by Lai Duen Mun. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1995. / Includes bibliographical references (leaves 82-91). / Abstract --- p.ii / Acknowledgements --- p.iii / Table of Contents --- p.vi / List of Tables --- p.v / List of Appendices --- p.vii / Introduction --- p.1 / Method --- p.28 / Results --- p.41 / Discussion --- p.63 / Limitation and Recommendation --- p.78 / Reference --- p.82 / Appendices --- p.92

by Wang Wei. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1991. / Includes bibliographical references (leaves 154-168). / ACKNOWLEDGMENTS --- p.v / SUMMARY --- p.vi / PUBLICATIONS --- p.viii / STATEMENT OF ORIGINALITY --- p.ix / LIST OF ABBREVIATIONS --- p.x / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.5 / Chapter 2.1 --- Chromosome --- p.6 / Chapter 2.2 --- Chromosome and Human Disease --- p.9 / Chapter 2.3 --- Chromosome and Tumour --- p.12 / Chapter 2.4 --- Chromosome in Gynaecologic Tumours --- p.17 / Chapter 2.4.1 --- Cervical tumour --- p.17 / Chapter 2.4.2 --- Uterine corpus tumour --- p.20 / Chapter 2.4.3 --- Ovarian tumour --- p.23 / Chapter 2.5 --- Methodology in cytogenetics --- p.26 / Chapter 2.5.1 --- Materials --- p.27 / Chapter 2.5.2 --- Methods of chromosome preparation --- p.28 / Chapter 2.5.3 --- Karyotype analysis --- p.34 / Chapter 2.6 --- Problems of cytogenetic analysis in solid tumour --- p.42 / Chapter CHAPTER 3 --- MATERIALS AND METHODS --- p.47 / Chapter 3.1 --- Chemicals and Solutions --- p.48 / Chapter 3.2 --- Chromosome preparation from solid gynaecologic tumours --- p.50 / Chapter 3.2.1 --- Solid tumour specimens --- p.50 / Chapter 3.2.2 --- Chromosome preparation --- p.54 / Chapter 3.3 --- Chromosome preparation from an established ovarian carcinoma cell line --- p.61 / Chapter 3.3.1 --- Origin of OCC1 cell line --- p.61 / Chapter 3.3.2 --- Characteristics of OCC1 cell line --- p.61 / Chapter 3.3.3 --- Maintaining of OCC1 cell line --- p.62 / Chapter 3.3.4 --- Chromosome preparation --- p.62 / Chapter 3.4 --- Karyotype analysis --- p.65 / Chapter CHAPTER 4 --- RESULTS --- p.66 / Chapter 4.1 --- Cytogenetic features of gynaecologic solid tumour --- p.67 / Chapter 4.1.1 --- Cervical cancer --- p.67 / Chapter 4.1.2 --- Uterine corpus cancer --- p.94 / Chapter 4.1.3 --- Ovarian cancer --- p.104 / Chapter 4.2 --- Cytogenetic features of OCC1 ovarian carcinoma cell line --- p.114 / Chapter CHAPTER 5 --- DISCUSSION --- p.123 / Chapter 5.1 --- Methodology of chromosome preparation in solid tumour --- p.124 / Chapter 5.2 --- Chromosome changes in gynaecologic solid tumour --- p.126 / Chapter 5.2.1 --- Cervical cancer --- p.126 / Chapter 5.2.2 --- Uterine corpus cancer --- p.132 / Chapter 5.2.3 --- Ovarian cancer --- p.138 / Chapter 5.2.4 --- In summary --- p.141 / Chapter 5.3 --- Chromosome changes in an OCC1 ovarian carcinoma cell line --- p.143 / Chapter CHAPTER 6 --- CONCLUSION --- p.148 / REFERENCES --- p.154

No description available.

by Chan Wing-Wah, Anita. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references (leaves 51-55). / LIST OF TABLES / LIST OF FIGURES / LIST OF ABBREVIATIONS / ACKNOWLEDGEMENTS / ABSTRACT / Chapter CHAPTER 1. --- INTRODUCTION --- p.1 / Chapter 1.1 --- General functions of copper --- p.1 / Chapter 1.2 --- Absorption and hepatic metabolism of copper --- p.2 / Chapter 1.3 --- Distribution of copper among components of human serum --- p.2 / Chapter 1.4 --- Plasma copper concentration in disease --- p.3 / Chapter 1.4.1 --- Patients with various tumours --- p.3 / Chapter 1.4.2 --- Patients with gynaecological tumours --- p.4 / Chapter 1.5 --- Serum caeruloplasmin concentration in various malignancies --- p.5 / Chapter 1.6 --- Aim of the study --- p.6 / Chapter 1.7 --- Introduction to some laboratory methods --- p.7 / Chapter 1.7.1 --- Flame atomic absorption spectrophotometry --- p.7 / Chapter 1.7.2 --- Electrothermal (flameless) atomic absorption spectrophotometry --- p.7 / Chapter 1.7.3 --- Separation of the non-protein bound (free) copper --- p.8 / Chapter CHAPTER 2. --- MATERIALS AND METHODS --- p.11 / Chapter 2.1 --- Materials --- p.11 / Chapter 2.2 --- Methods --- p.12 / Chapter 2.2.1 --- Preparation of the ultrafiltrate --- p.12 / Chapter i. --- Ultrafiltration --- p.12 / Chapter ii. --- Determination of protein in the ultrafiltrate --- p.12 / Chapter iii. --- Verification for copper binding property of the YMT membranes --- p.12 / Chapter 2.2.2 --- Establishment of the method for the determination of copper by the graphite furnace atomic absorption --- p.13 / Chapter i. --- Parameters --- p.13 / Chapter ii. --- Method evaluation --- p.13 / Chapter a. --- Precision: within-run precision between-day precision --- p.13 / Chapter b. --- Recovery --- p.15 / Chapter c. --- Linearity --- p.15 / Chapter d. --- Detection limit --- p.15 / Chapter 2.2.3 --- Determination of ultrafiltrable copper concentration --- p.16 / Chapter 2.2.4 --- Effect of storage --- p.16 / Chapter 2.2.5 --- Comparison between healthy male and female subjects --- p.17 / Chapter 2.2.6 --- Determination of serum total copper and caeruloplasmin --- p.17 / Chapter i. --- Determination of total copper --- p.17 / Chapter ii. --- Determination of caeruloplasmin --- p.17 / Chapter 2.3 --- Blood specimens --- p.18 / Chapter 2.4 --- Patient samples --- p.18 / Chapter 2.5 --- Control subjects --- p.18 / Chapter 2.6 --- Statistics --- p.19 / Chapter CHAPTER 3. --- RESULTS --- p.20 / Chapter 3.1 --- Some experimental studies about the YMT membranes --- p.20 / Chapter 3.1.1 --- Membrane leakage --- p.20 / Chapter 3.1.2 --- Verification for copper binding property of the YMT membranes --- p.20 / Chapter 3.2 --- Method evaluation --- p.20 / Chapter 3.2.1 --- Standard addition --- p.20 / Chapter 3.2.2 --- Precision --- p.23 / Chapter 3.2.3 --- Recovery --- p.23 / Chapter 3.2.4 --- Linearity --- p.23 / Chapter 3.2.5 --- Detection limit --- p.23 / Chapter 3.2.6 --- Effect of storage of specimens --- p.23 / Chapter 3.2.7 --- Comparison between healthy male and female subjects --- p.30 / Chapter 3.3 --- "Results of ultrafiltrable (free) copper, total copper and caeruloplasmin" --- p.35 / Chapter 3.3.1 --- "Serum total copper, caeruloplasmin and ultrafiltrable (free) copper in patients with gynaecological malignancies and control subjects" --- p.35 / Chapter 3.3.2 --- "Relationship between total copper, caerulo- plasmin and ultrafiltrable (free) copper concentration" --- p.35 / Chapter 3.4 --- "Results of ultrafiltrable (free) copper, total copper and caeruloplasmin versus FIGO stage" --- p.41 / Chapter CHAPTER 4. --- DISCUSSION --- p.45 / Chapter 4.1 --- About the ultrafiltration --- p.45 / Chapter 4.2 --- Validation of the method performance --- p.46 / Chapter 4.3 --- "Discussion on ultrafiltrable (free) copper, total copper and caeruloplasmin concentration in patients with gynaecological malignancies" --- p.48 / REFERENCE --- p.51

