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CURATOR
A pinboard by
NATALIA RODRIGUEZ

Graduated in Medicine at Complutense University of Madrid, Spain.

Specialist in the field of Gynecology and Obstetrics from 2015.

I was working in public health care hospitals and private clinic in Madrid. Started my PhD program in Cancer and Pregnancy at General University Hospital Gregorio Marañon, Madrid, when I was in my second year of my residency program. Then, I was awarded with a Foundation Grant to finish it in New York City. USA.

I was working as a Clinical Research Fellow in Gynecology Oncology Department at Memorial Sloan Kettering Cancer Center, in New York City. Currently, I am working as a fellow in GYNONC at Columbia University in the city of New York.

Education: Columbia University of the City of New York. USA.2017 Weill Cornell Medicine. New York. USA. 2016 University of Texas. Houston. USA. 2014. Complutense University of Madrid. Spain. 2010

Hospital Experience: Clínical research fellowship in GYNONC, Memorial Sloan Kettering Cancer Center. New York. USA. Gynecology Oncology training, MD Anderson Cancer center, Houston, Texas. USA Obstetrics Ultrasound, University Hospital Gregorio Marañon. Madrid. Spain. Reproductive Medicine, Fundacion Jimenez Diaz, Madrid. Spain Pelvic pathology, Fuenlabrada Hospital, Madrid. Spain ] Breast Radiology, University Hospital of Mostoles, Madrid. Spain General and Digestive Surgery training, Semmelweis Klinika, Budapest, Hungary.

Research Experience: Clinical Research Fellowship in Gynecology Oncology at Columbia University, New York. USA. Clinical Research Fellowship in Gynecology Oncology at Memorial Sloan Kettering Cancer Center, New York. USA. Clinical Research Fellowship in Cancer and Pregnancy at General University Hospital Gregorio Marañon, Madrid. Spain.

Other Activities: Reviewer "The journal of minimally invasive Gynecology" JMIG

doing my Phd Program in endometrial carcinoma and sentinel lymph node mapping, trying to improve the people quality of life.

PINBOARD SUMMARY

Lynch syndrome is an inherited disorder that predisposes patients to increased risk of cancers,

Objectives: Lynch syndrome (LS) is an inherited disorder that predisposes patients to increased risk of cancers, including endometrial cancer (EC). As a screening test, tumor-based immunohistochemistry (IHC) for mismatch repair (MMR) proteins are recommended to identify those EC patients at high risk for LS for genetic testing. The purpose of the study was to describe the patterns of uptake in LS screening for patients diagnosed with EC.

Methods: We identified women with endometrial cancer diagnosis who underwent cancer staging surgery within 6 months of diagnosis claim using the Market Scan insurance claims database (2013 - 2016). Utilization of IHC testing of MMR proteins, which includes MLH1, MSH2, MSH6 and PMS2, were identified using procedure codes, if ordered within 6 months before or after date of diagnosis. Trends in testing were analyzed with respect to demographic and enrollment information. Statistical methods included descriptive statistics and multivariate logistic regression.

Results:

Among 12,717 women identified with EC (mean 59.9 years, SD 10.4), 3333 (26.3%) had IHC screening of the 4 MMR genes. Table 1 summarizes the trend of testing from 2013 – 2016.MMR screening increased over time, from 3.93% in 2013 to 60.77% in 2016 (p<0.0001). Overall, MMR testing rate in EC patients < 50 years, and <60 years was 27% and 25.9%, respectively, and remained stable among different age cohorts. MMR testing rate did not significantly differ between commercial and Medicare insurance. Testing different among geographic regions at time of diagnosis (p<0.0001): least common in the Northeast (23.6%), and most common in the North Central region of U.S.

Conclusions:

The rate of LS screening by MMR IHC has significantly increased between 2013 and 2016 in recently diagnosed EC patients who underwent cancer-directed surgery. However, screening is still underutilized in both young, as well as older patients, despite recommendations.

3 ITEMS PINNED

Clinicopathological comparison of colorectal and endometrial carcinomas in patients with Lynch-like syndrome versus patients with Lynch syndrome.

