic competence is widely regarded as the primary determinant of implantation success, increasing attention has been directed toward endometrial and immunological factors that may contribute to repeated failure in selected patient populations. Among proposed immunomodulatory interventions, intravenous lipid emulsions (intralipids) have been investigated as a strategy to modulate uterine immune responses, particularly natural killer (NK) cell activity, in women undergoing in vitro fertilization (IVF). The biological rationale for intralipid therapy derives from observations that uterine NK (uNK) cells play essential roles in early placentation, including regulation of angiogenesis, trophoblast invasion, and cytokine balance. However, the clinical significance of altered NK cell numbers or function in RIF remains debated, and evidence linking immune modulation to improved live birth rates is inconsistent. Variability across studies is further compounded by heterogeneity in diagnostic criteria, immune testing methodologies, and treatment protocols. This narrative review aims to critically evaluate the available mechanistic and clinical evidence regarding intravenous intralipid infusion in IVF patients, with emphasis on recurrent implantation failure. We examine proposed mechanisms of action, summarize randomized controlled trials and meta-analyses, assess methodological limitations, and consider current professional society recommendations. Although some reports describe improvements in clinical pregnancy rates, conflicting findings and the absence of large, adequately powered trials preclude definitive conclusions. Current guidelines do not recommend routine intralipid use outside research settings. Future investigations should prioritize immune assessment and live birth as the primary endpoint.
Uterine fibroids are the most common benign uterine tumors and may require surgical management in symptomatic patients desiring uterine preservation. Robot-assisted laparoscopic myomectomy has emerged as a minimally invasive alternative to open surgery, offering reduced intraoperative blood loss and faster postoperative recovery. We describe our surgical technique as performed at Bichat-Claude Bernard University Hospital (AP-HP), with particular emphasis on intraoperative hemostatic strategies: uterine artery clamping with Bulldog MicroClamp clips, pericervical tourniquet using a Foley catheter, and multilayer myometrial closure with V-Loc barbed sutures. Preoperative prehabilitation, including GnRH agonist therapy and iron supplementation, is considered to optimize hemoglobin levels prior to surgery. Trocar placement, robotic docking configuration, and contained morcellation technique are also detailed. This standardized approach seems to yield excellent functional outcomes while minimizing hemorrhagic complications.
Accurate staging of cervical cancer is essential for guiding treatment selection and determining prognosis. Physical examination, although fundamental for assessing vaginal extension and obtaining biopsies, shows important limitations for evaluating parametrial invasion and overall FIGO staging. Pelvic MRI provides higher diagnostic performance, particularly when diffusion-weighted imaging is incorporated, improving assessment of tumour size, parametrial involvement and residual disease after chemoradiotherapy. Contrast-enhanced sequences offer additional value for detecting small lesions and characterizing stromal invasion. Functional MRI parameters, including ADC changes and dynamic enhancement patterns, show promise for early prediction of treatment response, although standardisation remains insufficient for routine clinical application. After conization, MRI demonstrates good sensitivity and excellent specificity for detecting residual tumour, but postoperative inflammatory changes may reduce accuracy when performed too early. For nodal staging, 18F-FDG PET-CT offers whole-body evaluation, with diagnostic sensitivity strongly influenced by tumour stage and nodal prevalence. PET-CT rarely influences management in IA1-IA2 and has limited impact in IB1 but becomes relevant in IB2-IIB and IIIA-IVA disease, particularly when positive nodal uptake may obviate lymphadenectomy. PET-derived metabolic parameters also correlate with recurrence and survival, though no validated thresholds allow direct clinical use. Serum SCC-Ag is associated with recurrence and survival in observational studies, but its clinical utility remains unproven due to heterogeneity of thresholds and absence of evidence that testing improves outcomes. Future research integrating modern MRI protocols, digital PET-CT technology and validated imaging biomarkers is needed to refine staging algorithms and optimize personalized management.