研究背景：婦科癌症的診斷及各種相關的治療，對性功能、生活質素及心理健康都有負面的影響。文獻指出心理教育對婦科癌症病人這方面的影響有正面的效果，但是效用的証據並不一致。 / 系統化綜述: 本研究首先進行系統化綜述，並根據喬安娜．布里格斯的方法進行，目的在於確定心理教育對婦科癌症病人的性功能、生活質素及心理健康的功效，以及辨認一套有效的心理教育課程給予婦科癌症病人。總共有十一份隨機控制實驗的文獻，包括九百七十五位婦科癌症病人，被納入本綜述，其中四份可比較的文獻進行了薈萃分析。根據兩份評估心理教育對抑鬱功效的文獻薈萃結果顯示，心理教育對改善抑鬱徵狀有顯著的改善。另外兩份文獻評估心理教育對生活質素的功效，薈萃結果顯示心理教育對身理方面的生活質素未有明顯的改善，相反地，提供資訊性的教育對婦科癌症病人心理方面的生活質素有明顯的功效。關於心理教育對性功能的功效，似乎對性生活有所改善，但是並未能在性功能的評估工具反映出來。關於心理教育對心理健康的功效，除了抑鬱以外，似乎未有足夠的証據顯示有顯著的功效。系統化綜述建議心理教育予婦科癌症病人應包括三種元素：資訊提供、行為治療及心理支持；形式可以是個人、個人及伴侶共同參予、或小組；應由護士提供；於癌症治療開始前進行，直至出院後；包括四堂課程，每堂三十分鐘至一小時完成。 / 試驗性研究目的：試驗性研究目的是測試提供一套根據系統化綜述結果設計的心理教育予香港婦科癌症病人的可行性，以及評估該課程對改善香港婦科癌症病人的性功能、生活質素、及心理健康的功效。 / 試驗性研究方法：試驗性研究採用隨機控制實驗的方法，把二十六位婦科癌症病人分配到兩個不同的組別。實驗組的參加者，接受一套心理教育；對照組的參加者於實驗組的同一時段收到研究員的訪問。不論哪個組別的參加者，都會進行指標評估，包括性功能、生活質素、不明朗、社交支持、焦慮及抑鬱的狀況。研究指標分別在手術前(T0)、手術後及住院期間(T1)，和手術後8星期(T2)。實驗組的參加者及於臨床工作的護士更會被邀請進行了簡單的傾談，從而了解她們對此心理教育的意見及感受。非參數統計推斷方法用以檢驗組內和組間於上述各指標的差異。實驗組的參加者及護士參予的面談，會進行錄音及內容分析。 / 研究結果：於兩組之間的比較，實驗組的參加者對疾病資料的不一致，有顯著的改善。但是，兩組之間的性功能、生活質素、不明朗、社交支持、焦慮及抑鬱均未有顯著的分別。參加者於面談中指出，心理教育可減低婦科癌症病人的壓力，對她們來說有著實際的用途。 / 研究結論：系統化綜述顯示心理教育對婦科癌症病人有正面的功效。雖然試驗性研究的定量資料結果指出心理教育對香港的婦科癌症病人，除了對疾病資料的不一致有所改善外，在其他各方面的評估，均未有顯著的功效，但是，品質數據的結果顯示婦科癌症病人確實需要心理教育，而此教育於臨床環境實行是可行的。 / Background: A diagnosis and treatment of gynecological cancer (GC) has adverse effects on the sexual functioning, quality of life and psychological outcomes of patients. Psychoeducational interventions (PEIs) are recommended for GC patients to improve their outcomes, but evidence for their effectiveness is far from conclusive. / Systematic review: A systematic review was first carried out according to the Joanna Briggs Institute (JBI) approach to identify the best available evidence relating to the effectiveness of PEIs for GC patients in sexual functioning, quality of life and psychological outcomes. A total of 11 randomized controlled trials (RCTs) involving 975 GC patients were included in the systematic review, but only four comparable studies were appropriate for meta-analysis. PEIs significantly improved depressive symptoms, standardized mean difference (SMD) = -0.80, 95% CI [-1.05 to -0.54], p = < .00001, among the patients. However, there was no significant benefit to the physical aspect of quality of life, SMD = -0.12, 95% CI [-0.45 to 0.20], p = .46. Conversely, information-only therapy demonstrated significant effects on the mental aspects of quality of life, SMD = -0.41, 95% CI [-0.74 to -0.08], p = .01. In addition, from qualitative data, PEIs appeared to be helpful in improving sexual life, but changes in sexual functioning scores were not statistically significant. The interventions appeared to have only limited beneficial effect on anxiety, distress, adjustment to illness and uncertainty, and had no significant effect in improving mood, self-esteem or ability to cope. The review also suggested that PEIs for GC patients would incorporate information provision, behavior therapy and psychological support. The format might be individual, with or without a partner’s participation, or in a group. A nurse was found to be the ideal provider. The interventions could be arranged at the start of cancer treatment and then be continued after discharge, and the number of sessions might be four, each lasting between 30 minutes and one hour. / Aim of pilot study: A program of PEIs was designed based on the systematic review, and piloted on Hong Kong GC patients to test the feasibility and effectiveness of implementing the interventions in Hong Kong. / Pilot research plan: The pilot study was a single-blinded RCT and mix-method design. Twenty-six subjects were randomly assigned to either the intervention or attention control group. The intervention group received the program of PEIs, while the attention control group received attention from the researcher over the same period. Data collection was carried out at baseline (T0), after the operation and during the in-hospital period (T1) and eight weeks after the operation (T2). Qualitative data was collected from the intervention group and nurses working in the clinical setting at T2. Non-parametric tests were used to compare the baseline and various outcome variables within and between groups. Audio-tapes of semi-structured interviews were transcribed verbatim, and content analysis was performed to identify significant themes. / Key findings of pilot study: Participants in the intervention group had statistically significantly less inconsistent information on illness than the attention control group, but there were no statistically significant differences in all other outcome variables including sexual functioning, quality of life, uncertainty, social support, anxiety and depression. Qualitative data from the participants indicated the program of PEIs reduced their stress level and was useful. / Conclusion: The systematic review demonstrated evidence of the positive effects of PEIs on GC patients. Although there were no significant effects appearing in most quantitative results of the intervention program in the pilot study, the qualitative results indicated that the interventions were found desirable by Hong Kong GC patients. Nurses identified implementing the program as feasible in clinical settings. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chow, Ka Ming. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 185-204). / Abstracts also in Chinese; appendixes includes Chinese. / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Aims and significance of the study --- p.4 / Chapter 1.3 --- Overview of the thesis --- p.4 / Chapter CHAPTER 2 --- LITERATURE REVIEW / Chapter 2.1 --- Introduction --- p.6 / Chapter 2.2 --- Impact of GC on sexual functioning --- p.6 / Chapter 2.2.1 --- Mixed types of GC --- p.7 / Chapter 2.2.2 --- Ovarian cancer --- p.10 / Chapter 2.2.3 --- Cervical cancer --- p.11 / Chapter 2.2.4 --- Impact of GC on sexual functioning in Chinese culture --- p.15 / Chapter 2.3 --- Impact of GC on quality of life --- p.18 / Chapter 2.3.1 --- Mixed types of GC --- p.19 / Chapter 2.3.2 --- Cervical cancer --- p.21 / Chapter 2.3.3 --- Impact of GC on quality of life in Chinese culture --- p.24 / Chapter 2.4 --- Impact of GC on psychological well-being --- p.25 / Chapter 2.4.1 --- Mixed types of GC --- p.26 / Chapter 2.4.2 --- Cervical cancer --- p.29 / Chapter 2.4.3 --- Impact of GC on psychological well-being in Chinese culture --- p.30 / Chapter 2.5 --- Current nursing practice on sexuality with GC patients --- p.30 / Chapter 2.5.1 --- Attitudes of health-care professionals towards sexuality --- p.31 / Chapter 2.5.2 --- Information needs of GC patients --- p.33 / Chapter 2.5.3 --- Sexuality assessment --- p.35 / Chapter 2.5.4 --- Sexuality interventions --- p.37 / Chapter 2.6 --- Psychoeducational interventions (PEIs) --- p.38 / Chapter 2.6.1 --- Theoretical background --- p.38 / Chapter 2.6.2 --- Effects of PEIs on cancer patients --- p.40 / Chapter 2.6.3 --- Effects of PEIs on GC patients --- p.42 / Chapter 2.7 --- Summary --- p.44 / Chapter CHAPTER 3 --- SYSTEMATIC REVIEW (PHASE I) / Chapter 3.1 --- Introduction --- p.46 / Chapter 3.2 --- Review objectives and questions --- p.46 / Chapter 3.3 --- Inclusion criteria --- p.48 / Chapter 3.3.1 --- Types of studies --- p.48 / Chapter 3.3.2 --- Types of participants --- p.48 / Chapter 3.3.3 --- Types of interventions --- p.48 / Chapter 3.3.4 --- Types of outcome measures --- p.49 / Chapter 3.4 --- Search strategy --- p.50 / Chapter 3.5 --- Methods of the review --- p.52 / Chapter 3.5.1 --- Assessment of methodological quality --- p.52 / Chapter 3.5.2 --- Data extraction --- p.52 / Chapter 3.5.3 --- Data synthesis --- p.53 / Chapter 3.6 --- Systematic review results --- p.54 / Chapter 3.6.1 --- Description of studies’ retrieval and selection --- p.54 / Chapter 3.6.2 --- Methodological quality of the included studies --- p.57 / Chapter 3.6.2.1 --- Randomization --- p.57 / Chapter 3.6.2.2 --- Blinding --- p.57 / Chapter 3.6.2.3 --- Consent and completion rates --- p.58 / Chapter 3.6.2.4 --- Power estimation --- p.58 / Chapter 3.6.2.5 --- Result data --- p.58 / Chapter 3.6.3 --- Details of the included studies --- p.59 / Chapter 3.6.3.1 --- Country of origin --- p.59 / Chapter 3.6.3.2 --- Samples --- p.59 / Chapter 3.6.3.3 --- Components of PEIs --- p.59 / Chapter 3.6.3.4 --- Comparison group --- p.61 / Chapter 3.6.3.5 --- Format of PEIs --- p.62 / Chapter 3.6.3.6 --- Provider of PEIs --- p.62 / Chapter 3.6.3.7 --- Provision time frame of PEIs --- p.63 / Chapter 3.6.3.8 --- Duration of PEIs --- p.63 / Chapter 3.6.3.9 --- Outcome measurements --- p.64 / Chapter 3.6.4 --- Effects of PEIs on outcomes --- p.64 / Chapter 3.6.4.1 --- Sexual functioning --- p.65 / Chapter 3.6.4.2 --- Quality of life --- p.65 / Chapter 3.6.4.3 --- Psychological outcomes --- p.68 / Chapter 3.6.4.3.1 --- Anxiety and depression --- p.68 / Chapter 3.6.4.3.2 --- Distress --- p.70 / Chapter 3.6.4.3.3 --- Adjustment to illness --- p.71 / Chapter 3.6.4.3.4 --- Mood --- p.71 / Chapter 3.6.4.3.5 --- Self-esteem --- p.72 / Chapter 3.6.4.3.6 --- Uncertainty --- p.72 / Chapter 3.6.4.3.7 --- Coping --- p.72 / Chapter 3.6.4.4 --- Brief summary --- p.72 / Chapter 3.6.5 --- Design of PEIs --- p.73 / Chapter 3.6.5.1 --- Effective components --- p.73 / Chapter 3.6.5.2 --- Effective format --- p.75 / Chapter 3.6.5.3 --- Effective provider --- p.76 / Chapter 3.6.5.4 --- Effective provision time frame --- p.76 / Chapter 3.6.5.5 --- Effective duration --- p.77 / Chapter 3.7 --- Discussion --- p.78 / Chapter 3.7.1 --- Effects of PEIs on sexual functioning --- p.80 / Chapter 3.7.2 --- Effects of PEIs on quality of life --- p.82 / Chapter 3.7.3 --- Effects of PEIs on psychological outcomes --- p.84 / Chapter 3.7.3.1 --- Anxiety and depression --- p.84 / Chapter 3.7.3.2 --- Distress --- p.86 / Chapter 3.7.3.3 --- Adjustment to illness --- p.87 / Chapter 3.7.3.4 --- Mood --- p.87 / Chapter 3.7.3.5 --- Self-esteem --- p.88 / Chapter 3.7.3.6 --- Uncertainty --- p.88 / Chapter 3.7.3.7 --- Coping --- p.89 / Chapter 3.7.4 --- Design of PEIs --- p.89 / Chapter 3.7.4.1 --- Effective components and theories --- p.89 / Chapter 3.7.4.2 --- Effective format --- p.92 / Chapter 3.7.4.3 --- Effective provider --- p.93 / Chapter 3.7.4.4 --- Effective provision time frame --- p.93 / Chapter 3.7.4.5 --- Effective duration --- p.94 / Chapter 3.8 --- Summary of systematic review --- p.95 / Chapter 3.8.1 --- Implications for practice --- p.95 / Chapter 3.8.2 --- Implications for research --- p.97 / Chapter 3.9 --- Summary --- p.100 / Chapter CHAPTER 4 --- METHODOLOGY OF PILOT STUDY (PHASE II) / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.2 --- Rationale for conducting a pilot study --- p.102 / Chapter 4.3 --- Aims and objectives --- p.103 / Chapter 4.4 --- Operational definition --- p.104 / Chapter 4.4.1 --- Psychoeducational interventions (PEIs) --- p.104 / Chapter 4.4.2 --- Sexual functioning --- p.105 / Chapter 4.4.3 --- Quality of life --- p.105 / Chapter 4.4.4 --- Uncertainty --- p.105 / Chapter 4.4.5 --- Anxiety --- p.106 / Chapter 4.4.6 --- Depression --- p.106 / Chapter 4.4.7 --- Social support --- p.106 / Chapter 4.5 --- Interventions --- p.107 / Chapter 4.5.1 --- Program of PEIs --- p.107 / Chapter 4.5.1.1 --- Theoretical framework underpinning the interventions --- p.107 / Chapter 4.5.1.2 --- Components of the program of PEIs --- p.113 / Chapter 4.5.1.2.1 --- Information provision --- p.113 / Chapter 4.5.1.2.2 --- Behavioral therapy --- p.113 / Chapter 4.5.1.2.3 --- Psychological support --- p.114 / Chapter 4.5.1.3 --- Design of the program of PEIs --- p.115 / Chapter 4.5.2 --- Attention control --- p.121 / Chapter 4.5.3 --- Usual care --- p.122 / Chapter 4.6 --- Methodology --- p.123 / Chapter 4.6.1 --- Study design --- p.123 / Chapter 4.6.2 --- Study setting --- p.125 / Chapter 4.6.3 --- Sample --- p.126 / Chapter 4.6.3.1 --- Sampling method --- p.126 / Chapter 4.6.3.2 --- Sample size determination --- p.127 / Chapter 4.6.3.3 --- Recruitment process --- p.128 / Chapter 4.7 --- Data collection --- p.129 / Chapter 4.7.1 --- Measures --- p.129 / Chapter 4.7.2 --- Study instruments --- p.130 / Chapter 4.7.2.1 --- Demographic data sheet --- p.130 / Chapter 4.7.2.2 --- Sexual functioning --- p.131 / Chapter 4.7.2.2.1 --- Justification for choosing the instrument --- p.134 / Chapter 4.7.2.3 --- Quality of life --- p.134 / Chapter 4.7.2.3.1 --- Justification for choosing the instrument --- p.136 / Chapter 4.7.2.4 --- Uncertainty --- p.136 / Chapter 4.7.2.4.1 --- Justification for choosing the instrument --- p.138 / Chapter 4.7.2.5 --- Social support --- p.139 / Chapter 4.7.2.5.1 --- Justification for choosing the instrument --- p.141 / Chapter 4.7.2.6 --- Anxiety and depression --- p.141 / Chapter 4.7.2.6.1 --- Justification for choosing the instrument --- p.143 / Chapter 4.7.2.7 --- Semi-structure interview --- p.144 / Chapter 4.7.2.7.1 --- Intervention recipients --- p.144 / Chapter 4.7.2.7.2 --- Health-care providers --- p.144 / Chapter 4.7.3 --- Data collection procedure --- p.145 / Chapter 4.8 --- Data analysis --- p.149 / Chapter 4.8.1 --- Quantitative data --- p.149 / Chapter 4.8.1.1 --- Comparison of baseline data --- p.151 / Chapter 4.8.1.2 --- Comparison of outcome variables --- p.151 / Chapter 4.8.2 --- Qualitative data --- p.153 / Chapter 4.9 --- Ethical considerations --- p.154 / Chapter 4.1 --- Summary --- p.155 / Chapter CHAPTER 5 --- RESULTS OF THE PILOT STUDY / Chapter 5.1 --- Introduction --- p.156 / Chapter 5.2 --- Recruitment of participants --- p.157 / Chapter 5.3 --- Characteristics of all participants --- p.159 / Chapter 5.3.1 --- Demographic and clinical characteristics --- p.159 / Chapter 5.3.2 --- Homogeneity of the participants --- p.161 / Chapter 5.4 --- Baseline outcome variables --- p.164 / Chapter 5.4.1 --- Baseline outcome variables of all participants --- p.164 / Chapter 5.4.2 --- Comparison of baseline outcome variables between intervention and attention control groups --- p.166 / Chapter 5.5 --- Outcome variables within-group changes --- p.168 / Chapter 5.5.1 --- Quality of life --- p.168 / Chapter 5.5.2 --- Uncertainty --- p.170 / Chapter 5.5.3 --- Social support --- p.174 / Chapter 5.5.4 --- Anxiety and depression --- p.179 / Chapter 5.6 --- Outcome variables between-group changes --- p.181 / Chapter 5.6.1 --- Sexual functioning --- p.181 / Chapter 5.6.2 --- Quality of life --- p.184 / Chapter 5.6.3 --- Uncertainty --- p.185 / Chapter 5.6.4 --- Social support --- p.187 / Chapter 5.6.5 --- Anxiety and depression --- p.190 / Chapter 5.7 --- Feasibility of implementing the PEI program in Hong Kong clinical settings --- p.191 / Chapter 5.7.1 --- Intervention recipients’ perspective --- p.191 / Chapter 5.7.1.1 --- Emotional support --- p.192 / Chapter 5.7.1.1.1 --- Offering psychology support --- p.192 / Chapter 5.7.1.1.2 --- Removing worries about sexual life --- p.192 / Chapter 5.7.1.2 --- Informational support --- p.193 / Chapter 5.7.1.2.1 --- Acquiring knowledge on illness --- p.193 / Chapter 5.7.1.2.2 --- Behavioral therapy helpful in post-operative care --- p.193 / Chapter 5.7.1.2.3 --- Resources available in the community --- p.194 / Chapter 5.7.1.3 --- Elements of the program --- p.194 / Chapter 5.7.1.3.1 --- Appropriate design of the interventions --- p.194 / Chapter 5.7.1.3.2 --- Content of information provided --- p.195 / Chapter 5.7.1.4 --- Feelings towards the program --- p.195 / Chapter 5.7.1.4.1 --- Appreciation of the interventions --- p.195 / Chapter 5.7.1.4.2 --- Lack of GC health education --- p.196 / Chapter 5.7.2 --- Health-care providers perspective --- p.196 / Chapter 5.7.2.1 --- Opinions regarding the program --- p.197 / Chapter 5.7.2.1.1 --- Quality of information provided --- p.197 / Chapter 5.7.2.1.2 --- Usefulness of the interventions --- p.197 / Chapter 5.7.2.2 --- Suggestions for improvement --- p.198 / Chapter 5.7.2.2.1 --- Content of information provided --- p.198 / Chapter 5.7.2.2.2 --- Format of the interventions --- p.199 / Chapter 5.7.2.2.3 --- Coverage of the patient population --- p.199 / Chapter 5.7.2.3 --- Feasibility of implementing the program in Hong Kong --- p.200 / Chapter 5.7.2.3.1 --- Anticipated barriers --- p.200 / Chapter 5.7.2.3.2 --- Solutions to the barriers --- p.201 / Chapter 5.8 --- Summary --- p.201 / Chapter CHAPTER 6 --- DISCUSSION OF THE PILOT STUDY / Chapter 6.1 --- Introduction --- p.205 / Chapter 6.2 --- Baseline characteristics of the participants --- p.205 / Chapter 6.2.1 --- Demographic and clinical characteristics --- p.206 / Chapter 6.2.2 --- Baseline outcome variables --- p.208 / Chapter 6.3 --- Effectiveness of the PEI program --- p.211 / Chapter 6.3.1 --- Quality of life --- p.211 / Chapter 6.3.2 --- Uncertainty --- p.214 / Chapter 6.3.3 --- Social support --- p.216 / Chapter 6.3.4 --- Anxiety and depression --- p.218 / Chapter 6.3.5 --- Sexual functioning --- p.221 / Chapter 6.4 --- Feasibility of implementing the PEI program in Hong Kong --- p.223 / Chapter 6.4.1 --- Intervention recipients’ perspective --- p.223 / Chapter 6.4.2 --- Health-care providers’ perspective --- p.226 / Chapter 6.5 --- Limitations of the pilot study --- p.229 / Chapter 6.5.1 --- Four types of validity threats --- p.229 / Chapter 6.5.2 --- Limitations in attention placebo, intervention format and integrity --- p.232 / Chapter 6.6 --- Summary --- p.234 / Chapter CHAPTER 7 --- CONCLUSION / Chapter 7.1 --- Introduction --- p.235 / Chapter 7.2 --- Implications for nursing practice --- p.235 / Chapter 7.3 --- Implications for future research --- p.236 / Chapter 7.4 --- Conclusion --- p.239 / REFERENCES --- p.241 / APPENDICES --- p.267