Abstract: Screening for DNA mismatch repair (MMR) deficiency in colorectal and endometrial carcinomas identifies patients at risk for Lynch syndrome. Some patients with MMR-deficient tumors have no evidence of a germline mutation and have been described as having Lynch-like syndrome. We compared the clinicopathological features of colorectal and endometrial carcinomas in patients with Lynch-like syndrome and Lynch syndrome. Universal screening identified 356 (10.6%) of 3352 patients with colorectal carcinoma and 72 (33%) of 215 patients with endometrial carcinoma with deficient DNA MMR. Sixty-six patients underwent germline mutation analysis with 45 patients (68%) having evidence of a germline MMR gene mutation confirming Lynch syndrome and 21 patients (32%) having Lynch-like syndrome with no evidence of a germline mutation. Most patients with Lynch-like syndrome had carcinoma involving the right colon compared to patients with Lynch syndrome (93% versus 45%; P < .002). All patients with colorectal carcinomas demonstrating isolated loss of MSH6 expression had Lynch syndrome confirmed by germline mutation analysis. Synchronous or metachronous Lynch syndrome-associated carcinoma was more frequently identified in patients with Lynch syndrome compared to Lynch-like syndrome (38% versus 7%; P = .04). There were no significant differences in clinicopathological variables between patients with Lynch-like syndrome and Lynch syndrome with endometrial carcinoma. In summary, 32% of patients with MMR deficiency concerning Lynch syndrome will have Lynch-like syndrome. Our results demonstrate that patients with Lynch-like syndrome are more likely to have right-sided colorectal carcinoma, less likely to have synchronous or metachronous Lynch syndrome-associated carcinoma, and less likely to demonstrate isolated loss of MSH6 expression within their tumor.

Pub.: 01 Sep '15, Pinned: 18 Sep '17

Significant frequency of MSH2/MSH6 abnormality in ovarian endometrioid carcinoma supports histotype‐specific Lynch syndrome screening in ovarian carcinomas

Abstract: Lynch syndrome screening in ovarian carcinoma is controversial. The aim of this study was to assess the frequency of deficient mismatch repair (dMMR) protein in a retrospective cohort enriched for non‐high‐grade serous carcinomas and its association with outcome within histological types.Tissue microarrays representing 612 ovarian carcinomas were tested for mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) by immunohistochemistry. dMMR was detected in 13.8% of endometrioid and 2.4% of clear cell carcinomas, but not in other histological types. Within endometrioid carcinomas, 11 of 25 dMMR cases showed abnormal MLH1/PMS2, 10 cases showed abnormal MSH2/MSH6, and four cases showed only abnormal MSH6, indicating that at least 7.7% of endometrioid carcinomas have dMMR probably related to Lynch syndrome. The four dMMR clear cell carcinomas showed abnormal MSH2/MSH6 in three cases and only abnormal MSH6 in one case, all probably related to Lynch syndrome. Within endometrioid carcinomas, dMMR was significantly associated with age <50 years, synchronous endometrial endometrioid carcinoma, a higher CA125 level at diagnosis, higher FIGO grade, absence of ARID1A, and at least 20 CD8‐positive intraepithelial lymphocytes per high‐power field, but was not associated with cancer‐specific death. Age <50 years, higher CA125 levels at diagnosis and at least 20 CD8‐positive intraepithelial lymphocytes per high‐power field remained significant after adjustment for multiple testing, but their sensitivity for identifying dMMR remained insufficient.Our data support the policy of histotype‐specific Lynch syndrome screening in ovarian carcinoma confined to endometrioid and clear cell carcinomas.

Pub.: 26 Feb '16, Pinned: 18 Sep '17

NATALIA RODRIGUEZ

Graduated in Medicine at Complutense University of Madrid, Spain. Specialist in the field of Gynecology and Obstetrics from 2015. I was working in public health care hospitals and private clinic in Madrid. Started my PhD program in Cancer and Pregnancy at General University Hospital Gregorio Marañon, Madrid, when I was in my second year of my residency program. Then, I was awarded with a Foundation Grant to finish it in New York City. USA. I was working as a Clinical Research Fellow in Gynecology Oncology Department at Memorial Sloan Kettering Cancer Center, in New York City. Currently, I am working as a fellow in GYNONC at Columbia University in the city of New York. Education: Columbia University of the City of New York. USA.2017 Weill Cornell Medicine. New York. USA. 2016 University of Texas. Houston. USA. 2014. Complutense University of Madrid. Spain. 2010 Hospital Experience: Clínical research fellowship in GYNONC, Memorial Sloan Kettering Cancer Center. New York. USA. Gynecology Oncology training, MD Anderson Cancer center, Houston, Texas. USA Obstetrics Ultrasound, University Hospital Gregorio Marañon. Madrid. Spain. Reproductive Medicine, Fundacion Jimenez Diaz, Madrid. Spain Pelvic pathology, Fuenlabrada Hospital, Madrid. Spain ] Breast Radiology, University Hospital of Mostoles, Madrid. Spain General and Digestive Surgery training, Semmelweis Klinika, Budapest, Hungary. Research Experience: Clinical Research Fellowship in Gynecology Oncology at Columbia University, New York. USA. Clinical Research Fellowship in Gynecology Oncology at Memorial Sloan Kettering Cancer Center, New York. USA. Clinical Research Fellowship in Cancer and Pregnancy at General University Hospital Gregorio Marañon, Madrid. Spain. Other Activities: Reviewer "The journal of minimally invasive Gynecology" JMIG