OBJECTIVE:To evaluate the feasibility and perioperative safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with sentinel lymph node biopsy (SLNB) for surgical staging of endometrial neoplasia. METHODS:We conducted a retrospective consecutive case series at a tertiary gynecologic oncology center between May 2024 and December 2025. All patients undergoing hysterectomy and SLNB for staging of suspected or confirmed early-stage endometrial neoplasia using the vNOTES approach were included. Demographic characteristics, operative parameters, conversions, and intra- and postoperative complications were recorded. Primary outcomes were feasibility-defined as completion of the procedure without conversion-, detection rate and perioperative safety. Secondary outcomes included operative time, blood loss, hospital stay, and factors influencing operative performance. RESULTS:Thirty-six patients were included. Median age was 63 years (IQR 57-69) and median BMI was 30 kg/m² (IQR 27-36). The procedure was completed by vNOTES in 33 patients (89%), with 1 conversion to laparoscopy (3%) and 2 conversions to laparotomy (6%) for specimen extraction. Median operative time was 125 min (IQR 115-150). Median hospital stay was 1 day (IQR 1-2; range 1-21). Estimated blood loss was <100 mL in 69% of procedures. Intraoperative complications occurred in 4 patients (11%), all bladder injuries recognized and repaired intraoperatively. Bilateral detection rate was 89% and unilateral detection rate was 100%. Operative time did not differ significantly between the first 10 cases and the subsequent procedures (median 125 vs 120 min, p = 0.86). No variable was significantly associated with the occurrence of complications, and BMI was not associated with operative duration. CONCLUSION:vNOTES hysterectomy with SLNB for endometrial cancer staging is feasible and demonstrates acceptable perioperative morbidity in a consecutive series. Further studies are required to assess long-term oncologic outcomes.
PURPOSE:The aim of the study was to describe the current surgical practices in managing isolated fallopian tubal torsion (IFTT) in children, identify the most appropriate surgical procedure, and assess the associated postoperative complications and recurrence rates. METHODS:A retrospective European multicentric study was conducted, included all patients aged 18 years or younger who underwent IFTT between 2006 and 2021. A detailed descriptive analysis based on a case series presentation was conducted. RESULTS:Sixty-four girls aged 6-17 years who underwent surgery for IFTT across eight European paediatric centers were included. Surgical procedures included: tubal detorsion (87%), partial salpingectomy (6%), total salpingectomy (44%), and salpingotomy (5%). Histopathological analysis identified tubal cysts and hydrosalpinx (HSX) as common causes of torsion. HSX was found in 15% of cases, and neosalpingostomy was performed in two patients with recurrent abdominal pain after initial surgery. Overall, 12% of patients required more than one surgical intervention due to persistent abdominal pain. CONCLUSION:IFTT alone, in the absence of tubal malformation, provides a favourable prognosis with a straightforward detorsion procedure. If a tubal malformation is detected during the surgery, an ablation of malformation is advised in order to avoid recurrences. In the event of HSX being present, the option of a neosalpingostomy can be proposed. Our results emphasize the importance of timely diagnosis and appropriate surgical management to reduce complications and improve outcomes in paediatric IFTT.