by Siu Pik-ngan. / Questionnarie in Chinese. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1997. / Includes bibliographical references (leaves 74-79). / List of Tables --- p.v / List of Figures --- p.vi / List of Appendices --- p.vii / Introduction --- p.1 / Method --- p.28 / Results --- p.36 / Discussion --- p.55 / References --- p.74 / Appendices --- p.80

Os sarcomas uterinos são tumores mesodérmicos raros que compreendem cerca de 3% de todos os cânceres nesse órgão. Apresentam diversidade histológica, comportamento agressivo, disseminação precoce e altas taxas mortalidade. Recentemente, os carcinossarcomas (CS) foram reclassificados histologicamente como carcinomas. Neste trabalho, os CS foram incluídos na casuística tanto para fins de comparação de seu componente mesenquimal, como por ainda fazerem parte da maioria dos estudos sobre sarcomas de corpo uterino e também da última classificação da WHO (Word Health Organization). Devido à sua diversidade e raridade, não há consenso relacionado aos fatores de risco para pior prognóstico e tratamento adequados para esses tumores. Informações sobre seus perfis gênicos e proteicos poderiam contribuir na caracterização de marcadores moleculares que auxiliassem no diagnóstico e prognóstico desses tumores, bem como no entendimento de sua biologia e comportamento clínico. Assim, nos propusemos a avaliar a presença de alterações gênicas nesses tumores, utilizando um painel de 409 genes, oncogenes e supressores de tumor, frequentemente mutados em tumores sólidos. Para isso, foram selecionadas 66 amostras, das quais 14 foram sequenciadas, incluindo, 5 carcinossarcomas (CCS), 4 leiomiossarcomas (LMS), 4 sarcomas de estroma endometrial (SEE) e 1 adenossarcoma (ADS). As reações foram realizadas utilizando a plataforma Ion Proton System (ThermoFisher) de Sequenciamento de Nova Geração. Nas 14 amostras encontramos 27 LoF e 40 mutações missenses, numa média de 39 inserções e 52 deleções por amostra, totalizando 70 mutações. Dessas, 25 encontram-se no banco de dados COSMIC. Os genes mais comumente mutados em nossa amostragem foram: TP53 (50%), KMT2D (36%), ATM (29%), DICER1 (21%), PIK3CA (21%), TRRAP (21%). Nosso objetivo principal era encontrar mutações específicas para cada subtipo histológico, porém apenas os SEEs (PDE4DIP) e os CCS (ERBB4 e PIK3CA) tiveram mutações especificas. Em outra análise, observamos que todos os subtipos histológicos compartilham o gene KMT2D. Embora não tenha sido possível estabelecer um perfil mutacional para cada subtipo histológico avaliado, nossos resultados abrem perspectivas para uma nova linha de pesquisa nos sarcomas de corpo do útero e certamente contribuem para um melhor entendimento dessas neoplasias / Uterine sarcomas are rare mesodermal tumors that comprise about 3% of all cancers in this organ. They present histological diversity, aggressive behavior, early dissemination and high mortality rates. Recently, carcinosarcomas (CCS) were histological reclassified as carcinomas. Here, we have included them in our series for purposes of comparison of the mesenchymal component and also because these tumors still form part of both the majority of studies and the WHO\'s latest classification for uterine sarcomas (Word Health Organization). Because of their diversity and rarity, there is no consensus regarding the risk factors for poor prognosis and appropriate treatment for these tumors. Thus, information about their gene and protein profiles can help in the diagnosis and prognosis of these tumors, as well as in the understanding of their biology and clinical behavior. We performed the New Generation Sequencing of 14 samples of uterine sarcomas (5 CCS, 4 LMS, 4 SEE and 1 ADS, using the Ion Proton System platform (ThermoFisher).) Among the 14 samples, we found 27 LoF (loss of gene function) and 40 missense mutations, with a mean of 39 insertions and 52 deletions per sample, totaling 70 mutations, 25 described in the COSMIC database. The most commonly mutated genes in our sample were TP53 (50%), KMT2D (36%), ATM (29%), DICER1 (21%), PIK3CA (21%), TRRAP (21%).Our main objective was to find specific mutations for each histological subtype, but only SEEs (PDE4DIP) and CCS (ERBB4 and PIK3CA) had specific mutations. In another analysis, we observed that all the histological subtypes share the KMT2D gene, which will be studied in future analyzes. Others analyzes, using a custom panel, are necessary to understand these mutations and its biological implication in uterine carcinosarcoma and sarcomas

Os sarcomas uterinos são tumores mesodérmicos raros que compreendem cerca de 3% de todos os cânceres nesse órgão. Apresentam diversidade histológica, comportamento agressivo, disseminação precoce e altas taxas mortalidade. Recentemente, os carcinossarcomas (CS) foram reclassificados histologicamente como carcinomas. Neste trabalho, os CS foram incluídos na casuística tanto para fins de comparação de seu componente mesenquimal, como por ainda fazerem parte da maioria dos estudos sobre sarcomas de corpo uterino e também da última classificação da WHO (Word Health Organization). Devido à sua diversidade e raridade, não há consenso relacionado aos fatores de risco para pior prognóstico e tratamento adequados para esses tumores. Informações sobre seus perfis gênicos e proteicos poderiam contribuir na caracterização de marcadores moleculares que auxiliassem no diagnóstico e prognóstico desses tumores, bem como no entendimento de sua biologia e comportamento clínico. Assim, nos propusemos a avaliar a presença de alterações gênicas nesses tumores, utilizando um painel de 409 genes, oncogenes e supressores de tumor, frequentemente mutados em tumores sólidos. Para isso, foram selecionadas 66 amostras, das quais 14 foram sequenciadas, incluindo, 5 carcinossarcomas (CCS), 4 leiomiossarcomas (LMS), 4 sarcomas de estroma endometrial (SEE) e 1 adenossarcoma (ADS). As reações foram realizadas utilizando a plataforma Ion Proton System (ThermoFisher) de Sequenciamento de Nova Geração. Nas 14 amostras encontramos 27 LoF e 40 mutações missenses, numa média de 39 inserções e 52 deleções por amostra, totalizando 70 mutações. Dessas, 25 encontram-se no banco de dados COSMIC. Os genes mais comumente mutados em nossa amostragem foram: TP53 (50%), KMT2D (36%), ATM (29%), DICER1 (21%), PIK3CA (21%), TRRAP (21%). Nosso objetivo principal era encontrar mutações específicas para cada subtipo histológico, porém apenas os SEEs (PDE4DIP) e os CCS (ERBB4 e PIK3CA) tiveram mutações especificas. Em outra análise, observamos que todos os subtipos histológicos compartilham o gene KMT2D. Embora não tenha sido possível estabelecer um perfil mutacional para cada subtipo histológico avaliado, nossos resultados abrem perspectivas para uma nova linha de pesquisa nos sarcomas de corpo do útero e certamente contribuem para um melhor entendimento dessas neoplasias / Uterine sarcomas are rare mesodermal tumors that comprise about 3% of all cancers in this organ. They present histological diversity, aggressive behavior, early dissemination and high mortality rates. Recently, carcinosarcomas (CCS) were histological reclassified as carcinomas. Here, we have included them in our series for purposes of comparison of the mesenchymal component and also because these tumors still form part of both the majority of studies and the WHO\'s latest classification for uterine sarcomas (Word Health Organization). Because of their diversity and rarity, there is no consensus regarding the risk factors for poor prognosis and appropriate treatment for these tumors. Thus, information about their gene and protein profiles can help in the diagnosis and prognosis of these tumors, as well as in the understanding of their biology and clinical behavior. We performed the New Generation Sequencing of 14 samples of uterine sarcomas (5 CCS, 4 LMS, 4 SEE and 1 ADS, using the Ion Proton System platform (ThermoFisher).) Among the 14 samples, we found 27 LoF (loss of gene function) and 40 missense mutations, with a mean of 39 insertions and 52 deletions per sample, totaling 70 mutations, 25 described in the COSMIC database. The most commonly mutated genes in our sample were TP53 (50%), KMT2D (36%), ATM (29%), DICER1 (21%), PIK3CA (21%), TRRAP (21%).Our main objective was to find specific mutations for each histological subtype, but only SEEs (PDE4DIP) and CCS (ERBB4 and PIK3CA) had specific mutations. In another analysis, we observed that all the histological subtypes share the KMT2D gene, which will be studied in future analyzes. Others analyzes, using a custom panel, are necessary to understand these mutations and its biological implication in uterine carcinosarcoma and sarcomas

<p>UVOD: Maligni tumori reproduktivnih organa nalaze se među vodećim uzrocima obolevanja i umiranja od malignih bolesti žena, kako u svetu, tako i u Srbiji. Jedan od najvažnijih puteva &scaron;irenja ovih bolesti je limfogeni, a konvencionalna radiolo&scaron;ka dijagnostika limfnih čvorova kod ovih pacijentkinja je neprecizna. Funkcionalna radiolo&scaron;ka dijagnostika, uključujući i magnentno rezonantnu sekvencu difuzionog kretanja (DWI) i iz nje izvedenu ADC mapu koja omogućava kvantitativnu analizu difuzionih osobina unutar limfnog čvora, daju obećavajuće rezultate u mogućnosti razlikovanja benignih od maligno izmenjenih limfnih čvorova male karlice i ingvinuma kod pacijentkinja obolelih od malignih tumora ženskih polnih organa. CILJ: Cilj studije je 1. utvrđivanje dijagnostičkih mogućnosti magnetnorezonantne sekvence difuzionog kretanja (DWI) u razlikovanju benignih od maligno izmenjenih limfnih čvorova male karlice i ingvinuma kod pacijentkinja obolelih od malignih tumora ženskih polnih organa, poređenjem preoperativno načinjenog magnetnorezonantnog pregleda i postoperativnog patohistolo&scaron;kog nalaza; 2. analiza povezanosti osobina metastatski izmenjenih limfnih čvorova na sekvenci difuzionog kretanja (DWI) i gradusa primarnog tumora, i 3. utvrđivanje uticaja tehničkih karakteristika sekvenci difuzinonog kretanja (DWI) na magnetnorezonantu procenu metastatske infiltracije karličnih i ingvinalnih limfnih čvorova i postoperativnog patohistolo&scaron;kog nalaza. MATERIJAL I METODE: Istraživanje je sprovedeno u periodu od 2013. do 2016.godine, kao prospektivna klinička studija u Centru za radiologiju, na Operativnom odeljenju Zavoda za ginekologiju, Klinike za ginekologiju i aku&scaron;erstvo i u Zavodu za patologiju Kliničkog Centra Vojvodine u Novom Sadu. Studija je obuhvatila 80 pacijentkinja obolelih od malignih tumora vulve, vagine, grlića materice, tela materice i jajnika. Na osnovu lokalizacije malignog tumora sve ispitanice su razvrstane u 5 grupa: grupa A- 3 žene obolele od carcinoma vulve, grupa B- 1 žena obolela od karcinoma vagine, grupa C-32 pacijentkinje obolele od karcinoma grlića materice, grupa D- 30 pacijentkinja obolelih od malignih tumora tela materice i grupa E- 14 žena obolelih od malignih tumora jajnika. Procena stadijuma bolesti definitivno je izvr&scaron;ena posle operacije na osnovu histopatolo&scaron;kog pregleda kompletnog hirur&scaron;kog materijala uključujući i pregled uklonjenih limfnih čvorova na osnovu aktuelne FIGO klasifikacije stadijuma bolesti zasebno za svaku pojedinačnu lokalizaciju malignog tumora. Svim pacijentkinjama je preoperativno načinjen magnetnorezonantni pregled male karlice na uređaju za magnetnu rezonancu 1.5 T General Electric Signa HDx u Centru za radiologiju, Kliničkog centra Vojvodine. Kod istih pacijentkinja naknadno je sprovedeno standardno hirur&scaron;ko lečenje po protokolu hirur&scaron;kog lečenja za dato maligno ginekolo&scaron;ko oboljenje sa karličnom i/ili ingvinalnom limfadenektomijom. Postoperativno