BACKGROUND:Active cigarette smoking is a prevalent, modifiable risk factor hypothesised to impair success in assisted reproductive technology (ART). Prior meta‑analyses have combined never‑smokers and former smokers in control groups, potentially diluting effect estimates. OBJECTIVE:To determine the effect of active cigarette smoking on live birth and other ART outcomes using a strict comparison between active smokers and never‑smokers. METHODS:We conducted a systematic review and meta‑analysis (PROSPERO: CRD420251128852) per PRISMA 2020. Databases were searched for observational studies comparing ART outcomes (using autologous oocytes) in active smokers versus never‑smokers. Two reviewers independently screened records, extracted data, and assessed risk of bias (Newcastle‑Ottawa Scale). Random‑effects models (REML‑HKSJ) pooled risk ratios (RRs) for dichotomous outcomes and mean differences (MD) for oocytes retrieved. Sensitivity analyses included restriction to strict never‑smoker controls. Certainty of evidence was assessed using GRADE. RESULTS:From 2585 records, 26 studies (16,359 participants) were included. Active smoking was associated with a significant 15% reduction in live birth (13 studies; RR 0.85, 95% CI: 0.79-0.92, I² = 72.4%) and 18% reduction in clinical pregnancy (21 studies; RR 0.82, 95% CI: 0.77-0.88, I² = 66.7%), but both were attenuated to non‑significance when restricted to strict never‑smoker controls (RR 0.88 for both). Miscarriage was not significantly associated with smoking (7 studies; RR 1.15, 95% CI: 0.89-1.48, I² = 78.1%). A small reduction in oocytes retrieved was observed (18 studies; MD -1.06, 95% CI: -2.01 to -0.12, I² = 98.9%). Certainty of evidence was moderate for live birth and clinical pregnancy, and low for miscarriage and oocytes retrieved. CONCLUSION:While pooled estimates suggest active smoking is associated with reduced live birth and clinical pregnancy rates in ART, these associations are not robust when a methodologically pure never‑smoker comparator is applied, and miscarriage was non‑significant. The moderate certainty for live birth and clinical pregnancy indicates a more robust evidence base than previously appreciated, though the precise risk remains uncertain. High‑quality prospective studies with biochemical verification and dose‑response data are urgently needed.
Decidualized ovarian endometriomas are benign lesions that can closely mimic ovarian malignancy on ultrasound. Correctly identifying them is crucial to avoid unnecessary interventions and associated adverse fetal-maternal outcomes. A systematic review of the literature was performed to identify common sonographic patterns and key diagnostic features reported across gestation. Thirteen studies comprising 35 cases were included. Ultrasound appearance evolved similarly: simple cysts with minimal vascularity in early pregnancy; rounded, vascularized papillary projections within cystic lesions during the second trimester; and solid-appearing, highly vascularized masses in the third trimester. Most cases were managed surgically. Expectant management was associated with postpartum regression and no reported complications. No malignant transformations were identified. Recognizing these imaging patterns facilitates accurate diagnosis, reduces unnecessary surgical procedures during pregnancy, and supports safe expectant management. Awareness of the dynamic, gestational evolution of decidualized endometriomas is essential for physicians involved in prenatal care.
INTRODUCTION:and Hypothesis: Endometriosis often causes pelvic pain, limiting movement and physical function. Performance-based tests are fundamental to measure functional status among these women. This study aimed to evaluate the reliability and validity (cross-sectional and longitudinal) of the 30-Second Chair-Stand Test (30CST) in women with endometriosis. METHOD:Observational longitudinal study from a specialized unit of a hospital. Participants completed a sociodemographic and clinical questionnaire. Functional performance was assessed using the 30CST at three time points: T1: In-clinic, baseline; T2: At home, pre-menstruation; T3: At home, during menstruation. Reliability was assessed via intraclass correlation coefficients (ICC) using a 2-way mixed-effects model. Minimal Detectable Change (MDC) was also calculated. Longitudinal validity was tested via two hypotheses supported by the fact that functional performance in women is significantly worse on menstrual phase, when compared to the premenstrual phase, through paired t-tests and standardized response means (SRM). Cross-sectional validity was assessed by comparing 30CST performance between pain groups (cut-off: 7). RESULTS:54 women participated with mean baseline pain 3.52 ± 3.21, and average 30CST performance ∼15 repetitions. Reliability was high across all contexts (ICC: 0.985, 0.975, and 0.981 at T1, T2, and T3, respectively). Performance during menstruation (T3) was significantly lower than pre-menstruation (T2) (mean difference=-1.22 repetitions, p < 0.001; SRM=-0.436). Cross-sectional validity showed that women with high baseline pain (≥7) performed significantly fewer repetitions than those with lower pain scores (p < 0.001), with a large effect size (Cohen's d = 1.59). CONCLUSION:The 30CST is a simple and reliable test with strong validity for women with endometriosis.
OBJECTIVE:Selective screening for gestational diabetes mellitus (GDM) remains a widespread strategy. Variation in the criteria identifying at-risk women questions its accuracy, with implications for clinical outcome and resource allocation. Our aim was to develop and externally validate a multivariable prediction model with improved performance compared to the current French pre-screening selection strategy. METHODS:Data was derived from the population-based 2021 (derivation sample) and 2016 (external validation sample) French National Perinatal Survey (ENP). Independent predictors of GDM were identified using a multivariable logistic regression model. Predictive performance was assessed through the area under the receiver operating characteristic curve. Diagnostic performance was assessed through sensitivity, specificity, and accuracy. Sensitivity analyses were conducted: (1) in maternity centers with quasi-universal screening, (2) outcome strictly defined as GDM cases associated with large-for-gestational-age births and (3) implementing doubly robust estimators of sensitivity and specificity. RESULTS:The study population included 10,834 women in the derivation sample and 11,633 in the validation sample, where the prevalence of GDM was respectively 19.4% and 13.2%. Maternal age, body mass index, obstetric history, family history of diabetes, and maternal country of birth were independent predictors of GDM. The prediction model demonstrated a statistically significant improvement in specificity (0.49 [95% CI: 0.48-0.50] vs. 0.46 [95% CI: 0.45-0.47]) and overall diagnostic accuracy (0.53 [95% CI: 0.52-0.54] vs. 0.50 [95% CI: 0.49-0.51]). CONCLUSION:The prediction model modestly improved performance while maintaining the same screening rate, though it is unlikely to justify additional complexity of implementation, therefore limiting its added-value in clinical practice. These findings suggest that available clinical predictors already capture most of the predictive information relevant for selective screening.
The necessity of sentinel lymph node biopsy (SLNB) in early-stage, node-negative (cN0) breast cancer is increasingly questioned in the era of surgical de-escalation and biologically driven treatment strategies. While SLNB has long replaced axillary lymph node dissection to reduce morbidity, it nevertheless carries a measurable risk of complications, including lymphedema, pain, and reduced arm mobility. Recent high-quality evidence suggests that SLNB may be safely omitted in selected patients without compromising oncologic outcomes. The SOUND randomized trial demonstrated that omission of SLNB in women with cT1N0, ultrasound-negative axilla treated with breast-conserving surgery (BCS) and whole-breast irradiation yields non-inferior 5-year distant disease-free survival, with axillary recurrence up to 1%. These findings were reinforced by the large INSEMA randomized trial, which included more than 5,000 cT1-2N0 patients and confirmed that SLNB omission does not adversely affect invasive disease-free survival or overall survival (non inferiority study). INSEMA, as SOUND, predominantly included women older than 50 years and postmenopausal, with approximately 90% of patients presenting with cT1N0 tumor. Importantly, INSEMA showed consistent and clinically significant improvements in patient-reported outcomes, including lower rates of chronic arm morbidity and lymphedema. Then the BOOG 2013-08 trial highlighted quality-of-life benefits at three years for patients who avoided SLNB. However, caution is warranted for underrepresented subgroups such as HER2-positive, triple-negative, high-grade, or lobular cancers. Plus, the rate of macrometastatic sentinel lymph nodes was under 10% for cT1N0 patients but was around 20% for cT2N0 patients. Collectively, these data support a paradigm shift toward selective axillary staging, emphasizing tumor biology, imaging accuracy, and systemic therapy over routine surgical assessment. Evidence indicates that SLNB omission is oncologically safe and functionally advantageous in Luminal cT1N0 patients.