je izvr&scaron;ena patohistolo&scaron;ka analiza hirur&scaron;ki uklonjenog materijala i limfnih čvorova razdvojenih po anatomskim grupama u karlici i ingvinalnoj regiji. REZULTATI: Ukupno 2320 limfnih čvorova je mapirano i patohistolo&scaron;ki pregledano kod 80 pacijenata. Metastaze u limfnim čvorovima patohistolo&scaron;ki su verifikovane kod 28 pacijenata (35%). Kod ovih 28 (35%) pacijentkinja, 152 (27,28%) od ukupno 557 limfnih čvorova bilo je metastatski izmenjeno na patohistolo&scaron;kom pregledu. Metastaze u limfnim čvorovima utvrđene su kod 2 pacijentkinje (7,14%) sa karcinomom vulve, 11 (39,28%) sa karcinomom cerviksa, 9 (32,14%) sa tumorima tela materice, te 6 (21,42%) sa tumorima jajnika. Od 28 pacijentkinja kod kojih su utvrđeni pozitivni limfni čvorovi, 14 pacijentkinja (50%) imalo je dobro diferentovan primarni tumor, 8 (28,57%) srednje diferentovan, dok je 6 (21,42%) imalo lo&scaron;e diferentovan primarni tumor. Od ukupno 152 metastatski izmenjena limfna čvora u na&scaron;oj studiji, 8 limfnih čvorova (5,26%) pripadalo je ingvinalnoj grupi od čega 5 (3,289%) povr&scaron;noj ingvinalnoj, a 3 ( 1,97%) dubokoj ingvinalnoj grupi, 8 (5,26%) parametrijalnoj grupi, 48 (31,58%) opturatornoj grupi, 40 (26,31%) spolja&scaron;njoj ilijačnoj grupi, 36 (23,684%) unutra&scaron;njoj ilijačnoj grupi, dok je 12 (7,89%) pripadalo zajedničkoj ilijačnoj grupi karličnih limfnih čvorova. Kraći prečnik limfnog čvora nije pokazao značajnu razliku između metastatskih ( mean &plusmn; SD, 8,3 &plusmn; 5.4 mm, raspon , 4.5-30 mm ) i limfnih čvorova koji nisu bili metastatski izmenjeni ( 6,3 mm &plusmn; 1,5 , 4,5-9,6 mm ; P= 0,191 ). Izmerena ADC vrednost bila je značajno niža kod metastatski izmenjenih limfnih čvorova (mean &plusmn; SD , ADC: 0,8725 x 10-3 mm2/s &plusmn; 0,0125) nego kod limfnih čvorova koji nisu bili metastatski izmenjeni (mean &plusmn; SD, ADC: 1,116 x 10- 3 mm2/s &plusmn; 0,1848; P=0,001). Prosečne vrednosti ADC kod b =800 s/mm2 i b =1200 s/mm2 nisu se značajno razlikovale između metastaski izmenjenih limfnih čvorova (mean &plusmn; SD, ADC: 0,8575 &plusmn; 0,0125 x 10-3 mm2/s, ADC:0,8859 &plusmn; 0,0125 x 10-3 mm2/s) i limfnih čvorova koji nisu metastatski izmenjeni (mean &plusmn; SD, ADC:1,0345 &plusmn; 0,1222 x 10-3 mm2/s, ADC:1,1125 &plusmn; 1638 x 10-3 mm2/s; P =0,657 i P = 0,877). Ako se koristi vrednost ADC od 0,860 x 10- 3 mm2 / s kao kritična vrednost za razlikovanje metastatskih od limfnih čvorova koji nisu metastatski izmenjeni, senzitivnost DWI MR iznosila je 89%, specifičnost 85% i ukupna tačnost 86%. Pozitivna prediktivna vrednost (PPV) DWI MR u detekciji limfnih metastaza u karličnoj i ingvinalnoj regiji iznosila je 30%. Negativna prediktivna vrednost (NPV) testa iznosila je 99%. Pozitivna prediktivna vrednost (PPV) MR zasnovana na kriterijumu ADC vrednosti značajno je veća u odnosu na sve kriterijuma veličine (P &lt; 0,001). Negativna prediktivna vrednost MR zasnovanoj na kriterijumima veličine limfnog čvora i na ACD vrednosti nisu se međusobno statistički značajno razlikovali (P&lt;0,05). Performanse dijagnostičke metode (MR) bile su značajno bolje za minimalnu ADC vrednost od svih kriterijuma baziranih na veličini limfnih čvorova ( P=0.001 za minimalnu ADC vrednost u odnosu na sve druge kriterijume). MRI na osnovu definisanog modela koji kombinuje kriterijum ADC vrednosti sa kriterijumom veličine ima sledeće dijagnostičke performanse za diferencijaciju malignih od benignih limfnih čvorova: senzitivnost od 95%, specifičnost 92%, sveukupna tačnost od 92,5%, pozitivnu prediktivnu vrednost od 46% i negativnu prediktivnu vrednost od 99.6%. ZAKLJUČAK: Kriterijum veličine limfnog čvora nije dovoljno precizan pokazatelj metastatske invazije limfnih čvorova. Sekvenca difuzionog kretanja (DWI) uvek se mora analizirati zajedno sa ADC mapom i visoko rezolutivnim T1 i T2 otežanim magnetnorezonantnim sekvencama. Studijom je dokazan visok stepen povezanosti između preoperativnog određivanja metastaske infiltracije karličnih i ingvinalnih limfnih čvorova malignih tumora ženskih polnih organa primenom sekvence difuzionog kretanja (DWI) i postoperativnog patohistolo&scaron;kog nalaza. Uz graničnu ADC vrednost od 0,860 x 10-3 mm2/ s, senzitivnost MRI DWI u otkrivanju metastatskih limfnih čvorova iznosi 89%, a specifičnost 85%. Kombinacija ADC vrednosti i morfolo&scaron;kih karakteristika limfnih čvorova konvencionalnim magnentno rezonantnim pregledom je najprecizniji prediktor postojanja metastatske infiltracije karličnih i ingvinalnih limfnih čvorova kod pacijentkinja sa malignim tumorima ženskih polnih organa. Tehničke karakteristike sekvenci difuzionog kretanja (DWI) u smislu razlike u visokim b vrednostima ne utiču na magnentno rezonantnu procenu metastatske infiltracije karličnih i ingvinalnih limfnih čvorova kod pacijentkinja sa malignim tumorima ženskih polnih organa. Studijom nije utvrđena statistički značajna razlika između preoperativno utvrđenih ADC vrednosti metastatski izmenjenih limfnih čvorova i stepena histolo&scaron;ke diferencijacije ovih tumora. Sekvenca difuzionog kretanja (DWI) je brza, jednostavna, neinvazivna metoda koja značajno doprinosi dijagnostičkim mogućnostima magnetne rezonance u razlikovanju benignih od malignih limfnih čvorova male karlice i ingvinuma.</p> / <p>INTRODUCTION: Malignant tumors of reproductive organs are among the leading causes of morbidity and mortality in women, both in Serbia and worldwide. Lymphatic spread is one of the most important pathways of tumor dissemination. However, conventional lymph node imaging in these patients is imprecise. Functional imaging, including diffusion-weighted magnetic resonance imaging (DWI MRI) and derived ADC map which allows quantitative analysis of diffusion parameters within a lymph node, provide promising results in discrimination benign from malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. AIM: Aim of the study was: 1. To assess diagnostic performances of DWI MRI in differentiation between benign and malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies, by comparison of preoperative magnetic resonance and postoperative histopathological findings. 2. To analyze correlation between DWI characteristics of metastatic lymph nodes and grade of the primary tumor, and 3. To evaluate the influence of technical characteristics of DWI sequences on MR assessment of metastatic pelvic and inguinal lymph node and postoperative histopathological findings. MATERIAL and METHODS: The prospective clinical study was conducted in Center for Radiology, Surgery Department of Clinic for Gynecology and Obstetrics and Pathology Department of Clinical Center of Vojvodina from 2013 to 2016. It comprised 80 patients with malignant tumors of vulva, vagina, uterine cervix and body and ovaries. Based on the localization of the tumor, all patients were divided into 5 groups: group A-3 patients with vulvar cancer, group B- 1 patient with vaginal cancer, group C- 32 patients with cervical cancer, group D- 30 patients with uterine body tumors and group E- 14 patients with malignant ovarian tumors. Staging of the disease was performed after surgery based on histopathological examination of complete surgical specimen, including examination of removed lymph nodes, based on current FIGO classification separately for each primary tumor location. Preoperatively, all patients underwent MRI examination (1.5 T General Electric Signa HDx) at Center for Radiology, Clinical Center of Vojvodina. The same patients underwent standard surgical treatment according to the treatment protocol regarding the tumor type and stage, with complete pelvic and/or inguinal lymphadenectomy. Histopathological examination of surgically removed material and lymph nodes separated in pelvic and inguinal anatomic groups was performed after the surgery. RESULTS: The total of 2320 of lymph nodes were mapped and histopathologically examined in 80 patients included in the study. Metastases in lymph nodes were histopathologically confirmed in 28 patients (35%). In these 28(35%) patients, in 152 (27,28%) out of 557 lymph nodes histopathological examination confirmed metastases. Lymph node metastases were confirmed in 2 patients (7.14%) with vulvar cancer, 11 (39.28%) with cervical cancer, 9 (32.14%) with uterine body tumors and 6 (21.42%)patients with ovarian tumors. In 28 patients with positive lymph nodes, 14 patients (50%) had well differentiated primary tumor, 8 (28.57%) moderately differentiated, while 6 (21.42%) patients had poorly differentiated primary tumor. Out of 152 metastatic lymph nodes in our study, 8 lymph nodes (5.26%) were inguinal ( 5 (3.289%) superficial inguinal and 3 ( 1.97%) deep inguinal group), 8 (5.26%) were parametrial, 48 (31. 58%) obturatory, 40 (26.31%) external iliac, 36 (23.684%) internal iliac, while 12 (7. 89%) belonged to common iliac pelvic lymph nodes group. Shorter lymph node axis did not show significant difference between metastatic ( mean &plusmn; SD, 8.3 &plusmn; 5.4 mm, range , 4.5-30 mm ) and benign lymph nodes ( 6.3 mm &plusmn; 1.5 , 4.5-9.6 mm ; P= 0.191 ). Measured ADC values were significantly lower in metastatic (mean &plusmn; SD , ADC: 0.8725 x 10-3 mm2/s &plusmn; 0.0125) than benign lymph nodes (mean &plusmn; SD, ADC: 1.116 x 10-3 mm2/s &plusmn; 0.1848; P=0.001). Mean ADC values at b =800 s/mm2 and b =1200 s/mm2 did not differ significantly between metastatic (mean &plusmn; SD, ADC: 0.8575 &plusmn; 0.0125 x 10-3 mm2/s, ADC:0.8859 &plusmn; 0,0125 x 10-3 mm2/s) and benign lymph nodes (mean &plusmn; SD, ADC:1.0345 &plusmn; 0.1222 x 10-3 mm2/s, ADC:1.1125 &plusmn; 1638 x 10-3 mm2/s; P =0.657 i P = 0.877). If ADC value of 0.860 x 10- 3 mm2 / s is determined as a cut off value for discrimination of benign and malignant lymph nodes, DWI MRI sensitivity was 89%, specificity 85% and overall accuracy was 86%. Positive predictive value (PPV) of DWI MR in detection of pelvic and inguinal lymph node metastases was 30%. Negative predictive value (NPV) of the test was 99%. MRI PPV based on ADC value criteria was significantly higher compared to all size-based criteria (P &lt; 0,001). MRI NPV based on size based and ADC values criteria did not differ significantly (P&lt;0,05). Performances of diagnostic method (MRI) were significantly better for minimal ADC value compared to all lymph node size-based criteria ( P=0.001 for minimal ADC value compared to all other criteria). Combination of ADC value criteria and size-based criteria yields MRI the following diagnostic performances in discrimination between benign and malignant lymph nodes: sensitivity 95%, specificity 92%, overall accuracy 92.5%, positive predictive value 46% and negative predictive value 99.6%. CONCLUSION: Lymph node size is not sufficiently precise criteria for determination of metastatic lymph node involvement. DWI sequence always needs to be evaluated together with ADC map and high resolution T1W and T2W magnetic resonance sequences. The study shows high correlation between preoperative assessment of pelvic and inguinal lymph node metastases from gynecological malignancies using MRI DWI and postoperative histopathological findings. With a cut off ADC value of 0.860 x 10-3 mm2/ s, sensitivity of MRI DWI in metastatic lymph node detection is 89%, while specificity is 85%. Combination of ADC values and morphological lymph nodes characteristics assessed by conventional MRI is the most precise predictor of metastatic pelvic and inguinal lymph node invasion in patients with gynecological malignancies. Technical characteristics of DWI i.e. different high b-values do not influence MR assessment of metastatic pelvic and inguinal lymph node involvement in patients with gynecological malignancies. The study did not confirm statistically significant difference between preoperatively measured ADC valued of metastatic lymph nodes and histological grade of primary tumors. DWI MRI sequence is fast, simple, noninvasive method which aids significantly to MRI diagnostic performances in discrimination between benign and malignant pelvic and inguinal lymph nodes.</p>